Tuesday, May 21, 2019

Iris Publishers- Open access Journal of Cancer Research & Clinical Imaging | Commentary of Sarcopenia and Postoperative Complications in Gastrointestinal Cancer

Authored by Mikhail V Osipov
The undoubted achievement of the authors of the article is the detailed literature review and scrupulous data collecting, which allowed researchers to identify multiply factors and analyze an impact of those on the outcome. The most appropriate design for this type of study is a multivariate analysis. Current study presents results of a several univariate comparisons using one-by-one comparison of separate risk factors affecting the outcome using the SPSS package. At the same time, age and gender of the patient - a major factors which could impact on the outcome - were not taken into account in the analysis. The results presented in the study lean on p-values given for factors that has categories, i.e. categorical variables - a stage or degree of severity (for example, BMI has 3 levels: Underweight, Eutrophy, Overweight, which obviously can have an opposite impact on the outcome). A question arises, which of those categories was used for the comparison giving single p-value and how this significance corresponds beside the levels of single risk factor. Also, the key question is how much the severity of Sarcopenia, which has 3 stages, affects the outcome. Authors should remember that this approach (direct comparison when combining all categories into one) the Simpson paradox could cause.
The use of the t-test is admissible for the discrete sample and normal distribution, and there’s need to check the distribution for normality before the analysis, otherwise in the present study, with a sample size of 46 cases and a discrete distribution pattern, t-test may cause deviation. It is appropriate to use Fisher test or mid-p test for discrete distribution in the present analysis. The use of nonlinear logistic regression requires, above all, a description of the model, which the authors did not specify. Although the presence of Sarcopenia empirically to a certain extent can influence the occurrence of postoperative complications due to difficulties in adapting process of human organism, the result obtained in this study requires further improvement. In this regard, the authors are recommended to correct the results of the study in accordance with the specified shortcomings.
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Iris Publishers- Open access Journal of Cancer Research & Clinical Imaging | BMI and Association with Histopathological Characteristics of the Tumor in Postmenopausal Women
Author by Pr Selma Sakhri

The purpose of our study is to analyze the association between the increased bodyweight, by using the body mass index (BMI), and the histopathology of breast cancer (size of tumor, grade, hormone receptors, her2, lymph nodes) in postmenopausal women. In this retrospective study, 99 patients were examined, who were operated in our clinic who suffer from breast cancer from 12/2012 to 12/2014. ER and PR tumors were categorized as positive if 1% of the nuclei was stained. HER2 tumors were categorized as positive if ›10% of the nuclei was stained. The patients were categorized as being normal weight with BMI‹24, 9Kg/m2, overweight with BMI 25-29,9 Kg/m2, or obese with BMI›30Kg/m2. The average of BMI was 28, 28kg/m2 (range 18, 64-44, 76). In the category of normal weight patients (BMI = 24,9Kg/m2), we diagnosed 10 patients of stage I (25%), 18 patients of stage II (45%), and 12 of stage III (30%). As far as tumor size concerns, 11 patients were in T1 (27,5%), 9 were in T2 (22,5%) and 5 in T3 (12,5%) stage. Regarding the lymph nodes, 20 patients were diagnosed in N0 (50%), 14 in N1 (35%), 5 in N2 (12,5%) and 2 in N3 (5%). Referring to the hormone receptors and the expression of Her2, the most common combination was ER+PR+Her2- in 26 patients (65%), followed by ER+PR+Her2+ in 4 (10%), ER-PR-Her2+ in 3(7,5%) and ER-PRHer2- in 2 (5%). In the category of overweight patients (BMI 25- 29,9kg/m2) we diagnosed 5 of stage I (18,5%), 10 (37%) of stage II, and 12 (44,4%) of stage III. Concerning the tumor size, we had 13 patients in T1 stage (48, 14%), 9 in T2 (33,33%) and 5 in T3 (18,5%). As far as lymph nodes concerns, 13 patients were diagnosed in N0 (48,14%), 5 in N1 (18,5%), 3 in N2 (11,11%) and 5 in N3 (18,5%). Referring to the hormone receptors and the expression of Her2 , the most common combination was ER+PR+Her2- in 15 patients (55,55%), ER+PR+Her2+ in 4 (14,8%), ER-PR-Her2+ in 3 (11,11%) and ER-PR-Her2- in 1 (3,7%).In the category of obese patients (BMI›30Kg/m2) the grade was: 9 patients in stage I (34,6%), 9 in stage II (34,6%) and 8 in stage III (30,7%). Referring to the tumor size, we had 9 patients in T1 (34,6%), 15 in T2 (57,7%) and 3 in T3 (11,11%). Respecting the lymph nodes 15 patients were in N0 (57,7%).

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Monday, May 20, 2019

Iris Publishers- Open access Journal of Nursing & Care | Is complementary therapy (Vitamin D) effective among Psychiatric disorder? (Depression)?

Authored by Qusai Mohammed Harahsheh

The relationship between vitamin D and depression was clarified in many studies, some of this studies shown that there is a strong relationship between vitamin D and depression and shown that positive effect of vitamin D among patient with depressive disorder such as decreasing depressive symptoms like worthless, hurt restless, hopeless and feeling empty and cost effective and other positive effects comparing with antidepressants medication. On the other hand few studies shown that there is no relationship between vitamin D and depressive disorder, and it’s just improve the bone tissue with calcium assistance. On this literature review the current author will clarify many articles related to the relationship between vitamin D and the depressive disorder. Studies found positive effect of vitamin D on Depressive disorder many studies shown positive effect of vitamin D on depressive disorder and many studies shown that there is a relationship between decreasing vitamin D and increasing depressive symptoms severity(Jisheng Zhane et al 2014) found that the people with low serum of vitamin D has a higher severity depressive symptoms compared with people with normal vitamin D level, on the same time in this experimental article the author use vitamin D supplementation for group of people with severe depressive symptoms within specific period of time and concluded that there is a positive effect in decreasing the severity of symptoms (JishengZhane., et al 2014) , moreover the smart point on this article was using the vitamin D supplementation just in winter to avoid important external factors like seasonal factors and sun light strength, on same time the author linked between the chronic diseases which prevent people spending time out door (under sun light) and vitamin D deficiency which may increase the severity of depressive symptoms which reflect the 2nd reason to choose winter season.
Furthermore, an experimental study done in summer 2009 for 44 healthy student given vitamin D supplementation for 5 days resulting on improving their mood in that period compared with pre supplementation status by using specific tool after and before the experiment [6].Moreover [6] conclude that the higher level of vitamin D in human body has strong relationship with preventing depression.
Moreover a study done in U.S. for 18875 young adults population to link between the concentration of serum vitamin D and depression, by using specific tool for assessment (Diagnostic interview schedule), the sample age was 15-39 years old, they estimate an odd ratio after analyzing the data for vitamin D deficiency and having depression, compared with persons which have normal vitamin D value [7]. On the same topic [7] shown many characteristic which considered as a higher provenance of vitamin D deficiency, this characteristic are below poverty people, female gender, persons which didn’t get supplements, non-Hispanic, black people higher BMI people, west regions and south regions European cities and people who have at least one depressive episode, all of characteristic have ≤ 50 mole/liter, vitamin D serum which mean vitamin D deficiency, this number looked very low compared with 75 mole/liter of serum vitamin D within other people.

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Iris Publishers-Open access Journal of Nursing & Care | Argumentative Essay Paper on Seclusion Usage Among Aggressive Patients in Psychiatric Sitting

Authored by Qusai Mohammed Harahsheh

Every person in our world adapt with live challenges in different way, but some people cannot develop ways to cope with this challenge which resulted to mental disorders among this person as a chain of destructive behaviors images. In general, mental illness are inability to cope with different stressors which developed by environment internally or externally, this failure of coping reflected as incongruent feelings, thoughts and behaviors with norms which used locally or culturally, on the same time this maladaptive interfere with people function socially, physically and occupationally [1]. Mental and psychiatric science developed many methods to control this destructives behaviors such as medication, technique, and seclusion, the point here about using seclusion from legal and ethical dimensions, is it acceptable or not?.Seclusion defined as involuntary isolation of patient in specific room, this room named as seclusion room, and has many characteristics focusing on non-stimulating place, it must be locked, supervised by window, and contain the safety measurements as a hole (Health Care Commission, 2008), On the other hand the mental health commission defined the seclusion as a place has locked door designed in way which prevent going outside, this person stay in this room alone and on a specific time.
Furthermore the argumentative essay defined as a type of writing that need from the author to define a position on specific topic depend on evidence such as articles, personal experience, historical examples and litterers to support author viewpoint (Sweat, 2003). Although many opinions focusing on the harm effect of using seclusion related to break the autonomy, humanity and many other principles, many studies shown that seclusion as one of the most important measurement used in close units for mental health patient as a result of aggressive behaviors which may affect patient his self-integrity, other patients and health care provides safety who working on this settings (Happell & Harrow, 2010), moreover the number of seclusion episode varied from 3.7 – 110/1000 in patient/day in USA and Netherlands and 1.3 – 1517/1000 patient/day in Australia, Belgium [2]. Actually ethical consideration against seclusion are not newly identified, in 1839 the British Psychiatrist John Connolly advocate to eliminate the seclusion from treatment, because it’s penetrate many of most important patient rights. On the other hand, the failure of using the psychotropic agent in 1950 to control aggression behaviors pushed health care providers to use seclusion as essential elements to treat mentally ill patient (Guthrie, 1978) The current author strongly against using seclusion among mentally ill in-patients, who has destructive behaviors in psychiatric sittings. The purpose of this essay is to clarify a holistic overview related to using seclusion among mentally ill in-patients and discuss many opinions which focused on use or not use seclusion among mentally ill in-patients from legal and ethical dimensions, followed by summary and conclusion.

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Friday, May 17, 2019

Iris Publishers- Open access journal of Urology & Nephrology | Hypercapnia in Hemodialysis (HD)

Authored by  David Tovbin

Acute intra-dialytic exacerbation of hypercapnia in hemodialysis (HD) patient has been initially reported 18 years ago [1]. Subsequent similar case was reported few years later [2]. Common features of both patients were morbid obesity, a previously stable HD sessions and an acute respiratory infection at time of hypercapnia [1,2]. HD patients with decreased ventilation reserve, due to morbid obesity with or without obstructive sleep apnea (OSA) and/or obesity hypoventilation syndrome (OHS) as well as chronic obstructive pulmonary disease (COPD), are at increased risk. COPD is common among HD patients but frequently under-diagnosed [3]. Most COPD patients do well during HD with only mild- moderate pco2 increases and slightly decreased pH as compared to non-COPD chronic HD patients [2,4]. However, acute pulmonary congestion or infection or gradual but significant deterioration in respiratory state, may induce hypercapnia with intradialytic exacerbation, hypercapnic encephalopathy and respiratory arrest [1,2,5]. A proposed mechanism is that tissue hypoxia due to hypoxemia and/ or low tissue perfusion as in sepsis and/or shock increase intradialytic acid generation, bicarbonate buffering and production of co2, which cannot be exhaled at those states [1,2]. Some patients with severe COPD or OHS have baseline chronic severe hypercapnia and need the special measures which will be described below when starting hemodialysis. Symptoms of hypercapnic encephalopathy are correlated stronger with the changes in cerebrospinal pH induced by rapid diffusion of co2, than with those of arterial pH and/or Pco2. Both hypoxemia and on the other hand uncontrolled oxygen therapy with high inspiratory oxygen fractions (FiO2), which further decrease respiratory drive, have deleterious effects [5]. Nowadays, morbid obesity and associated obstructive sleep apnea (OSA) and possibly obesity hypoventilation syndrome (OHS) are common in the general population and even more in the population at risk for reaching HD [6-8]. Non-invasive positive pressure ventilation (NIPPV) such as continuous positive airway pressure (CPAP) and bi-level positive airway pressure (BiPAP) are nowadays commonly used in hypercapnic patients [5,9,10]. In the 2 case reports and in our experience with similar patients, BiPAP prevented intra-dialytic exacerbation of hypercapnia and possibly respiratory arrest [1,2]. In recent years, new interest was raised to HD dialysate bicarbonate concentration. After standardizing to inflammation malnutrition complex and comorbidities midweek pre-dialysis serum bicarbonate level was recommended as >22 mEq/L [11]. As higher dialysate bicarbonate concentration became more prevalent, a large observation cohort study demonstrated that high dialysate bicarbonate concentration was associated with worse outcome especially in the more acidotic patients.

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Iris Publishers- Open access journal of Urology & Nephrology | Robotic Pyeloplasty in Infants: A Review of Safety and Outcomes
Authored by Christina Kim

Over the last 30 years, robotic surgery has evolved into the preferred surgical approach for many operative cases. Robotics has been associated with lower pain scales, shorter hospitalizations, and improved cosmesis. [1,2] However, its acceptance in pediatrics have been hampered by longer operative times, smaller working space, and limited fine surgical instruments.
Many find these challenges even more pronounced when performing robotic surgery in infants. Although the data in infants is less robust, many studies have shown benefits similar to the adult population. Specifically, multiple reports of robotic surgery in infants have shown lower postoperative analgesic use. Additionally, hospital stays are shorter, which may lead to quicker return to work for parents and guardians.
Multiple reports have shown low complication rates of robotic surgery in infants. When complications have occurred, they are usually Clavien Grade 1 and 2, with occasional grade 3. Often the complications are not from the robotic technique but are linked to other factors such as the ureteral stents [3,4]. Most importantly, the success rates of surgery are comparable to open surgeryWhen robotic surgery was introduced, there was excitement due to three-dimensional imaging, 10-fold camera magnification, tremor filtering, and new camera control by the surgeon. Also, there is instrument articulation with full range of motion. Surgeons hoped these enhancements would allow precise suturing, improve tissue handling, and increase ease of doing complex surgical cases.
A wide variety of robotic procedures have been described in children. However, reported outcomes in children (particularly in infants) are limited. To date, pyeloplasty is the primary pediatric robotic surgery with comparable safety and efficacy when compared to open or standard laparoscopic approach. This has been supported by large multi-centric studies [5]. Also, this has been supported by the European Association of Urology Pediatric guidelines. The guidelines recognize the benefits of minimally invasive surgery by stating that “in experienced hands, laparoscopic or retroperitoneoscopic techniques and robot-assisted techniques have the same success rates as standard open procedures.” Also, they state that “Robotic-assisted laparoscopic pyeloplasty has all the same advantages as laparoscopic pyeloplasty plus better maneuverability, improved vision, ease in suturing and increased ergonomics but higher costs”. However, the role for robotic pyeloplasty in infants is less supported when the EUA states “There does not seem to be any clear benefit of minimal invasive procedures in a very young child, but current data is insufficient to defer a cut-off age.

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Thursday, May 16, 2019

Iris Publishers- Open access Journal of Biomedical Engineering & Biotechnology | Comparison of Cholinergic Status with Quantitative EEG in Healthy Subjects and Patients Suspected of Dementia

Authored by Rolf Ekedahl

Introduction: Objective is to evaluate quantitative electroencephalography (qEEG) variables to distinguish healthy subjects from patients who investigated for dementia and, to assess also at follow-up examination if acetylcholinesterase inhibitor (AChEI) treatment or not influenced the qEEG.
Methods: Average value from four EEG epochs obtained with eyes closed (E.Cl.) and eyes open (E.O.), the peak frequency with eyes closed and the Vigilance-index (ratio of E.O./E.Cl. average powers) calculated. A healthy group and a group suspected of having primary dementia compared, and the assumed dementia group evaluated with follow-up qEEG after approximately 12-14 months with or without acetylcholinesterase inhibitor treatment. The statistical analyze (Student`s t-test) p-values compared the healthy individuals against the suspected dementia patients, and at follow-up of AChEI treated against non-treated analyzed with paired p-values.
Result: When the healthy group compared with suspected dementia group at baseline, all variables were altered statistically significant except E.Cl. average power. The Vigilance-index (p-value < 0.001) and average power of E.O. (p-value < 0.001) increased, and the mean peak- frequency (p-value < 0.001) decreased. At the follow-up for the suspected dementia group, the Vigilance-index of the untreated increased significantly (p-value < 0.001) but not for the AChEI treated group. No other statistically significant changes for the other parameters.
Conclusion: The Vigilance-index may be used to assess cholinergic deficits in patients with dementia, also early in the course of the disease and evaluate the effects of AChEI treatment. Also, identify unwanted central cholinergic side-effects of other medication.
Longitudinal studies using electroencephalography (EEG) and follow-up are rare in dementia studies; however, varying effects on EEG parameters reported from existing studies [1-7]. Probably due to the heterogeneity and different stages of the dementia diseases, and also mixed types of dementia, e.g., Alzheimer’s dementia (AD), vascular dementia (VaD), Lewy body dementia (LBD) studied. Interpreting the EEG measurements is also tricky because the procedures used to collect and analyze data are different. The commonly used EEG parameters have assessed changes in the proportion of different frequency bands, average frequency, EEG power, the ratio of low-frequency activity to global and fluctuations in EEG frequency and coherence.
Varying proportions of patients did not display EEG changes at follow-up compared to baseline values [1,3,4,5,8]. Therefore, examinations of other EEG parameters that better reflect the electrophysiological changes in patients with dementia diseases needed for improving the diagnostic precision. Particularly in the early stages of dementia, and to monitor disease progression and evaluate the effects of Acetylcholinesterase inhibitor (AchEI) treatment. One possible way is to try to find methods to measure the cholinergic deficit in patients with primary degenerative dementia, such as AD [9-17]. Which, potentially could lead to an earlier AChEI treatment initiation in the early course of the disease than previous EEG methods [18-28] and other diagnostic measures, but also be used as a biomarker for dementia disease characterized by cholinergic deficiency.

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Iris Publishers- Open access Journal of Cancer Research & Clinical Imaging | Commentary of Sarcopenia and Postoperative Complications ...