Andrology

The 14th international prostate forum Mevlana Derya Balbay, Abdullah Erdem Canda Asian Journal of Andrology 2019 21(1):1-2

PSA screening - for whom and when? Peter Albers Asian Journal of Andrology 2019 21(1):3-5

Current and emerging trends in prostate cancer immunotherapy Adam Schatz, Badar M Mian Asian Journal of Andrology 2019 21(1):6-11

Current concepts and trends in the treatment of bone metastases in patients with advanced prostate cancer Miriam Hegemann, Moritz Maas, Steffen Rausch, Simon Walz, Jens Bedke, Arnulf Stenzl, Tilman Todenhöfer Asian Journal of Andrology 2019 21(1):12-18 Bone metastases have a major impact on quality of life and survival of patients with advanced prostate cancer. In the last decade, the development and approval of substances inhibiting the vicious cycle of bone metastases have enabled the reduction of complications caused by bone metastases in patients with castration-resistant prostate cancer. These drugs have raised awareness of the importance of skeletal-related events which in the meantime represent an important end point also in trials using agents not specifically designed for bone lesions. Second-generation antihormonal drugs such as enzalutamide or abiraterone have been shown to have a positive impact on the incidence of skeletal complications and therefore provide an important tool in the armamentarium used for treating bone metastases. Radiopharmaceuticals such as radium-223 dichloride ([223Ra]) have been demonstrated not only to reduce skeletal-related events and bone-related pain, but also to prolong overall survival, thereby being the first bone-targeting agent showing a survival benefit. As previous studies have not provided an obvious benefit of bone-targeted lesions in castration-sensitive disease, the use of these agents is not recommended. In oligometastatic prostate cancer, the role of local treatment of metastases using stereotactic radiation or radiosurgery is a matter of intense debates and may play an increasing role in the future.

Contemporary grading of prostate cancer: 2017 update for pathologists and clinicians Silvia Gasparrini, Alessia Cimadamore, Marina Scarpelli, Francesco Massari, Andrea Doria, Roberta Mazzucchelli, Liang Cheng, Antonio Lopez-Beltran, Rodolfo Montironi Asian Journal of Andrology 2019 21(1):19-23 The Gleason grading system for prostate cancer (PCa) was developed in the 1960s by DF Gleason. Due to changes in PCa detection and treatment, the application of the Gleason grading system has changed considerably in pathology routine practice. Two consensus conferences were held in 2005 and in 2014 to update PCa Gleason grading. This review provides a summary of the changes in the grading of PCa from the original Gleason grading system to the prognostic grade grouping, as well as a discussion of the clinical significance of the percentage of Gleason patterns 4 and 5.

Circulating tumor cells and their role in prostate cancer Moritz Maas, Miriam Hegemann, Steffen Rausch, Jens Bedke, Arnulf Stenzl, Tilman Todenhöfer Asian Journal of Andrology 2019 21(1):24-31 Circulating tumor cells (CTC) have become an important biomarker in patients with advanced prostate cancer. CTC count has been demonstrated to be a prognostic factor for overall survival in patients with metastatic castration-resistant prostate cancer (mCRPC). In localized prostate cancer, a clear correlation between CTC counts and clinicopathological risk parameters and outcome has not been observed. Currently, the focus of research is shifting from CTC enumeration towards molecular characterization of CTC leading to the discovery of markers predicting treatment response. The role of androgen receptor splice variants expressed by CTC as markers of resistance to abiraterone and enzalutamide has been assessed by various studies. The identification of CTC markers predicting treatment response represents a key step to guide the selection of treatment (e.g., abiraterone/enzalutamide vs taxanes), particularly in patients with mCRPC. As an alternative to CTC, the analysis of circulating tumor DNA has been shown to enable a noninvasive disease characterization having high potential to promote precision oncology.

Radical prostatectomy in patients aged 75 years or older: review of the literature Philipp Mandel, Thenappan Chandrasekar, Felix K Chun, Hartwig Huland, Derya Tilki Asian Journal of Andrology 2019 21(1):32-36 Given the demographic trends toward a considerably longer life expectancy, the percentage of elderly patients with prostate cancer will increase further in the upcoming decades. Therefore, the question arises, should patients ≥75 years old be offered radical prostatectomy and under which circumstances? For treatment decision-making, life expectancy is more important than biological age. As a result, a patient's health and mental status has to be determined and radical treatment should only be offered to those who are fit. As perioperative morbidity and mortality in these patients is increased relative to younger patients, patient selection according to comorbidities is a key issue that needs to be addressed. It is known from the literature that elderly men show notably worse tumor characteristics, leading to worse oncologic outcomes after treatment. Moreover, elderly patients also demonstrate worse postoperative recovery of continence and erectile function. As the absolute rates of both oncological and functional outcomes are still very reasonable in patients ≥75 years, a radical prostatectomy can be offered to highly selected and healthy elderly patients. Nevertheless, patients clearly need to be informed about the worse outcomes and higher perioperative risks compared to younger patients.

Focal therapy for localized prostate cancer: is there a "middle ground" between active surveillance and definitive treatment? Cihan H Demirel, Muammer Altok, John W Davis Asian Journal of Andrology 2019 21(1):37-44 In recent years, it has come a long way in the diagnosis, treatment, and follow-up of prostate cancer. Beside this, it was argued that definitive treatments could cause overtreatment, particularly in the very low, low, and favorable risk group. When alternative treatment and follow-up methods are being considered for this group of patients, active surveillance is seen as a good alternative for patients with very low and low-risk groups in this era. However, it has become necessary to find other alternatives for patients in the favorable risk group or patients who cannot adopt active follow-up. In the light of technological developments, the concept of focal therapy was introduced with the intensification of research to treat only the lesioned area instead of treating the entire organ for prostate lesions though there are not many publications about many of them yet. According to the initial results, it was understood that the results could be good if the appropriate focal therapy technique was applied to the appropriate patient. Thus, focal therapies have begun to find their “middle ground” place between definitive therapies and active follow-up.

Hypogonadism is independently associated with varicocele repair in a contemporary cohort of men in the USA Cailey Guercio, Dattatraya Patil, Akanksha Mehta Asian Journal of Andrology 2019 21(1):45-49 We aimed to identify demographic and clinical predictors of varicocele repair in a contemporary cohort of men in the USA. We queried the 2009–2015 MarketScan Database using relevant ICD9, ICD10, and CPT codes to identify all 18–45 year olds with varicoceles. Differences in age, area of residence, clinical characteristics, and medical management between men who did and did not undergo varicocelectomy (open, laparoscopic, or microsurgical) during the study period were compared using unpaired t-tests and Chi-squared tests for continuous and categorical variables, respectively. Multivariable logistic regression analysis was used to evaluate age, semen analyses, and serum hormone assessment as predictors of varicocele repair. SAS version 9.4 was used for all statistical analyses. Significance was set at P < 0.05. Approximately 40% of men with varicoceles underwent repair, primarily through an open approach. Men who underwent repair were more likely to have a diagnosis of male infertility (15.5% vs 7.9%, P < 0.001) and male hypogonadism (3.4% vs 0.9%) and were more likely to complete semen analyses (36.1% vs 12.2%, P < 0.001) and serum testosterone evaluation (42.5% vs 18.8%, P < 0.001). In multivariable regression models, the strongest predictors of varicocele repair were semen analysis (OR = 2.78, 95% CI: 2.56–3.02), age 18–25 years (OR = 2.66, 95% CI: 2.36–2.98), and serum testosterone evaluation (OR = 1.67, 95% CI: 1.51–1.86). Although male infertility remains the most important indication for varicocele repair, male hypogonadism is emerging as an independent predictor of varicocelectomy, which may represent a change in the clinical management of varicoceles in the USA.

Sperm fine-needle aspiration (FNA) mapping after failed microdissection testicular sperm extraction (TESE): location and patterns of found sperm Sheba Jarvis, Heather K Yee, Natalia Thomas, Imok Cha, Kedar Che Prasad, Jonathan W A Ramsay, Paul J Turek Asian Journal of Andrology 2019 21(1):50-55 We sought to evaluate the ability of fine-needle aspiration (FNA) mapping to find sperm and to guide sperm retrieval after failed microdissection testicular sperm extraction (micro-TESE) in nonobstructive azoospermic men. In this study of consecutive male infertility cases, interventions included testicular FNA mapping and subsequent sperm retrieval. Outcomes included the frequency and location of found sperm on FNA maps after failed micro-TESE and the salvage sperm retrieval success. Among 548 patients undergoing FNA mapping from 2010 to 2016, 82 men with previous micro-TESE procedures were identified. The mean time between micro-TESE and FNA mapping was 2.2 years. A total of 2825 (1424 on right and 1401 on left) sites were mapped. At least one site revealed mature sperm in 24 (29.3%) of 82 men with prior failed micro-TESE procedures. There was an equal likelihood of detecting sperm in either testis (6.1% right; 5.7% left; P = 0.58). Digital “heat maps” revealed differences in sperm findings within the testis with mature sperm more likely found in the testis periphery rather than centrally. Fifteen (62.5%) patients subsequently underwent sperm retrieval procedures guided by FNA maps. Sufficient sperm were retrieved in all cases, and in 10 (66.7%) of 15 cases, extra sperm were frozen for future use. In a significant proportion of failed micro-TESE procedures representing the largest study to date, sperm were detected by FNA mapping and could be reliably retrieved through FNA map-guided surgical sperm retrieval. When present, sperm were more likely to be found in the testis periphery rather than centrally with FNA mapping.

Health Sciences

Effects of different daytime exercises on the quality of sleep and appetite of obese women Khadijeh Irandoust, Morteza Taheri International Archives of Health Sciences 2018 5(4):111-114 Aims: The aim of this study was to determine the effects of daytime aerobic exercise on the subsequent sleep and appetite of obese women. Materials and Methods: It was a semi-experimental study with pre and post-test design. Fifteen obese women were asked to do aerobic exercises three sessions a week for 2 weeks, with each session lasting 60 min at 60% of maximum heart rate either at 9:00 am or 18:00 pm. A body composition analyzer (InBody-320, South Korea) was used to measure weight, fat percentage, and body mass index (BMI). Nocturnal sleep–wake schedule data and sleep patterns in the two conditions (morning vs. evening) were recorded at 1-min intervals and scored with the Actiwatch Sleep Analysis 8 software. Paired t-test and independent t-test were used to analyze the data. Results: Results (age, 46.9 ± 5.2 years; BMI, 33.6 ± 3.2 kg/m2; and percentage of body fat ≥35%) showed that sleep efficiency, wake bouts, actual sleep, and sleep latency were improved after exercise training (P ≤ 0.05). Furthermore, morning exercise condition resulted in a better improvement in sleep efficiency (73.41% ± 6.94%), wake bouts (15.81% ± 3.30%), and sleep latency (79.47% ± 6.09%) compared to that of evening exercise (P ≤ 0.05). It was also reported that the perceived satiety was not significantly different in the two conditions (P = 0.94 and P = 0.076, respectively, for morning and evening), while the perceived hungry was improved significantly in the morning condition (P = 0.003). Conclusion: As a result, aerobic exercises at the time of the morning can lead to a better quality of sleep and decline in hungry of obese women compared to the evening exercise.

The effectiveness of cognitive therapy on quality of life in patients with type II diabetes Narges Mousavian, Adis Kraskian Mujembari, Alireza Aghayousefi International Archives of Health Sciences 2018 5(4):115-119 Context: Patients with diabetes face various physical and psychological problems such as depression, anxiety, disability, low mobility and obesity leading eventually to decrease quality of life. As a result, life quality is so important about diabetes and its treatment. Aims: The aim of this study was to determine the effectiveness of cognitive therapy on quality of life in patients with diabetes. Subjects and Methods: The research method was semi-experimental with pretest/posttest/follow-up and control group design. The population of the research were included all patients with type II diabetes who were referred to the Diabetes Clinic of Ganjavian Hospital. The sample volume included 40 subjects and an available sampling method was applied. Moreover, the substitution between control group and experimental group was randomly implemented. To collect the data, diabetes quality of life questionnaire was used. The intervention group has been received therapeutic sessions, and the control group was in waiting list. Data were collected through questionnaire of quality of life. Results: The results of the covariance analysis showed that cognitive therapy improved the quality of life in the experimental group in the posttest and follow-up stage (P < 0.05). Cognitive therapy training can be effective in improving the quality of life in patients with type II diabetes (P < 0.05). Conclusion: In order to findings, it can be concluded that the presentation of cognitive therapy beside other medical interventions is as a part of comprehensive treatment and care of diabetes.

Designing a epileptics patients services management model for Iranian health system Ebrahim Koochaki, Monika Motaghi International Archives of Health Sciences 2018 5(4):120-125 Aim: Epilepsy is increasingly developed worldwide, considered as one of the most important healthcare problems in the second half of 12th century. Methodology: This study is a quantitative-qualitative/cross sectional-practical method research. The conceptual model was derived from comparative studies of the United States, Australia, United Kingdom, Canada and the relevant experts' perspectives. The study population consisted of all professionals related to the healthcare management of epilepsy in all geographical regions of Iran. The obtained data were analyzed using software SPSS 16 and AMOS. Exploratory and confirmatory factor analysis were also performed, and the final model was obtained and its fitness was confirmed. Results: Nine factors were entirely identified for the final model of healthcare management of epileptic patients: Organizational structure of the leading policy, makers, methods of governmental interventions in financing resources, types of services necessary to provide patients, instances of epilepsy, monitoring, and controlling epilepsy healthcare services among which methods of governmental interventions in financing resources and monitoring and controlling epilepsy healthcare services had the minimum and maximum factor load value, respectively. Conclusion: As it can be observed from the study data, training and raising the public awareness toward epilepsy in the country is an essential tool to prevent these types of diseases, as identifying the initial main risks aiming at prohibition of epidemic diseases and also proper healthcare services in case of development are the most important initiations to be taken.

Critical success factors of lean management: An investigation of factors affecting lean management in public hospitals in Kohgiluyeh and Boyerahmad and Bushehr provinces Lida Gholizadeh, Iravan Masoudi Asl, Kamran Hajinabi, Pouran Raeeisi Dehkordi International Archives of Health Sciences 2018 5(4):126-130 Aim: Lean is a set of operating philosophies and methods that help create maximum value for patients by reducing waste and waits. It emphasizes the consideration of the customer's needs, employee involvement, and continuous improvement. The aim of this study was of factors affecting lean management in public hospitals in Kohgiluyeh and Boyerahmad and Bushehr provinces. Materials and Methods: This research was descriptive correlation study. The questionnaire was used to collect the data. Factor analysis and multiple regression analysis were conducted to understand the relationship between these factors and lean implementation success. With using 60 questions questionnaire, the content validity of the method developed by the researchers and expert judgment and Cronbach's alpha and test–retest reliability of the method was investigated, and the opinions of 500 primary health-care practitioners were collected. Then, a two-stage exploratory and confirmatory factor analysis and structural equation modeling with the use of statistical software SPSS for Window 17.0 software (SPSS Inc., lllinois, USA) (Leland Stanford Junior University) and AMOS 20 carried out to review and modify the conceptual model. Results: Exploratory factor analysis identified five factors of human, technology, management, processes, and relational that explains 58.5% of the total variance. Confirmatory factor analysis also showed that among identified factors, technology factor with 0.953 coefficient has greatest impact and management factor with 0.615 coefficient has the lowest impact on the pattern of lean management in public hospitals to improve the quality of services. Conclusions: The factors affecting the deployment of lean management in public hospitals and appropriate strategy for using the lean management to improve the delivery of primary health care and reduce waste. The results represent guidelines for using effective implementation of lean management to increase efficiency and ability to compete in the global market offers.

The effectiveness of the integrated group therapy on increasing the prisoners' self-esteem Zahra Keshtkar, Mahsa Nabavi, Mustafa Bolghan-Abadi International Archives of Health Sciences 2018 5(4):131-134 Context: The previous studies have shown the commitment of most crimes and offensive behaviors are the root of psychological disorders. Aims: The purpose of this study is to investigate the effectiveness integrated group therapy in increasing the male prisoners' self-esteem of central prison of Mashhad. Settings and Design: Statistical population included all the male prisoners of the central prison of Mashhad who were addicted to drugs. A sample from these prisoners was selected randomly and was assigned in experimental and control groups (12 participants in each group). Subjects and Methods: The research method of this study was semi-experimental with pretest/posttest/follow-up and control group design. Weekly group sessions were holding which last for 2 h during 1½ months. For gathering the data demographic and Coopersmith's self-esteem questionnaire were used. Statistical Analysis Used: For analyzing the data, ANCOVA test was used. Results: Findings show that those who had received the intervention expressed high level of self-esteem to those who had not received it (control group participants). Conclusions: It could be concluded that the group therapy by the integrated approach has effective influence on increasing the male prisoner's self-esteem of central prison of Mashhad.

Effectiveness of the successful intelligence program in improving learning behaviors of students with attention-deficit/hyperactivity disorder Foroogh Khakpoor, Ahmad Abedi, Gholamreza Manshaee International Archives of Health Sciences 2018 5(4):135-139 Aims: The aim of the research was to study the effectiveness of the successful intelligence program on the learning behaviors and academic performance of students with attention-deficit/hyperactivity disorder (ADHD). Settings and Design: The quasi-experimental research method was used with a pretest-posttest and control group design. Materials and Methods: The statistical population of the research was included all of the sixth graders of Tehran City in the 2016–2017 academic year. Hence, of the 101 elementary schools in District 15 of Tehran Municipality, eight schools were selected using the random cluster sampling method. Afterward, all of the students of the eight selected schools were questioned using Conners' Teacher Rating Scale, which resulted in the diagnosis of 45 students with ADHD. Fifteen students were randomly put in the experimental group, and 15 were randomly put in the control group. The learning behavior scale was also used to collect the data. Afterward, the successful intelligence program was administered on the experimental group throughout six sessions. The control group was also on the waiting list. To analyze the data, multivariate covariance analysis test was used. Results: The investigation results revealed that training in the successful intelligence program was effective in improving the learning behaviors of the trained students. Conclusions: Considering the research findings it could be stated that training in the successful intelligence program is effective in improving the learning behaviors of students suffering from ADHD. Hence, school counselors are recommended to administer this program.

Community attitude toward the mentally ill and its related factors in Kashan, Iran Nazeninzahra Jalali, Saeide Tahan, Seyed Gholamabbas Moosavi, Ali Fakhri International Archives of Health Sciences 2018 5(4):140-144 Aims: Today, the prevalence of mental disorders is increasing. In Iran, more than 20% of people suffer from mental problems too. Despite all scientific developments in diagnosis and treatment of the mentally ill patients, presenting psychotherapy service is still facing some problems because of the negative attitudes which require more investigation. The current research aims to study the attitudes of Kashan city population about the mentally ill and the contributing factors. Materials And Methods: In this study, the samples were chosen randomly at two levels among health posts and their covered population in Kashan city (364 samples). Community Attitudes toward the Mentally Ill questionnaire was used for data collecting. The data were analyzed by SPSS software and statistical tests. Findings: Most of the participants had a positive attitude toward the mentally ill (with the mean of 3.66 from 5 score and standard deviation of 0.37). Attitude of women and higher-educated people were, respectively, better than men (PV < 0.01) and lower-educated people (PV < 0.01). There was no meaningful difference between attitude toward the mentally ill and employment, and there was no meaningful correlation between the attitude score and age either. Conclusion: The results confirm the role of education on the positive attitude of people toward the mentally ill. The positive attitude can show the appropriate awareness of people on these lines.

The effect of aquatic exercises on inflammatory markers of cardiovascular disease in obese women Khadijeh Irandoust, Morteza Taheri International Archives of Health Sciences 2018 5(4):145-149 Aims: the purpose of this study was to investigate the effects of aquatic exercises on inflammatory markers of cardiovascular (homocysteine, C-reactive protein [CRP], and fibrinogen) in obese women. Materials and Methods: It was a semi-experimental with pre- and posttest design. Thirty-seven obese women volunteered to participate in the research, of which 28 had inclusive criteria for research. The age of participants ranged from 35 to 40 years and their body fat percentage was above 30%. The exercise protocol included a combination of resistance, stretching, and balance exercises that were carried out three sessions a week for 10 weeks. Statistical Analysis Used: Paired t-test and independent test were used to analyze the data. Results: The results suggested that homocysteine, CRP, and fibrinogen indices of obese women were significantly improved following combined aquatic exercises (P ≤ 0.05). Furthermore, a significant decrease in body fat percentage with improvement of cholesterol and systolic blood pressure were found in experimental group (P ≤ 0.05). Conclusions: The overall result was that combined aquatic exercises would not only attenuate cardiovascular risk factors such as homocysteine, fibrinogen, and CRP but also improve the other cardiovascular disease risk factors such as obesity, cholesterol, and blood pressure.

Priorities of occupational health, safety, and environment issues based on national programs and regulations from the perspective of occupational health experts in Kashan city in 2017 Allhayer Aghaei, Mitra Hanani, Masoud Motalebi Kashani, Seyyed Gholam Abbas Mousavi International Archives of Health Sciences 2018 5(4):150-161 Background: Safety, health, environment is one of the most important issues of human societies in the current and future. Prioritization is one of the important issues affecting the prevention of diseases and occupational accidents and environmental hazards; therefore, the aim of this study, prioritize current programs and regulations entrust to occupational health experts. Methods: The present study is a cross-sectional study of the descriptive type that was conducted on 151 occupational health experts of Kashan City in 2017. The data collection tool was a questionnaire that made by the researcher. Data analysis was conducted with (SPSS 16) and descriptive and analytical statistics. Results: The results showed that there is a statistically significant difference between items in the executive and supervisory sectors and the highest priorities are based on the mean and standard deviation of the scores assigned by occupational health experts: controlling mechanical factors and ergonomics within the context of occupational health controls in the executive sector. Priorities are based on the average and standard deviation of total scores allocated by occupational health experts: the most important priorities are safety in the protection of machines shield and fire safety, chemical safety, and electrical safety. Conclusion: The most important priority for all those present in the research, safety in the protection machine gears shield (transmission parts for gear belt buckles, etc.) should be considered as an important priority for officials and observers of the executive and supervisory sectors, and to maintain and to enhance safety at the workplace machine safeguarding is very important.

Call for raising the financial allocation to attain the goal of toilet for all: World Health Organization Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava International Archives of Health Sciences 2018 5(4):162-163

Clinical Trials in Degenerative Diseases

Sacubitril/valsartan improves ejection fraction in heart failure with reduced ejection fraction: A retrospective study Walid Ibrahim, Ahmed S Yassin, Ahmed Subahi, Hassan Mohamed, Ayman Khaddam, Muhammad Bajwa, Ashraf Abugroun, Amir Kaki, Mahir Elder, Tamam Mohamad Clinical Trials in Degenerative Diseases 2018 3(4):119-122 Background and objectives: The discovery and introduction of Neprilysin inhibitor in treating chronic heart failure (New York Heart Association class II–IV) with reduced ejection fraction (HFrEF) is a remarkable landmark in therapy. The clinical outcome of reducing the incidence of death from cardiovascular causes or first hospitalization for worsening heart failure was demonstrated at the large randomized, double blind, “Angiotensin-Neprilysin inhibition versus enalapril in heart failure (PARADIGM-HF trial).” We studied a total of 228 patients with HFrEF who was recently started on sacubitril/valsartan (EntrestoTM; previously known as LCZ696) testing the hypothesis of improving ejection fraction with sacubitril/valsartan, defined as an increase of ejection fraction from the baseline before treatment by 10–15%. Methods: This is a single-center, retrospective, descriptive study. The data was collected from the charts of patients followed up for a mean of 4.7 weeks after initiation of treatment with sacubitril/valsartan. A total of 228 patients with heart failure were prescribed 200 mg of sacubitril/valsartan twice daily, an improvement in ejection fraction by 10–15% was considered a successful response. Results: Out of the 228 patients, 51.3% showed a successful response. Most of the patients 97.9% and 58.0% were taking beta-blockers and aspirin respectively. The absolute number of black patients who improved was higher than others ethnic groups. However, the higher percentage of ejection fraction improvement 71% was reported among other ethnicities (not blacks or Caucasians). Patients without episodes of hospitalization showed better improvement than those with one or more episodes. Conclusion: In a predominantly black population with HFrEF, sacubitril/valsartan has shown improvement in ejection fraction effect. This finding was independent of other risk factors and concomitant heart failure treatment; however, further studies are recommended to validate this result. Ethics: Ethical approval of this study was obtained from the Research Committee, DMC/Wayne State University (IRB# 015618MP4X) on February 14, 2018.

Efficacy and safety of Vidangadi Yoga (ayurvedic polyherbal medicine) in type 2 diabetes mellitus: A randomized controlled clinical study Shailesh Vinayak Deshpande, Krutika Subhash Jadhav Clinical Trials in Degenerative Diseases 2018 3(4):123-129 Background and objectives: Incidence of diabetes mellitus is increasing due to genetic predisposition, high body fat, and insulin resistance. Though multiple oral hypoglycaemic agents and insulin are available, these are associated with side effects, primary and secondary failure. Hence, evaluation of antidiabetic potential of medicines described in traditional health sciences such as Ayurveda (Indian system of medicine) is also important. This study aimed to assess the efficacy and safety of Vidangadi Yoga (ayurvedic polyherbal medicine) and metformin in the management of type 2 diabetes mellitus (T2DM) based on biochemical parameters and adverse events. Methods: In this prospective, randomized, open-label, active-controlled, two-arm study, 61 patients with T2DM were included and randomly divided two groups. Patients in the Vidangadi Yoga group received Vidangadi Yoga tablet 500 mg thrice daily before food with water, while patients in the metformin group received metformin 500 mg after food twice daily for 90 days. Subjects were asked to undergo follow-up at the interval of 15 days until the completion of 90 days. Assessment was done on changes observed in fasting and postprandial blood glucose, glycosylated haemoglobin, lipid profile, haemogram, hepatic, renal profile, and clinical symptoms. Results: After 90 days of medication, fasting and postprandial blood glucose levels in both groups were significantly decreased when compared with baseline (P < 0.001). There were no significant differences in fasting and postprandial blood glucose levels between both groups. After 90 days of medication, haemogram, and hepatic and renal profiles (safety parameters) in the two groups were not significantly different from baseline. No adverse events were related with the use of the studied medicine. Conclusion: Vidangadi Yoga exhibits equivalent efficacy to metformin and is safe in lowering fasting and postprandial blood glucose levels. Ethics and trial registration: This study was approved by the institutional ethics committee of PDEA’s College of Ayurved and Research Centre, Pune, Maharashtra, India (approval number 6833) on March 22, 2014 and was registered with Clinical Trials Registry- India (CTRI) (No. CTRI/2015/04/005719) on April 25, 2015.

Effects of a heel raise program on central hemodynamics and cognitive performance in chronic stroke: Study protocol for a randomized, controlled, crossover trial Andrew Mitchelmore, Danielle Lambrick, Simon Jobson, Lee Stoner, James Faulkner Clinical Trials in Degenerative Diseases 2018 3(4):130-134 Background and objectives: As survival rates after incident stroke increase, the burden caused by secondary stroke and pressure placed on rehabilitation centers also rises. Lifestyle interventions have the potential to drive secondary-prevention treatments. Low-intensity interventions, such as heel raises, may offer a simple method of improving cardiovascular health and cognitive ability in chronic stroke. Here we present a protocol which attempts to determine whether a heel raise training program can improve markers of vascular health and cognitive function. Design: A randomized, controlled, crossover trial. Methods: Fifteen participants (> 3 months post-stroke diagnosis) will be randomly assigned to an intervention-first group (n = 8) or a control-first group (n = 7). In the intervention period, participants will complete 170 heel raises per day for 10 weeks. Heel raises will be completed in sets of ten, within a period of 170 minutes, from a seated position. In the control period, participants will go about their normal lives for 10 weeks. On completion of each program, participants will have a 4-week washout before commencing the alterative arm. Outcome measures: The primary outcomes (pre- and post-measures of peripheral and central blood pressure and pulse wave velocity) will be recorded, as these variables are strongly linked to vascular health after stroke. Secondary outcomes (cognitive function and maximal voluntary contractions) will be assessed using the Stroop task and electromyography respectively. A mixed-model analysis of variance will identify whether a heel raise intervention has a significant effect on the proposed primary and secondary outcome variables. Discussion: The potential improvements in vascular health may demonstrate that lower-limb heel raise exercise is a beneficial exercise stimulus for this population group. Ethics and dissemination: The protocol received ethical approval from the University of Winchester Ethics Committee (approval No. BLS/17/11) on November 30, 2017 and will be conducted in accordance with the Declaration of Helsinki, formulated by the World Medical Association. Written informed consent will be obtained from all participants. Recruitment began in June 2018. Analysis of the primary and secondary outcome measures will be completed in January 2019, and the study will finish in February 2019. Trial registration: The study was registered with ClinicalTrials.gov (NCT03423433) on February 6, 2018.

Acute-Onset Optic Neuropathy in Wilson’s Disease

Wilson's disease (WD), also known as hepatolenticular degeneration, is a rare autosomal recessive condition of excess copper accumulation that is most commonly associated with hepatic, neurologic, psychiatric, and ocular manifestations. While Kayser-Fleischer rings and sunflower cataracts are well known in WD, visual impairment is very rare. We report the case of a 20-year-old female who presented with acute liver failure and associated monocular vision loss. WD was found to be a cause of her liver disease and decreased vision.
Case Rep Ophthalmol 2018;9:520–525

http://bit.ly/2F6ohAM

Diffuse Large B-Cell Lymphoma of the Lacrimal Sac in a Japanese Patient

Purpose: To report a Japanese patient with diffuse large B-cell lymphoma (DLBCL) in the lacrimal sac. Methods: This is a case report of a 52-year-old Japanese woman who presented with a 3-month history of epiphora on the right side and a 1-month history of swelling on the right medial canthal area. Lacrimal sac irrigation showed patency of the lacrimal drainage system. Imaging studies revealed a lacrimal sac mass with involvement of the nasolacrimal duct. Results: Histopathology and immunohistochemistry of the biopsy specimen revealed DLBCL. Systemic workup revealed no other lesion. The patient received 6 cycles of R-CHOP regimen. After completion of the 5th cycle of R-CHOP, all of the symptoms had resolved. Conclusion: We report a case of DLBCL in the lacrimal sac, which is the most common type of lacrimal sac lymphoma in Japan. Since DLBCL is one of the aggressive types of lymphoma, Japanese patients with lacrimal sac lymphoma tend to have a poor prognosis.
Case Rep Ophthalmol 2018;9:516–519

http://bit.ly/2F5viBF

Influenza : Antiviral Chemoprophylaxis

 in Community Settings

X. Who should be considered for antiviral chemoprophylaxis to prevent influenza in the absence of exposure or an institutional outbreak (preexposure chemoprophylaxis)?

Antiviral drugs should not be used for routine or widespread chemoprophylaxis outside of institutional outbreaks; antiviral chemoprophylaxis can be considered in certain situations:

32. Clinicians can consider antiviral chemoprophylaxis for the duration of the influenza season for adults and children aged ≥3 months who are at very high risk of developing complications from influenza and for whom influenza vaccination is contraindicated, unavailable, or expected to have low effectiveness (eg, persons who are severely immunocompromised) (C-II).
33. Clinicians can consider antiviral chemoprophylaxis for the duration of the influenza season for adults and children aged ≥3 months who have the highest risk of influenza-associated complications, such as recipients of hematopoietic stem cell transplant in the first 6–12 months posttransplant and lung transplant recipients (B-II).
34. Clinicians can consider short-term antiviral chemoprophylaxis in conjunction with prompt administration of inactivated influenza vaccine for unvaccinated adults and children aged ≥3 months who are at high risk of developing complications from influenza in whom influenza vaccination is expected to be effective (but not yet administered) when influenza activity has been detected in the community (C-II).
35. Clinicians can consider short-term antiviral chemoprophylaxis for unvaccinated adults, including healthcare personnel, and for children aged ≥3 months who are in close contact with persons at high risk of developing influenza complications during periods of influenza activity when influenza vaccination is contraindicated or unavailable and these high-risk persons are unable to take antiviral chemoprophylaxis (C-III).
36. Clinicians can consider educating patients and parents of patients to arrange for early empiric initiation of antiviral treatment as an alternative to antiviral chemoprophylaxis (C-III).

XI. Which antiviral drugs should be used for preexposure chemoprophylaxis for influenza?

37. Clinicians should use an NAI (oral oseltamivir or inhaled zanamivir) if preexposure chemoprophylaxis for influenza is administered rather than an adamantane antiviral (A-II).

XII. What is the duration of preexposure antiviral chemoprophylaxis to prevent influenza?

38. Clinicians should administer preexposure antiviral chemoprophylaxis for adults and children aged ≥3 months who are at very high risk of developing complications from influenza (eg, severely immunocompromised persons such as hematopoietic stem cell transplant recipients) for whom influenza vaccination is contraindicated, unavailable, or expected to have low effectiveness, as soon as influenza activity is detected in the community and continued for the duration of community influenza activity (A-II).
39. Clinicians should test for influenza and switch to antiviral treatment dosing in persons receiving preexposure antiviral chemoprophylaxis who become symptomatic, preferably with an antiviral drug with a different resistance profile if not contraindicated (A-II).

XIII. Which asymptomatic persons exposed to influenza should be considered for postexposure antiviral chemoprophylaxis in a noninstitutional setting?

40. Clinicians can consider postexposure antiviral chemoprophylaxis for asymptomatic adults and children aged ≥3 months who are at very high risk of developing complications from influenza (eg, severely immunocompromised persons) and for whom influenza vaccination is contraindicated, unavailable, or expected to have low effectiveness, after household exposure to influenza (C-II).
41. Clinicians can consider postexposure antiviral chemoprophylaxis (in conjunction with influenza vaccination) for adults and children aged ≥3 months who are unvaccinated and are household contacts of a person at very high risk of complications from influenza (eg, severely immunocompromised persons), after exposure to influenza (C-II).
42. Clinicians can consider educating patients and arranging for early empiric initiation of antiviral treatment as an alternative to postexposure antiviral chemoprophylaxis (C-III).

XIV. When should postexposure antiviral chemoprophylaxis be started?

43. If chemoprophylaxis is given, clinicians should administer postexposure antiviral chemoprophylaxis as soon as possible after exposure, ideally no later than 48 hours after exposure (A-III).
44. Clinicians should not administer once-daily postexposure antiviral chemoprophylaxis if >48 hours has elapsed since exposure. Full-dose empiric antiviral treatment should be initiated as soon as symptoms occur, if treatment is indicated (A-III).

XV. How long should postexposure antiviral chemoprophylaxis be given?

45. Clinicians should administer postexposure antiviral chemoprophylaxis in a nonoutbreak setting for 7 days after the most recent exposure to a close contact with influenza (A-III).
46. Clinicians should test for influenza and switch to antiviral treatment dosing in persons receiving postexposure antiviral chemoprophylaxis who become symptomatic, preferably with an antiviral drug with a different resistance profile if not contraindicated (A-III).

XVI. Which antiviral drugs should be used for postexposure chemoprophylaxis?

47. Clinicians should administer an NAI (inhaled zanamivir or oral oseltamivir) if postexposure chemoprophylaxis for influenza is given, rather than an adamantane antiviral (A-II).

https://www.idsociety.org/practice-guideline/influenza/

A survey of anesthetic preference and preoperative anxiety in hip and knee arthroplasty patients: the utility of the outpatient preoperative anesthesia appointment

Abstract

Purpose

The general public's perceptions of anesthesia and the risks associated with it may be skewed. The outpatient preoperative appointment with an anesthesiologist allows for patient education regarding different anesthetic options and counseling regarding anxiety related to anesthesia and surgery. This study investigates whether the preoperative appointment for hip and knee arthroplasty alters patient preference for general or spinal anesthesia and reduces patient anxiety.

Methods

Sixty-two patients undergoing hip or knee arthroplasty were administered two verbal questionnaires at the preoperative clinic. The first questionnaire was completed prior to meeting the anesthesiologist and addressed patient anesthetic preferences, previous anesthetic experiences, and perioperative anxiety and need for information using the Amsterdam Preoperative Anxiety and Information Scale (APAIS). The second questionnaire was completed immediately following the appointment and addressed the patient's anesthetic preference, reasons for any preference changes, and anxiety levels and need for information using the APAIS. The clinic anesthesiologist was blinded to the nature of the study.

Results

Following the clinic appointment, a significant decrease in patients wanting general anesthesia (from 48 to 18%, P < 0.001) and a significant increase in patients wanting spinal anesthesia (from 39 to 76%, 95%, P < 0.01) was noted. A significant decrease in overall anxiety and anxiety related to the patients' upcoming surgeries and need for information was also noted.

Conclusions

The preoperative anesthesia meeting serves an important role in educating patients regarding anesthesia, and can influence patients' choice of anesthetic while also reducing overall patient anxiety.

http://bit.ly/2VsUuI3