Quality of life among family caregivers of cancer patients: an investigation of SF-36 domains.

BACKGROUND: With improving survival rates, cancer has become more of a chronic disease with long-term palliative care requirements. Thus, it is even more than ever necessary to pay careful attention to the well-being of family caregivers of cancer patients, as cancer trajectory is a challenging path for both patients and their caregivers. This study focusses on ascertaining the level of quality of life (QoL) domains and their attributable significant factors among a population of cancer family caregivers. METHODS: This was a cross-sectional study. The study population consist of caregivers of adult cancer patients in Zanjan, Iran between 2019 and 2020. Medical Outcomes General Health Survey Short Form 36 (SF-36) was the instrument to measure outcome variables. Clinical and basic characteristics of the caregivers and their patients were also collected using a questionnaire designed for this purpose. Data were analyzed using Independent samples t-test, Analysis of Variance, and stepwise linear regression in SPSS v.26. RESULTS: Of the caregivers 167 were male and 133 were female. The mean age of the participants was 40.77 ± 12.56, most of whom were offspring of the patients (148, 49.3%), married (239, 79.7%), and self-employed (81, 27.0%). both domains of bodily pain (76.50 ± 16.67) and physical functioning (74.88 ± 20.27) showed the highest scores among caregivers. Age and gender of caregivers, duration of caregiving, Eastern Cooperative Oncology Group (ECOG) performance status scale as well as type and stage of cancer, and type of treatment were among the significant predictors of QoL domains (All, p < 0.001). CONCLUSION: Findings of the present study substantiated various significant predictors for QoL along with low levels of QoL domains among the caregivers of cancer patients. Securing such findings proves the magnitude of probable unmet needs and psychological challenges in this population and provides the health policy makers with some valuable clues to draw effective strategies to address such issues.

Effectiveness of muscle strengthening exercises on the clinical outcomes of patients with knee osteoarthritis: A randomized four-arm controlled trial.

Background: Knee osteoarthritis (OA) is one of the major causes of dysfunction that reduces patients' quality of life. The aim of current study was to investigate the effectiveness of muscle strengthening exercises on the clinical outcomes of patients with knee OA. Methods: We conducted a single-blind clinical trial on 96 patients with mild to moderate knee osteoarthritis. Patients were randomly assigned to 4 groups with 24 patients and followed-up for 8 weeks. Quadriceps, hamstring and both hamstring and quadriceps strengthening exercises were received by the first (G1), second (G2) and third (G3) groups, respectively. The fourth group (G4) was the control group and did not receive any intervention. The main outcome variables were pain, physical function and morning stiffness. This study was retrospectively registered at irct.ir (Iranian Registry of Clinical Trials) with the code IRCT20220206053950N2, 2022-09-07. Results: Our findings demonstrated a significant impact of interventions on VAS score, pain, and stiffness (All, p < 0.001). Nonetheless, the effect of interventions was not significant for physical function (P = 0.78). After adjusting for the potential confounders, similar results were observed. Besides, the results of Dunnett post hoc test showed that either G1 or G3 had the most decrease in VAS and WOMAC-morning stiffness scores compared to G2 and G4. Conclusion: Based on the evidence from the present study, we can recommend a combination of quadriceps and hamstring strengthening exercises as the most effective intervention to reduce pain and morning stiffness in patients with OA.

Clinical Manifestations of Behçet's Disease: A Retrospective Cross-Sectional Study.

Introduction: Behçet's Disease (BD) is a systemic vasculitis, highly prevalent in Eastern Asia to Mediterranean countries. Iran is among the countries with the highest prevalence of BD, and previous studies in different countries have shown a broad range of clinical manifestations of the disease. The present study is conducted to evaluate the prevalence of the clinical manifestations of BD in patients referring to rheumatology clinics of two distinct referral hospitals in Tehran and Zanjan, Iran. Methods: In this retrospective, cross-sectional study, the medical records of patients with BD were reviewed, and age at onset, sex, the delay between the onset of symptoms and diagnosis, clinical manifestations, HLA B27, HLA B51, HLA B5, haematuria, proteinuria, leukocyturia, Erythrocyte Sedimentation Rate (ESR), and pathergy phenomenon were included in the study. The collected data were analysed by χ2 test using SPSS 23. Results: A total of 188 patients (Male/female ratio = 1.47) were included in the study with mean ± SD age at onset of 27.98 ± 10.47 years and a mean ± SD of delay between the onset of symptom and diagnosis of 5.70 ± 7.16 years. The most common clinical manifestation was mucosal involvement (85.1%), followed by the ocular lesion (55.3%) and skin manifestations (44.7%). The Pathergy phenomenon was observed in 98 patients (52.1%). Moreover, 45.2% had positive HLA B5, followed by HLA B51 (35.1%) and HLA B27 (12.2%). Conclusion: This study demonstrated that male/female ratio and mean age at onset were comparable to the results of previous studies in Iran. Significant associations between HLAB5 and clinical manifestations underline the pivotal role of genetic factors in BD.

Effectiveness of oral famotidine in reducing the hematologic complications of radiotherapy in patients with esophageal and cardia cancers: a randomized controlled trial.

BACKGROUND: Chemoradiotherapy complications has always been of great concern to both clinicians and patients during the course of treatment. The purpose of the present study was to examine the effectiveness of oral famotidine on the reduction of hematologic complications of patients with esophageal and gastric cardia cancers undergoing radiotherapy. METHODS: A single-blind controlled trial was conducted on 60 patients with esophageal and cardia cancers, who were undergoing chemoradiotherapy. Patients were randomly assigned to 2 groups with 30 patients to receive either 40 mg of oral famotidine (daily and 4 h before each session) or placebo. Complete blood count with differential, platelet counts, and hemoglobin levels were obtained weekly during treatment. The main outcome variables were lymphocytopenia, granulocytopenia, thrombocytopenia, and anemia. RESULTS: The findings indicated a significant effect of famotidine on reduction of thrombocytopenia among intervention group compared to control group (P < 0.0001). Even so, the effect of intervention was not significant for other outcome variables (All, P ≥ 0.05). The lymphocyte (P = 0.007) and platelet (P = 0.004) counts were also significantly greater in famotidine group in comparison with placebo group at the end of the study. CONCLUSION: As evidenced by the findings of the current study, famotidine might be recommended as an effective radioprotective agent among patients with esophageal and gastric cardia cancers to prevent Leukocyte and platelet reduction to some extent. Trial registration This study was prospectively registered at irct.ir (Iranian Registry of Clinical Trials) with the code IRCT20170728035349N1, 2020-08-19.

Caregiving burden, depression, and anxiety among family caregivers of patients with cancer: An investigation of patient and caregiver factors.

Background: Caring for patients with cancer can result in significant burden, anxiety, and depression among family caregivers, leading to alterations in their mental and physical wellbeing. Evidence on the level of cancer caregivers' burden, depression, anxiety, their role in assisting their patients, and other patient and caregiver factors that play in improving/worsening the outcomes, is limited. This study explored the prevalence of caregiving burden, depression, and anxiety with a focus on the patient and caregiver-related factors among cancer family caregivers. Methods: A cross-sectional study was conducted on the population of caregivers of adult patients with cancer in Zanjan, Iran between 2019 and 2020. The Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), and the Zarit Burden Inventory (ZBI) were used to measure outcome variables. Clinical and basic characteristics of the caregivers and patients were also collected. An independent samples t-test, analysis of variance, Pearson's correlation coefficient, and stepwise linear regression were performed using SPSS software version 26. Results: Mean ± standard deviation age of the caregivers (167 men and 133 women) was 40.77 ± 12.56. Of the caregivers, 46.3, 53, and 30.7% showed severe depression, anxiety, and burden, respectively. There was a significant positive correlation between ZBI with both BDI [r (298) = 0.19, p < 0.01] and BAI [r (298) = 0.20, p < 0.01]. Caregiving ≥24 months (B = 14.36, p < 0.001), outpatient care setting (B = -12.90, p < 0.001), being retired (B = -12.90, p < 0.001), depression (B = 0.28, p < 0.001), supplemental health insurance (B = -7.79, p < 0.001), being illiterate (B = 7.77, p < 0.01), surgery (B = 8.55, p < 0.01), ECOG1 (B = 4.88, p < 0.01), and patient's age (B = 0.11, p < 0.05) were found to be significant predictors of caregiving burden. Conclusion: High levels of depression, anxiety, and burden were observed among the caregivers of patients with cancer. These findings underline the importance of paying close attention to the needs and psychological challenges of this population.

Effectiveness of isometric exercises on disability and pain of cervical spondylosis: a randomized controlled trial.

BACKGROUND: Neck pain and disability is a significant public health problem with only very few evidence-based treatment option. The aim of this study was to evaluate the effect of isometric exercise on pain and disability of cervical spondylosis. METHODS: Twenty four patients with cervical osteoarthritis and neck pain (22 females and 2 males; mean age, 46.70 ± 13.71 years) were recruited and randomly allocated into 2 arms: neck isometric exercises (n = 12) and conservative management without exercise (n = 12). The Neck Disability Index (NDI) and Neck Pain and Disability Scale (NPAD) were used to assess participants at baseline and after 4 weeks. RESULTS: Basic characteristics, NDI score and NPAD score were not significantly different between groups at baseline. The exercise arm demonstrated significantly lower scores regarding NDI (mean, 17.41 vs. 25.58; P-value = 0.035) and NPAD (mean, 25.33 vs. 66.67; P < 0.001), compared to the control arm after 4 weeks. The exercise arm also showed significant within group reduction considering NDI and NPAD scores after 4 weeks (Both, P < 0.001). CONCLUSION: Our findings suggested that isometric exercises might be a beneficial treatment for improving pain and disability caused by cervical spondylosis. Trial registration This study was registered at irct.ir (Iranian Registry of Clinical Trials) with the code IRCT20220206053950N1, 07.05.2022, retrospectively registered.

EVALUATION OF 5-FLUOROURACIL-INDUCED CARDIOTOXICITY: ROLE OF CARDIAC BIOMARKERS.

BACKGROUND: Side effects of chemotherapy in cancer patients need to be investigated in more detail. AIM: To determine the incidence of cardiotoxicity in patients treated with different chemotherapy regimens containing 5-fluorouracil (5-FU) in Zanjan, Iran. PATIENTS AND METHODS: In a prospective cohort study, patients with different types of solid gastrointestinal tumors who were candidates for 5-FU based chemotherapy regimens were enrolled. The study population consisted of 100 patients (48 females and 52 males) with a mean age of 63.99 ± 12.40 years. We measured serum cardiac troponin I (cTnI) levels before and during each chemotherapy cycle and determined the occurrence of cardiotoxicity in patients based on the levels of cTnI, clinical signs and symptoms as well as electrocardiogram findings. In addition, we assessed a history of diabetes, hypertension, smoking, dyslipidemia and previous chest radiation as potential risk factors for cardiotoxicity. RESULTS: The incidence of cardiotoxicity was 8%, of which 5 patients were diagnosed with acute coronary syndrome, 2 patients with arrhythmias and one with hypotension. In addition, there was no significant association between studied risk factors and 5-FU induced cardiotoxicity. CONCLUSION: The incidence of cardiotoxicity in patients receiving 5-FU infusion regimens was notable. Thus, paying more attention to the 5-FU-induced cardiotoxicity is necessary in order to improve the prognosis of patients with cancer.

Predicting factors for abnormal brain computed tomography in children with minor head trauma.

BACKGROUND: Deciding whether a cranial Computed Tomography (CT) scan in a patient with minor head trauma (MHT) is necessary or not has always been challenging. Diagnosing Traumatic Brain Injury (TBI) is a fundamental part of MHT managing especially in children who are more vulnerable in terms of brain CT radiation consequences and TBI. Defining some indications to timely and efficiently predict the likelihood of TBI is necessary. Thus, we aimed to determine the impact of clinical findings to predict the need for brain CT in children with MHT. METHODS: In a prospective cohort study, 200 children (2 to 14 years) with MHT were included from 2019 to 2020. The data of MHT-related clinical findings were gathered. The primary and secondary outcomes were defined as a positive brain CT and any TBI requiring neurosurgery intervention, respectively. In statistical analysis, we performed Binary Logistic regression analysis, Fisher's exact test and independent samples t-test using SPSS V.26. RESULTS: The mean age of participants was 6.5 ± 3.06 years. Ninety patients underwent brain CT. The most common clinical finding and injury mechanism were headache and falling from height, respectively. The results of brain CTs were positive in seven patients (3.5%). We identified three predicting factors for an abnormal brain CT including headache, decreased level of consciousness, and vomiting. CONCLUSION: We showed that repetitive vomiting (≥2), headache, and decreased level of consciousness are predicting factors for an abnormal brain CT in children with MHT.

Predicting and Weighting the Factors Affecting Workers' Hearing Loss Based on Audiometric Data Using C5 Algorithm.

INTRODUCTION: With the extensively spread of industrialization in the world, noise exposure is becoming more prevalent in the industrial settings. The most important and definite harmful effects of sound include hearing loss, both permanent and temporary. OBJECTIVE: This study was designed aimed to use the C5 algorithm to determine the weight of factors affecting the workers' hearing loss based on the audiometric data. METHODS: This cross-sectional, descriptive, analytical study was conducted in 2018 in a mining industry in southeastern Iran. In this study, workers were divided into three exposed groups with different sound pressure levels (one control group and two case groups). Audiometry was conducted for each group of 50 persons; hence, the total number of subjects was 150. The stages of this study include: 1) selecting factors (predictive) to check and weigh them; 2) conducting the audiometry for both ears; 3) calculating the permanent hearing loss in each ear and permanent hearing loss of both ears; 4) classifying the types of hearing loss; and 5) investigating and determining the weight of factors affecting the hearing loss and their classification based on the C5 algorithm and determining the error and accuracy rate of each model. To assess and determine the factors affecting the hearing loss of workers, the C5 algorithm and IBM SPSS Modeler 18.0 were used. SPSS V.18 was used to analyze the linear regression and paired t-test tests, too. RESULTS: The results showed that in the first model (SPL <70 dBA), the 8KHz frequency with the weight of 31% had the highest effect, the factors of work experience and the frequency of 250Hz each with the weight of 3%, had the least effect, and the accuracy of the model was 100%. In the second model (SPL 70-80 dBA) the frequency of 8KHz with the weight of 21% had the highest effect, the frequency of 250Hz and the working experience each had the lowest effect with the weight of 7% and the accuracy of the model was calculated as 100%. In the third model (SPL >85 dBA), the 4KHz frequency with the weight of 31% had the highest effect, and the work experience with a weight of 1% had the lowest effect, and the accuracy of the model was 94%. In the fourth model, the 4KHz frequency with the weight of 22% had the highest effect and 250Hz and age each with the weight of 8% had the lowest effects; the accuracy of this model was calculated to be 99.05%. CONCLUSIONS: During investigating and determining the weight of the factors affecting hearing loss by the C5 algorithm, the high weight and effect of the 4KHz frequency were predicted in hearing loss changes. Considering the high accuracy obtained in this modeling, this algorithm is a suitable and powerful tool for predicting and modeling the hearing loss.

The effect of patient satisfaction with academic hospitals on their loyalty.

OBJECTIVES: Patients' loyalty to a health care institution can lead to the aggregation of patients' medical history in an institution and facilitating access to records by health care providers. Considering the increase of the competition between providers, it is important to gain patients' satisfaction, which leads to their return and loyalty. Therefore, this study evaluated the effect of patients' satisfaction with service quality on their loyalty. METHODS: A cross-sectional descriptive and analytical study was carried out in academic hospitals. A sample of 260 patients admitted to these hospitals was recruited. The data gathering tool was an expert-validated questionnaire which its reliability was confirmed by Cronbach's alpha. Data were analyzed using descriptive statistics, correlation coefficient, and multivariate regression analysis in SPSS20. RESULTS: The mean score of service quality was calculated 74.23 out of 100. Among the quality dimensions, "physician visit" had the highest score with 84.01 ± 20, and the "waiting time" dimension had the lowest score with the mean score of 62.45 ± 27.53. The mean score of patients' loyalty was 67.88 ± 29.79. Satisfaction with the six dimensions of service quality: "cost of services," "hospital environment," "delivered services," "access to physicians and health care institutions," "provision of information to patients," and "acquaintance with hospitals" were identified as the most influencing factors on loyalty. CONCLUSIONS: The results showed that patient satisfaction with service quality affects their hospital choices and increases loyalty. In order to increase patient loyalty to academic hospitals, improving the services quality along with delivering cost-effective cares, improving hospital environment, and providing useful information to patients are recommended.