Nowadays, the appropriate control of rheumatoid arthritis (RA) involves the absence of clinical disease activity, delaying joint destruction as long as possible and adequate quality of life of the affected. With currently available therapeutic modalities, this therapeutic goal can be achieved in a large number of patients. The aim of this research was to determine the effectiveness of an IL-6 blocker (Tocilizumab) in patients with RA in everyday clinical practice. We also analyzed whether a change in the mode of drug administration (switching from intravenous to subcutaneous drug formulation) had an impact on drug effectiveness (using the DAS 28 SE and CDAI indexes) and quality of life of patients with RA (HAQ, Beck Depression Inventory, FACIT F score and SF 36 questionnaire). The study included 53 subjects diagnosed with RA, treated with Tocilizumab. After a six-month use of subcutaneous Tocilizumab, we concluded that the method of drug administration did not have an impact on its effectiveness and on all the examined parameters of quality of life assessment.

Situs inversus totalis represents a rare autosomal recessive morphological anomaly of the internal viscera, equally affecting both genders. The genetic defect occurs in the 2nd week of embryonic life, when a 270-degree clockwise rotation of the primitive digestive tube occurs. The incidence of calculosis of gallbladder in patients with situs inversus is the same as in the general population. A 61-year-old female patient with a history of four episodes of colicky, left hypochondrium and epigastric pain, without fever and jaundice, was admitted for elective laparoscopic cholecystectomy. CT of abdomen confirmed situs inversus totalis that was previously known to the patient. The patient was positioned in supine position and a mirror image configuration of the operating room was obtained, with surgeon and scrub nurse on the right side and assistant on the left side of the patient. Four trocars were introduced mirroring the standard position of the 5 mm trocars. During the dissection, second assistant was introduced for the laparoscope, due to the surgeon's limited motor skills in his left hand for delicate dissection, rendering him inapt to perform precise and safe dissection. The total operating time amounted to 110 minutes, which is three times longer than the standard operating time at our institution. The most critical point of the operation in constellation of situs inversus totalis is applying the clips, which requires precision and strength in the same moment. In the available literature, 40 open cholecystectomies before introduction of laparoscopy and 92 laparoscopic cholecystectomies were reported. To our knowledge, this is the first and the only reported laparoscopic cholecystectomy for situs inversus in North Macedonia.

In late December 2019, Wuhan, China, became the center of an unknown outbreak of pneumonia that spread rapidly throughout China and around the world, including Iran, and the World Health Organization (WHO) declared the novel disease a public health emergency with global concern. Since the COVID-19 outbreak, many studies have been performed on epidemiological data and clinical signs in adults. However, coherent studies in this field are very rare in infants, and support and attention to infants in the pandemic situation should be doubled due to the weakness and underdevelopment of the neonatal immune system. Therefore, the present study aimed to review COVID-19 infection in infants in which there are discussions on topics such as diagnostic tests, clinical manifestations, recommendations on breastfeeding, the criteria for discharge, and family education in pandemic conditions. The literature review shows no existing evidence of COVID-19 placental transmission from mother to infant, and that all samples prepared from amniotic fluid, umbilical cord blood and breast milk in mothers with COVID -19 was negative for COVID-19 infection, and the clinical manifestations of COVID-19 were non-specific in infants, especially premature infants. Given that there is a limited number of births from a mother with COVID-19, and because the epidemiological and clinical pattern of COVID-19 in infants is unclear, this review study describes diagnostic tests, clinical manifestations, breastfeeding considerations, discharge criteria, and family education in the current understanding of COVID-19 infection in newborns and provides information for better management of SARS-CoV-2 infection in newborns.

The aim of the paper was to examine the echocardiographic parameters of the right ventricle (RV), its diameter and pulmonary arterial pressure (PAP); to determine their relationship to B-type natriuretic peptide (BNP), troponin and (TnI) and high-sensititity C-raective protein (hsCRP), and to evaluate their prognostic significance to one-year mortality in patients with acute heart failure (AHF). The study included a total of 225 patients (pts) (70.29 ± 9.74 years) who were admitted to Intensive care unit due to the signs and symptoms of AHF. The values of standard biochemical parameters, BNP, TnI and hsCRP were determined during the first 24 hours after admission. All patients underwent echocardiographic examination. During a one-year follow-up, 78 (34.70%) patients died. As compared with the group of survivors (n = 147), the group of non-survivors had higher values of BNP (853.10 ± 384.92 vs. 1399.68 ± 464.44 pg/mL, p < 0.001), TnI (0.59 ± 2.04 vs. 2.00 ± 8.29 ng/ml, p < 0.05), right ventricular diameter and PAP (p < 0.001). BNP was positively correlated with TnI (r = 0.311), PAP (r = 0.255) and right ventricular diameter (r = 0.304, p < 0.001 for all correlations). The cut-off value of BNP ≥ 1062.04 pg/ml, PAP ≥ 44.5 mmHg and TnI ≥ 0.04 ng/ml were associated with a higher risk of mortality. Our results have shown that BNP, PAP and TnI are strong and independent predictors of one-year mortality in hospitalized patients with acute heart failure.

Pelvis is a strong bony-ligamentous structure containing many organs, vessels and nerves. Three forces or a combination of those forces produce pelvic fractures. The main causes of pelvic fractures are traffic accidents and falls from height. Biomechanically pelvic ring can be stable or unstable. Biomechanically unstable pelvic ring after the injury may provoke hemodynamic instability. Mortality rate in hemodynamically unstable patients with pelvic fractures remains high. Hemodynamically unstable patients require urgent closing of the pelvic volume with pelvic C clapms or external fixator. This fixation is usually temporary. The massive venous bleeding from the injured pelvis needs the pelvic packing (tamponade); arterial bleeding needs angiography and embolization. After a patient's hemodynamic status stabilizes, further evaluation and mechanical stabilization of the pelvis is needed. The definitive stabilization of the pelvis includes hemodynamically stable patients and implies anterior, posterior or both anterior and posterior pelvic ring fixation. The main indication for the anterior stabilization is symphyseal diastasis greater than 2,5 cm. Anterior stabilization can be achieved with external fixator or with symphyseal plating. The primary indication for surgery of posterior pelvic ring complex is vertical pelvic instability. Stable mechanical fixation can be applied with anterior sacro-iliac plating, percutaneous ilio-sacral screws, and trans-iliac sacral bars. Inadequate treatment of pelvic injury may cause permanent disability and serious chronic disorders.

<p>The purpose of the study was to investigate the effects of Exendin-4 on polycystic ovary syndrome (PCOS) in rats in chronic mild stress medium. For establishing the PCOS model, dehydroepiandrosterone (DHEA) (6mg/100g) in 0.2ml sesame oil was injected subcutaneously to 21-day old rats (n = 67). In addition, 0.2ml sesame oil was injected subcutaneously to the rats in groups involving solution injection only. At the initial stage of the study, the rats were grouped as control, solution and PCOS, whereas stress and Exendin-4 groups were also added in the second stage of the study. In PCOS groups, Exendin-4 was applied intraperitoneally (10μg/kg/day) in mild chronic stress medium for four weeks. The results revealed that weight, fasting blood glucose, fasting blood insulin and HOMA-IR levels in the rats with PCOS were significantly higher than in the other groups; also, corticosterone levels of stress groups were significantly higher than in the other groups. In addition, harmful effects of PCOS on ovarian tissues were observed in histological examinations. However, after Exendin-4 application in PCOS groups, weight, fasting blood glucose, fasting blood insulin, HOMA-IR and LH/FSH levels were decreased, whereas Exendin-4 application in PCOS group treated with stress was not as effective as the application of Exendin-4 on rats with PCOS. Exendin-4 application also increased the number of healthy follicles in PCOS group, whereas there was no change in the number of healthy follicles in PCOS+Stress group.</p> <p> </p>

<p>Among many factors influencing human beauty, the correct position of the upper front teeth, including central incisors, is undoubtedly of particular importance. When determining the intermaxillary relationship, an important phase is determination of the medial line of a person’s face or places of contact of the upper central incisors. The aim of this study was to test the hypothesis that the place of mutual contact of the upper central incisors in most cases coincided with the central groove of the lower lip. Examination included two groups of respondents. The first group consisted of 100 female and the second of 100 male respondents, with age range from 18 to 30 years. A starting point in measuring was the central groove of the lower lip. Measuring the horizontal distance of the central groove of the lower lip and the mutual contact of the upper central incisors was performed with a slight touch of the upper teeth with the lower lip. The measurement was performed using a digital vernier SH, with the resolution of 0.01 mm. After performing statistical analysis, the results showed that in a large percentage of cases, the central groove of the lower lip coincided with the point of mutual contact of the upper central incisors. The point of contact of the upper incisors can be determined simply by transferring the position of the groove to the upper interocclusal rim,with a slight contact between the lips and interocclusal rim.</p> <p> </p>

<p>With the aim to analyze the clinical manifestations and outcomes of influenza, we evaluated the symptoms of proven H1N1 cases and outcomes of patients admitted to hospitals Babol University of Medical Sciences during 2015 - 2016. In this descriptive cross-sectional study, we included patients diagnosed with influenza-like illness (ILI) from October 2015 to March 2016 at hospitals affiliated to Babol University of Medical Sciences.To diagnose H1N1 infection, reverse transcription-polymerase chain reaction (RT-PCR) was performed on nasopharyngmeal swabs collected from the patients. In the current study, 123 patients were admitted due to ILI.The RT-PCR result was positive in 47.2% of patients. Symptoms such as productive cough (35.3%), sore throat (51.4%), headache (50%), dyspnea (53.2%) were comparable between PCR + H1N1 confirmed cases and H1N1 negative cases. Among the H1N1 confirmed cases, 48.3% were admitted to the intensive care unit (ICU) because of the disease severity, and 20.7% died even after receiving the therapy for several days. Among the infected cases, 20 women were pregnant, out of which three subjects died. Mortality was mostly observed in the age ˃ 50 (39%) (p = 0.03). Myalgia was significantly less observed in the group with mortality compared to other age groups (6.5% vs. 93.5%) (p = 0.005). The mortality rate of patients who received vancomycin was found to be significantly low (40%) (p = 0.01). In mortality group, the frequency of patients with creatinine levels > 1.5 mg/dL was significantly higher (58.3%) (p = 0.009) than in the group of patients who recovered. The average length of hospitalization in the mortality group was significantly longer than the hospitalization of the recovered group (11.1 days vs. 6.3 days) (p = 0.02). The current study reported a mortality rate that was more than expected in comparison to previous seasons. Our study results suggest that the absence of typical influenza symptoms such as myalgia should not cause a delay in the diagnosis of this infection in cold seasons.</p>

Abstract The aim of this study was to evaluate the risk factors that influence the perforation, regardless of the presence of H. pylori infection, in a sample of Iraqi patients with peptic ulcers, admitted to Al-Kindy Teaching Hospital. A total of 90 patients who had perforated peptic ulcer participated in this study. The diagnosis was based on history, clinical examination, laboratory and radiological investigations and was confirmed intraoperatively. A number of probable risk factors for perforation were investigated. Eighty participants were males and 10 were females (male to female ratio 8:1). About 42.2% of patients were in their fifth decade of life. Forty-nine (54.4%) patients were asymptomatic before perforation occurred. Among the risk factors, smoking (66.7%), stress (60%) and blood group A (53.3%) play a significant risk for the occurrence of perforation. We concluded that smoking, stress, non-steroidal anti-inflammatory drugs, and to a lesser extent fasting and blood group A, play a major role as risk factors for the occurrence of peptic ulcer perforation. Other factors seem to play a minor role in this respect.

Nursing students are more susceptible to sleep disturbances. The dormitory life also decreases the quality of their sleep. Due to the restriction of the use of drugs for the management of sleep disorders, the study was conducted to investigate the effect of aromatherapy with Citrus aurantium essence on the sleep quality among nursing students. In this randomized controlled trial, 100 nursing female students, who lived a dormitory life and met the inclusion criteria, were randomly allocated to the intervention and control group. The intervention group received aromatherapy with the essence of Citrus aurantium for 15 minutes overnight, for 14 nights, while the control group received no intervention. The sleep quality of all the students was measured by Pittsburgh Sleep Quality Index (PSQI) after the intervention in both groups. The data were analyzed using the SPSS 11.5 software and inferential and descriptive statistics. The obtained results showed that the mean score of sleep quality of the intervention and control group before the intervention was 7.38 ± 2.12 and 7.19 ± 2.43, respectively, which yielded no statistically significant difference (p = 0.403); however, after the intervention in the intervention group (3.30 ± 0.97) compared with the control group (7.73 ± 2.64), there was a significant difference (p < 0.001). This means that the intervention group compared with the control group had better sleep quality. We expect aromatherapy with the essence of Citrus aurantium, which is a relatively simple, inexpensive, and non-invasive technique with low side effects, to be used by nursing students residing in dormitory to manage their sleep quality.