Oral administration of proniosomal glibenclamide formulation protects testicular tissue from hyperglycemia fluctuations and ROS via Nrf2/HO-1 pathway.

Type 2 diabetes causes high blood sugar due to insulin malfunction and is linked to male infertility. Using proniosomes can enhance the effectiveness of Glibenclamide, a medication that stimulates insulin secretion. In our study, male rats with diabetes were treated with GLB with or without proniosomal for 14 days. Proniosomal formulations maintained glucose levels prevented weight loss and showed normal testicular tissue. GLB-proniosomal reduces ROS caused by T2DM through Nrf2, HO-1 pathway and increases CAT, SOD, and GSH production in response to insulin and glucose uptake. The reference and proniosomal treatments showed CAT and SOD significant enzymatic elevation compared to the positive and negative control. CAT significantly correlated with Gpx4 expression with P = 0.0169 and r = 0.98; similarly, the enzymatic activity of SOD also showed a positive correlation between the average glucose levels (r = 0.99 and P = 0.0037). Intestinally, GSH analysis revealed that only proniosomal-GLB samples are significantly elevated from the positive control, with a P value of 0.0210. The data showed proniosomal-GLB was more effective than pure GLB, confirmed by higher Nrf2 (2.050 folds), HO-1 (2.148 folds), and GPx4 (1.9 folds) transcript levels relative to the control with less sample diversity compared to the reference samples, indicating proniosomal stabilized GLB in the blood. Administering GLB and proniosomes formulation has effectively restored testicular function and sperm production in diabetic rats by regulating ROS levels and upregulating anti-ROS in response to glucose uptake. These findings may lead to better treatments for diabetic patients who have infertility issues.

Predictors of burden perceived by informal caregivers of patients registered in the home health-care unit.

Context: Studies have reported multiple variables that can affect the level of burden on informal caregivers. The need for informal caregivers is expected to increase in the upcoming years. Informal caregivers are an important extension of the formal health-care system. Aims: The aim of this study was to discover the characteristics of informal caregivers of adult patients, to determine the socioeconomic, psychological, and physical consequences facing informal caregivers, and to measure caregivers' burdens and needs. Settings and Design: An analytical cross-sectional study that was carried out in Saudi Arabia, in the home health-care unit of King Abdelaziz University Hospital in the city of Jeddah. Subjects and Methods: A.validated self-administered questionnaire in Arabic and English was used. The required sample size was 122 participants. Ethical approval was obtained. Statistical Analysis Used: Descriptive statistics consisted of means, standard deviations, frequency tables, cross-tabulation, and charts. Categorical variables were compared using the Chi-square test to determine significant relationships between variables. Results: A.total of 124 participants responded to a request to participate in the study. The majority of the caregivers (92) were family members. There was a significant relationship between the nature of the connection between the caregiver and the recipient in association with the burden scale (P = 0.001). No significant relationship was found between caregivers' gender, marital status, or income level and the burden score. Conclusions: Most of the caregivers reported no burden to minimal burden. The relationship with the care recipient has a negative impact on the burden scale.

Résumé Contexte: Des études ont fait état de plusieurs variables qui peuvent influer sur le niveau de charge des aidants naturels. Le besoin d'aidants naturels devrait augmenter dans les années à venir. Les aidants naturels constituent un prolongement important du système formel de soins de santé. Objectifs: Le Le but de cette étude était de découvrir les caractéristiques des aidants proches de patients adultes, de déterminer les effets socio-économiques, psychologiques, et les conséquences physiques auxquelles sont confrontés les aidants naturels, et pour mesurer les fardeaux et les besoins des aidants. Paramètres et conception : une analyse étude transversale qui a été menée en Arabie Saoudite, dans l'unité de soins à domicile de l'Hôpital Universitaire Roi Abdelaziz de la ville de Djeddah. Sujets et méthodes: Un questionnaire auto-administré validé en arabe et en anglais a été utilisé. La taille d'échantillon requise était 122 participants. L'approbation éthique a été obtenue. Analyse statistique utilisée: Les statistiques descriptives se composaient de moyennes, d'écarts types, tableaux de fréquences, tableaux croisés et graphiques. Les variables catégorielles ont été comparées à l'aide du test du chi carré pour déterminer les relations significatives entre variables. Résultats: Au total, 124 participants ont répondu à une demande de participation à l'étude. La majorité des soignants (92) étaient des membres de la famille. Il y avait une relation significative entre la nature du lien entre le soignant et le bénéficiaire dans association avec l'échelle de charge (P = 0,001). Aucune relation significative n'a été trouvée entre le sexe, l'état matrimonial ou le niveau de revenu des aidants. et le score de charge. Conclusions: La plupart des soignants ont signalé un fardeau nul à un fardeau minimal. La relation avec le bénéficiaire des soins a un impact négatif sur l'échelle de la charge. Mots-clés: Fardeau de l'aidant, personnes âgées et bénéficiaires de soins, soins à domicile, aidants proches.

Psychological interventions for women with non-metastatic breast cancer.

BACKGROUND: Breast cancer is the most common cancer affecting women worldwide. It is a distressing diagnosis and, as a result, considerable research has examined the psychological sequelae of being diagnosed and treated for breast cancer. Breast cancer is associated with increased rates of depression and anxiety and reduced quality of life. As a consequence, multiple studies have explored the impact of psychological interventions on the psychological distress experienced after a diagnosis of breast cancer. This review is an update of a Cochrane Review first published in 2015. OBJECTIVES: To assess the effect of psychological interventions on psychological morbidities and quality of life among women with non-metastatic breast cancer.  SEARCH METHODS: We searched the Cochrane Breast Cancer Group Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov up to 16 March 2021. We also scanned the reference lists of relevant articles. SELECTION CRITERIA: Randomised controlled trials that assessed the effectiveness of psychological interventions for women with non-metastatic breast cancer. DATA COLLECTION AND ANALYSIS: Two review authors independently appraised, extracted data from eligible trials, and assessed risk of bias and certainty of the evidence using the GRADE approach. Any disagreement was resolved by discussion. Extracted data included information about participants, methods, the intervention and outcomes. MAIN RESULTS: We included 60 randomised controlled trials comprising 7998 participants. The most frequent reasons for exclusion were non-randomised trials and the inclusion of women with metastatic disease. The updated review included 7998 randomised women; the original review included 3940 women. A wide range of interventions was evaluated. Most interventions were cognitive- or mindfulness-based, supportive-expressive, and educational. The interventions were mainly delivered face-to-face (56 studies) and in groups (50 studies) rather than individually (10 studies). Most intervention sessions were delivered on a weekly basis with an average duration of 14 hours. Follow-up time ranged from two weeks to 24 months.  Pooled standardised mean differences (SMD) from baseline indicated that the intervention may reduce depression (SMD -0.27, 95% confidence interval (CI) -0.52 to -0.02; P = 0.04; 27 studies, 3321 participants, I2 = 91%, low-certainty evidence); anxiety (SMD -0.43, 95% CI -0.68 to -0.17; P = 0.0009; 22 studies, 2702 participants, I2 = 89%, low-certainty evidence); mood disturbance in the intervention group (SMD -0.18, 95% CI -0.31 to -0.04; P = 0.009; 13 studies, 2276 participants, I2 = 56%, low-certainty evidence); and stress (SMD -0.34, 95% (CI) -0.55 to -0.12; P = 0.002; 8 studies, 564 participants, I2 = 31%, low-certainty evidence). The intervention is likely to improve quality of life in the intervention group (SMD 0.78, 95% (CI) 0.32 to 1.24; P = 0.0008; 20 studies, 1747 participants, I2 = 95%, low-certainty evidence). Adverse events were not reported in any of the included studies. AUTHORS' CONCLUSIONS: Based on the available evidence, psychological intervention may have produced favourable effects on psychological outcomes, in particular depression, anxiety, mood disturbance and stress. There was also an improvement in quality of life in the psychological intervention group compared to control group. Overall, there was substantial variation across the studies in the range of psychological interventions used, control conditions, measures of the same outcome and timing of follow-up.

The Effect of Using a Camouflaged Dental Syringe on Children's Anxiety and Behavioral Pain.

BACKGROUND: Seeing a dental syringe can be terrifying, especially for young children, and hiding it during local anesthesia (LA) administration can sometimes be challenging for the pediatric dentist. OBJECTIVE: To assess the effect of a camouflaged dental syringe on children's anxiety and behavioral pain in comparison to the traditional dental syringe during local anesthesia administration in pediatric patients. MATERIALS AND METHODS: This randomized clinical trial included cooperative and healthy 6- to 10-year-old children scheduled for non-urgent dental treatment that required buccal infiltration anesthesia (BIA) in the maxillary arch. The subjects were randomized into either the test or the control groups. In the test group, subjects received BIA using the camouflaged dental syringe. Subjects in the control group received the BIA using a traditional dental syringe. A single-trained dentist administered all the anesthesia. Heart rate (HR) was monitored at three different time points (before, during, and after) the BIA administration. Subjects' anxiety and behavioral pain were measured using Venham's Anxiety Rating Scale (VARS) and the Face, Leg, Activity, Cry, and Consolability (FLACC) scale, respectively, by two trained and calibrated investigators. RESULTS: A total of 60 subjects with a mean age of 8.3 ±1.3 years were included. The scores of the VARS in the subjects in the camouflaged group were somewhat lower than the subjects in the traditional group, but the observed difference did not reach statistical significance (P=0.113). However, subjects in the camouflaged group showed significantly lower FLACC scores compared to the traditional group (P=0.034). CONCLUSION: The utilization of a camouflaged dental syringe is effective in improving children's behavior during local anesthesia administration; therefore, it is recommended as an alternative to using the traditional syringe.

Fibrolamellar Hepatocellular Carcinoma in the Absence of Risk Factors: A Case Report.

Cancer of the liver and intrahepatic bile ducts is the sixth most frequently diagnosed cancer worldwide. In addition, primary liver cancer is the fourth leading cause of cancer-related mortality worldwide, and the second most lethal tumor after pancreatic cancer. Early diagnosis and rapid workup for the suspected case are the only paths for treating the patient with curative intent. Hepatocellular carcinoma (HCC) is usually associated with risk factors like chronic viral hepatitis and alcohol ingestion. Since HCC typically progresses silently, clinical diagnosis can be challenging, and the diagnosis may require the use of one or more imaging modalities and liver biopsy. In this case, the patient is a 29-year-old man with no risk factors, who was diagnosed early and treated without the need for a liver transplant.

Characteristics of Patients with SARS-CoV-2 Positive Cerebrospinal Fluid: A Systematic Review.

BACKGROUND: The coronavirus disease 2019 (COVID-19) has been shown to affect several systems, notably the respiratory system. However, there has been considerable evidence implicating the nervous system in COVID-19 infection. This study aims to investigate the clinical characteristics of patients whose cerebrospinal fluid (CSF) tested positive for SARS-CoV-2. METHODS: A comprehensive search of PubMed, EMBASE, Scopus, WHO Coronavirus database, bioRxiv, medRxiv, and Web of Science databases was carried out in August 2020. Original studies involving patients who tested positive for SARS-COV-2 in their CSF were included. Key search terms encompassed all variations of "COVID-19" AND "Cerebrospinal Fluid". RESULTS: A total of 525 studies were identified. Fifty-six full-text articles were assessed, of which 14 were included. In total, 14 patients tested positive for SARS-CoV-2 in their CSF. 21.4% (3/14) of patients had negative nasopharyngeal (NP) swabs despite a positive CSF sample. About 14.2% (2/14) of patients who initially had positive NP swabs developed neurological deterioration after a supposed recovery as indicated by their negative NP swabs, but their CSF still tested positive for SARS-CoV-2. Common symptoms were headache (42.8%; 6/14), fever (35.6%; 5/14), vomiting (28.6%; 4/14), cough (28.6; 4/14), visual disturbances (28.6%; 4/14), diarrhea (21.4%; 3/14), and seizures (21.4%; 3/14). Four patients (28.6%) were admitted to ICU, one (7.14%) was admitted to a rehabilitation facility, and two (14.3%) died. CONCLUSION: Physicians should be familiar with the presenting neurological features of COVID-19, and be aware that they can occur despite a negative NP swab. The results of this study are intended to aid in the development of informed guidelines to diagnose and treat COVID-19 patients with neurological manifestations.

Emirati Women's Knowledge about the Menopause and Menopausal Hormone Therapy.

The aim of this study was to investigate the knowledge of Emirati women aged 30-64 about menopause, menopausal hormone therapy (MHT), and their associated health risks, and additionally, to determine the relationships between Emirati women's knowledge about menopause and their sociodemographic and reproductive characteristics. A community-based cross-sectional study was conducted of 497 Emirati women visiting five primary healthcare centers in Dubai. Data were collected using a questionnaire composed of sociodemographic and reproductive characteristics, menopause knowledge scale (MKS), and menopause symptoms knowledge and MHT practice. The mean menopause symptoms knowledge percentage was 41%, with a standard deviation of 21%. There were significant differences in the mean knowledge percentage among categories of education level (p < 0.001) and employment (p = 0.003). No significant differences in the knowledge percentages were found among categories of menopausal status. "Pregnancy cannot occur after menopause" was the statement with the highest knowledge percentage (83.3%), while the lowest knowledge percentages were "risk of cardiovascular diseases increases with menopause'' (23.1%), "MHT increases risk of breast cancer'' (22.1%), and "MHT decreases risk of colon cancer'' (13.9%). The knowledge of Emirati women about menopause, MHT, and related heart diseases was very low; therefore, an education campaign about menopause and MHT risks is needed to improve their knowledge for better coping with the symptoms.

Knowledge about and determinants for diagnosing hidradenitis suppurativa by ministry of health primary healthcare physicians in Jeddah city 2019: An analytical cross-sectional study.

CONTEXT: Hidradenitis suppurativa is a noncontagious, inflammatory, chronic and recurrent disease. The prevalence of HS is estimated to be between less than 1 and 4%. It is more common in females than males at a 2:1 ratio. Many cases of HS are either misdiagnosed or remain undiagnosed. AIMS: To assess knowledge of diagnosing hidradenitis suppurativa by Ministry of Health primary health care physicians in Jeddah city, 2019 and to identify the determinants and knowledge of diagnosing hidradenitis suppurativa. SETTINGS AND DESIGN: An analytical cross-sectional study conducted in Jeddah city, 2019, among primary health care physicians of the MOH. METHODS AND MATERIAL: Estimated sample size was 114. The required primary health care centers were 38 centers. The centers were chosen by a simple random sampling technique. A reliable self-administered questionnaire was used. Ethical approval was obtained. STATISTICAL ANALYSIS USED: Descriptive statistics consisted of means, standard deviations, frequency tables, cross tabulation and charts). Categorical variables were compared using the chi-square test to determine significant relationships between variables. RESULTS: 65.4% (68) diagnosed the disease correctly. Most of their knowledge came from clinical practice (39.4%). There was a significant relationship with current job title and medical degree (P-value < 0.0005). CONCLUSION: The present study showed good knowledge about and ability to diagnose HS. A more advanced medical degree and more years of clinical experience was positively associated with the ability to diagnose HS.

Arab and Muslim scientists and their contributions to the history of ophthalmology.

Arab and Muslim scientists were pioneers in the development of medical sciences, treating patients, and performing operations in many medical specialties. This article reviews their major contributions in ophthalmology that led to the development of this field. Considering the little-known role of Arab and Muslim scientists in the history of ophthalmology, this article provide insights into the great physicians from the 10th to the 13th century. Despite the destruction of Islamic civilizations by the Mongols in the late 14th century, some of their books and manuscripts are still preserved, testifying to their influence, including the first detailed drawing of the eye anatomy by Hunayn AlAbadi (808 A.D.), proposing the first occlusive treatment for amblyopia by Thabit Alharrani (823 A.D.), discovering the science of optics and theory of vision related to light reflection by Al-Hasan ibn Al-Haytham (965 A.D.), inventing of the hollow needle used to aspirate cataract by Ammar Al-Mawsili (1010 A.D.), and drawing surgical instruments by Khalifah ibn Al-Mahasin (1256 A.D.).

Attitudes and barriers towards conducting research amongst primary care physicians in Bahrain: a cross-sectional study.

BACKGROUND: Research in primary care is essential for disease diagnosis, management and prevention in relation to the individuals, families and the community. This research aims to study the attitude of primary care physicians towards conducting research in Bahrain and to identify the main barriers encountered during research. METHODS: A cross-sectional study was conducted amongst 200 randomly selected primary care physicians registered in Ministry of Health affiliated primary healthcare centers in Bahrain. A self-administered validated questionnaire was adopted and used for data collection. Research data was analyzed using the Statistical Package for Social Sciences (SPSS) version 23. RESULTS: Primary care physicians had a positive attitude towards conducting research with a total mean score (SD) of 4.47(0.65) (on a scale from 1 to 5 with higher scores indicating more positive attitudes). The total mean score (SD) for barriers encountered by physicians during research was 3.34 (0.80). Insufficient research allotted time (76.5%), insufficient financial support (63%), lack of financial incentives (51%) and lack of statistical support (50%) were major barriers. Physicians designation and board certificate were significantly associated with attitudes and barriers towards research (P-value < 0.05). CONCLUSION: The majority or primary care physicians had positive attitudes towards conducting research. The major difficulties faced by physicians in conducting research are: Insufficient research allotted time, lack of financial incentives and inadequate statistical support. The study addressed a gap in building research capacity which should be embraced by many institutions through partnership and collaboration.

Efficacy of autologous fat transfer for the correction of contour deformities in the breast: A systematic review and meta-analysis.

BACKGROUND: Autologous fat transfer (AFT), also known as fat grafting or lipofilling, has already become a part of clinical practice for treating contour deformities of the breast, even though evidence regarding its efficacy is still lacking. This is the first meta-analysis on this subject, aimed to facilitate intuitive interpretation of the available data by clinicians, guideline committees and policy makers. METHODS: A literature search was performed on 1 September 2017 in PubMed, EMBASE and the Cochrane Library to identify all relevant studies. A rigorous data extraction and standardisation process allowed pooling of clinical outcome data into a meta-analysis. RESULTS: Eighty-nine studies consisting of 5350 unique patients were included. The mean follow-up was 1.9 years. Meta-analysis revealed a very high overall patient and surgeon satisfaction rate of 94.3% and 95.7%, respectively, which was also confirmed by high satisfaction scores and Breast-Q scores. Overall, only 1.5 sessions were needed to achieve the desired result. Though evidence on the long-term volume retention is lacking, based on the current data it was calculated to be 52.4% at one year. Only 5.0% of procedures resulted in clinical complications and 8.6% of breasts required biopsy due to abnormal clinical or radiological findings. CONCLUSIONS: AFT seems to be an effective procedure in breast reconstruction, reflected by the high patient and surgeon satisfaction and low incidence of clinical and radiological complications. Future research should focus on evaluating the technical and patient factors influencing the rate of fat resorption as well as its oncological safety.

The lifestyle habits and wellbeing of physicians in Bahrain: a cross-sectional study.

BACKGROUND: Lifestyle habits of physicians are of paramount importance both because they influence the physician's own health and because these habits have been shown to affect patients' care. There is limited information on physician health and lifestyle habits in Bahrain. METHODS: In a cross-sectional study design, an anonymous self-administered questionnaire that assesses wellbeing and lifestyle habits was distributed to a random sample of 175 out of 320 primary health care physicians in Bahrain. Descriptive analyses were performed, and the variables were cross-tabulated using SPSS version 20.0. RESULTS: 152 physicians agreed to participate in the study. Respondents were 67.1% female with a mean age of 45 (SD = 10). The majority were of Bahraini nationality. The most prevalent reported health conditions were hyperlipidaemia (25.5%), hypertension (20.3%), and diabetes (11.0%). Only 29.6% of physicians reported performing ≥ 30 min of exercise in a usual week. Of physicians exercising ≥ 30 min weekly, only 13% exercised ≥ 5 days weekly. 98.0% report never drinking, 1.3% report previously drinking, and 0.7% report drinking less than once weekly. The average body mass index (BMI) was 27.8 (SD = 5), with 39% of physicians being overweight and 33% obese. BMI was directly associated with sleep time (P0.027, r(2) = 0.034), age (P < 0.01, r(2) = 0.179), male gender (P = 0.031, r(2) = 0.054), and a known diagnosis of hypertension (P = 0.007, r(2) = 0.079) or hyperlipidaemia (P = 0.008, r(2) = 0.088). CONCLUSIONS: There is a clear pattern of unfavourable lifestyle habits and obesity among primary health care physicians in Bahrain. We encourage institutions and public health sectors to be more proactive in assisting physicians to attain healthier lifestyles.

Psychological interventions for women with non-metastatic breast cancer.

BACKGROUND: Breast cancer is the most common cancer affecting women worldwide. It is a distressing diagnosis and, as a result, considerable research has examined the psychological sequelae of being diagnosed and treated for breast cancer. Breast cancer is associated with increased rates of depression and anxiety and reduced quality of life. As a consequence, multiple studies have explored the impact of psychological interventions on the psychological distress experienced after a diagnosis of breast cancer. OBJECTIVES: To assess the effects of psychological interventions on psychological morbidities, quality of life and survival among women with non-metastatic breast cancer. SEARCH METHODS: We searched the following databases up to 16 May 2013: the Cochrane Breast Cancer Group Specialised Register, CENTRAL, MEDLINE, EMBASE, CINAHL and PsycINFO; and reference lists of articles. We also searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) search portal and ClinicalTrials.gov for ongoing trials in addition to handsearching. SELECTION CRITERIA: Randomised controlled trials that assessed the effectiveness of psychological interventions for non-metastatic breast cancer in women. DATA COLLECTION AND ANALYSIS: Two review authors independently appraised and extracted data from eligible trials. Any disagreement was resolved by discussion. Extracted data included information about participants, methods, the intervention and outcome. MAIN RESULTS: Twenty-eight randomised controlled trials comprising 3940 participants were included. The most frequent reasons for exclusion were non-randomised trials and the inclusion of women with metastatic disease. A wide range of interventions were evaluated, with 24 trials investigating a cognitive behavioural therapy and four trials investigating psychotherapy compared to control. Pooled standardised mean differences (SMD) from baseline indicated less depression (SMD -1.01, 95% confidence interval (CI) -1.83 to -0.18; P = 0.02; 7 studies, 637 participants, I(2) = 95%, low quality evidence), anxiety (SMD -0.48, 95% CI -0.76 to -0.21; P = 0.0006; 8 studies, 776 participants, I(2) = 64%, low quality evidence) and mood disturbance (SMD -0.28, 95% CI -0.43 to -0.13; P = 0.0003; 8 studies, 1536 participants, I(2) = 47%, moderate quality evidence) for the cognitive behavioural therapy group than the control group. For quality of life, only an individually-delivered cognitive behavioural intervention showed significantly better quality of life than the control with an SMD of 0.65 (95% CI 0.07 to 1.23; P = 0.03; 3 studies, 141 participants, I(2) = 41%, very low quality evidence). Pooled data from two group-delivered studies showed a non-significant overall survival benefit favouring cognitive behavioural therapy compared to control (pooled hazard ratio (HR) 0.76, 95% CI 0.25 to 2.32; P = 0.63; 530 participants, I(2) = 84%, low quality evidence). Four studies compared psychotherapy to control with one to two studies reporting on each outcome. The four studies were assessed as high risk of bias and provided limited evidence of the efficacy of psychotherapy. Adverse events were not reported in any of the included studies. AUTHORS' CONCLUSIONS: A psychological intervention, namely cognitive behavioural therapy, produced favourable effects on some psychological outcomes, in particular anxiety, depression and mood disturbance. However, the evidence for survival improvement is still lacking. These findings are open to criticism because of the notable heterogeneity across the included studies and the shortcomings of the included studies.

Understanding the experiences and quality of life issues of Bahraini women with breast cancer.

We explored the experiences of Bahraini women who have survived breast cancer and their perception of quality of life after diagnosis. We conducted in depth, semi-structured face-to-face interviews with twelve women diagnosed with breast cancer. A qualitative method using semi-structured interviews on a purposive sample of 12 Bahraini women with breast cancer was conducted. Similarities and differences in women's experience were identified through thematic analysis of interview transcripts using a constant comparative approach. The themes identified were meaning of cancer and quality of life, spirituality and beliefs about causes of breast cancer, coping mechanisms, impact of illness and change in relationships. Quality of life was framed in terms of the ability to perform daily duties with emphasis on the physical component of quality of life. Themes that differed from previous western studies included a heavy emphasis on spiritual practices for comfort; the use of traditional clothing (hijab and abaya) to hide hair and body changes; the important role played by the family and husband in treatment decisions and concerns regarding satisfying the sexual needs of the husband, which were related to a fear of losing the husband to a second wife. Evil eye, stress and God's punishment were believed to be fundamental causes of the disease. The emotional shock of the initial diagnosis, concerns about whether to reveal the diagnosis and a desire to live a normal life were consistent with previous studies. However, cultural and religious issues such as role of the husband and impact of prayers were also important here. These themes are important to healthcare professionals for ensuring an individualized approach to the treatment of women with breast cancer.

Strategies for managing hot flashes.

Hormone therapy--at the lowest possible dose for the shortest period of time--remains the best option for menopausal women with moderate to severe vasomotor symptoms.

Diuretic and nephroprotective effect of Jawarish Zarooni Sada--a polyherbal unani formulation.

A number of drugs, both single and compound preparations are used widely in Tibb-e-Unani (Unani medicine) in the management of renal diseases. But such drugs mostly, have not been investigated for their described effects. Jawarish Zarooni Sada (JZS) is one such polyherbal preparation containing 15 ingredients, mainly described to be diuretic and nephroprotective. Therefore, in the present study ethanol and water extracts of JZS (300 mg each) were investigated for diuretic activity by measuring the total urine output over a period of 6h. Sodium and potassium level in urine sample was also estimated. Nephroprotective activity of JZS against gentamicin-induced nephrotoxicity was investigated by administering JZS along with high dose of gentamicin (40 mg/kg) and elevation of serum urea and serum creatinine was taken as the index of nephrotoxicity. JZS showed significant diuretic and nephroprotective effect.