The most common problem of modern medicine is the development of increasing antifungal drug resistance nowadays including fungal infections of the skin and its appendages caused by dermatomycetes, yeast-like fungi, and molds so, there will be a need for alternative antifungal treatment. Natural substances with high antifungal properties like essential oils and their components show potential in this regard. Citrus lemon and Citrus sinensis essential oils were screened against Malassezia furfur by disc diffusion method and Minimum Inhibitory Concentration was determined by Modified Microdilution method. Citrus lemon (lemon) and Citrus sinensis (orange) show excellent inhibitory effects on the lipophilic, yeast-like fungus Malassezia furfur which causes Pityriasis versicolor, a chronic superficial fungal disease of the skin. The diameter of the inhibition zone was found to be 70 mm and 60 mm respectively. Malassezia furfur was found to be resistant against Clotrimazole & Ketoconazole. The minimum inhibitory concentration (MIC) of lemon and orange oil against Malassezia furfur was found to be 0.6 µl/ml and 0.8 µl/ml. These findings concluded that the use of Citrus lemon (lemon) and Citrus sinensis (orange) oil showed remarkable and excellent antifungal activity, and can be used as a traditional herbal medicine for the control of Pityriasis versicolor infection of the skin after undergoing clinical trials.
Psoriasis has been associated with metabolic syndrome and nonalcoholic fatty liver disease. We wanted to investigate the abdominal ultrasonography results of psoriasis patients before biological agent treatment. Between April 2019 and February 2022, abdominal ultrasonography results of psoriasis patients which were performed before biological agent treatment were reviewed retrospectively. This study included 90 patients, 45 females, and 45 males with a mean age of 48.91±13.43 years. The most common ultrasonography finding was increased echogenicity of the liver parenchyma due to steatosis (58.9%) which was followed by an increase in liver size (25.6%), kidney cysts (17.8%), gallstones (8.9%) and increase in spleen size (7.8%). Hepatic steatosis was more frequent in older patients (p<0.001), patients with diabetes (p=0.007), and patients who were previously treated with biological agents (p=0.007). 70.4% of the patients with moderate or severe hepatic steatosis were female. Herein, hepatic steatosis was detected in 53 (58.9%) patients. Nonalcoholic fatty liver disease which presents as hepatic steatosis in early stages has an asymptomatic course and poor prognosis in psoriasis patients. We suggest that abdominal ultrasonography should be performed in psoriasis patients before biological agent treatment, especially in females, patients with advanced age, patients who were previously treated with biological agents, and patients with diabetes.
Breast cancer remains a significant health concern, with predictions indicating a rise in global incidence. While the primary focus is on oncological radicality, the aesthetic and psychological impacts of surgical interventions, such as radical mastectomy, cannot be ignored. This study, conducted over 8 years, aimed to identify factors that can prevent unnecessary lymphadenectomy. The research analyzed various parameters, including age, BMI, tumor size, and immunohistochemistry, to determine their correlation with axillary lymph node invasion. The results highlighted the importance of tumor size and estrogen receptor status in predicting axillary lymph node metastasis. The study underscores the value of sentinel lymph node biopsy in early breast cancer treatment, emphasizing its benefits over complete axillary lymph node dissection.
Background and Aim: Health technology assessment for drugs is a necessary step in developing health policies that are focused on patients and getting the best value for scarce resources. One important feature of health technology assessment is transparency. In many countries, health technology assessment is followed by negotiations between pharmaceutical companies and health authorities to determine whether a drug will be publicly funded. These negotiations often result in Managed Entry Agreements, which typically include confidentiality clauses covering the final price of the drug. Methods: We reviewed Romanian legislation starting in 2014 to assess the level of confidentiality and transparency in drug pricing and reimbursement. Results: We found that for drugs with Managed Entry Agreements, the level of discounts is confidential, the public does not know how much the government is paying for each of these drugs, the volumes (units) of drugs are not transparently published by the payer, the outcomes, in terms of patients treated by therapeutic area, therapeutic success, and resource utilization, are confidential. Conclusions: We consider that too much confidentiality can prevent the public from knowing if the government is getting good value for money, but too little confidentiality can lead to higher drug prices or a lack of drugs from the market.
The assessment of coping mechanisms in patients diagnosed with oncological diseases is essential for mental health specialists, who have to design the most appropriate case management strategy for comorbid mood disorders, anxiety disorders, adjustment disorders, and other psychiatric conditions that may be detected in this vulnerable population. The adequate treatment of these disorders is important for the preservation of mental health status, quality of life, and overall functionality in patients diagnosed with cancer. Coping mechanisms modulate the vulnerability toward psychiatric disorders, but they also have an impact on treatment adherence, which is an important factor correlating with prognosis. Appraisal-focused, problem-focused, emotion-focused, and occupation-focused coping represent the most well-defined strategies patients use when confronted with a stressful life situation, like a diagnosis with potentially vital consequences. Maladaptive coping strategies may also be identified in these patients, e.g., withdrawal from reality, including complete or partial denial of the disease, substance abuse, behavioral addictions, refusal of the recommended treatment, etc. The psychotherapeutic approach in patients with oncological diseases should include an initial evaluation of the coping strategies used either currently or in the past stressful conditions, an assessment of all the psychosocial resources the patients have (e.,g., support group, professional insertion, hobbies), and screening for mood and anxiety disorders that may have been triggered by the cancer diagnosis. Consequently, within the psychotherapeutic framework, a trained specialist can enhance the role of adaptive coping strategies and highlight the disadvantages of dysfunctional ones. This process may possess a favorable impact on treatment adherence, mental health status, and quality of life in patients with cancer.
Body composition has been associated with better performance in military populations. However, there is no consensus about the most suitable body composition values for army paratroopers. To analyze body composition differences among the type of specialty, age group, and gender of army paratroopers, for a better improvement of their operability. 104 paratroopers of the Spanish Army were analyzed. Anthropometric and morphological data were analysed throw an In-Body720. There was a significant effect of age on intracellular water. Older soldiers had lower values of intracellular water, protein, and skeletal muscle mass than middle-aged soldiers. No significant differences (P ≤ 0.05) for the effect of the kind of work and age together or taken separately. Men had significantly higher values than women for height, weight, extracellular water, protein, fat-free mass, and skeletal muscle mass, and significantly lower values for the percentage of body fat, while no differences were found for body fat mass and body mass index. We conclude that paratroopers’ body composition depends on age in skeletal muscle mass, intracellular water, and protein. For better unit readiness, soldiers must be monitored to analyze the effect of training and nutrition habits on their body composition.
Background: Silver-Russell Syndrome (SRS) and Beckwith-Wiedemann Syndrome (BWS) are two syndromes that are poorly diagnosed in many affected people due to mild and subtle symptoms, genetic complexity, and lack of familiarity with the hallmarks. Objective: The present study was conducted with the aim of determining mutations in H19, IGF2, CDKN1C, KCNQ1, and NSD1 genes in Iranian children suspected of SRS and BWS by the MS-MLPA method. Methods: In this case series study, which was conducted in 2022 in Pars Genome Laboratory, Karaj, Iran, 10 children suspected of SRS or BWS syndrome were included. These 10 Iranian children were referred by pediatric endocrinologists. 5 ml of peripheral blood was taken per patient for DNA extraction. MS-MLPA method was undertaken for possible mutations (methylation and deletion) in H19, IGF2, CDKN1C, KCNQ1, and NSD1 genes. Results: The interpretation of MS-MLPA results showed that out of 10 children (4 boys and 6 girls) suspected of having SRS or BWS syndrome (based on the pediatric endocrinologist’s diagnosis), only 3 children were definitively diagnosed with SRS or BWS syndrome. Based on this, methylation changes in the promoter of ICR1 and ICR2, which are related to the genes H19, IGF2, CDKN1C, KCNQ1, and NSD1, lead to the development of SRS or BWS syndrome. Conclusion: The present findings showed that methylation changes in H19, IGF2, CDKN1C, KCNQ1, and NSD1 genes are associated with the occurrence of SRS or BWS syndrome. In this study, we show that MS-MLPA can serve as a rapid, inexpensive, and reliable method for the molecular diagnosis of these syndromes.
Background: Lung tissue changes following COVID-19 may persist for a long time after discharge and recovery, but not enough information is available about these chronic pulmonary sequels. We addressed to evaluation of chronic pulmonary sequels on CT scans of patients with COVID-19. Methods: This cross-sectional study was conducted on 94 patients with COVID-19 who were evaluated by CT scan at the time of discharge and also underwent continuous evaluation by CT scan of the lungs for at least three months. Through reviewing the hospital archive files, patients' backgrounds and three-month follow-up information were collected. Results: Chronic pulmonary involvement during the follow-up of patients was found in 83%. Peripheral and diffuse involvements were revealed in 79.8% and 3.2% respectively. Also, single-lobar and multi-lobar involvements were found in 69.1%% and 13.8% respectively. In terms of abnormal lung findings on CT scan, ground-glass opacity was found in 20.2%, Crazy- paving pattern in 2.1%, reticulation in 3.2%, parenchymal band in 12.8%, consolidation in 1.1% and bronchiectasis in 3.2%. The mean CT score was also 4.21 ± 3.45. The appearance of findings in CT patients was strongly influenced by the patients 'age, body mass index, underlying comorbidities, and also, the severity of initial COVID-19. Conclusion: Within at least three months of disease recovery in hospitalized patients with COVID-19, evidence of pulmonary involvement in 83% in the form of chronic pulmonary sequels can be expected. The most common findings related to pulmonary involvement included GOO in 20.2% and parenchymal band in 12.8% of cases.
Besides the motor and sensory dysfunction that characterizes multiple sclerosis, during the disease evolution and with the accumulation of new demyelinating lesions in specific areas of the central nervous system, autonomic dysfunction be-comes more prevalent among patients suffering from multiple sclerosis. Although not usually addressed, the complex spectrum of autonomic dysfunction manifestations has the potential of a negative impact on the daily activities of multiple sclerosis patients, needing specific investigations and therapeutic measures destined to alleviate symptoms and increase the quality of life. Since urinary dysfunction is evident from the early stages of multiple sclerosis on urodynamic studies even in patients without urinary complaints, it is indicated to thoroughly screen for urinary tract dysfunction as well as other autonomic dysfunctions in all the multiple sclerosis patients.
Erectile dysfunction (ED) has an intricate pathogenesis, with organic and psychosocial factors contributing to the shaping of its clinical manifestations and functional impairment. ED disrupts not only an individual’s sexual life but may also contribute to impairments of self-esteem, social functioning, quality of life, overall well-being, mood, etc. The assessment process and therapeutic interventions should be adequate to the specific profile of each patient, therefore an interdisciplinary approach is usually recommended, in order to find the vulnerability factors, recent triggers, psychiatric and organic comorbidities or causes, and elements that contribute to maintaining the sexual dysfunction, such as lifestyle factors, interpersonal conflicts, or inadequate sexual education. This narrative review explores the evidence-based approaches to structured psychiatric, psychological, and therapeutical assessment in patients with ED, and the most validated psychosocial treatments available. The results support the use of recognized diagnostic criteria within DSM-5TR and ICD-11, together with structured instruments (scales, questionnaires, and inventories), in a multidisciplinary approach. The cognitive model and cognitive-emotional model of ED support the initiation of cognitive-behavioral therapy in these patients. Other interventions, like the PLISSIT model, sexual therapy, couple therapy, and sexual-focused psychoeducation are also supported by evidence. In conclusion, ED requires a combined, psychiatric, psychologic, psychotherapeutic, and organic-oriented assessment, with the purpose of tailoring the treatment to the patient’s particularities.
