Acute presentation of cocoon abdomen as intestinal obstruction mimicking with strangulated eventration: A case report

INTRODUCTION

Abdominal cocoon syndrome (ACS), or sclerosing encapsulating peritonitis (SEP) is a rare cause of intestinal obstruction in which the bowel and internal abdominal organs are wrapped with a fibrocollagenous cocoon-like encapsulating membrane. While cocooning of the abdomen primarily manifests in individuals undergoing peritoneal dialysis (PD), it has also been reported to occur spontaneously. Remarkably rare, SEP may present with complete mechanical bowel obstruction in select cases.

CASE PRESENTATION

We hereby report a case of an 87-year-old female patient with a prior history of abdominal surgery, who presented to our emergency department with a clinical picture of complete small bowel obstruction. Clinical and radiological data were suggestive of a strangulated midline hernia, prompting a therapeutic laparotomy. The surgical exploration revealed the encasement of the small bowel loops within a thick fibrocollagenous membrane. Efficient resolution was achieved through skillful adhesiolysis and the meticulous excision of the fibrocollagenous membrane.

DISCUSSION

SEP is more prevalent in men, with a higher incidence observed in tropical and subtropical countries. While the precise pathophysiology remains elusive, it is hypothesized that subclinical intraabdominal inflammation gives rise to the formation of a dense fibrocollagenous membrane. This membrane encapsulates intraperitoneal organs, ultimately leading to intestinal obstruction. Patients typically present with a recurrent history of small bowel obstruction, notably in the absence of prior abdominal surgery. Abdominal CT scan with experienced radiologist interpretation can aid in preoperative diagnosis. In cases where non-operative management fails and recurrent obstructions persist, surgical adhesiolysis stands as the well-established gold standard.

CONCLUSION

SEP is a rare abdominal disease, posing challenges for preoperative diagnosis. Laparotomy plays an important role in its diagnosis and treatment. The primary objective of the surgical intervention is to release the encapsulation of the bowel and safeguard the optimal functioning of the small intestines as much as possible.

Clinical Supervision of Medical Students in Primary Health Care Services: General Practitioners' Perspectives in Morocco

Introduction

Clinical supervision is crucial to establish a learning climate in which the supervisor guides the supervised. Clinical supervisors might have numerous barriers and motivations. Our study aimed to explore the clinical supervision practices among general practitioners and to describe their motivations, barriers, and needs.

Methods

A qualitative study was conducted using purposive sampling which is a non-probabilistic sampling method. The population was the general practitioners who were working at the primary health care centers either in the public or the private sectors (N=16). Individual semi-structured interviews were conducted by two authors, using an interview guide. All interviews were recorded, transcribed, and coded. A thematic content analysis was done manually based on an inductive approach.

Results

Sixteen general practitioners participated. Three main themes emerged from the study: 1) General practitioners' practices in clinical supervision, 2) the enablers to adequate clinical supervision in general practice, and 3) the general practitioners' fundamental barriers and needs in clinical supervision. Despite their lack of clinical supervision training, they could describe the different clinical supervision steps without giving their exact names. We found that their teaching skills must be reinforced. General practitioners were mainly motivated by personal and professional interests as well as moral obligations. Numerous barriers and needs were identified at the organizational, relational, and financial levels. The principles barriers and needs were the lack of clinical supervision training, lack of equipment, and remuneration.

Conclusion

The current study highlighted the motivations and challenges of general practitioners concerning clinical supervision. These results are helpful for all responsible institutions involved in clinical supervision and upcoming programs in Morocco.

Cross-cultural adaptation of the Moroccan Arabic dialect version of the Primary Care Assessment Tool

OBJECTIVE

To adapt the Primary Primary Care Assessment Tool-Adult Edition into the Moroccan Arabic dialect and to assess its reliability and validity from the perspective of Moroccan adult patients.

METHOD

A committee of experts carried out the cross-cultural adaptation of the Primary Care Assessment Tool. The adapted questionnaire was subject to forward and backward translation and a pilot study. Exploratory factor analysis assessed the internal consistency, reliability, and construct validity of items and scales. Finally, descriptive statistics were performed on the final factor structure.

RESULTS

A 43-item Moroccan Arabic dialect version of the Primary Care Assessment Tool-Adult Edition was developed. It consisted of six multi-item scales that represented the four main dimensions of primary care: first contact, continuity, comprehensiveness, and coordination. Four derived dimensions were included: cultural competence, communication, advice, and community orientation. All six scales demonstrated robust internal consistency, item-total solid correlations, and construct validity. The calculated Cronbach's alpha coefficients ranged from 0.78 to 0.90.

CONCLUSIONS

Comprehensive metric analyses supported the reliability and validity of the Moroccan Arabic dialect version of the Primary Care Assessment Tool-Adult Edition in assessing core primary care domains from the patients' experience. This tool could be used for future research on primary care in Morocco.

Fluid balance control in critically ill patients: results from as-treated analyses of POINCARE-2 randomized trial

BACKGROUND

Intention-to-treat analyses of POINCARE-2 trial led to inconclusive results regarding the effect of a conservative fluid balance strategy on mortality in critically ill patients. The present as-treated analysis aimed to assess the effectiveness of actual exposure to POINCARE-2 strategy on 60-day mortality in critically ill patients.

METHODS

POINCARE‑2 was a stepped wedge randomized controlled trial. Eligible patients were ≥ 18 years old, under mechanical ventilation and had an expected length of stay in ICU > 24 h. POINCARE-2 strategy consisted of daily weighing over 14 days, and subsequent restriction of fluid intake, administration of diuretics, and/or ultrafiltration. We computed a score of exposure to the strategy based on deviations from the strategy algorithm. We considered patients with a score ≥ 75 as exposed to the strategy. We used logistic regression adjusted for confounders (ALR) or for an instrumental variable (IVLR). We handled missing data using multiple imputations.

RESULTS

A total of 1361 patients were included. Overall, 24.8% of patients in the control group and 69.4% of patients in the strategy group had a score of exposure ≥ 75. Exposure to the POINCARE-2 strategy was not associated with 60-day all-cause mortality (ALR: OR 1.2, 95% CI 0.85-1.55; IVLR: OR 1.0, 95% CI 0.76-1.33).

CONCLUSION

Actual exposure to POINCARE-2 conservative strategy was not associated with reduced mortality in critically ill patients. Trial registration POINCARE-2 trial is registered at ClinicalTrials.gov (NCT02765009). Registered 29 April 2016.

Job satisfaction of primary healthcare professionals (public sector): A cross-sectional study in Morocco

Healthcare professionals (HCPs) are indispensable for improving the availability and quality of healthcare services. Therefore, the present cross-sectional study aimed to measure the job satisfaction of HCPs working in primary care (PC) centers in Marrakech, according to the job satisfaction scale. Using census sampling, this study involved HCPs working in PC centers. Data were collected using an electronic questionnaire and analyzes were performed using Jamovi (version 1.6). The Warr-Cook-Wall scale was used to assess the satisfaction of these professionals. Student's t-test, Kruskal-Wallis test and Mann-Whitney non-parametric tests were used for group comparisons (p < 0.05). The lowest satisfaction scores were recorded for general practitioners (GPs) and nurses. These were work safety (1.54 ± 0.85 vs. 1.51 ± 0.82), salary (1.58 ± 0.79 vs. 1.72 ± 0.87), chance of promotion (1.68 ± 0.87 vs. 1.80 ± 0.93), possibility of using its capacities (1.90 ± 1.04 vs. 2.01 ± 1.08), and workload (1.88 ± 1.10 vs. 2.05 ± 1.06). A statistically significant difference was observed between different professional statuses regarding facility management (p = 0.049). The overall job satisfaction of HCPs was low, especially among GPs and nurses: the scores for intrinsic job satisfaction with respect to sociodemographic characteristics were low, whereas they were medium for extrinsic job satisfaction. Further research is warranted to clarify the intrinsic and extrinsic factors of job satisfaction in Morocco's healthcare sector.

General practitioners' knowledge, attitudes and practices towards health promotion in Morocco

Background

Health promotion (HP) is a part of the general practitioners' (GPs) competencies defined by the World Organization of Family Doctors. The implementation of HP in their practice is unsatisfactory.

Aims

The aim of this study was to explore GPs knowledge, attitudes and practices in Morocco about HP at the primary healthcare services.

Methods

A cross-sectional study was conducted using an online self-administrated questionnaire including, knowledge, attitudes and practices of GPs toward HP. Descriptive and bivariate analyses were conducted.

Results

Two hundred and forty GPs responded to our questionnaires, the sex ratio was 1.12 with an average age of 40.46 ± 9.05 years. More than half of our participants perceived HP as a concept indistinct from prevention, 70.4% believed that HP refers to the biomedical model. On a Likert scale of 1-5, the level of HP knowledge was 2.71 ± 1.13. The most discussed topics with the population were tobacco, alcohol, overweight and obesity. Statistically significant association was found between the competencies of GPs in lifestyle behaviours and the practice of this competence.

Conclusion

The knowledge of GPs remains insufficient, and their practices focus more on the areas in which they feel competent, which requires the implementation of specific training for the development of GPs skills in HP.

Gender norms and access to sexual and reproductive health services among women in the Marrakech-Safi region of Morocco: a qualitative study

INTRODUCTION

Improving access to sexual and reproductive health remains a public health challenge, especially for women, whose access is affected by several determinants, such as gender inequality, which is the underlying barrier to all other determinants. Many actions have been carried out, but much remains to be done before all women and girls can exercise their rights. This study aimed to explore how gender norms influence access to sexual and reproductive health services.

METHOD

A qualitative study was conducted from November 2021 to July 2022. The inclusion criteria were women and men aged over 18 years old, living in the urban and rural areas of the Marrakech-Safi region in Morocco. A purposive sampling method was used to select participants. Data were obtained through semi-structured interviews and focus groups with selected participants. The data were coded and classified using thematic content analysis.

RESULTS

The study highlighted inequitable, restrictive gender norms that lead to stigmatization and affect the sexual and reproductive healthcare-seeking behavior and access of girls and women in the Marrakech-Safi region. These most common gender norms for women include parental refusal, stigmatization, and social exclusion of girls from sexual and reproductive health education services; strong decision-making power of family members over contraceptive use and women's adherence to pregnancy monitoring and access to supervised delivery; and culturally constructed role allocation, assigning a reproductive role to women and making them responsible for the health of new-borns.

CONCLUSION

Sexual and reproductive health projects must strive to be gender sensitive. Gender-blind projects are missed opportunities to improve health outcomes and advance gender equality.

Perceptions de la santé publique par les étudiants et les enseignants de la faculté de médecine de Marrakech

BACKGROUND

The COVID-19 pandemic has highlighted the pivotal role of public health. The aim of this study was to explore the perception of public health among medical students and faculty members (teachers).

METHODS

A cross-sectional study was conducted at the medical school of Marrakech (FMPM) in May 2020. Data collection regarding the place of public health (during the training and in the practice) was done by electronic questionnaire. The analysis was descriptive and bivariate.

RESULTS

259 responses were received (78.4% were students). The female / male sex ratio = 1.27. Almost 98.5% believed that public health knowledge and experiences were relevant for clinical practice. The main activities that reflect public health were prevention and health promotion (81%), epidemiological surveillance and epidemic management (89.6%) (98.2% among teachers versus 87.2% among students, p = 0.009). During the pandemic, 85.7% of teachers and 77% of students developed an interest in public health (p = 0.196). Only 6.6% were interested in a career in public health. Compared to teachers, students had a positive perception during the pandemic (p = 0.001).

CONCLUSION

The results highlight the lack of knowledge about the fields of application despite heightened sensitivity at the onset of the pandemic. Lessons can be learned in terms of improving public health training, raising awareness of the choice of this specialty and actions in favor of better visibility.

Perceptions and stress factors among physicians in pre-graduate and post-graduate training in Morocco: COVID-19 pandemic context

Context: On 30 January, 2020, WHO stated that the global COVID-19 epidemic is a public health emergency. Facing this critical situation, health-care workers were at risk of developing psychological distress and other mental health problems. Aims: This study seeks to explore the feelings, attitudes and perceptions of the COVID-19 pandemic among physicians in pre-graduate and post-graduate training from Marrakesh University Hospital Centre. Methods and Material:We conducted a cross-sectional study with internal and resident-physicians in May 2020. Data collection was based on a self-administered electronic questionnaire. The sociodemographic informations, pandemic impact on the occupational and social fields and stress factors were evaluated. Statistical significance was set at p < 0.05. Results: The number of participants was 74. The sex ratio was 1.4 with an average age of 26.1 ± 3.6 years. Two-thirds were directly involved in the management of patients with SARS-CoV2. The majority reported that their work puts them at high-risk of exposure to SARS-CoV2 and 66% felt stressed at work, female physicians were more stressed than men (p = 0.028). Not knowing when the pandemic will be under control and the risk of developing an infection with SARS-CoV2 were the main sources of stress. About motivators for similar situations, respondents emphasized family support (91.9%) and recognition by management and supervisors for the additional efforts they provide (83.8%). Conclusions: The protection of health-care workers is an important component of public health measures to combat this pandemic. Special interventions to promote health-care workers mental well-being must be implemented immediately.

Social accountability: Attitudes and awareness among undergraduate medical students in Morocco

INTRODUCTION

As future health professionals, medical students should be aware of their social accountability and their role in the society. The aim was to assess the attitudes and awareness of medical students regarding the social accountability and to identify the factors determining their attitudes and possible levers for action.

METHODS

Online survey among undergraduate students at the medical school in 2019 (N = 2128). The data collection tool was developed based on the literature review, the principles of social accountability SR and the toolkit (The development of the Students' Toolkit on Social Accountability of Medical Schools was a collaboration between the International Federation of Medical Students' Associations (IFMSA) and the Training for Health Equity Network (THEnet). The data were collected in December by LimeSurvey software version 1.90 and analyzed by SPSS version 16 according to the usual descriptive and bivariate. The Fisher test was used to compare two percentages and the Student t-test to compare two means on two independent samples (significance level was 0.05). The verbatims were grouped and analyzed.

RESULTS

271 students participated (response rate = 12.7%). The mean age was 20.6±2.6 years (N = 257). The Female/Male ratio was 1.85. Only 33.5% had heard of social accountability. It was linked to "commitment to the community" in 75.1% of cases, "to be a good citizen" in 66.1% and "to be responsible for one's actions" in 56.4%. Nearly 79% thought that students did not really have a role in society and that they should focus on their studies. Being a member of an association was a factor determining the positive attitude towards the SA (82.1% versus 65.2%, p=0.031). Students believed that the school had some strategies of social accountability. The results of the verbatim emphasize the need to multiply the practices and opportunities for interaction with the social environment for students.

CONCLUSION

The level of knowledge of the concepts by the students seems to be average. It would be necessary to look for the means to plead in favor of reinforcing our school strategies to concretize the principles of SR while training the students.

WITHDRAWN: Incidence and mortality of COVID-19 in Iranian multiple sclerosis patients treated with disease-modifying therapies

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[Is the ureteral length associated with the patient's size?]

OBJECTIVE

To assess the relation between the ureteral length and the patients' size.

PATIENTS AND METHOD

Prospective study made between September 2012 and May 2014, on 87 patients with 42 men and 45 women, in whom the ureteral measure was performed during the various procedures that require the use of a pigtail stent. The average age of the population was 53 years old (±15.9) with an average height of 168.3cm (±8.4). This has been achieved through ureteral catheter combining fluoroscopy and endoscopy.

RESULTS

The ureteral average length was 23.5cm (±2.33). The ureteral average length was 23.8cm (±2.18) for man and 23.2cm (±2.44) for women. In this population, there were a positive correlation between the size of the patients and the length of the ureters (r=0.75; P=0.01). However, this correlation was not found in all subgroups, particularly among women (r=0.16; P=0.30) and on the right side of men (r=0.34; P=0.12). This correlation was still true for the left side in the men's group (r=0.50; P=0.02).

CONCLUSION

In this study, there is a positive correlation between the patients' size and the ureteral length. But this correlation is not found in some subgroups. It is better to perform in vivo the ureteral measurement to have the precise length in order to set up a pigtail stent adapted to the patient.

LEVEL OF EVIDENCE

3.

Increasing the activity of copper exchanged mordenite in the direct isothermal conversion of methane to methanol by Pt and Pd doping

PtCu– and PdCu–mordenite allow for isothermal reaction at 200 °C for the stepwise methane to methanol conversion with higher yields under isothermal conditions than after high temperature activation.

PtCu- and PdCu–mordenite allow for isothermal reaction at 200 °C for the stepwise methane to methanol conversion with comparably high yields. In contrast to traditional Cu-zeolites, these materials are more reactive under isothermal conditions than after high temperature activation.

The Ability of Fibrinogens, FI and FII, to Support ADP- Induced Platelet Aggregation

Fibrinogen plays an integral part in ADP-induced platelet aggregation. Controversy exists in regard to the role of the carboxy termini of fibrinogen Aa chains in this reaction. We have attempted to clarify this problem in view of the availability of a highly purified FII fibrinogen fraction. Kabi fibrinogen or its purified fractions FI, FII and FIII-IV-V were added to washed platelets in the presence of Tyrode-HEPES buffer pH 7.4. Aggregation was initiated by the addition of calcium and ADP. These fibrinogen fractions equally promoted ADP-induced platelet aggregation. The major difference among these fractions is in their Aα chains. The FI fraction contains intact Aα chains while FII and FIH-IV-V fractions have one and two partially degraded Aα chains at the carboxy terminal portion respectively. We conclude that the carboxy terminal portion of the Aα chain does not play an important role in promoting ADP-induced platelet aggregation.

Down-regulation of CatSper 1 and CatSper 2 genes by lead and mercury

In the study of the expression of CatSper genes, consideration of the effects of environmental metal toxicity is very important. Therefore, in this study, the effects of lead acetate and mercury chloride exposure on expression of CatSper genes, sperm parameters, histology of testis and prooxidant antioxidant balance (PAB) values of serum were investigated. A total of 28 mice was divided into four groups. The control group did not receive injections. The sham group received normal saline intraperitoneally. Lead and mercury groups were injected 60 and 1.25 mg/kg/daily lead acetate and mercury chloride respectively intraperitoneally for 2 weeks. After 35 days, the sperm analysis and histology of left testis were performed. In addition, serum was obtained to measure the PAB values. The right testis was used for molecular analysis of real-time PCR. Administration with either lead acetate or mercury caused significant damage to the seminiferous tubules as well as a reduction in sperm parameters compared to the control group. The relative expression of CatSper 1 and CatSper 2 in the lead group was lower than that of the control group (-0.01 ± 0.24, -0.007 ± 0.52 vs. 1 ± 0.50, P = 0.34). The relative expression of CatSper 1 and CatSper 2 was significantly lower in the mercury group compared to the control ones (-0.24 ± 2.28, -4.49 ± 4.86 vs. 1 ± 0.50, P = 0.21). PAB values significantly increased in lead or mercury exposed- mice compared to the control ones (0.93 ± 0.17, 1.54 ± 0.17 vs. 0.51 ± 0.11; P ≤ 0.000). The results of this study showed that administration with either lead acetate or mercury chloride caused degenerative damage in seminiferous tubules and reduction in sperm quality and expression of CatSper 1, 2 genes in mice. Therefore, it is possible in infertile men who have had exposure to lead acetate or mercury chloride. Owing to structural similarities, these metals are substitutes for calcium ions and have effects on calcium channels. These cause immobility in sperm by blocking CatSper-specific calcium channels. However, more studies are required to elucidate the mechanism underlying the impact of different doses of heavy metals on CatSper genes expression.

Comparison of anti-Mullerian hormone level between uterine artery embolization and myomectomy in uterine fibroma

Background: Uterine fibroma was a general gynecologic condition. When pharmacological therapies fail, surgical interferences such as myomectomy, hysterectomy, or embolization of uterine artery (UAE) are used as that state. This study aimed to compare hormone of anti-Mullerian measure among two methods of UAE, myomectomy into the treatment of uterine fibroma. Material and Method: In this clinical trial held in Imam Reza Hospital of Kermanshah, 40 cases by uterine fibroma were entered into the group of UAE (20 cases) and myomectomy (20 cases). Anti-Mullerian hormone levels were measured twice (ago and later therapeutic interventions) using the Monobinal kit. The information are examined by the SPSS (ver. 20.0) software by applying the Leven's test, paired and independent t-test, Wilcoxon, and Mann-Whitney tests. Results: There is n't matter variation in terms of age between two groups (P> 0.05). Not important variation is recognized regarding anti-Mullerian hormone level before and after six months the medical intervention in either group (P> 0.05). Also, no important variation was detected among the 2 groups in terms of the anti-Mullerian hormone level (P= 0.58). Conclusion: The results obtained demonstrated that where is not statistically important variation among UAE and myomectomy by in terms of anti-Mullerian hormone, which reflects ovarian capacity. Therefore, UAE, which is a less invasive method, can be a suitable substitute for surgical methods in the therapy of significant uterine fibroids between women of the sexual period.

Enterocyte-afferent nerve interactions in dietary fat sensing

The central nervous system (CNS) constantly monitors nutrient availability in the body and, in particular, in the gastrointestinal (GI) tract to regulate nutrient and energy homeostasis. Extrinsic parasympathetic and sympathetic nerves are crucial for CNS nutrient sensing in the GI tract. These extrinsic afferent nerves detect the nature and amount of nutrients present in the GI tract and relay the information to the brain, which controls energy intake and expenditure accordingly. Dietary fat and fatty acids are sensed through various direct and indirect mechanisms. These sensing processes involve the binding of fatty acids to specific G protein-coupled receptors expressed either on the afferent nerve fibres or on the surface of enteroendocrine cells that release gut peptides, which themselves can modulate afferent nerve activity through their cognate receptors or have endocrine effects directly on the brain. Further dietary fat sensing mechanisms that are related to enterocyte fat handling and metabolism involve the release of several possible chemical mediators such as fatty acid ethanolamides or apolipoprotein A-IV. We here present evidence for yet another mechanism that may be based on ketone bodies resulting from enterocyte oxidation of dietary fat-derived fatty acids. The presently available evidence suggests that sympathetic rather than vagal afferents are involved, but further experiments are necessary to critically examine this concept.

High dietary fat intake influences the activation of specific hindbrain and hypothalamic nuclei by the satiety factor oleoylethanolamide

Chronic exposure to a diet rich in fats changes the gastrointestinal milieu and alters responses to several signals involved in the control of food intake. Oleoylethanolamide (OEA) is a gut-derived satiety signal released from enterocytes upon the ingestion of dietary fats. The anorexigenic effect of OEA, which requires intestinal PPAR-alpha receptors and is supposedly mediated by vagal afferents, is associated with the induction of c-fos in several brain areas involved in the control of food intake, such as the nucleus of the solitary tract (NST) and the hypothalamic paraventricular (PVN) and supraoptic nuclei (SON). In the present study we investigated whether the exposure to a high fat diet (HFD) alters the hindbrain and hypothalamic responses to OEA. To this purpose we evaluated the effects of OEA at a dose that reliably inhibits eating (10mg/kg i.p.) on the induction of c-fos in the NST, area postrema (AP), PVN and SON in rats maintained either on standard chow or a HFD. We performed a detailed analysis of the different NST subnuclei activated by i.p. OEA and found that peripheral OEA strongly activates c-fos expression in the AP, NST and in the hypothalamus of both chow and HFD fed rats. The extent of c-fos expression was, however, markedly different between the two groups of rats, with a weaker activation of selected NST subnuclei and stronger activation of the PVN in HFD-fed than in chow-fed rats. HFD-fed rats were also more sensitive to the immediate hypophagic action of OEA than chow-fed rats. These effects may be due to a decreased sensitivity of vagal afferent fibers that might mediate OEA's actions on the brain and/or an altered sensitivity of brain structures to OEA.

The familial aggregation of cigarette smoking in kish, iran

BACKGROUND

Based on WHO reports, smoking is an epidemic in developing countries. One of important issues about this behavior is its distribution pattern in family members. The main purpose of this study was to evaluate if cigarette smoking had a tendency to cluster or aggregate in the families and what the determinants were.

METHODS

Using a multi-stage random cluster sampling approach, a household survey was conducted in Kish Island in 2009. We used the Alternating Logistic Regressions algorithm to model to show the familial aggregation.

RESULTS

The odds ratio for the aggregation of cigarette smoking between family members was 1.63 (1.29-2.06) which increased to 1.96 (1.50-2.55) after adjustment for demographic factors. There was no significant correlation between siblings' cigarette smoking nor was between spouses but the pairwise odds ratio for parents offspring was significant. In other words, cigarette smoking in at least one of the parents increased the odds of being a smoker in offspring significantly.

CONCLUSION

The study showed that the smoking behavior aggregated in families significantly. The inter-parent offspring aggregation was the main component of the familial aggregation. Higher education and age-gender interaction were determinants of smoking in the families. The programs for prevention and cessation of this behavior in the community might be more successful if they were designed in a family-based rather than an individual-based approach.

Effect of group reminiscence therapy on depression in older adults attending a day centre in Shiraz, southern Islamic Republic of Iran

The aim of this study was to examine the effectiveness of group reminiscence therapy on depression symptoms among elderly people attending a day centre in Shiraz, Islamic Republic of Iran. A sample of 49 people aged 60+ years participated in 6 group reminiscence sessions that were held twice weekly for a 3-week period and completed a Farsi version of the 15-item geriatric depression scale. Mean depression scores decreased significantly from 8.18 (SD 1.20) before the intervention to 6.73 (SD 1.20) immediately after it and 7.55 (SD 1.19) 1 month after the intervention. When analysed by demographic characteristics only marital status showed a statistically significant difference in depression scores comparing before and after the intervention.

Recurrent retinal detachment: does initial treatment matter?

BACKGROUND/AIMS

To evaluate the treatment course of patients with primary rhegmatogenous retinal detachment (RRD) that re-detach after initial retinal detachment surgery.

METHODS

Patients were divided into three groups based on initial surgical treatment: scleral buckle procedure (SBP) (63 eyes), pars plana vitrectomy (PPV) (88 eyes) and combined SBP/PPV (135 eyes). Charts were reviewed for a mean follow-up of 12 months.

RESULTS

Average number of secondary procedures to achieve anatomical success was lowest in the SBP group (1.1), compared with the PPV group (1.47) and the SBP/PPV group (1.5) (p<0.05). Patients that re-detached after initial PPV/SBP, PPV or SBP required silicone oil injection in 83%, 60% and 22% of the cases and had final best-corrected visual acuity better than or equal to 20/50 in 21%, 33% and 45% of the cases, respectively. Phakic patients that re-detached after initial treatment with PPV/SBP, PPV and SBP required pars plana lensectomy (PPL) in 42%, 25% and 12.5% of the cases, respectively.

CONCLUSION

Patients with primary RRD that re-detach after initial treatment with SBP require fewer number of secondary operations and silicone oil injections, show a trend for better visual outcomes and are less likely to develop dense cataract or to require PPL compared to patients that re-detach after initial PPV or PPV/SBP.

The homeobox gene Arx is a novel positive regulator of embryonic myogenesis

Skeletal muscle fibers form in overlapping, but distinct phases that depend on the generation of temporally different lineages of myogenic cells. During primary myogenesis (E10.5-E12.5 in the mouse), embryonic myoblasts fuse homotypically to generate primary fibers, whereas during later development (E14.5-E17.5), fetal myoblasts differentiate into secondary fibers. How these myogenic waves are regulated remains largely unknown. Studies have been hampered by the lack of markers which would distinguish embryonic from fetal myoblast populations. We show here that the homeobox gene Arx is strongly expressed in differentiating embryonic muscle, downstream of myogenic basic helix-loop-helix (bHLH) genes. Its expression progressively decreases during development. When overexpressed in the C2C12 myogenic cell line, Arx enhances differentiation. Accordingly, it stimulates the transcriptional activity from the Myogenin promoter and from multimerized E-boxes when co-expressed with MyoD and Mef2C in CH310T1/2. Furthermore, Arx co-immunoprecipitates with Mef2C, suggesting that it participates in the transcriptional regulatory network acting in embryonic muscle. Finally, embryonic myoblasts isolated from Arx-deficient embryos show a delayed differentiation in vivo together with an enhanced clonogenic capacity in vitro. We propose here that Arx acts as a novel positive regulator of embryonic myogenesis by synergizing with Mef2C and MyoD and by establishing an activating loop with Myogenin.

Free radical generation by skeletal muscle of adult and old mice: effect of contractile activity

Oxidative modification of cellular components may contribute to tissue dysfunction during aging. In skeletal muscle, contractile activity increases the generation of reactive oxygen and nitrogen species (ROS). The question of whether contraction-induced ROS generation is further increased in skeletal muscle of the elderly is important since this influences recommendations on their exercise participation. Three different approaches were used to examine whether aging influences contraction-induced ROS generation. Hind limb muscles of adult and old mice underwent a 15-min period of isometric contractions and we examined ROS generation by isolated skeletal muscle mitochondria, ROS release into the muscle extracellular fluid using microdialysis techniques, and the muscle glutathione and protein thiol contents. Resting skeletal muscle of old mice compared with adult mice showed increased ROS release from isolated mitochondria, but no changes in the extracellular levels of superoxide, nitric oxide, hydrogen peroxide, hydroxyl radical activity or muscle glutathione and protein thiol contents. Skeletal muscle mitochondria isolated from both adult and old mice after contractile activity showed significant increases in hydrogen peroxide release compared with pre-contraction values. Contractions increased extracellular hydroxyl radical activity in adult and old mice, but had no significant effect on extracellular hydrogen peroxide or nitric oxide in either group. In adult mice only, contractile activity increased the skeletal muscle release of superoxide. A similar decrease in muscle glutathione and protein thiol contents was seen in adult and old mice following contractions. Thus, contractile activity increased skeletal muscle ROS generation in both adult and old mice with no evidence for an age-related exacerbation of ROS generation.

Neurohypophysial dysmorphogenesis in mice lacking the homeobox gene Uncx4.1

A number of transcription factors have been implicated in the development of the hypothalamo-neurohypophysial system (HNS). Null mutations for these factors caused severe defects in proliferation, migration and survival during early embryogenesis. While they have informed about early events of HNS developments no insights in mechanisms of late development and maturation of this major peptidergic system have been obtained as yet. In a screen for adult-expressed homeobox genes we identified Uncx4.1 as a gene expressed in adult and embryonic magnocellular neurons of the (HNS). Null mutation of Uncx4.1 left these neurons viable and able to express neuropeptides. However, the connectivity of magnocellular neurons with posterior pituitary elements was compromised. As a consequence neuronal fibres traversed to the adenohypophysis. The penetrance of this phenotype was about 50%. The data show a selective role of Uncx4.1 in controlling the development of connections of hypothalamic neurons to pituitary elements, allowing central neurons to reach the peripheral blood circulation and to deliver hormones for control of peripheral functions.