In this study, IL-6 levels were assessed as inflammatory biomarker of bacterial sepsis in patients hospitalized at the ICU of the hospital of Colombia.Materials and methodsProspective study on 62 patients diagnosed with sepsis and septic shock. An ELISA assay was used to test serum levels of IL-6 at admission and 48 h after admission. Variables were analyzed by χ2 test (alfa <0.05). Multivariable Cox regression was used to determine the survival with the statistical program SPSS v23.00.ResultsPatient's median age was 53 years old and 59.7% were male. Lung was the most common primary site of infection (43.5%), and hypertension comorbidity with higher prevalence (40%). Infection by Gram negative bacteria were significantly more frequent among patients than Gram positive (P = 0.037). Overall, survival analysis showed that 10 (16.1%) patients died with a survival median of 7.00 +4.874 (2–3) days. In patients with sepsis we detected a significant decline in the average of IL-6 serum levels after 48 h of admission [7.50 (SD: 7.00–68.00) pg/mL vs. 68.00 [SD: 7.00–300.00] pg/mL (P = 0.000). Only 25% of patients with septic shock who presented high levels of IL-6 at the time of admission and at 48 h had a survival up to 15 days (P = 0.005).ConclusionWe found significant differences between the plasma levels of IL-6 during the first 48 h after admission to the ICU among patients with sepsis and septic shock. Patients with sepsis had a significant decline in IL-6 levels, whereas in patients who developed septic shock, levels of this cytokine remained high and have a lower survival compared to those who maintained low levels of IL-6.

ObjectiveGlucagon-like peptide 1 (GLP-1), a gut-derived peptide has been reported to have insulin-like effects. Our aim is to examine GLP1 levels in hyperemesis gravidarum (HEG).Materials-methodsThe study population consisted of 2 groups: Group 1 (control subjects) consisted of 22 women with uncomplicated singleton pregnancies in the first trimester. Group 2 consisted of 22 singleton pregnancies complicated by HEG. Glucose and GLP1 levels were determined. Enzyme-linked Immunosorbent Assay Kit for Glucagon like Peptide 1 (GLP1) was used (Uscn, Life Science Inc.).ResultsNo significant differences in maternal age, gestational age and gravida were observed between hypermetric and control groups. Maternal serum GLP1 levels were significantly higher in HEG compared with control group (P = 0.004).ConclusionThe results of our study revealed that the presence of increased GLP1 levels in women with HEG could contribute to the pathogenesis of the disease. Our results indicated that increased GLP1 levels may be associated with hyperemesis gravidarum. The limitation of our study was the restricted number of patients. Large prospective and randomized studies are required to evaluate the effect of GLP1 levels on hyperemesis gravidarum.

A 48-year-old male patient was admitted to our outpatient clinic with complaints of shortness of breath. He also had a holo-diastolic murmur at the right sternal border and an apical impulse being displaced laterally and inferiorly. Transthoracic echocardiography showed a severe aortic regurgitation without aortic valve stenosis and a mildly dilated left ventricle accompanied by an ejection fraction of 55%. The aortic regurgitation jet was eccentric and there were significant holodiastolic flow reversals in the descending thoracic aorta. Surgical management was advised for this patient because of symptomatic severe aortic regurgitation. Then, the patient underwent preoperative coronary angiography through the right femoral artery route. The left coronary ostium could be engaged with a 6 Fr Judkins left diagnostic catheter; however, the catheter jumped through the ascending aorta. Afterwards, the catheter was engaged and again jumped through the ascending aorta. Engagement and jumping cycles observed between successive systole to diastole. In our opinion, this catheter movement is explained by wide pulse pressure, like the severe characteristic physical findings of severe aortic regurgitation. Further studies are needed to understand whether this catheter movement is angiographically evidence of severe aortic regurgitation.

BackgroundPulmonary Arterial Hypertension (PAH) carries a poor prognosis in both adult and pediatric patients. It is a life-threatening condition in newborns. Current recommendations advocate the use of targeted monotherapy as a first-line approach for the treatment of Persistent Pulmonary Hypertension of the Newborn (PPHN). In case of an inadequate clinical response to treatment, an addition of a second or third agent is considered. PAH is usually managed with a phosphodiesterase 5 inhibitor or an endothelin receptor blocker. There are limited pediatric studies that address questions like which class of therapy should be initiated first or if a combination should be initiated together. With this background, the present study was initiated to compare the efficacy, safety, and tolerability of bosentan as an adjuvant to sildenafil and sildenafil alone in PPHN.ResultsA total of 40 patients were enrolled in the study. Out of them, 26 were males (65%) and 14 were females (35%). PPHN was most commonly seen in the 29 (72.5%) of participants with a history of first order birth. Mean duration of symptoms was 14.05 ± 2.06 days. The participants were randomized to two groups. Group A consisted of total 25 participants that received both bosentan and sildenafil and group B had 15 participants that received sildenafil alone. Both groups were comparable in terms of birth weight and present weight, consanguinity, and mode of delivery. Efficacy was determined by the reduction in mean baseline Pulmonary Artery Systolic Pressure (PASP). PASP in group A was 75.56 ± 10.62 mm Hg and in group B was 64.86 ± 12.25 mm Hg which was not statistically significant (P > 0.05). PASP on the third and seventh day in group A were 43.72 ± 8.63 and 24.47 ± 3.52 mm Hg compared to 42.28 ± 9.43 and 27.276 ± 8.38 respectively in group B which was statistically significant (P < 0.05).There were two deaths each in both groups. Two participants in Group A developed liver function abnormalities. None of the participants in Group B had adverse effects.ConclusionMost common clinical manifestations were nonspecific. Cardiovocal syndrome was common in PPHN. We conclude that oral sildenafil treatment is a safe, simple and effective treatment for persistent pulmonary hypertension in newborn. Combination of bosentan with sildenafil is more effective and safe in reducing pulmonary artery (PA) pressures in high-risk patients with PPHN.

Background and aimsVascular endothelial growth factor (VEGF) is regarded as a potent stimulating factor for angiogenesis and vascular permeability and probably is connected with an inflammatory reaction. Our study aimed to determine the effect of VEGF in the inflammatory process in the oral mucosa of experimental animals in the modulation of atopic disease.Materials and methodsAtopic condition was simulated by the ovalbumin model. Obtained specimens of oral mucosa were examined histologically; immunohistochemistry was performed with detection VEGF, CD23, CD20.ResultsMost pronounced changes with twice increased expression activity of VEGF has been detected in the affected areas of the lamina propria and were associated with perivascular inflammatory microinfiltration, but unexpected expression in the epithelial layer has been revealed surround of intraepithelial inflammatory cells mainly. Pronounced correlations have been detected as VEGF and CD23 (r = 0.91), VEGF and CD20 (r = 0.87), CD23 and CD20 (r = 0.89).Discussiondescribed the changes in the tissues of the oral mucosa could be served as a basis for the development of preventive measures in patients with atopic diseases.discussionConclusionsActivation of VEGF is connected with accumulation of inflammatory infiltrate represented by B-lymphocytes, activated macrophages, eosinophils with a correlation in atopic process.

IntroductionNegligence of proper time and poor performance of resuscitation team can lead to more mortality and negative consequences of cardiac arrest, as well as less survival. This study was conducted with objective of determining the arrival time of physician and resuscitation team to survive the victims of cardiopulmonary arrest.Materials and methodsIn this prospective and descriptive-analytic study, the resuscitation performance and the arrival time of resuscitation team in 143 inpatients who had been diagnosed with witnessed cardiopulmonary arrest were examined using a researcher-made checklist. Data analysis was performed using parametric and non-parametric statistical tests and SPSS.ResultsInitial survival rate was 26.6%. In general, the mean time of physician’s presence after the code announcement in minutes and seconds was 02:31 ± 01:22. It was also 02:24 ± 01:15 in successful cases and 02:34 ± 01:25 in unsuccessful cases. Independent t-test did not show a significant difference between the physician’s presence time and the rate of initial successful resuscitation (p = 0.504). The time of first shock after observing ventricular fibrillation/tachycardia (in minutes and seconds) was 01:30 ± 00:47. According to independent t-test, the aforementioned time was less than the mean time (02:31 ± 01:22) of physician’s presence (p < 0.001).ConclusionsIn this study, the initial survival rate in comparison to other regions in the country was almost more favorable and it was similar to global norms. In this study, the starting time of resuscitation was within the acceptable range. There was no relationship between the presence of physician and the initial survival rate of patients, as well as the use of defibrillator (by physician compared to other team members) and intubation with the initial survival rate. This could indicate the adequate performance of resuscitation team in the absence of physician on the condition of having sufficient knowledge and skill.

IntroductionSleep quality is an essential aspect in human health and function. Considering high prevalence of using smartphones and social networks among students and their impact on sleep quality, this study was conducted to determine the relationship between the overuse of cell phone and addiction to social networks and students’ sleep quality.Materials and methodsThis cross-sectional study was conducted in Kermanshah University of Medical Sciences, Kermanshah, Iran in 2018. Using cluster sampling, 321 students from different disciplines were selected. Data gathering tools consisted of the questionnaire of Pittsburgh Sleep Quality Index (PSQI). Cell phone use and addiction to social networks were assessed using Cell Phone Overuse Scale and a researcher-made questionnaire, respectively. Data were analyzed using SPSS software (version 19) and Pearson’s correlation test.ResultsThe mean total score of sleep quality in students was 6.58 ± 1.05. There was a positive and significant correlation between sleep quality and social networks addiction score (p < 0.05, r = 0.5) and cell phone overuse (p < 0.05, r = 0.44); this is an inverse correlation, because higher scores of the total PSQI denote a lower sleep quality and, in Cell Phone Overuse Scale, higher scores shows overuse.ConclusionsAccording to the findings of this study, there was a significant statistical relationship between the overuse of cell phone and social networks and students’ sleep quality. In other words, students who have had overuse of cell phones had poorer sleep quality. Therefore, providing effective educational programs to improve the sleep quality in this group is essential.

ObjectiveTo develop and validate a risk score model for recognizing prediabetes among Indonesian adults in primary care.MethodsThis was a cross-sectional diagnostic study. After excluding subjects with diabetes from Indonesian National Basic Health Survey (INBHS) data set, 21,720 subjects who have completed fasting plasma glucose test and aged >18 years were selected for development stage. About 6,933 subjects were selected randomly from INBHS for validation stage in different diagnostic criteria of prediabetes-based random plasma glucose. Logistic regression was used to determine significant diagnostic variable and the receiver operating characteristic analysis was used to calculate area under the curve (AUC), cutoff point, sensitivity, specificity, and predictive values.ResultsAge, sex, education level, family history of diabetes, smoking habit, physical activity, body mass index, and hypertension were significant variables for Indonesian Prediabetes Risk Score (INA-PRISC). The scoring range from 0 to 24, the AUC was 0.623 (95% CI 0.616–0.631) and cutoff point of 12 yielded sensitivity/specificity (50.03%/67.19%, respectively). The validation study showed the AUC was 0.646 (95% CI 0.623–0.669) and cutoff point of 12 yielded sensitivity/specificity (55.11%/65.81%, respectively).ConclusionINA-PRISC, which consists of eight demographical and clinical variables, is a valid and a simple prediabetes risk score in primary care.

AimThe aim of this study is to compare subcutaneous 5% dextrose versus subacromial corticosteroid injection for the treatment of chronic rotator cuff tendinopathy.MethodsWe carried out a randomized clinical trial with two parallel groups at a university hospital. Overall, 57 (32 women) were included in two groups of corticosteroid (n = 29) and dextrose (n = 28). The mean pain score was 6.6 (1.0). We used a visual analog scale for pain and goniometry for the range of motion. The measurements were repeated 1 month after the interventions. For corticosteroid, a single injection of triamcinolone and 1% lidocaine, and for dextrose, a mixture of 5% dextrose and 2% lidocaine three times weekly were prescribed.ResultsBoth interventions were effective in decreasing pain compared to the baseline (both p < 0.001). The difference in pain between the two groups was nearly significant 1-month post-intervention (p = 0.052). The comparison of the two groups in considerable pain reduction (≥2.8) was in favor of dextrose (p = 0.046). The differences in the range of motion were not conclusive. None of the participants reported an important adverse effect.ConclusionThe 5% dextrose treatment is at least as effective as corticosteroid for reducing pain in patients with rotator cuff tendinopathy.

ObjectivesGonadotropin-releasing hormone agonist (GnRHa) could influence the levels of sex hormones and thyroid hormones. The aim of this study was to investigate the effect of GnRHa on thyroid function.Materials and methodsThe data of the patients were collected from the registrations of July 2014–October 2014. A total of 41 women who underwent one-time IVF cyclus were evaluated in this cross-sectional study. The patients were categorized into two groups according to the serum T3, T4, and TSH levels before and 2 weeks’ after the administration of GnRHa.ResultsMean basal TSH and mean TSH levels on hCG day were 1.98 ± 0.77 and 1.75 ± 0.70, respectively. The difference between the two groups was statistically significant (p < 0.05). GnRHa did not lead to statistically significant difference on serum-free T3 and T4 levels.ConclusionsIn conclusion, our results demonstrate that GnRHa led to a decrease on serum TSH level. Serum-free T3 and T4 levels were remained unchanged and this might be due to early measurement of the hormone levels (just 2 weeks later from GnRHa administration).