morteza valaei

Chronic granulomatous disease (CGD) is a rare disorder normally diagnosed in infancy.

A 27-year-old man admitted with non-specific symptoms of CGD first underwent endoscopy and colonoscopy procedures as primary evaluation of clinical presentation. Eighteen months after the first admission, he was referred to the emergency department for hematemesis and critical situations, such as a severe anemic with Hgb= 2.6 mg/dl. Due to this clinical presentation, emergently critical management was done, and endoscopic investigation showed some ulcers and deformities at the duodenal bulb and jejunum. Other imaging procedures, such as sonography and abdominal CT scans, revealed splenomegaly. He underwent splenectomy, and after that, endoscopic treatment with balloon TTS dilation was scheduled, but this procedure failed. So, we decided to do a gastro-jujenostomy that alleviated the clinical symptoms. After nine months, he was referred to GOO, and endoscopic evaluation showed giant ulceration with severe stricture in the duodenum and a polyp in the jejunostomy. Finally, Based on clinical presentation and pathologic evidence of biopsies, the patient approached CGD as the final diagnosis.

Step-by-step rule out of different highly suspicious diseases may result in a definite CGD diagnosis, and rapid management of these patients may increase the chance of survival.

Context: 

The gastrointestinal microbiota is pivotal in cardiovascular surgery outcomes. This systematic review and meta-analysis aims to synthesize current evidence regarding the impact of gut microbiota on postoperative metabolomic markers and patient recovery.

Evidence Acquisition: 

Following PRISMA guidelines, a comprehensive search was conducted across MEDLINE, Web of Science, EMBASE, Scopus, and Cochrane's CENTRAL databases. Studies involving patients undergoing cardiovascular surgery and reporting on gut microbiota were included. Data extraction focused on study characteristics and metabolomic outcomes. The Newcastle-Ottawa Scale (NOS) assessed the risk of bias.

Six studies met the inclusion criteria, involving 530 patients. Meta-analysis revealed that a beneficial gut microbiota profile is associated with less increase in LDL cholesterol (Mean Difference: 14.4 mg/dL, SE: 0.816), a smaller decrease in HDL cholesterol (Mean Difference: -4.9 mg/dL, SE: 0.437), a lower rise in triglycerides (Mean Difference: 11.2 mg/dL, SE: 0.552), and a reduced elevation in CRP levels (Mean Difference: 2.4 mg/L, SE: 0.291) post-surgery. The overall risk of bias ranged from moderate to low across studies.

The findings suggest that gut microbiota composition significantly influences lipid metabolism and inflammatory responses post-cardiovascular surgery. A favorable microbiota profile may provide a protective effect against postoperative complications. These insights underline the potential for microbiota-modulating interventions in enhancing cardiovascular surgery outcomes.

The present study was conducted to investigate the factors affecting women's perception of fertility during the Covid-19 pandemic. The research method is qualitative and has a descriptive phenomenological approach. The statistical population of the study is 30-year-old mothers with one child and at least a bachelor's degree during the period from June 21, 2020 to November 5, 2020 in Tehran. 20 mothers were selected by purposive sampling according to the criterion type. The data of this study were analyzed based on the mothers' lived experiences and by conducting a semi-structured interview about the women's perceptions of fertility during the Covid-19 period. For the validity and formality of the interview questions, the professors of the Department of Psychology and experts in the field of qualitative research were consulted. Then all data were analyzed using Colaizzi's seven-step method and MAXODA version 12 software. The results of the present study are provided in 8 main themes, disease risks with 3 subthemes, stress with 6 subthemes, desire for pregnancy with 3 subthemes, economic conditions with 3 subthemes, psychological security with 4 subthemes, improvement of family relations with 8 subthemes, research and study with 2 subthemes, and foresight is obtained with 5 subthemes. As a result, due to the increasing public awareness of the importance of pregnancy, most women prefer to plan their pregnancy. Therefore, addressing the factors related to women's perception of fertility in the high-risk period of Covid-19 may lead to comprehensive maternal awareness and safe pregnancy.

Chlorine-containing bleach, as a common disinfectant, can cause mild to severe symptoms from nasal irritation to life-threatening conditions such as acute respiratory distress syndrome (ARDS). However, the toxicity level of chlorine gas depend on the duration and concentration of exposure. Herein, we describe the case of a 44-year-old man admitted to the emergency department with a chief complaint of severe shortness of breathing and hemoptysis following an accidental, short- time exposure to a chlorine-containing bleach. Because the life-threatening condition, he was transferred to Intensive Care Unit (ICU) and received mechanical ventilation along with a corticosteroid agent and antibiotic therapy. Despite limited data on management of the severe complications of the exposure, the patient successfully recovered after 4 days.

 Digoxin is a drug for ventricular rate control in atrial fibrillation (AF). The major challenge in digoxin therapy is to adjust the appropriate concentration range for this drug due to its narrow therapeutic index. Unique physiochemical properties of drinking water affect the pharmacological actions and delivery of drugs to the body whether they are administered orally, topically, or by injection. The aim of this study was to evaluate water hardness effect on digoxin therapy in an experimental rat model.

 48 rats weighing 200-220 g were randomly assigned to three groups that received drinking water with 50, 400, and 800 mg/l hardness degrees for 28 days. Then each group was assigned into two groups. One received digoxin 0.2 mg/kg a day orally for four days. The other group received normal saline (as control group). Continuous recording of electrocardiogram (ECG) was performed by PowerLab system (AD Instruments Company) before and day 4 of digoxin treatment. Then serum samples were collected and assessed for digoxin, sodium, potassium, calcium, magnesium, blood urea nitrogen (BUN), and creatinine levels.

 Water hardness in the range of 50-800 mg/l had no effect on serum digoxin levels
(P > 0.050), but consuming hard drinking water (400 and 800 mg/l) could increase serum calcium levels and then cause mortality (37.5% in both groups), following changes in ECG due to digoxin consumption.

 Consuming hard drinking water probably interferes with digoxin pharmacodynamics in the way of toxicity induction.

Acute kidney injury (AKI) is one of the serious complications of cardiac surgery. It is worsened when accompanied by low cardiac output syndrome.

In this study, we compared kidney function based on the KDIGO criteria in isolated on-pump and off-pump coronary artery bypass graft (CABG) surgery.

In this cohort study, 52 patients with LCOS were enrolled after on-pump (28 patients) and off-pump (24 patients) CABG. In the first six hours after ICU entrance, blood samples were taken for serum creatinine based on routine. For determining AKI after surgery, we used the KDIGO criteria as a primary endpoint. Also, some clinical parameters were recorded before, during, and after surgery. The data were analyzed by SPSS software, version 24, using paired and independent t-test, ANOVA, and Pearson correlation test and non-parametric tests such as Mann-Whitney and Kruskal-Wallis tests at a significance level of P < 0.05.

There was no significant difference in age (P = 0.3) and gender (P = 0.57) between the two groups. Among cardiac disease risk factors, only hypertension (P = 0.02) had a significant difference between the two groups, but AKI in patients with hypertension did not show a significant difference (P = 0.09). In paraclinical parameters, serum creatinine showed a significant difference before and after surgery in on-pump (P < 0.001) and off-pump (P = 0.007) groups. Also, this parameter had a significant difference at 6 h, 12 h, 24 h, and 48 h after surgery between the on-pump and on-pump groups. The AKI incidence showed a significant difference between the two groups (P < 0.001).

The incidence of AKI was more in on-pump patients than in off-pump patients. Also, a significant difference was observed between their clinical parameters. Thus, to improve the patients’ clinical outcomes and lower the health costs, we suggest that patients with a high risk of LCOS be followed up after CABG, especially on-pump CABG.

The purpose of this study was to investigate the effect of self-talk on psychological and physiological responses of competitive anxiety of elite taekwondo athletes. For this purpose, 33 male elite taekwondo athletes were selected and randomly divided into two groups: control (n = 16) and experiment (n = 14). In the pre-test (first competition), the cognitive components of competitive anxiety (cognitive anxiety, confidence and physical anxiety) and the physiological component of salivary cortisol were measured in both groups. The experimental group performed10 sessions of self-talk exercises and the control group had only physical exercises, and after the intervention, the post-test (second competition) was taken. One-variable covariance analysis was used to analyze the data. The results showed that cognitive and physical anxiety decreased in the experimental group compared to the control group, and self-confidence increased. Also, salivary cortisol levels decreased significantly in the post-test compared to the pre-test in experimental group. Based on the findings of this study, it is suggested to use self-talk to reduce the cognitive and physiological components of competitive anxiety.

Ambiguity in the philosophy of education and failure to meet the requirements, on the one hand, and the lack of background and anxiety for the institutionalization of educational philosophy in the educational system and the illiterate outbreak of the tendency to develop testing skills in the students on the other hand has risks at the individual and social levels. This study conducted a semi-structured interview with 15 of the top rankings in undergraduate, graduate and postgraduate undergraduate, postgraduate and specialist enrollments by analyzing perceptions and experiences, based on phenomenological method so that the effect of registration in so-called test classes on student performance the exam will be interpreted in a national exam. The findings revealed 4 general themes, the drop in literacy of graduates with 7 sub-themes, low-income elites with 4 sub-themes, the weakening of formal education with 4 sub-themes and the theme of social inequality with 9 subsamples. The results show that, although the use of these classes increases the probability of success in multiple-choice tests, it has led to the formation and intensification of social inequality. In other words, the ill-fated promotion of the use of pre-school classes has paved the way for the ineffectiveness of formal education and, as a result of neglecting the many talents who have no such ability to use these kinds of training for reasons such as material, social and cultural, ability to admit to high-paying and popular courses. It seems that this has led to a neglect of the potential of the community and the intensification of social inequality; it doubles the need for rethinking to prevent the deepening of the hazards enumerated.