Background: High-resolution manometer (HRM) of the esophagus has become the main diagnostic test in the evaluation of esophageal motility disorders. The development of high-resolution manometry catheters and software displays of manometry recordings in color-coded pressure plots have changed the diagnostic assessment of esophageal disease. The first step of the Chicago classification described abnormal esophagogastric junction deglutitive relaxation. The latest classification system, proposed by Pandolfino et al, includes contraction patterns and peristalsis integrity based on integrated relaxation pressure 4 (IRP4). It can be discriminating the achalasia from non-achalasia esophageal motility disorders. The aim of this study was to assessment of clinical findings in non-achalasia esophageal motility disorders based on the most recent Chicago classification.
Methods: We conducted a prospective cross-sectional study of 963 patients that had been referred to manometry department of Gastrointestinal and Liver Research Center, Firozgar Hospital, Tehran, Iran, from April, 2012 to April, 2015. They had upper GI disorder (Dysphasia, non-cardiac chest pain, regurgitation, heartburn, vomiting and asthma) and weight loss. Data were collected from clinical examinations as well as patient questionnaires. Manometry, water-perfused, was done for all patients. Manometry criteria of the patients who had integrated relaxation pressure 4 (IRP4) ≤ 15 mmHg were studied.
Results: Our finding showed that the non-achalasia esophageal motility disorders (58%) was more common than the achalasia (18.2%). Heartburn (68.5%), regurgitation (65.4%) and non-cardiac chest pain (60.6%) were the most common clinical symptoms. Although, vomiting (91.7%) and weight loss (63%) were the most common symptoms in referring patients but did not discriminate this disorders from each other’s. Borderline motor function (67.2%) was the most common, absent peristalsis (97%) and the hyper-contractile esophagus were rarest in the non- achalasia esophageal motility disorders.
Conclusion: However, achalasia is a treatable esophageal motility disorder but non-achalasia esophageal motility disorders were more common. Thus, manometrial study is an imperative tool for proper diagnosis and treatment of these patients, especially in gastro-esophageal reflux disease. Clinical finding could not accurately diagnosis between different types of non-achalasia esophageal motility disorders from each other’s.
Methods: To examine immune system responses to sports activities, articles were collected from all databases: Science Direct, PubMed, Scopus, Web of Science, Springer, Google Scholar, SID, and the most recent articles were selected.
Results: High-intensity and long-term physical exercise can be effective in suppressing immune responses. Therefore, moderate-intensity exercise can be an effective strategy. Maintaining the function of the immune system in athletes was dependent on nutritional strategies, sleep control, stress management, and strict adherence to proper exercise principles and health protocols. Athletes are more prone to viral infections in the early hours after strenuous, prolonged physical exercise; and they should be limited in contact with people who may increase their risk of infectious diseases. We should mention that moderate-intensity physical exercise can improve the function of immunoglobulins, anti-inflammatory cytokines, neutrophils, natural killer cells, cytotoxic T cells, and immature B cells. Maintaining social distance, especially immediately after strenuous exercise, is also recommended for athletes due to the increased risk of infectious diseases. The immune system has been considered an effective part of sports activities in athletes in recent years. The prevalence of viral diseases such as COVID-19 has not been and will not be for the first and last time in life. Therefore, using questionnaires and initial monitoring (adherence to diets, corona testing, adherence to health protocols) can be the first step. Conclusion: Finally Due to the pandemic of coronary heart disease and its unknowingness, providing some health and nutrition guidelines for starting exercises and sports competitions to prevent the transmission of this disease is on the agenda of this article. |
Conclusion: Managers need to focus on high-frequency and high-cost services to reduce the cost and financial losses for services that are under the global payment system. Depending on the specific cost pattern of each service, the strategies adopted to control the costs of that service should also be different.
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Conclusion: Complications of pregnancy and childbirth in pregnant women infected with Corona virus include an increase in premature birth and an increase in the rate of cesarean section. Pregnancy in women with scleroderma at the right time and careful delivery monitoring will increase the probability of successful pregnancy outcome and all patients need counseling.
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Results: Of the 91 hospitalized patients, 70.3% (64 cases) were prescribed vancomycin without performing an antibiogram culture based on experience and 29.7% (27 cases) were based on an antibiogram culture. In 96.7% (88 cases) , the duration of intravenous vancomycin infusion did not comply with the protocol. Red Man Syndrome was observed in 8.8% (8 cases). In 91.2 % (83 cases), no adverse effects were reported. In 65.9% (60 cases), the drug dose was determined based on the correct renal function Glomerular filtration rate (GFR) and in 34.1%, the drug dose was determined regardless of the renal function of the patients. Vancomycin doses were lower and higher than the guidelines in 6 and 25 patients, respectively. Out of all patients, eighty four cases recovered and seven cases died.
Conclusion: In almost half of the patients, Vancomycin were prescribed based on experience and without performing an antibiogram test. Use of guidelines, Serum level monitoring programs and continuous medical education for doctors can be effective in rational use of antibiotics. |
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