Journal of Clinical and Basic Research

Effectiveness of Acceptance and Commitment Therapy on Psychological Hardiness, Social Isolation and Loneliness of Women with Breast Cancer

Seyyed Kamal Mirniyam

Background and objectives: There are alternative and complementary approaches for general health issues and palliative care for women with breast cancer. This study aimed at evaluating the effectiveness of acceptance and commitment therapy (ACT) on psychological hardiness, social isolation, and loneliness of women with breast cancer.
Methods: This was a quasi-experimental study with a pretest-posttest design. The study population consisted of all women with breast cancer who had been referred to the oncology ward of Shohada Tajrish Hospital in Tehran (Iran) in 2020. Thirty subjects were enrolled via purposive sampling and then assigned to an experimental group (n=15) and a control group (n=15). The experimental group received eight sessions of ACT interventions (90 minutes a session), and the control group did not receive any intervention. The subjects were followed-up for eight weeks after the last ACT session. Data were collected using the Lang and Goulet Psychological Hardiness Scale, Social Isolation Questionnaire, and the UCLA Loneliness Scale. The collected data were analyzed using repeated measures ANOVA.
Results: The mean age of subjects and mean duration of marriage were 34.23±6.12 years and 8.46±5.14 years, respectively. Based on the findings, the mean scores of psychological hardiness (p=0.005), social isolation (p=0.001), and loneliness (p=0.001) differed significantly between the study groups in the posttest stage.
Conclusion: According to the results, it seems that ACT is effective in increasing psychological hardiness and reducing social isolation and loneliness of women with breast cancer.

A Review of Pleiotropic Potential of Erythropoietin as an Adjunctive Therapy for COVID-19

Mohamad Reza Kalani

Coronavirus disease 2019 (COVID-19) is a severe acute respiratory disease with a high prevalence. According to the research and statistical data, in January 2021, there have been 92,262,621 confirmed cases of COVID-19 and more than two million deaths. Infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the main cause of this disease. In addition to the respiratory system, the disease affects the gastrointestinal tract, central-peripheral nervous system, circulatory system, and kidneys. Therefore, any therapeutic action to reduce COVID-19-related symptoms and complications is essential. In this study, we conducted a systematic review of the published literature and preprints on the efficacy of erythropoietin (EPO) and recombinant human EPO as a safe stimulant and tissue protector in the treatment of COVID-19. We also briefly described the structure of coronavirus, its pathogenesis, and the structure of EPO and recombinant human EPO. All relevant articles published in the Science Direct, PubMed, and Google Scholar databases were searched. According to the results, EPO is a cytoprotective cytokine induced by hypoxia. The pleiotropic effects of EPO are associated with its erythrocyte-forming, anti-apoptotic, anti-inflammatory activities. It also exerts protective effects on the heart, lungs, kidneys, arteries, and central and peripheral nervous systems. It has been demonstrated that EPO can increase hemoglobin levels, thereby increasing oxygen delivery to the tissues. Therefore, recombinant human EPO therapy can be used for counteracting the adverse effects of COVID-19 including hypoxic myocarditis, acute renal failure, pulmonary edema, and brain-spinal cord ischemic injury. Overall, the use of EPO and recombinant human EPO therapy increases blood coagulation, tumor growth, thromboembolism, and purification of red blood cells, which must be accompanied by anticoagulants such as heparin.

Evaluation of Plasma Levels of Folic Acid and Homocysteine in Babies Born With Various Types of Neural Tube Defects: A Single Center Study in South India

Anitha Nancy

Background and objectives: Neural tube defects (NTDs) are common congenital anomalies caused by genetic, environmental, or nutritional factors. Normal plasma folic acid levels in the fetus are required for proper development of the neural tube. Plasma folic acid level has an inverse relationship with homocysteine level. This study aimed to determine plasma folic acid and homocysteine levels in babies born with NTDs and healthy controls.
Methods: The study included 30 clinically diagnosed NTD cases and 30 healthy age- and sex-matched control subjects. Plasma levels of folic acid and homocysteine were measured using a direct chemiluminescence method. Data were compared using the independent t-test. Statistical analysis of data was performed using GraphPad InStat 3.0 at significance of 0.05
Results: The mean plasma level of folic acid in NTD cases (5.1±4.9 mol/l) was significantly lower than that in healthy controls (19.5±2.1 mol/l) (p<0.05). The mean plasma level of homocysteine in NTD cases (14.3 ± 2.4 ng/ml) was significantly higher than that in healthy controls (4.9±1.8 ng/ml)(p<0.05). The mean plasma level of folic acid was 20.1±1.5 µmol/l, 8.5 ±2.9 µmol/l, and 1.9 ±0.4 µmol/l in mild, moderate, and severe cases of NTD, respectively. The mean plasma level of homocysteine was 10.7±3.4 ng/ml, 15.4±1.2 ng/ml, and 18.5±0.8 ng/ml in mild, moderate, and severe cases of NTD, respectively.
Conclusion: Low level of folic acid and high level of homocysteine are directly associated with the development of neural tube abnormalities. Moreover, the severity of the NTD is inversely related to plasma level of folic acid and directly related to plasma level of homocysteine.

A Case of Late Infantile Metachromatic Leukodystrophy Presenting with Gradually-onset Paraplegia

Sara Rahafard

Background: Metachromatic leukodystrophy (MLD) is an autosomal recessive neurodegenerative disease, with an estimated prevalence rate of 1 per 40,000 to 160,000 worldwide. Progressive alteration in motor and cognitive functions is the most common clinical presentation. Late infantile MLD is the most common form of the disease that presents with a progressive decrease in visual acuity, impaired swallowing, muscle rigidity, seizures, and developmental delays. We herein present a rare case of late infantile MLD in a four-and-half-year-old male patient presenting with gradually-onset paraplegia.
Case description: The patient had normal growth and neurodevelopmental pattern until 15 months of age. Afterward, he had a gradually increasing abnormality in gate and finally became paralyzed since the age of three years. The patient was also suffering from dysphagia, bilateral ptosis, and bad temperament. Normal metabolic test, myopathies, and brain MRI findings led to the diagnosis of MLD with gradually-onset paraplegia.
Conclusion: Generally, early diagnosis of MLD may increase the chance of recovery from the disease. We suggest considering MLD in patients suffering from behavioral, visual, and motor regressions, especially those with normal metabolic tests.

Effect of Acceptance and Commitment Therapy on Depression and Quality of Life among Women with Chronic Pain during COVID-19 Pandemic Lockdown

Mohamad Reza Sobhani

Background and objectives: The coronavirus disease 2019 (COVID-19) pandemic is one of the most important healthcare and social challenges. The aim of this study was to evaluate the effect of acceptance and commitment therapy (ACT) on depression and quality of life among women with chronic pain during the COVID-19 pandemic lockdown.
Methods: This study had a quasi-experimental pretest-posttest design with a control group. The study included 35 women with chronic pain who were randomly divided into an experimental group (n=18) and a control group (n=17). The experimental group received six sessions of weekly treatment based on the ACT matrix. All participants completed the Beck Depression Inventory (BDI-ΙΙ) and the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF) in pretest and posttest. Collected data were analyzed with SPSS (version 23) using descriptive statistics (mean and standard deviation), analysis of covariance (ANCOVA), independent t-test, and the Levene's test. A p-value less than 0.05 was considered statistically significant.
Results: The weekly ACT treatment significantly reduced depression (F=8.72, p=0.01) and significantly increased quality of life (F=11.24, p=0.01).
Conclusion: Group psychotherapy based on the ACT matrix can significantly reduce depression and increase quality of life among women with chronic pain during the COVID-19 pandemic lockdown.