Familial adenomatous polyposis (FAP) is an autosomal dominant inherited syndrome characterized by multiple adenomatous polyps (predisposing to colorectal cancer development) and numerous extracolonic manifestations. T...Familial adenomatous polyposis (FAP) is an autosomal dominant inherited syndrome characterized by multiple adenomatous polyps (predisposing to colorectal cancer development) and numerous extracolonic manifestations. The underlying genetic burden generates variable clinical features that may influence operative management. As a precancerous hereditary condition, the rationale of performing a prophylactic surgery is a mainstay of FAP management. The purpose of the present paper is to bring up many controversial aspects regarding surgical treatment for FAP, and to discuss the results and perspectives of the operative choices and approaches. Preferably, the decision-making process should not be limited to the conventional confrontation of pros and cons of ileorectal anastomosis or restorative proctocolectomy. A wide discussion with the patient may evaluate issues such as age, genotype, family history, sphincter function, the presence or risk of desmoid disease, potential complications of each procedure and chances of postoperative surveillance. Therefore, the definition of the best moment and the choice of appropriate procedure constitute an individual decision that must take into consideration patient’s preferences and full information about the complex nature of the disease. All these facts reinforce the idea that FAP patients should be managed by experienced surgeons working in specialized centers to achieve the best immediate and long-term results.展开更多
AIM: To evaluate the role of intravitreal ranubizumab (IVR) in the treatment of familial exudative vitreoretinopathy (FEVR) of stage 2 or greater either as primary or an ajunct to conventional treatments. METH...AIM: To evaluate the role of intravitreal ranubizumab (IVR) in the treatment of familial exudative vitreoretinopathy (FEVR) of stage 2 or greater either as primary or an ajunct to conventional treatments. METHODS: Retrospective, non-controlled clinical study. Thirty patients (37 eyes) diagnosed with FEVR were enrolled. Twenty patients (66.67%) were male and 10 patients (33.33%) were female. Age ranged from 0.4 to 35 years old (median 3y). IVR was used either as primary or as a combined therapy according to the retinal neovasuclar activities. The follow up ranged from 1 to 57mo with mean 16.73±15.73 (median 11)mo. The treatment effect of retinal neovasuclar activites were recorded as well as the ocular and systemic side effects. RESULTS: Among 30 patients (37 eyes), 10 eyes received single IVR, 1 eye received 2 injections. Three eyes were treated with IVR and simutanous laser photocoagulation. Laser indirect ophthalmoscopy (LIO) was applied in 5 eyes 1mo after the primary IVR. Seven eyes were treated surgically following the primary IVR due to persistent retinal neovasuclar activities and retinal traction. IVR was used as combined treatment with vitrectomy in 11 eyes. Retinal neovascular regression was notified 1mo following the primary IVR in all eyes. Neither systemic nor ocular complications were recorded. CONCLUSION: IVR may be an effective modality in the treatment of FEVR either as primary or as an ajunct to the conventional therapies. The long term effect and safty of IVR still need further research.展开更多
Cytokines play pleiotropic roles in human health and disease by regulating both innate and adaptive immune responses.Interleukins(ILs),a large group of cytokines,can be divided into seven families,including IL-1,IL-2,...Cytokines play pleiotropic roles in human health and disease by regulating both innate and adaptive immune responses.Interleukins(ILs),a large group of cytokines,can be divided into seven families,including IL-1,IL-2,IL-6,IL-8,IL-10,IL-12,and IL-17 families.Here,we review the functions of ILs in the pathogenesis and resolution of liver diseases,such as liver inflammation(e.g.,IL-35),alcoholrelated liver disease(e.g.,IL-11),non-alcoholic steatohepatitis(e.g.,IL-22),liver fibrosis(e.g.,Il-17a),and liver cancer(e.g.,IL-8).Overall,IL-1 family members are implicated in liver inflammation induced by different etiologies,such as alcohol consumption,high-fat diet,and hepatitis viruses.IL-2 family members mainly regulate T lymphocyte and NK cell proliferation and activation,and the differentiation of T cells.IL-6 family cytokines play important roles in acute phase response in liver infection,liver regeneration,and metabolic regulation,as well as lymphocyte activation.IL-8,also known as CXCL8,is activated in chronic liver diseases,which is associated with the accumulation of neutrophils and macrophages.IL-10 family members contribute key roles to liver immune tolerance and immunosuppression in liver disease.IL-12 family cytokines influence T-cell differentiation and play an essential role in autoimmune liver disease.IL-17 subfamilies contribute to infection defense,liver inflammation,and Th17 cell differentiation.ILs interact with different type I and type II cytokine receptors to regulate intracellular signaling pathways that mediate their functions.However,most clinical studies are only performed to evaluate IL-mediated therapies on alcohol and hepatitis virus infection-induced hepatitis.More pre-clinical and clinical studies are required to evaluate IL-mediated monotherapy and synergistic therapies.展开更多
The purpose of this study is to investigate the impact of family training based on matrix model in reducing the amount of drug consumption by heroin and crack addicts. The subjects were referral to Karaj Clinic, Karaj...The purpose of this study is to investigate the impact of family training based on matrix model in reducing the amount of drug consumption by heroin and crack addicts. The subjects were referral to Karaj Clinic, Karaj City, Iran, for crack abuse in 2013. In order to select participants convenience sampling was been used and totally 45 patients were selected (15 heroin addict, 15 crack addict, and 15 with combination of heroin and crack addiction) and put into two groups of experimental and control groups randomly. For collecting the data, Addiction Severity Index questionnaire was used. Descriptive and inferential statistics were used through one-way analysis of covariance for data analyzing. The results indicated that there was statistical difference between the experimental and control group with consumption of heroin and crack in family status, mental and substance use and also it has been shown that the experimental group with heroine consumption achieved better performance compared with the control group in the amount of consumption.展开更多
Children with attention deficit and hyper activity disorder have various problems such as low academic performance, social and communication problems, anxiety, depression, aggression, conduct disorder and delinquency,...Children with attention deficit and hyper activity disorder have various problems such as low academic performance, social and communication problems, anxiety, depression, aggression, conduct disorder and delinquency, and also when they become adults, they have problems in social relationships that these problems can increase or decrease in dealing with family. Hence, this study was performed in order to examine the impact of family-based behavioral treatment compared with Barkley behavior therapy in reducing symptoms of children with attention deficit disorder—ADHD. To meet the aim, 20 of children with age range of 7 to 12 years old with attention deficit disorder—hyperactivity were selected in both experimental and control groups, and exposed to the treatment of behavioral family therapy groups and changes in behavior Barkley. Before and after the treatment, they were evaluated according to the scale of the Conner’s Parent Rating Scale-Revised Short Form (CPRS-R: S). Results of multivariate analysis of covariance indicated that there were significant differences between the experimental group who had received family-based behavioral treatments based on changes in behavior Barkley and a control group who had received drug treatment in variables, including conduct problems, learning problems, psychosomatic symptoms, and signs of impulsive hyperactivity, anxiety and hyperactivity (p < 0.01). These results could be guidance for counsel or sand therapists for children with attention deficit disorder—ADHD.展开更多
Objective: It is unclear if and to what extent family history of breast/ovarian cancer or BRCA1/2-mutation carriership influences breast cancer treatment strategy. We investigated whether treatment differed between pa...Objective: It is unclear if and to what extent family history of breast/ovarian cancer or BRCA1/2-mutation carriership influences breast cancer treatment strategy. We investigated whether treatment differed between patients from BRCA1/2 families and those unselected for family history. Methods: We included 478 BRCA1/2-related patients referred for genetic testing before or after diagnosis. Two references were used: 13,498 population-based and 6896 hospital-based patients. Surgical treatment and adjuvant chemotherapy use was analyzed using logistic regression models, stratified by tumor size, nodal status, age at and period of diagnosis, and estrogen receptor status (ER). Results: BRCA1/2 cases aged 35 - 52 years at diagnosis and/or with tumors < 2 cm were more likely to have undergone a modified radical mastectomy (Odd Ratios (OR) ranging from 2.8 to 5.1) compared to the references. This effect was most pronounced in patients treated after 1995 (OR 5.7 to 10.3). Compared to the reference groups, chemotherapy was more often administered to BRCA1 and ER-negative BRCA1/2-cases irrespective of age and nodal status (OR 1.9 to 24.3). Conclusion: After 1995 treatment of BRCA1/2-associated patients consisted notably of more mastectomies and adjuvant chemotherapy than their population-based counterparts with the same tumor characteristics. There is a need to be aware of such differences in daily practice and interpretation of survival studies on BRCA1/2 mutation carriers.展开更多
This paper entitled, Theological Moral Appraisal of the Challenges of Infertility Treatments on Christian Families in Africa seeks to explore the effects of infertility treatments on Christian families in Africa. It a...This paper entitled, Theological Moral Appraisal of the Challenges of Infertility Treatments on Christian Families in Africa seeks to explore the effects of infertility treatments on Christian families in Africa. It also attempts to give appraisal of the activities of birth science and issues surrounding it and proffer some ways forward for its better use to enhance the dignity of humans and safeguard our families. This is because many Christian families in Africa have deviated from the commands of the creator in an attempt to find solution to the problem of infertility that has engulfed many families, with the assistant of the modem reproductive technology. Many Christian families in Africa have broken down, the sacramental nature and the dignity of Christian marriage and family have been relegated to the background; and many legal, moral and social problems from these techniques abound. In this situation, some people are calling on the Church to condemn outfight the use of the modem reproductive technology. But this will not solve the problem of infertility which is staring us calling for solution. Some scholars have pointed out that the advent of reproductive technology has come to stay, and that it has already given smiles to many faces and families. This paper employs descriptive, analytical and social methods. The paper argues that Science should not be devoid of Religion. There must be a link between Science and Religion as the creator intended. This will enable the activities in birth science to be in line with the mind of the creator. When this is done as it should, our families and society are spared and the dignity human person respected. Science and Religion are not at war, instead they are meant to serve humans. They are complementary and should always be in partnership to serve humanity.展开更多
BACKGROUND Gastrointestinal stromal tumors(GISTs)are the most common mesenchymal tumors of the gastrointestinal(GI)tract,and cases of GISTs tend to be of the disseminated type,with a global incidence of 10 to 15 cases...BACKGROUND Gastrointestinal stromal tumors(GISTs)are the most common mesenchymal tumors of the gastrointestinal(GI)tract,and cases of GISTs tend to be of the disseminated type,with a global incidence of 10 to 15 cases/million each year.The rarer familial GISTs,which often represent a population,differ in screening,diagnosis,and treatment.Familial GISTs include primary familial GISTs with predominantly KIT/PDGFRA mutations and wild-type GISTs.However,whether the same genetic family has different phenotypes has not been reported.CASE SUMMARY We report two cases of rare GISTs in the same family:A male patient with the V561D mutation in exon 12 of the PDGFRA gene,who has been taking the targeted drug imatinib since undergoing surgery,and a female patient diagnosed with wild-type GIST,who has been taking imatinib for 3 years since undergoing surgery.The favorable prognosis of these patients during the 7-year follow-up period validates the accuracy of our treatment strategy,and we have refined the entire process of diagnosis and treatment of familial GISTs in order to better manage this rare familial disease.CONCLUSION Different mutation types of familial GISTs in the same family are very rare,thus it is very important to make the correct diagnosis and treatment strategies according to the results of molecular detection for the management of familial GISTs.展开更多
Background: Cervical cancer is a significant health concern in Bangladesh, with high mortality rates due to limited awareness and costly treatments. The disease stages influence treatment protocols, ranging from surge...Background: Cervical cancer is a significant health concern in Bangladesh, with high mortality rates due to limited awareness and costly treatments. The disease stages influence treatment protocols, ranging from surgery and radiotherapy for early stages to chemotherapy and radiation for advanced stages, but survival rates decrease as the cancer progresses. Objective: The objective of this study is to determine the economic impact of the disease and recommend cost-efficient strategies for prevention and treatment. Methods: A population-based, cross-sectional study was conducted with a stratified sample of cervical cancer patients from selected healthcare facilities across Bangladesh. Data collection involved structured interviews and validated questionnaires. The study measured the economic impact, treatment costs, and other related expenses. Quantitative data analysis was performed using SPSS v22, MS-Excel, and R Programming, with Multivariate regression analysis and Post Hoc tests, including the chi-square test, applied to selected indicators. Results: All respondents in the study were female, aged 34 - 75, with 72.3% aged 40 - 50. Most were illiterate (38.6%) and housewives (95.0%). Additionally, 98% were married, 85.10% married before age 18, and 46.50% experienced their first menstruation before age 12. Families typically had a monthly income of 10,000 - 30,000 Taka, spending similar amounts on treatment. Significant relationships were found between educational qualifications, occupation, personal hygiene practices, history of oral contraceptive use, and age of marriage (p Conclusion: The article emphasizes the impact of monthly family income on cervical cancer treatment costs, stressing the need for comprehensive support services to address the financial and emotional burdens faced by patients. Improving access to quality care and implementing measures can enhance outcomes for cervical cancer patients in Bangladesh.展开更多
Familial hypercholesterolemia(FH)is characterized by elevated low-density lipoprotein cholesterol levels due to genetic mutations,presenting with xanthomas,corneal arch,and severe cardiovascular diseases.Early identif...Familial hypercholesterolemia(FH)is characterized by elevated low-density lipoprotein cholesterol levels due to genetic mutations,presenting with xanthomas,corneal arch,and severe cardiovascular diseases.Early identification,diagnosis,and treatment are crucial to prevent severe complications like acute myocardial infarction.Statins are the primary treatment,supplemented by Ezetimibe and proprotein convertase subtilisin/kexin type 9 inhibitors,though their effectiveness can be limited in severe cases.Over 90%of FH cases remain undiagnosed,and current treatments are often inadequate,underscoring the need for improved diagnostic and management systems.Future strategies include advancements in gene testing,precision medicine,and novel drugs,along with gene therapy approaches like AAV-mediated gene therapy and clustered regularly interspaced short palindromic repeats.Lifestyle modifications,including health education,dietary control,and regular exercise,are essential for managing FH and preventing related diseases.Research into FH-related gene mutations,especially LDLR,is critical for accurate diagnosis and effective treatment.展开更多
Background: In 2017, the elderly made up 27.3% of Japan’s population, accounting for 57.2% of all ambulance trips. When an elderly person is in a critical life situation, it is difficult to ascertain their decisions ...Background: In 2017, the elderly made up 27.3% of Japan’s population, accounting for 57.2% of all ambulance trips. When an elderly person is in a critical life situation, it is difficult to ascertain their decisions about treatment choices, and for family members who become surrogate decision-makers, this is a grave responsibility. Aim: This study aimed to shed light on the constructs that support decision-making by family members and medical staff in critical situations, and to investigate decision-making by families of the elderly in critical situations. Method: We selected 29 papers published in Japan and elsewhere that focused on families involved in treatment decisions in critical life situations and analyzed them using Rodgers’ concept analysis approach. Results: From 475 codes, we extracted six attributes, four antecedents, and four consequences. The unusual setting of the “critical care unit”, lack of time, and unstable psychological state are all considered by family members making treatment decisions, along with the patient’s prognosis, their relationship with the patient, conjecture about the patient’s wishes, and taking other family member’s views into account. Medical staff supports the family throughout the process, through provision of treatment, preparing family members to face reality, empathizing with the difficulty of decision-making, building relationships with family members, monitoring the decision-making process, and being attentive to family members’ feelings until the end. Conclusion: Our results indicate the importance of advance confirmation of patients’ wishes, and the role played by cultural context and family relations in decision-making by family members of the elderly.展开更多
In this paper</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> we present a thorough review of one of the most</span><span style...In this paper</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> we present a thorough review of one of the most</span><span style="font-family:Verdana;"> life-threatening autoimmune diseases, Systemic lupus erythematosus (lupus). Symptoms, risk factors, including genetic and epidemiological factors are discussed. Treatment, life expectancies, and Health Related Quality of Life of patients with SLE will be discussed as well. Special attention will be given to Lupus Nephritis.展开更多
About half of the patients diagnosed with bipolar disorder(BD) become non-adherent during longterm treatment, a rate largely similar to other chronic illnesses and one that has remained unchanged over the years. Non-a...About half of the patients diagnosed with bipolar disorder(BD) become non-adherent during longterm treatment, a rate largely similar to other chronic illnesses and one that has remained unchanged over the years. Non-adherence in BD is a complex phenomenon determined by a multitude of influences. However, thereis considerable uncertainty about the key determinants of non-adherence in BD. Initial research on nonadherence in BD mostly limited itself to examining demographic, clinical and medication-related factors impacting adherence. However, because of inconsistent results and failure of these studies to address the complexities of adherence behaviour, demographic and illness-related factors were alone unable to explain or predict non-adherence in BD. This prompted a shift to a more patient-centred approach of viewing nonadherence. The central element of this approach includes an emphasis on patients' decisions regarding their own treatment based on their personal beliefs, life circumstances and their perceptions of benefits and disadvantages of treatment. Patients' decisionmaking processes are influenced by the nature of their relationship with clinicians and the health-care system and by people in their immediate environment. The primacy of the patient's perspective on non-adherence is in keeping with the current theoretical models and concordance-based approaches to adherence behaviour in BD. Research over the past two decades has further endorsed the critical role of patients' attitudes and beliefs regarding medications, the importance of a collaborative treatment-alliance, the influence of the family, and the significance of other patient-related factors such as knowledge, stigma, patient satisfaction and access to treatment in determining non-adherence in BD. Though simply moving from an illness-centred to a patientcentred approach is unlikely to solve the problem of nonadherence in BD, such an approach is more likely to lead to a better understanding of non-adherence and more likely to yield effective solutions to tackle this common and distressing problem afflicting patients with BD.展开更多
The study examined the patterns of disclosing the HIV diagnosis to infected children and family members, and determined the demographic characteristics associated with disclosure. Semi structured interviews were condu...The study examined the patterns of disclosing the HIV diagnosis to infected children and family members, and determined the demographic characteristics associated with disclosure. Semi structured interviews were conducted with caregivers of HIV infected children aged 4 - 17 years receiving antiretroviral treatment (ART). A total of 149 caregivers were recruited from a paediatric HIV clinic of a district hospital in South Africa. Caregivers reported that 59 (39.6%) children were told their HIV diagnosis, and majority 36 (61%) were informed of the diagnosis by people other than their biological mothers. Older child age was a determining factor for HIV disclosure to children, 22 (37.2%) learned of their HIV diagnosis between 11 and 16 years. The mean age of disclosed children was 10.6 years. Caregivers took about 3 years after the initial HIV diagnosis to disclose to children, while 143 (99.3%) caregivers reported that disclosure to family members happened immediately after the child's HIV diagnosis. About 28 (31.5%) non-disclosed caregivers planned to disclose to the child between 12 and 18 years, while 13 (14.6%) were not sure about the ideal age to disclose to the child. The lack of consensus regarding the appropriate age for disclosure and the delayed age for future disclosure, suggest that despite increased access to ART for children, there are still significant barriers to disclosing HIV to infected children in this setting. There is a need for health care providers to support caregivers to disclose shortly after diagnosis especially in view of the older age of diagnosis among children enrolled in ART program in this setting.展开更多
Objective:Cancer has one of the highest disease mortality rates.Families are very important in the treatment of people with cancer.By using a phenomenological design,this study aimed to explore the experience of famil...Objective:Cancer has one of the highest disease mortality rates.Families are very important in the treatment of people with cancer.By using a phenomenological design,this study aimed to explore the experience of families in caring for a person with cancer and to identify the needs of these families.Methods:First,eight interviews were under taken with family members selected through a purposive sampling method.Then,another three interviews were conducted for data validation.The collected data were analyzed using the framework method of analysis.Results:The core theme,“Prioritizing the efforts:Being aware of the best we could do for our family,”reflected family’s experiences of caring for a person with cancer and was underpinned by five themes:“Decisions to make,”“Keeping up the good support,”“Acknowledging the others’contributions,”“Assisting my family to alleviate the disease,”and“Adapting to the current situation.”Conclusions:The results suggest that building mutual trust and communication between family and healthcare professionals is vital in decision-making for people with cancer.Family may also work with the person in fulfilling their needs,without disregarding the needs of the family.When suppor ting the needs of people with diabetes,the family requires appropriate information,and thus,healthcare professionals wisely select which information can help the family make a decision regarding the treatment.After administering the treatment and providing information for people with cancer and their family,asking for feedback is required for evaluation.展开更多
Introduction: The effectiveness of treatment depends on the efficacy of the therapy and the level of compliance of the patient. NF (non-specific factors) involved in treatment are all those effects that do not depe...Introduction: The effectiveness of treatment depends on the efficacy of the therapy and the level of compliance of the patient. NF (non-specific factors) involved in treatment are all those effects that do not depend on the pharmacological properties of the drug. Materials and Methods: The job lasted a year. The sample consisted of patients with mental health disorders and was divided into two groups. Treatment compliance was measured with the Morisky-Green Test. Results were compared using the chi square test and relative risk. Results and Discussion: Group A had 23 patients ending 91.3% of them and group B of 22 patients, ending the 77.27%. At the beginning of the study, we found in the group A 0.86 NF/patients while in the group B 0.82 NF/patient. At the end of the study there was a 54.65% decrease in group A while in group B the proportion remained. At the beginning of the study both groups had approximately 40% of compliant patients. Data that remained in the control group rose to 80.95% in group A at the end of the study. Conclusions: The work demonstrates the negative influence of these factors on adherence to treatment.展开更多
Background: Obesity is a high-cost social disease, the management of which, usually assigned to general practice, is less supported by evidence-based medicine. Most general practitioners feel unprepared to face the pr...Background: Obesity is a high-cost social disease, the management of which, usually assigned to general practice, is less supported by evidence-based medicine. Most general practitioners feel unprepared to face the problem. Objectives: In 2000, at the Pediatric Department of Ferrara, we started a Family Group Therapeutic Education Program for the treatment of childhood obesity. More than 300 families have attended the program. Following our positive results, we created a professional training course on therapeutic education, addressed to healthcare personnel involved in the treatment of childhood obesity. The purpose of the present study is to discover if it is possible to promote the development of a shared therapeutic education strategy for obesity, involving primary care physiccians/pediatricians, specialists and dietitians. Methods: The integrated professional training course consists of a four-day seminar along with an on-line course for distance learning. The assessment of the project takes into account the following criteria: a multidimensional questionnaire (a pre- and post-test which explores: knowledge, motivation, self-efficacy, methodology, communication, modeling, etc.), an appreciation questionnaire with responses collected over the course of 2 years. Moreover, the nine participants of our 2008 training course began to use the new therapeutic tools in their practice and six of them sent us the anthropometric measurements of patients whom they have treated over the past two years using this approach allows us to present outcomes in terms of implementation of this therapeutic education program in everyday professional practice. Results and Conclusions: The course was attended by 15 healthcare professionals: ten in 2008 and five in 2009, from different Italian centers. Results seem to indicate a great interest and appreciation by the participants. Results based on BMI z-score reduction of the children cared for by our trainees seem to support the efficacy of our educational method in clinical practice. If these preliminary results are confirmed, new training projects for the management of childhood obesity can be planned and addressed to a wider healthcare professional public.展开更多
文摘Familial adenomatous polyposis (FAP) is an autosomal dominant inherited syndrome characterized by multiple adenomatous polyps (predisposing to colorectal cancer development) and numerous extracolonic manifestations. The underlying genetic burden generates variable clinical features that may influence operative management. As a precancerous hereditary condition, the rationale of performing a prophylactic surgery is a mainstay of FAP management. The purpose of the present paper is to bring up many controversial aspects regarding surgical treatment for FAP, and to discuss the results and perspectives of the operative choices and approaches. Preferably, the decision-making process should not be limited to the conventional confrontation of pros and cons of ileorectal anastomosis or restorative proctocolectomy. A wide discussion with the patient may evaluate issues such as age, genotype, family history, sphincter function, the presence or risk of desmoid disease, potential complications of each procedure and chances of postoperative surveillance. Therefore, the definition of the best moment and the choice of appropriate procedure constitute an individual decision that must take into consideration patient’s preferences and full information about the complex nature of the disease. All these facts reinforce the idea that FAP patients should be managed by experienced surgeons working in specialized centers to achieve the best immediate and long-term results.
文摘AIM: To evaluate the role of intravitreal ranubizumab (IVR) in the treatment of familial exudative vitreoretinopathy (FEVR) of stage 2 or greater either as primary or an ajunct to conventional treatments. METHODS: Retrospective, non-controlled clinical study. Thirty patients (37 eyes) diagnosed with FEVR were enrolled. Twenty patients (66.67%) were male and 10 patients (33.33%) were female. Age ranged from 0.4 to 35 years old (median 3y). IVR was used either as primary or as a combined therapy according to the retinal neovasuclar activities. The follow up ranged from 1 to 57mo with mean 16.73±15.73 (median 11)mo. The treatment effect of retinal neovasuclar activites were recorded as well as the ocular and systemic side effects. RESULTS: Among 30 patients (37 eyes), 10 eyes received single IVR, 1 eye received 2 injections. Three eyes were treated with IVR and simutanous laser photocoagulation. Laser indirect ophthalmoscopy (LIO) was applied in 5 eyes 1mo after the primary IVR. Seven eyes were treated surgically following the primary IVR due to persistent retinal neovasuclar activities and retinal traction. IVR was used as combined treatment with vitrectomy in 11 eyes. Retinal neovascular regression was notified 1mo following the primary IVR in all eyes. Neither systemic nor ocular complications were recorded. CONCLUSION: IVR may be an effective modality in the treatment of FEVR either as primary or as an ajunct to the conventional therapies. The long term effect and safty of IVR still need further research.
文摘Cytokines play pleiotropic roles in human health and disease by regulating both innate and adaptive immune responses.Interleukins(ILs),a large group of cytokines,can be divided into seven families,including IL-1,IL-2,IL-6,IL-8,IL-10,IL-12,and IL-17 families.Here,we review the functions of ILs in the pathogenesis and resolution of liver diseases,such as liver inflammation(e.g.,IL-35),alcoholrelated liver disease(e.g.,IL-11),non-alcoholic steatohepatitis(e.g.,IL-22),liver fibrosis(e.g.,Il-17a),and liver cancer(e.g.,IL-8).Overall,IL-1 family members are implicated in liver inflammation induced by different etiologies,such as alcohol consumption,high-fat diet,and hepatitis viruses.IL-2 family members mainly regulate T lymphocyte and NK cell proliferation and activation,and the differentiation of T cells.IL-6 family cytokines play important roles in acute phase response in liver infection,liver regeneration,and metabolic regulation,as well as lymphocyte activation.IL-8,also known as CXCL8,is activated in chronic liver diseases,which is associated with the accumulation of neutrophils and macrophages.IL-10 family members contribute key roles to liver immune tolerance and immunosuppression in liver disease.IL-12 family cytokines influence T-cell differentiation and play an essential role in autoimmune liver disease.IL-17 subfamilies contribute to infection defense,liver inflammation,and Th17 cell differentiation.ILs interact with different type I and type II cytokine receptors to regulate intracellular signaling pathways that mediate their functions.However,most clinical studies are only performed to evaluate IL-mediated therapies on alcohol and hepatitis virus infection-induced hepatitis.More pre-clinical and clinical studies are required to evaluate IL-mediated monotherapy and synergistic therapies.
文摘The purpose of this study is to investigate the impact of family training based on matrix model in reducing the amount of drug consumption by heroin and crack addicts. The subjects were referral to Karaj Clinic, Karaj City, Iran, for crack abuse in 2013. In order to select participants convenience sampling was been used and totally 45 patients were selected (15 heroin addict, 15 crack addict, and 15 with combination of heroin and crack addiction) and put into two groups of experimental and control groups randomly. For collecting the data, Addiction Severity Index questionnaire was used. Descriptive and inferential statistics were used through one-way analysis of covariance for data analyzing. The results indicated that there was statistical difference between the experimental and control group with consumption of heroin and crack in family status, mental and substance use and also it has been shown that the experimental group with heroine consumption achieved better performance compared with the control group in the amount of consumption.
文摘Children with attention deficit and hyper activity disorder have various problems such as low academic performance, social and communication problems, anxiety, depression, aggression, conduct disorder and delinquency, and also when they become adults, they have problems in social relationships that these problems can increase or decrease in dealing with family. Hence, this study was performed in order to examine the impact of family-based behavioral treatment compared with Barkley behavior therapy in reducing symptoms of children with attention deficit disorder—ADHD. To meet the aim, 20 of children with age range of 7 to 12 years old with attention deficit disorder—hyperactivity were selected in both experimental and control groups, and exposed to the treatment of behavioral family therapy groups and changes in behavior Barkley. Before and after the treatment, they were evaluated according to the scale of the Conner’s Parent Rating Scale-Revised Short Form (CPRS-R: S). Results of multivariate analysis of covariance indicated that there were significant differences between the experimental group who had received family-based behavioral treatments based on changes in behavior Barkley and a control group who had received drug treatment in variables, including conduct problems, learning problems, psychosomatic symptoms, and signs of impulsive hyperactivity, anxiety and hyperactivity (p < 0.01). These results could be guidance for counsel or sand therapists for children with attention deficit disorder—ADHD.
文摘Objective: It is unclear if and to what extent family history of breast/ovarian cancer or BRCA1/2-mutation carriership influences breast cancer treatment strategy. We investigated whether treatment differed between patients from BRCA1/2 families and those unselected for family history. Methods: We included 478 BRCA1/2-related patients referred for genetic testing before or after diagnosis. Two references were used: 13,498 population-based and 6896 hospital-based patients. Surgical treatment and adjuvant chemotherapy use was analyzed using logistic regression models, stratified by tumor size, nodal status, age at and period of diagnosis, and estrogen receptor status (ER). Results: BRCA1/2 cases aged 35 - 52 years at diagnosis and/or with tumors < 2 cm were more likely to have undergone a modified radical mastectomy (Odd Ratios (OR) ranging from 2.8 to 5.1) compared to the references. This effect was most pronounced in patients treated after 1995 (OR 5.7 to 10.3). Compared to the reference groups, chemotherapy was more often administered to BRCA1 and ER-negative BRCA1/2-cases irrespective of age and nodal status (OR 1.9 to 24.3). Conclusion: After 1995 treatment of BRCA1/2-associated patients consisted notably of more mastectomies and adjuvant chemotherapy than their population-based counterparts with the same tumor characteristics. There is a need to be aware of such differences in daily practice and interpretation of survival studies on BRCA1/2 mutation carriers.
文摘This paper entitled, Theological Moral Appraisal of the Challenges of Infertility Treatments on Christian Families in Africa seeks to explore the effects of infertility treatments on Christian families in Africa. It also attempts to give appraisal of the activities of birth science and issues surrounding it and proffer some ways forward for its better use to enhance the dignity of humans and safeguard our families. This is because many Christian families in Africa have deviated from the commands of the creator in an attempt to find solution to the problem of infertility that has engulfed many families, with the assistant of the modem reproductive technology. Many Christian families in Africa have broken down, the sacramental nature and the dignity of Christian marriage and family have been relegated to the background; and many legal, moral and social problems from these techniques abound. In this situation, some people are calling on the Church to condemn outfight the use of the modem reproductive technology. But this will not solve the problem of infertility which is staring us calling for solution. Some scholars have pointed out that the advent of reproductive technology has come to stay, and that it has already given smiles to many faces and families. This paper employs descriptive, analytical and social methods. The paper argues that Science should not be devoid of Religion. There must be a link between Science and Religion as the creator intended. This will enable the activities in birth science to be in line with the mind of the creator. When this is done as it should, our families and society are spared and the dignity human person respected. Science and Religion are not at war, instead they are meant to serve humans. They are complementary and should always be in partnership to serve humanity.
基金National Natural Science Foundation of China,No.82160842Clinical Research Project of Research Fund of Gansu Provincial Hospital,No.23GSSYD-17General Program of the Joint Scientific Research Fund,No.23JRRA1521.
文摘BACKGROUND Gastrointestinal stromal tumors(GISTs)are the most common mesenchymal tumors of the gastrointestinal(GI)tract,and cases of GISTs tend to be of the disseminated type,with a global incidence of 10 to 15 cases/million each year.The rarer familial GISTs,which often represent a population,differ in screening,diagnosis,and treatment.Familial GISTs include primary familial GISTs with predominantly KIT/PDGFRA mutations and wild-type GISTs.However,whether the same genetic family has different phenotypes has not been reported.CASE SUMMARY We report two cases of rare GISTs in the same family:A male patient with the V561D mutation in exon 12 of the PDGFRA gene,who has been taking the targeted drug imatinib since undergoing surgery,and a female patient diagnosed with wild-type GIST,who has been taking imatinib for 3 years since undergoing surgery.The favorable prognosis of these patients during the 7-year follow-up period validates the accuracy of our treatment strategy,and we have refined the entire process of diagnosis and treatment of familial GISTs in order to better manage this rare familial disease.CONCLUSION Different mutation types of familial GISTs in the same family are very rare,thus it is very important to make the correct diagnosis and treatment strategies according to the results of molecular detection for the management of familial GISTs.
文摘Background: Cervical cancer is a significant health concern in Bangladesh, with high mortality rates due to limited awareness and costly treatments. The disease stages influence treatment protocols, ranging from surgery and radiotherapy for early stages to chemotherapy and radiation for advanced stages, but survival rates decrease as the cancer progresses. Objective: The objective of this study is to determine the economic impact of the disease and recommend cost-efficient strategies for prevention and treatment. Methods: A population-based, cross-sectional study was conducted with a stratified sample of cervical cancer patients from selected healthcare facilities across Bangladesh. Data collection involved structured interviews and validated questionnaires. The study measured the economic impact, treatment costs, and other related expenses. Quantitative data analysis was performed using SPSS v22, MS-Excel, and R Programming, with Multivariate regression analysis and Post Hoc tests, including the chi-square test, applied to selected indicators. Results: All respondents in the study were female, aged 34 - 75, with 72.3% aged 40 - 50. Most were illiterate (38.6%) and housewives (95.0%). Additionally, 98% were married, 85.10% married before age 18, and 46.50% experienced their first menstruation before age 12. Families typically had a monthly income of 10,000 - 30,000 Taka, spending similar amounts on treatment. Significant relationships were found between educational qualifications, occupation, personal hygiene practices, history of oral contraceptive use, and age of marriage (p Conclusion: The article emphasizes the impact of monthly family income on cervical cancer treatment costs, stressing the need for comprehensive support services to address the financial and emotional burdens faced by patients. Improving access to quality care and implementing measures can enhance outcomes for cervical cancer patients in Bangladesh.
基金Supported by National Key Research and Development Program of China,No.2022YFE0209900.
文摘Familial hypercholesterolemia(FH)is characterized by elevated low-density lipoprotein cholesterol levels due to genetic mutations,presenting with xanthomas,corneal arch,and severe cardiovascular diseases.Early identification,diagnosis,and treatment are crucial to prevent severe complications like acute myocardial infarction.Statins are the primary treatment,supplemented by Ezetimibe and proprotein convertase subtilisin/kexin type 9 inhibitors,though their effectiveness can be limited in severe cases.Over 90%of FH cases remain undiagnosed,and current treatments are often inadequate,underscoring the need for improved diagnostic and management systems.Future strategies include advancements in gene testing,precision medicine,and novel drugs,along with gene therapy approaches like AAV-mediated gene therapy and clustered regularly interspaced short palindromic repeats.Lifestyle modifications,including health education,dietary control,and regular exercise,are essential for managing FH and preventing related diseases.Research into FH-related gene mutations,especially LDLR,is critical for accurate diagnosis and effective treatment.
文摘Background: In 2017, the elderly made up 27.3% of Japan’s population, accounting for 57.2% of all ambulance trips. When an elderly person is in a critical life situation, it is difficult to ascertain their decisions about treatment choices, and for family members who become surrogate decision-makers, this is a grave responsibility. Aim: This study aimed to shed light on the constructs that support decision-making by family members and medical staff in critical situations, and to investigate decision-making by families of the elderly in critical situations. Method: We selected 29 papers published in Japan and elsewhere that focused on families involved in treatment decisions in critical life situations and analyzed them using Rodgers’ concept analysis approach. Results: From 475 codes, we extracted six attributes, four antecedents, and four consequences. The unusual setting of the “critical care unit”, lack of time, and unstable psychological state are all considered by family members making treatment decisions, along with the patient’s prognosis, their relationship with the patient, conjecture about the patient’s wishes, and taking other family member’s views into account. Medical staff supports the family throughout the process, through provision of treatment, preparing family members to face reality, empathizing with the difficulty of decision-making, building relationships with family members, monitoring the decision-making process, and being attentive to family members’ feelings until the end. Conclusion: Our results indicate the importance of advance confirmation of patients’ wishes, and the role played by cultural context and family relations in decision-making by family members of the elderly.
文摘In this paper</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> we present a thorough review of one of the most</span><span style="font-family:Verdana;"> life-threatening autoimmune diseases, Systemic lupus erythematosus (lupus). Symptoms, risk factors, including genetic and epidemiological factors are discussed. Treatment, life expectancies, and Health Related Quality of Life of patients with SLE will be discussed as well. Special attention will be given to Lupus Nephritis.
文摘About half of the patients diagnosed with bipolar disorder(BD) become non-adherent during longterm treatment, a rate largely similar to other chronic illnesses and one that has remained unchanged over the years. Non-adherence in BD is a complex phenomenon determined by a multitude of influences. However, thereis considerable uncertainty about the key determinants of non-adherence in BD. Initial research on nonadherence in BD mostly limited itself to examining demographic, clinical and medication-related factors impacting adherence. However, because of inconsistent results and failure of these studies to address the complexities of adherence behaviour, demographic and illness-related factors were alone unable to explain or predict non-adherence in BD. This prompted a shift to a more patient-centred approach of viewing nonadherence. The central element of this approach includes an emphasis on patients' decisions regarding their own treatment based on their personal beliefs, life circumstances and their perceptions of benefits and disadvantages of treatment. Patients' decisionmaking processes are influenced by the nature of their relationship with clinicians and the health-care system and by people in their immediate environment. The primacy of the patient's perspective on non-adherence is in keeping with the current theoretical models and concordance-based approaches to adherence behaviour in BD. Research over the past two decades has further endorsed the critical role of patients' attitudes and beliefs regarding medications, the importance of a collaborative treatment-alliance, the influence of the family, and the significance of other patient-related factors such as knowledge, stigma, patient satisfaction and access to treatment in determining non-adherence in BD. Though simply moving from an illness-centred to a patientcentred approach is unlikely to solve the problem of nonadherence in BD, such an approach is more likely to lead to a better understanding of non-adherence and more likely to yield effective solutions to tackle this common and distressing problem afflicting patients with BD.
文摘The study examined the patterns of disclosing the HIV diagnosis to infected children and family members, and determined the demographic characteristics associated with disclosure. Semi structured interviews were conducted with caregivers of HIV infected children aged 4 - 17 years receiving antiretroviral treatment (ART). A total of 149 caregivers were recruited from a paediatric HIV clinic of a district hospital in South Africa. Caregivers reported that 59 (39.6%) children were told their HIV diagnosis, and majority 36 (61%) were informed of the diagnosis by people other than their biological mothers. Older child age was a determining factor for HIV disclosure to children, 22 (37.2%) learned of their HIV diagnosis between 11 and 16 years. The mean age of disclosed children was 10.6 years. Caregivers took about 3 years after the initial HIV diagnosis to disclose to children, while 143 (99.3%) caregivers reported that disclosure to family members happened immediately after the child's HIV diagnosis. About 28 (31.5%) non-disclosed caregivers planned to disclose to the child between 12 and 18 years, while 13 (14.6%) were not sure about the ideal age to disclose to the child. The lack of consensus regarding the appropriate age for disclosure and the delayed age for future disclosure, suggest that despite increased access to ART for children, there are still significant barriers to disclosing HIV to infected children in this setting. There is a need for health care providers to support caregivers to disclose shortly after diagnosis especially in view of the older age of diagnosis among children enrolled in ART program in this setting.
基金supported by Universitas Tanjungpura(No.3387/UN22.9/PG/2021)。
文摘Objective:Cancer has one of the highest disease mortality rates.Families are very important in the treatment of people with cancer.By using a phenomenological design,this study aimed to explore the experience of families in caring for a person with cancer and to identify the needs of these families.Methods:First,eight interviews were under taken with family members selected through a purposive sampling method.Then,another three interviews were conducted for data validation.The collected data were analyzed using the framework method of analysis.Results:The core theme,“Prioritizing the efforts:Being aware of the best we could do for our family,”reflected family’s experiences of caring for a person with cancer and was underpinned by five themes:“Decisions to make,”“Keeping up the good support,”“Acknowledging the others’contributions,”“Assisting my family to alleviate the disease,”and“Adapting to the current situation.”Conclusions:The results suggest that building mutual trust and communication between family and healthcare professionals is vital in decision-making for people with cancer.Family may also work with the person in fulfilling their needs,without disregarding the needs of the family.When suppor ting the needs of people with diabetes,the family requires appropriate information,and thus,healthcare professionals wisely select which information can help the family make a decision regarding the treatment.After administering the treatment and providing information for people with cancer and their family,asking for feedback is required for evaluation.
文摘Introduction: The effectiveness of treatment depends on the efficacy of the therapy and the level of compliance of the patient. NF (non-specific factors) involved in treatment are all those effects that do not depend on the pharmacological properties of the drug. Materials and Methods: The job lasted a year. The sample consisted of patients with mental health disorders and was divided into two groups. Treatment compliance was measured with the Morisky-Green Test. Results were compared using the chi square test and relative risk. Results and Discussion: Group A had 23 patients ending 91.3% of them and group B of 22 patients, ending the 77.27%. At the beginning of the study, we found in the group A 0.86 NF/patients while in the group B 0.82 NF/patient. At the end of the study there was a 54.65% decrease in group A while in group B the proportion remained. At the beginning of the study both groups had approximately 40% of compliant patients. Data that remained in the control group rose to 80.95% in group A at the end of the study. Conclusions: The work demonstrates the negative influence of these factors on adherence to treatment.
文摘Background: Obesity is a high-cost social disease, the management of which, usually assigned to general practice, is less supported by evidence-based medicine. Most general practitioners feel unprepared to face the problem. Objectives: In 2000, at the Pediatric Department of Ferrara, we started a Family Group Therapeutic Education Program for the treatment of childhood obesity. More than 300 families have attended the program. Following our positive results, we created a professional training course on therapeutic education, addressed to healthcare personnel involved in the treatment of childhood obesity. The purpose of the present study is to discover if it is possible to promote the development of a shared therapeutic education strategy for obesity, involving primary care physiccians/pediatricians, specialists and dietitians. Methods: The integrated professional training course consists of a four-day seminar along with an on-line course for distance learning. The assessment of the project takes into account the following criteria: a multidimensional questionnaire (a pre- and post-test which explores: knowledge, motivation, self-efficacy, methodology, communication, modeling, etc.), an appreciation questionnaire with responses collected over the course of 2 years. Moreover, the nine participants of our 2008 training course began to use the new therapeutic tools in their practice and six of them sent us the anthropometric measurements of patients whom they have treated over the past two years using this approach allows us to present outcomes in terms of implementation of this therapeutic education program in everyday professional practice. Results and Conclusions: The course was attended by 15 healthcare professionals: ten in 2008 and five in 2009, from different Italian centers. Results seem to indicate a great interest and appreciation by the participants. Results based on BMI z-score reduction of the children cared for by our trainees seem to support the efficacy of our educational method in clinical practice. If these preliminary results are confirmed, new training projects for the management of childhood obesity can be planned and addressed to a wider healthcare professional public.