Cardiologists play an important role in assisting cardiac patients who

Cardiologists play an important role in assisting cardiac patients who experience sexual dysfunction to learn how to live with their disability and return to normal sexual activity. Therefore, it Dihydromyricetin is necessary that cardiologists assess these problems in this group of patients. Lack of such provision could have long-term side effects for patients and their partners. To the best of our knowledge, no study has assessed cardiologists\’ attitudes toward and performance of discussing sexual issues in Iran. Only one study was carried out in Kerman, Iran, and it concerned the knowledge and attitude of nurses toward sexual activity. Therefore, the aim of the present study was to evaluate the attitudes and performance of cardiologists concerning sexual issues in patients with CVD; thus, we examined whether cardiologists in Iran assessed sexual problems with their patients and, if not, their reasons for not doing so.



This study is the first nationwide survey in Iran to investigate the attitudes and performance of cardiologists about sexual issues in patients with CVD. The key findings of this study conclude there is a gap between cardiologists\’ attitudes and their actual practices. Most cardiologists agreed with the importance of sexual issues for cardiac patients, but they did not routinely discuss sexuality with their patients. Previous studies have found that most health care providers and cardiologists do not routinely ask patients about sexual problems.
Almost half the participants reported that if patients ask questions about their sexual activities, they regularly answer them (passive performance); the survey findings indicated that the cardiologists believed the conversation about sexual issues should be initiated by the patients. This finding is similar to the study conducted by Nicolai et al, which indicated that more than half the respondents expected the patient to take the lead in discussing sexual function. In a survey by Vassiliadou et al, cardiologists stated that patients much more often initiated discussion about difficulties with sexual performance.
Most cardiologists accepted their responsibility for addressing the sexual issues of patients with CVD, but only one third of them were confident about their knowledge and skills. In the survey by Nicolai et al, approximately one third of cardiologists accepted their responsibility to discuss sexual matters with their patients and most stated fucoxanthin had “some” or “a lot” of the necessary knowledge to discuss sexual problems with their patients. In these two studies, cardiologists did not routinely discuss sexuality with their patients. The factors indicated to cause cardiologists\’ lack of routine in assessing sexual health were somewhat different; for example, almost half the Dutch cardiologists indicated the absence of an opening to raise the subject as an important reason not to raise it, but patient discomfort and cultural and religious reasons appeared to be important obstacles for most participants in the present study.
Similar to the results reported by Nicolai et al, these findings are alarming because, since 1999, several recommendations for the clinical management of sexual function in men and women with CVD have been provided to help physicians communicate with patients about sexual activity.
Several factors can be effective in cardiologists\’ lack of routine in assessing sexual issues. The first assumption is that they have insufficient knowledge about sexual issues of patients with CVD. We did not examine the knowledge of cardiologists about the sexual issues of patients with CVD, but approximately two thirds of cardiologists stated they did not have enough knowledge and skills. Because most cardiologists stated that the sexual issues of patients is important from their own viewpoint and that most of them are motivated to receive additional training, there seems to be a need for more knowledge and training to help them understand how to conduct a sexual assessment and offer counseling. In the study about physicians\’ knowledge of ED in Saudi Arabia, the cardiologists scored lower marks than urologists, andrologists, and general surgeons. Another study conducted on Dutch cardiologists indicated that most cardiologists had insufficient knowledge about the effects of cardiovascular drugs on sexual function. A study about cardiologists\’ knowledge and opinions concerning their patients\’ sexual activity indicated that Greek cardiologists tend to underestimate the scale of the problem and are poorly informed about all aspects of cardiac patients\’ sexual issues. One comprehensive review about the state of sexual health education worldwide has shown that sexual medicine education is inadequate in most centers; therefore, cardiologists might need more knowledge and specific practical training to conduct the sexual assessment and counseling of cardiac patients.

Introduction Various medical conditions can affect the

Various medical conditions can affect the oral health of patients. With advances in medical treatment and improved survival rates for many disorders, dentists can be expected to treat an increasing number of patients with complex medical conditions. In particular, the prevalence of chronic renal disease (CRD) is increasing worldwide (Olivas-Escárcega et al., 2008). Common renal disorders seen in children include congenital nephropathies, nephrotic syndrome, chronic renal failure (CRF), glomerulonephritis, hydronephrosis, and multicystic renal dysplasia, which ultimately lead to end-stage renal disease (ESRD) (Bagga et al., 2009; Warady and Chadha, 2007).
CRF is a progressive and irreversible decline in the total number of functioning nephrons, which causes a decline in the glomerular Dihydromyricetin rate. CRF is accompanied by clinical and laboratory changes that are related to the inability of the kidney to excrete metabolites and perform endocrine functions, including secretion of active vitamin D and erythropoietin (Fogo and Kon, 2004). Nephrotic syndrome is a common chronic disorder that is characterized by alterations of permselectivity at the glomerular capillary wall, resulting in protein loss through the urine. Nephrotic range proteinuria is defined as proteinuria exceeding 1000mg/m2/d or a spot urinary protein-to-creatinine ratio exceeding 2mg/mg (Bagga and Mantan, 2005). ESRD is the stage when renal replacement therapy by dialysis or transplantation is required (Greenberg and Glick, 2003).
In children, renal disease can give rise to a wide spectrum of oral manifestations in the hard and soft tissues. Renal disease may lead to the development of pale oral mucosa (Al Nowaiser et al., 2003), dental calculus (Davidovich et al., 2009; Martins et al., 2008), enamel hypoplasia (Al Nowaiser et al., 2003; Martins et al., 2008), dry mouth (Martins et al., 2008), low caries rate (Al Nowaiser et al., 2003; Nakhjavani and Bayramy, 2007; Nunn et al., 2000), poor oral hygiene, and uremic stomatitis, and may cause changes in the salivary composition (Guzeldemir et al., 2009) and flow rate (Al Nowaiser et al., 2003; Guzeldemir et al., 2009; Martins et al., 2008). These complications can lead to excessive bleeding, anemia, increased susceptibility to infection, drug intolerance, renal osteodystrophy, adrenal crisis, and enamel defects in children. This manuscript provides an up-to-date review of the clinical and oral manifestations of CRD and the role of pediatric dentists in the treatment of patients with CRD.

There is limited information on the epidemiology of CRD in the pediatric population. Because this disease is often asymptomatic in its early stages, it is both underdiagnosed and underreported (Warady and Chadha, 2007). The estimated incidence of ESRF in childhood, either due to a congenital or acquired condition, is 10–12 cases per 1 million children, with a prevalence varying from 39 to 56 million children (Trivedi and Pang, 2003). In North America, up to 11% of the population (19 million) may have chronic kidney disease (Coresh et al., 2003). Surveys in Australia, Europe, and Japan describe the prevalence of chronic kidney disease to be 6–16% of their respective populations (El Nahas and Bello, 2005; Hallan et al., 2006). The overall prevalence of genetic kidney disease in children in Australia and New Zealand is 70.6 children per million in the age-representative population. Congenital anomalies of the kidney and urinary tract (16.3 cases per million children) and steroid-resistant nephrotic syndrome (10.7 cases per million children) are the most frequent anomalies (Fletcher et al., 2013).
Fifty-seven percent of the world’s population resides in Asia, which is a geographic region characterized by a very high proportion of children. In spite of this, epidemiological information from Asia is scant and primarily based on patients referred to tertiary medical centers (Hari et al., 2003). Estimates of the annual incidence of nephrotic syndrome range from 2 to 7 cases per 100,000 children and prevalence from 12 to 16 cases per 100,000 (Eddy and Symons, 2003). There is epidemiological evidence of a higher incidence of nephrotic syndrome in children from South Asia (Mc Kinney et al., 2001). Prevalence rates of genetic renal diseases, like congenital and infantile nephrotic syndrome, are high in Kingdom of Saudi Arabia. Postinfection glomerular pathologies are also common (Kari, 2012).

br Conclusions In this research

In this research, the use of intact skin, blood, bone marrow and internal organs proved efficient for diagnosing leishmaniosis by PCR and its variant. Asymptomatic dogs should be monitored in areas where human cases have been reported. L. (V.) braziliensis was transferred from the skin to the internal organs via the bloodstream, increasing the dogs’ exposure to the vector, which could indicate a significant participation in the protozoan cycle. Future studies with xenodiagnosis using competent phlebotomine sand flies are required to more accurately define the dog’s role in this complex disease.

Competing interests

This study was supported by the National Council for Scientific and Technological Development, Brazil (CNPq, grant no. 480292/2012-4), CAPES (PNPD grant no. 2847/2011) and by the Fundação Araucária (FA, grant no. 122).

Haemaphysalis longicornis is a species of hard tick (Ixodidae) and the only one that infests livestock in New Zealand (Heath, 2016). The progressive expansion of the range of H. longicornis in New Zealand has been mapped three times since first discovered in 1911 near Kaitaia, Northland (Myers, 1924). These distribution maps were compiled by Myers (1924), Neilson (1980) and Heath (2016) and are reproduced in Fig. 1. The Myers (1924) map was based on field observation of ticks on livestock and anecdotal evidence, the Neilson (1980) map was based on a postal survey, published data (Heath, 1974, 1977) and personal communication, and the Heath (2016) map was the result of a comprehensive telephone survey, field observation and tick surveillance on deer (McFadden et al., 2016b). However no attempt has been made to model the spatial distribution of H. longicornis in the interim.
The phenology of H. longicornis has been extensively reviewed by Heath (2016), but briefly H. longicornis is a three-host tick, requiring a new host for each of the three independent feeding stages, and has four stages in its life cycle; egg, six-legged larva, eight-legged nymph, and eight-legged adult. The largest proportions of the tick’s life Dihydromyricetin by time are occupied by the free-living stages which are spent mostly hidden under herbage at ground level. Studies on the abiotic (=free-living) requirements of H. longicornis stages and instars show that relative humidity, rainfall and temperature are integral to their development and survival and that for each stage there are subtle differences in these requirements (Heath, 1979, 1981, 2016; Yano et al., 1985). The biotic (=on-host) requirements for H. longicornis are extensively met in New Zealand and suitable hosts include cattle, deer, goats, horses, hares, sheep, dogs, kiwis, and even humans (Myers, 1924; Heath, 2016).
H. longicornis is haematophagous during all the active life stages and is considered to be the only competent vector for Theileria orientalis in New Zealand (Heath, 2016). Other bovine disease organisms for which H. longicornis is a known competent vector include Babesia ovata (cattle), B. major (cattle and wild ruminants) and Anaplasma bovis (cattle and small ruminants). However, none of these pathogens occur in New Zealand (Heath, 2002). The haemoplasmas Mycoplasma wenyonii and Candidatus Mycoplasma haemobos do occur in New Zealand (McFadden et al., 2016a) and it is probable that H. longicornis is also involved in their transmission.
T. orientalis is a tick-borne, obligate intracellular protozoan parasite of cattle and buffaloes, and belongs to the phylum Apicomplex### (Watts et al., 2016). Theileria-associated bovine anaemia (TABA) is an infectious disease of cattle associated with types of the T. orientalis group, in which affected cattle can sometimes develop a severe and life threatening anaemia (McFadden et al., 2013). Since 1982 there have been 2 epidemics of TABA in New Zealand (James et al., 1984; Lawrence et al., 2016a) with the latest starting in 2012 being associated with the more pathogenic T. orientalis (Ikeda) type (Gias et al., 2016; Pulford et al., 2016). Even so the estimated mortality rates associated with Ikeda infection are low, 0.24% in New Zealand (Vink et al., 2016) and between 0.13 and 0.29% in Japan (Shimizu et al., 1992).