Aprepitant, fosaprepitant and risk of ifosfamide-induced neurotoxicity: a systematic review.

Ifosfamide is one of the chemotherapy regimens which potentially causes neurotoxicity in patients up to 30%. Aprepitant is administered as an anti-emetic agent in chemotherapy and regarding the inhibitory effect on CYP3A4, aprepitant can increase the risk of ifosfamide adverse effects. This study aims to systematically investigate the relation of ifosfamide-induced neurotoxicity and aprepitant or fosaprepitant in chemotherapy cancer patients. Four databases including PubMed, Scopus, Web of Science, and Embase were systematically reviewed without language restriction and hand searching was performed until December 2021. Total 1639 publications were retrieved and nine studies fulfilled the eligibility criteria. For quality assessment, we used Newcastle-Ottawa quality assessment scales (NOS) for retrospective cohort studies and Cochrane Collaboration tool to assess the risk of bias for a randomized controlled trial. Overall, the results of our systematic review indicated a positive enhanced trend between neurotoxicity and concomitant use of ifosfamide and aprepitant or fosaprepitant, but the association was not statistically significant. As indicated by our findings, several studies identified low albumin as a risk factor for ifosfamide-induced encephalopathy. However, further clinical studies with a larger population of patients are required to evaluate the clinical significance of ifosfamide-related neurotoxicity and aprepitant or fosaprepitant.

Pain in percutaneous liver core-needle biopsy: a randomized trial comparing the intercostal and subcostal approaches.

PURPOSE: Effective pain control during and after percutaneous core needle liver biopsy is important with regard to ethical considerations and patient comfort. In this randomized double-blind study, we compared post-biopsy pain in the patients undergoing liver core-needle biopsy using either subcostal or intercostal approaches. METHODS: All patients referred for ultrasound-guided CNLB between July 2017 and January 2018 to our interventional radiology department were randomized into two groups. Biopsy was performed through intercostal approach in the first group and through subcostal approach in the second group. The intensity of pain 0, 2, and 4 h after the procedure was compared in two groups using a 100-mm visual analogue scale. All biopsies were performed without procedural IV sedation. If patients' discomfort  demanded administration of IV analgesics during or after the procedure, then the patients were excluded from the study. RESULTS: In patients without routine procedural IV sedation, there was no significant difference in the pain level between the intercostal and subcostal groups immediately after the procedure (p = 0.055), but we found a significant difference in the pain level between the two groups 2 (7.5 mm, p = 0.001) and 4 (2 mm, p = 0.001) h after the procedure. CONCLUSION: The minimum amount of change in the VAS score that is considered clinically important is 13 mm on a 100-mm scale. Pain differences at 2 and 4 h in the two groups in this study were statistically but not clinically significant. Therefore, the authors suggest the use of subcostal route for ultrasound-guided liver biopsy whenever possible, but the results do not warrant the routine use of post-procedure analgesics in whom biopsy is performed via intercostal route.

A theory-based exercise intervention in patients with heart failure: A protocol for randomized, controlled trial.

BACKGROUND: Regular exercise has been associated with improved quality of life (QoL) in patients with heart failure (HF). However, less is known on the theoretical framework, depicting how educational intervention on psychological, social, and cognitive variables affects physical activity (PA). The purpose of this study is to assess the effectiveness of a social cognitive theory-based (SCT-based) exercise intervention in patients with HF. MATERIALS AND METHODS: This is a randomized controlled trial, with measurements at baseline, immediately following the intervention, and at 1, 3, and 6 months follow-up. Sixty patients who are referred to the cardiac rehabilitation (CR) unit and meet the inclusion criteria will be randomly allocated to either an intervention group or a usual-care control group. Data will be collected using various methods (i.e., questionnaires, physical tests, paraclinical tests, patients' interviews, and focus groups). The patients in the intervention group will receive eight face-to-face counseling sessions, two focus groups, and six educational sessions over a 2-month period. The intervention will include watching videos, using book and pamphlets, and sending short massage services to the participants. The primary outcome measures are PA and QoL. The secondary outcome measures will be the components of SCT, heart rate and blood pressure at rest, body mass index, left ventricular ejection fraction, exercise capacity, and maximum heart rate. CONCLUSION: The findings of this trial may assist with the development of a theoretical model for exercise intervention in CR. The intervention seems to be promising and has the potential to bridge the gap of the usually limited and incoherent provision of educational care in the CR setting.

Research priorities in the field of HIV and AIDS in Iran.

BACKGROUND: HIV is a multidimensional problem. Therefore, prioritization of research topics in this field is a serious challenge. We decided to prioritize the major areas of research on HIV/AIDS in Iran. MATERIALS AND METHODS: In a brain-storming session with the main national and provincial stakeholders and experts from different relevant fields, the direct and indirect dimensions of HIV/AIDS and its related research issues were explored. Afterward, using the Delphi method, we sent questionnaires to 20 experts (13 respondents) from different sectors. In this electronic based questioner, we requested experts to evaluate main topics and their subtopics. The ranges of scores were between 0 and 100. RESULTS: The score of priorities of main themes were preventive activities (43.2), large scale planning (25.4), the estimation of the HIV/AIDS burden (20.9), and basic scientific research (10.5). The most important priority in each main theme was education particularly in high risk groups (52.5), developing the national strategy to address the epidemic (31.8), estimation of the incidence and prevalence among high-risk groups (59.5) and developing new preventive methods (66.7), respectively. CONCLUSIONS: The most important priorities of researches on HIV/AIDS were preventive activities and developing national strategy. As high risk groups are the most involved people in the epidemic, and they are also the most hard-to-reach sub-populations, a national well designated comprehensive strategy is essential. However, we believe with a very specific and directed scheme, special attention to research in basic sciences is necessary, at least in limited number of institutes.