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This study aims to know the Brazilian medical literature scientific production on spirituality as a health care practice, as well as to identify the principal interventions-executed by these professionals-that have been characterized as Integrative and Complementary Health Practices. A scope methodology proposed by the Joanna Briggs Institute was used in the following phases: identification of research questions; identification of relevant studies; selection of studies; data mapping; grouping, synthesis of results. Two researchers alone carried out the searches, and a third researcher responded to the doubts of inclusion and exclusion of the identified articles. PubMed was the database, with the descriptors in Portuguese and English. Among the 71 articles identified, 27 were analyzed. The largest number of studies is concentrated in 2016 (44.44%). Concerning the type of study, the clinical trial prevails (77.77%). It was through meditation (29.63%) and Yoga (25.92%) that the discussion of spirituality-as Integrative and Complementary Practices in Health-materialized. Both had positive implications on the health of the groups participating in the studies. Based on the articles synthesis and on the regulations by the Ministry of Health and World Health Organization, it is plausible to assert that spirituality is ingrained in Integrative and Complementary Health Practices and that the concern in these practices has been enhancing.

There are disagreements about the diagnostic value of the current risk stratification systems in patients with acute upper gastrointestinal bleeding (UGIB). The present study aimed to determine the diagnostic value of the Glasgow-Blatchford score in UGIB patients. This study was conducted on 182 patients with UGIB who underwent endoscopy in the Emergency Department of Imam Reza Hospital, Mashhad, Iran. Glasgow-Blatchford Score (GBS) of each patient was estimated by using the clinical and laboratory parameters. The relationship between Blatchford score and endoscopic findings was assessed. Additionally, the sensitivity and specificity of GBS were measured based on high- and low-risk patients. According to the results, GBS had a high sensitivity (90.9%), specificity (79%), as well as positive (76%), and negative predictive values (92.2%). However, no significant relationship was observed between the Glasgow-Blatchford score and re-bleeding. As the findings of the present study indicated, Glasgow-Blatchford was a good predictive method for the determination of the high-risk and low-risk patients with UGIB. Nevertheless, this method showed poor performance in the prediction of re-bleeding.

Retinopathy of prematurity (ROP) remains a painful examination, despite the common application of local anesthetic eye drops. This study aimed at examining the analgesic effects of 25% glucose in a premature infant pain profile (PIPP) in the first eye examination of infants with ROP. This three-group, randomized clinical trial was conducted from March to February 2017. One oral dose of 25% glucose solution (1 cc/kg) was administered one minute before the first examination of ROP. Mydriatic and anesthetic eye drops were locally instilled in the eyes before the examination for each group. Then, comparisons were made with the control group, which did not receive oral glucose (B), as well as the group which received 1 ml/kg of distilled water (C). The main investigator, who was blinded to the groups, evaluated pain using PIPP at one minute before, during, and one and five minutes after the procedure (ethics code: IR.TUMS.MEDICINE.REC.1396.3130). The baseline characteristics were comparable between the groups. During the procedure, the group receiving oral 20% glucose showed significantly lower PIPP scores (13.8±1.39) compared to the other groups (group B: 15.95±1.27 and group C: 15.10±1.19) (P=0.001). The positive effects persisted for five minutes in this group after the procedure (7.6±1.26), compared to the other groups (P=0.034). During and after ROP screening, oral 25% glucose in combination with local anesthetic eye drops can cause a significant reduction in pain.

Kawasaki disease (KD) is an acute febrile systemic vasculitis of unknown etiology and the major cause of pediatric acquired cardiac disease worldwide, particularly in developed countries. This study characterizes the epidemiologic and clinical features of KD in the Pediatric Rheumatology Department service in a general hospital. 120 patients with the diagnosis of KD between 1990 and 2009 were enrolled. We investigated the epidemiologic and clinical features of coronary artery involvement of the patients. Frequency of many parameters including age, sex, season, clinical and laboratory findings, response to treatment, and complications of the patients determined. During the 20-year study period, 120 patients <15 years of age were admitted for KD. Among them, 39.2% were at the extremes of the age spectrum, with 2.5% <6 months and 36.7% >5 years of age, male to female ratio of 1.3:1 and the classic KD to incomplete KD ratio of 3.1:1. KD recurred in 5% of all cases. It occurred most frequently in the winter and least frequently in the summer. The occurrence of coronary artery abnormalities (CAA) was 4.2%. Kawasaki disease should be considered in any pediatric patients with a prolonged refractory febrile illness in order to prevent CAA formation.

Oral ibuprofen has been known as a conventional treatment for closing patent ductus arteriosus (PDA) in preterm newborns. Since the use of it might lead to various side effects, other treatments needed to be evaluated. Therefore in a prospective study, we compared the efficacy and safety of intravenous acetaminophen versus oral ibuprofen for the closure of PDA. In this study which was done prospectively and under control, 50 preterm neonates with gestational ages and weights less than 37 weeks old and 2500 grams, respectively, who had PDA, large enough hemodynamically, were included in the study. The patients were divided into two groups: A (intravenous acetaminophen) & B (oral ibuprofen). The two groups were given at most two 3-day courses of the medication (the second course if necessary) and evaluated at the end of each course by echocardiography so as to determine the response to the treatment at each step. The rate of ductal closure, the need for additional treatment, side effects, complications and the newborn’s clinical status were recorded. The rate of ductal closure in the both groups after one course of treatment was similar and showed no meaningful significance statistically (P=0.306). But that of the side effects was much higher in group B with a P=0.021. Intravenous Acetaminophen is not only as efficacious as oral Ibuprofen for the treatment of PDA in preterm infants, but also is less likely to lead to side effects and complications.

Several studies have been conducted on the effect of transcranial direct current stimulation on adult patients. But, in recent years, only a few studies have been carried out in children and teenagers because the aim of the present study was to compare the effectiveness of TACS and Ritalin in the treatment of attention deficit hyperactivity disorder (ADHD) symptoms. This interventional clinical trial study was performed on 62 children with ADHD who were referred to the private psychiatric clinic of children in Tehran. The children were randomly assigned to two coded groups based on a lottery so that they were enrolled in the TACS or the Ritalin group. A questionnaire child syndrome inventory (parental form) and integrated visual and auditory (IVA) test with a pretest and posttest design was used in this study. TACS therapy protocol was employed (3 days a week for eight weeks using alternating current stimulation at 10 Hz over two points on the prefrontal cortex: the anode centered over F3 [the left dorsolateral prefrontal cortex] and the cathode over F4[the right dorsolateral prefrontal cortex]). Results showed that the posttest scores of the TACS-treated group were higher than those of the Ritalin-treated group, and there was a significant difference between the areas of visual attention (visual vigilance, visual focus, Sustained attention visual) and response control visual and auditory prudence (P<0.05). Results indicated that TACS was more effective and more durable compared to Ritalin in reducing attention deficit, hyperactivity, and impulsivity.

Our aims were determining the student’s views about the effect of using the study guide on advance preparation in a flipped class setting and testing the effect of flipped class on higher cognition. Using a quasi-experimental design in Tehran University of Medical Sciences, one batch was taught using a flipped classroom and another batch by a lecture in 3 sessions. The student’s views were assessed using a questionnaire, and the effect of flipped class on levels of higher cognition based on Bloom's taxonomy was measured using two tests in two-time intervals. Seventy-two students believed that the study guide helped them to devote their time to study. Data did not support our hypothesis that flipped class could result in higher cognition one month and four months after the intervention T=-0.75, df=197, P=0.45 in knowledge Questions, T=-1.08, df=197, P=0.28 in comprehensive questions, T=-0.30, df=197, P=0.76 in an application, and T=-0.91, df=197, P=0.36 in analytical questions. Study guides could be effective tools to get students to interact with pre-assigned readings in a flipped class context. Our hypothesis that flipped class could result in higher cognition was not supported.

Mucous membrane pemphigoid (MMP) is a rare inflammatory, autoimmune, and subepithelial vesiculobullous disease in which tissue-bound autoantibodies are produced against one or more components of the basement membrane. Oral lesions of the pemphigoid begin in the form of vesicles or bullae that often involve throughout the mouth but may be confined to specific areas, especially the gingiva, in a pattern known as desquamative gingivitis. The positive Nikolsky's sign is characteristic of pemphigus vulgaris, in which a blister can appear on the normal-appearing skin if exerting lateral pressure, and is very rare in the mucosa and other vesiculobullous diseases. Here we report a case of mucous membrane pemphigoid that developed as desquamated gingivitis in a 46-year-old woman with positive Nikolsky's sign in the gingival mucosa. In the histopathologic view, a subepithelial cleft was observed. The results of direct and indirect immunofluorescence tests and related therapeutic interventions are also presented. Positive Nikolsky's sign can be observed in the mucosa as well as in the mucous membrane pemphigoid in addition to pemphigus vulgaris, and vesiculobullous lesions should be diagnosed based on the sum of clinical, histopathological, and immunofluorescence findings.

A lack of congenital Inferior Vena Cava (IVC) is an uncommon malformation that has been identified in combination with idiopathic Deep Venous Thrombosis (DVT), exclusively. It may not even be revealed during the lifetime. A 63-year-old female was accepted with three months of abdominal and pelvic pain and localized edema on the right flank. During this admission, she was examined and recognized for deep vein thrombosis (DVT). Ct scan images showed a lack of the Inferior Vena Cava with enormous thrombosis collaterals of the superficial vein in the abdomen. In this case report, we report a woman with side pain who has an absence of the IVC.

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