Digital Commons Network^™

Report Of The Pathogenesis And Pathophysiology Of Lyme Disease Subcommittee Of The Hhs Tick Borne Disease Working Group, Sam T. Donta, Leith J. States, Wendy A. Adams, Troy Bankhead, Nicole Baumgarth, Monica E. Embers, Robert B. Lochhead, Brian Stevenson

Microbiology, Immunology, and Molecular Genetics Faculty Publications

An understanding of the pathogenesis and pathophysiology of Lyme disease is key to the ultimate care of patients with Lyme disease. To better understand the various mechanisms underlying the infection caused by Borrelia burgdorferi, the Pathogenesis and Pathophysiology of Lyme Disease Subcommittee was formed to review what is currently known about the pathogenesis and pathophysiology of Lyme disease, from its inception, but also especially about its ability to persist in the host. To that end, the authors of this report were assembled to update our knowledge about the infectious process, identify the gaps that exist in our understanding of …

Gene Expression Analysis Of Environmental Temperature And High-Fat Diet-Induced Changes In Mouse Supraclavicular Brown Adipose Tissue, Yufeng Shi, Honglei Zhai, Sharon John, Yi-Ting Shen, Yali Ran, Giang Hoang, Miao-Hsueh Chen

Children’s Nutrition Research Center Staff Publications

Obesity, a dysregulation of adipose tissue, is a major health risk factor associated with many diseases. Brown adipose tissue (BAT)-mediated thermogenesis can potentially regulate energy expenditure, making it an attractive therapeutic target to combat obesity. Here, we characterize the effects of cold exposure, thermoneutrality, and high-fat diet (HFD) feeding on mouse supraclavicular BAT (scBAT) morphology and BAT-associated gene expression compared to other adipose depots, including the interscapular BAT (iBAT). scBAT was as sensitive to cold induced thermogenesis as iBAT and showed reduced thermogenic effect under thermoneutrality. While both scBAT and iBAT are sensitive to cold, the expression of genes involved …

Cilësia E Jetës Te Pacientët Me Diabet Tip 2, Arta Rama

Theses and Dissertations

Hyrja: Diabeti mellitus i tipit 2 (T2DM) është një problem global shëndetësor në zgjerim, i lidhur ngushtë me epideminë e mbipeshes. Individët me diabet mellitus tip 2 janë në rrezik të lartë për të dy ndërlikimet mikrovaskulare (përfshirë retinopatinë, nefropatinë dhe neuropatinë) dhe komplikimet makrovaskulare (të tilla si sëmundjet kardiovaskulare) për shkak të hiperglikemisë dhe përbërësve individualë të sindromës së rezistencës ndaj insulinës (metabolike).

Qëllimi: Ky punim ka për qëllim ngritjen e cilësisë së jetës te personat që vuajnë nga diabeti mellitus tip 2, pra përmirësimin e jetesës, këshillimin që të mirren me sporte të ndryshme, përfshirë këtu ecjen …

Clinical Characterization Of Pediatric Gastroparesis Using A Four-Hour Gastric Emptying Scintigraphy Standard, Sharon Wolfson, Zoe Wilhelm, Antone R Opekun, Robert Orth, Robert J Shulman, Bruno P Chumpitazi

Children’s Nutrition Research Center Staff Publications

Objectives: Four-hour gastric emptying scintigraphy (GES) is the recommended method to identify both adult and childhood gastroparesis (GP). Previous pediatric studies have, however, not used this standard. We sought to determine the characteristics and outcomes of children versus adolescents with GP using the 4-hour GES evaluation.

Methods: We performed a retrospective chart review of pediatric patients diagnosed with GP by 4-hour GES (>10% retention at 4 hours). Demographics, body mass index, GP-related symptoms, comorbidities, etiologies, therapies (eg, medications), healthcare utilization, and response to therapy were captured systematically. Symptoms were compared from the initial versus last gastroenterology visit. Outcomes were …

Health-Related Quality Of Life In Parents And Partners Of People With Type 1 Diabetes: Development And Validation Of Type 1 Diabetes And Life (T1dal) Measures, Marisa E Hilliard, Charles G Minard, David G Marrero, Maartje De Wit, Stephanie N Dubose, Alandra Verdejo, Sarah S Jaser, Davida Kruger, Roshanak Monzavi, Viral N Shah, R Paul Wadwa, Ruth S Weinstock, Debbe Thompson, Viena T Cao, Barbara J Anderson

Children’s Nutrition Research Center Staff Publications

Introduction: Despite the significant impact of type 1 diabetes (T1D) on family, few instruments are available to assess health-related quality of life (HRQOL) among family members of people with T1D. This study aimed to develop and evaluate the psychometric properties of new measures of diabetes-specific HRQOL for parents and partners of people with T1D. We report on the multistep development and validation process for the self-report Type 1 Diabetes and Life (T1DAL) measures, with versions for parents of youth age <8, 8-11, 12-17, and 18-25 years, and for partners of people age ≥18 years with T1D.

Method: First, we conducted qualitative interviews (total parents/partners n = 38) to develop draft measures and piloted them (total n …

Female Mice May Have Exacerbated Catabolic Signalling Response Compared To Male Mice During Development And Progression Of Disuse Atrophy, Megan E. Rosa-Caldwell, Seongkyun Lim, Wesley A. Haynie, Jacob L. Brown, John William Deaver, Francielly Morena Da Silva, Lisa T. Jansen, David E. Lee, Michael P. Wiggs, Tyrone A. Washington, Nicholas P. Greene

Health, Human Performance and Recreation Faculty Publications and Presentations

Background

Muscle atrophy is a common pathology associated with disuse, such as prolonged bed rest or spaceflight, and is associated with detrimental health outcomes. There is emerging evidence that disuse atrophy may differentially affect males and females. Cellular mechanisms contributing to the development and progression of disuse remain elusive, particularly protein turnover cascades. The purpose of this study was to investigate the initial development and progression of disuse muscle atrophy in male and female mice using the well-established model of hindlimb unloading (HU).

Methods

One hundred C57BL/6J mice (50 male and 50 female) were hindlimb suspended for 0 (control), 24, …

Dean's Update, June 2021, Jerry Nadler

SOM Dean's Research Newsletter

No abstract provided.

A Novel Biomarker Panel For The Early Detection And Risk Assessment Of Hepatocellular Carcinoma In Patients With Cirrhosis, Ilvira M Khan, Donjeta Gjuka, Jingjing Jiao, Xiaoling Song, Ying Wang, Jing Wang, Peng Wei, Hashem B El-Serag, Jorge A Marrero, Laura Beretta

Faculty, Staff and Students Publications

Novel biomarkers for hepatocellular carcinoma (HCC) surveillance in patients with cirrhosis are urgently needed. We previously identified osteopontin (OPN) as a promising biomarker for the early detection of HCC. This study is to further validate the performance of OPN and identify fatty acids (FA) that could improve OPN's performance in HCC risk assessment in patients with cirrhosis. To that end, we selected 103 patients with cirrhosis under surveillance. Among them, 40 patients developed HCC during follow-up. We investigated in these 103 patients, the association between HCC incidence and prediagnostic serum levels of AFP, OPN, and 46 FAs. OPN performance was …

Ube2i Deletion In Adipocytes Causes Lipoatrophy In Mice, Aaron R Cox, Natasha Chernis, Kang Ho Kim, Peter M Masschelin, Pradip K Saha, Shawn M Briley, Robert Sharp, Xin Li, Jessica B Felix, Zheng Sun, David D Moore, Stephanie A Pangas, Sean M Hartig

Faculty, Staff and Students Publications

OBJECTIVE: White adipose tissue (WAT) expansion regulates energy balance and overall metabolic homeostasis. The absence or loss of WAT occurring through lipodystrophy and lipoatrophy contributes to the development of hepatic steatosis and insulin resistance. We previously demonstrated that sole small ubiquitin-like modifier (SUMO) E2-conjugating enzyme Ube2i represses human adipocyte differentiation. The role of Ube2i during WAT development remains unknown.

METHODS: To determine how Ube2i impacts body composition and energy balance, we generated adipocyte-specific Ube2i knockout mice (Ube2i

RESULTS: Surprisingly, Ube2i

CONCLUSIONS: Our results demonstrate that Ube2i expression in mature adipocytes allows WAT expansion during postnatal growth. Deletion of Ube2i in …

Effect Of Serine-Dipeptide Bacterial Lipid Treatment On Gene Expression In Hepg2 Liver Cells, Shaharia Ferdus

Honors Scholar Theses

While greater abundances of Bacteroidetes are associated with better health outcomes, this phylum is a major producer of serine-dipeptide lipids, which are thought to promote inflammation via Tolllike receptor (TLR) stimulation. Lipid 654 (L-654) is one class of serine-dipeptide lipids that has been isolated from arterial plaques and is thought to contribute to atherogenesis. Recent evidence shows that not only does long-term L-654 exposure attenuate atherosclerosis, it also significantly reduces hepatic lipid levels and markers of inflammation in mice. To better understand the impact on the human liver, L-654 was administered to HepG2 hepatocytes at concentrations of 0.5 μg/mL or …

Bioactivities And Action Mechanisms Of Active Compounds From Hottuynia Cordata Thunb On Human Lung Cancer Cells, Yuh-Fung Chen, Wen-Hsin Chang, Huei-Yann Tsai, Min-Min Lee, Tian-Shung Wu

BioMedicine

Background: Lung cancer is the leading cause of death in Taiwan for years. Besides the currently used chemotherapy, herbal medicine may play a role in the treatment of lung cancer. Hottuynia cordata Thunb (HC), one of the frequently used herbal medicine in Taiwan, has been widely used in various diseases. Review from literatures, HC has many effects, including anti-inflammatory, anti-viral, anti-bacterial, anti-SARS, and anti-tumor activities. However, there is no literatures describe its active compounds on lung cancer. This present study aims to evaluate the possible effect and action mechanism of active compounds from HC (aristolactam BII, aristolactam AII, and …

Hormones Can Influence Drug Addiction-A Narrative Review, Morteza Karimian, Hamidreza Famitafreshi

BioMedicine

Drug addiction is a dangerous condition that is the concern of human societies. Nevertheless, several issues exist ahead of people with a drug use disorder during addiction. Accordingly, various types of studies have been conducted to understand better the problems that people with a drug use disorder encountered. People with a drug use disorder usually have a problem tolerating the withdrawal period and some relapse to drug abuse. Complementary studies further revealed that some hormones like oxytocin (OXT), vasopressin, hypothalamic-pituitary-adrenal axis (HPA) axis hormones, sex hormones, thyroid hormones, and nutritional hormones are probably involved in addiction processes. These hormones completely …

Component Causes Of Infectious Bovine Keratoconjunctivitis—Non-Moraxella Organisms In The Epidemiology Of Infectious Bovine Keratoconjunctivitis, John Dustin Loy, Kristin A. Clothier, Gabriele Maier

School of Veterinary and Biomedical Sciences: Faculty Publications

• Non-Moraxella organisms are associated with infectious bovine keratoconjunctivitis (IBK).

• Mycoplasma bovoculi can cause conjunctivitis and has a potential role in IBK pathogenesis.

• Other Non-Mycoplasma agents can cause disease that resembles IBK but is clinically different.

• Genomics and molecular technology are advancing research in this area.

• Classification and determination of pathogenesis potential of these organisms may be better understood through metagenomics and whole genome sequencing.

The Associations Of Chronic Stress, Social Support, Health Behaviors And Metabolic Syndrome Among Hispanic Women, Edna Esquer

Dissertations

The Associations of Chronic Stress, Social Support, Health Behaviors and Metabolic Syndrome Among Hispanic Women

Background: Metabolic syndrome (MetS) prevalence is 25% among Mexican American women 30 – 49 years of age, compared to 22% among non-Hispanic Whites in the United States. Little is known about the additional contributions of chronic stress, social support and health behaviors to the development of MetS among this population.

Purpose: Describe the associations between chronic stress, social support, and health behaviors and the presence of MetS in Hispanic women living in an underserved community.

Methods: A retrospective cohort study design. The Adult Treatment Panel …

Esomeprazole Attenuates Inflammatory And Fibrotic Response In Lung Cells Through The Mapk/Nrf2/Ho1 Pathway, Afshin Ebrahimpour, Min Wang, Li Li, Anil G Jegga, Mark D Bonnen, N Tony Eissa, Ganesh Raghu, Soma Jyothula, Farrah Kheradmand, Nicola A Hanania, Ivan O Rosas, Yohannes T Ghebre

Faculty, Staff and Students Publications

INTRODUCTION: Idiopathic pulmonary fibrosis (IPF) is an orphan disease characterized by progressive loss of lung function resulting in shortness of breath and often death within 3-4 years of diagnosis. Repetitive lung injury in susceptible individuals is believed to promote chronic oxidative stress, inflammation, and uncontrolled collagen deposition. Several preclinical and retrospective clinical studies in IPF have reported beneficial outcomes associated with the use of proton pump inhibitors (PPIs) such as esomeprazole. Accordingly, we sought to investigate molecular mechanism(s) by which PPIs favorably regulate the disease process.

METHODS: We stimulated oxidative stress, pro-inflammatory and profibrotic phenotypes in primary human lung epithelial …

Perceptions Of Family-Level Social Factors That Influence Health Behaviors In Latinx Adolescents And Young Adults At High Risk For Type 2 Diabetes, Erica G Soltero, Neeku Navabi, Felipe G Castro, Stephanie L Ayers, Jenny Mendez, Deborah I Thompson, Gabriel Q Shaibi

Children’s Nutrition Research Center Staff Publications

Given that health behaviors occur within the context of familial social relationships, a deeper understanding of social factors that influence health behaviors in Latinx families is needed to develop more effective diabetes prevention programming. This qualitative study identified perceived family-level social factors that influence health behaviors in Latinx adolescents (12–16 years; N = 16) and young adults (18–24 years; N = 15) with obesity and explored differences in perceptions across sex and age. Participants completed an in-depth interview that was recorded, transcribed, and coded using thematic content analysis. Emergent themes central to health behaviors included: perceived parental roles and responsibilities, …

Identification Of Binding Regions Of Bilirubin In The Ligand-Binding Pocket Of The Peroxisome Proliferator-Activated Receptor-A (Pparalpha), Darren M. Gordon, Stephen H. Hong, Zachary A. Kipp, Terry D. Hinds Jr.

Pharmacology and Nutritional Sciences Faculty Publications

Recent work has shown that bilirubin has a hormonal function by binding to the peroxisome proliferator-activated receptor-α (PPARα), a nuclear receptor that drives the transcription of genes to control adiposity. Our previous in silico work predicted three potential amino acids that bilirubin may interact with by hydrogen bonding in the PPARα ligand-binding domain (LBD), which could be responsible for the ligand-induced function. To further reveal the amino acids that bilirubin interacts with in the PPARα LBD, we harnessed bilirubin’s known fluorescent properties when bound to proteins such as albumin. Our work here revealed that bilirubin interacts with threonine 283 (T283) …

Effects Of Social Determinants Of Health In Progression To Type 2 Diabetes, Folabi I. Ariganjoye

Applied Research Projects

The prevalence of prediabetes and diabetes in the United States and around the world has increased faster than expected in the last 30 years. The economic burden this costs a nation can be astronomic both in terms of expense and loss in productivity. One-third of U.S. adults, 86 million people, have prediabetes. Effective management is needed that can reach these 86 million, and others at high risk, to reduce their progression to diagnosed Type 2 diabetes. After the literature review, there was not enough literature to support how these led to the progression to diabetes. The abundant literature is centered …

A Neural Basis For Brain Leptin Action On Reducing Type 1 Diabetic Hyperglycemia, Shengjie Fan, Yuanzhong Xu, Yungang Lu, Zhiying Jiang, Hongli Li, Jessie C Morrill, Jing Cai, Qi Wu, Yong Xu, Mingshan Xue, Benjamin R Arenkiel, Cheng Huang, Qingchun Tong

Children’s Nutrition Research Center Staff Publications

Central leptin action rescues type 1 diabetic (T1D) hyperglycemia; however, the underlying mechanism and the identity of mediating neurons remain elusive. Here, we show that leptin receptor (LepR)-expressing neurons in arcuate (LepRArc) are selectively activated in T1D. Activation of LepRArc neurons, Arc GABAergic (GABAArc) neurons, or arcuate AgRP neurons, is able to reverse the leptin’s rescuing effect. Conversely, inhibition of GABAArc neurons, but not AgRP neurons, produces leptin-mimicking rescuing effects. Further, AgRP neuron function is not required for T1D hyperglycemia or leptin’s rescuing effects. Finally, T1D LepRArc neurons show defective nutrient sensing and signs of cellular energy deprivation, which are …

Consumption Of High-Fructose Corn Syrup Compared With Sucrose Promotes Adiposity And Increased Triglyceridemia But Comparable Nafld Severity In Juvenile Iberian Pigs, Magdalena Maj, Brooke Harbottle, Payton A Thomas, Gabriella V Hernandez, Victoria A Smith, Mark S Edwards, Rob K Fanter, Hunter S Glanz, Chad Immoos, Douglas G Burrin, Tasha M Santiago-Rodriguez, Michael R La Frano, Rodrigo Manjarín

Children’s Nutrition Research Center Staff Publications

Background: Fructose consumption has been linked to nonalcoholic fatty liver disease (NAFLD) in children. However, the effect of high-fructose corn syrup (HFCS) compared with sucrose in pediatric NAFLD has not been investigated.

Objectives: We tested whether the isocaloric substitution of dietary sucrose by HFCS would increase the severity of NAFLD in juvenile pigs, and whether this effect would be associated with changes in gut histology, SCFA production, and microbial diversity.

Methods: Iberian pigs, 53-d-old and pair-housed in pens balanced for weight and sex, were randomly assigned to receive a mash diet top-dressed with increasing amounts of sucrose (SUC; n = …

Alzheimer’S And Patient Caregiver Burnout: A Comprehensive Review Of The Literature, Madeline J. Hekeler

Senior Honors Projects, 2020-current

The term ‘silent epidemic’ has become fitting for Alzheimer’s disease, as it is now the sixth leading cause of death in the US. Caring for AD patients at home in the US costs billions of dollars each year. The current comprehensive literature review discusses the background/history of AD, pathology and modes of transmission of AD, behavioral and natural risk factors, prevention and treatment options, and how the aforementioned factors contribute to caregiver burnout and subsequently affect the AD patient. The extensive examination of the literature determined several gaps to be addressed. More specifically, burnout among AD caregivers has become an …

The Effect Of Polyunsaturated And Saturated Fatty Acids On Seizure Presence And Severity In A Cohort Of Subjects In An Epilepsy Monitoring Unit, Jana K. Wells

Theses & Dissertations

Ketogenic diet therapies (KDTs) have been used to treat epilepsy for nearly 100 years. Although effective, restrictive diet patterns and unknown impacts on long-term health outcomes often prevent their use as first-line therapy. To date, a distinct mechanism of action for KDTs has not been determined and evidence suggests fatty acids (FAs) may play a role in eliciting anti-seizure effects. This dissertation aimed to provide insights into the effect of polyunsaturated fatty acids (PUFAs) and saturated fatty acids (SFAs) on seizure presence and severity through the analysis of dietary intake in a cohort of patients admitted to an epilepsy monitoring …

An Explanatory Sequential Mixed Methods Nutrition And Physical Activity Intervention Study On Changes In Knowledge, Self-Efficacy, And Outcome Expectations Of Fathers, Sarah Hortman

Theses & Dissertations

Overweight and obesity rates are a continuing concern resulting in poor health outcomes and annual healthcare costs in the billions of dollars. An upstream approach of health promotion is critical to change the focus from treatment and management to prevention of chronic disease. Preventing chronic disease through evidence-based health promotion practices incorporating educational interventions aimed at dietary and physical activity behaviors will preclude negative health outcomes including cardiovascular disease, type 2 diabetes, and hypertension.

The family environment is an important consideration in the prevention of chronic disease including obesity. Parents are role models for their children, including fathers who are …

Fucoxanthin: A Review Of Potential Benefits Relative To Human Health, Michael R. White

Masters Theses, 2020-current

Fucoxanthin is a carotenoid sourced and extracted mainly from dark orange and brown seaweeds found in the pacific ocean, such as the wakame algae. The allenic bonds and unique oxygen groups give fucoxanthin its unique structure and are thought to be part of the reason fucoxanthin has unique physiological functions. Fucoxanthin has potentially numerous effects on the physiology of human health, ranging from skin health to metabolic health, which have been demonstrated in animal model research. The goal of this review is to examine current literature to discuss fucoxanthin’s potential application as a nutraceutical, treatment for obesity, type 2 diabetes, …

Fucoxanthin: A Review Of Potential Benefits Relative To Human Health, Michael R. White

Masters Theses, 2020-current

Fucoxanthin is a carotenoid sourced and extracted mainly from dark orange and brown seaweeds found in the pacific ocean, such as the wakame algae. The allenic bonds and unique oxygen groups give fucoxanthin its unique structure and are thought to be part of the reason fucoxanthin has unique physiological functions. Fucoxanthin has potentially numerous effects on the physiology of human health, ranging from skin health to metabolic health, which have been demonstrated in animal model research. The goal of this review is to examine current literature to discuss fucoxanthin’s potential application as a nutraceutical, treatment for obesity, type 2 diabetes, …

Identifying And Predicting Food Parenting Practice Profiles Among Canadian Parents, Claire N Tugault-Lafleur, Olivia De-Jongh González, Teresia M O'Connor, Sheryl O Hughes, Louise C Mâsse

Children’s Nutrition Research Center Staff Publications

Background: Food parenting practices (FPP) can affect children's eating behaviours, yet little is known about how various FPP co-occur. The primary aim was to identify profiles of FPPs use among Canadian parents. Secondary aims included examining sociodemographic correlates of FPP profiles and evaluating whether children's eating behaviours differed across FPP profiles.

Methods: Parents (n = 799) of 5-12-year-old children completed a validated FPP Item Bank and the Children's Eating Behaviour Questionnaire. Latent Class Analysis (LCA) was used to identify distinct FPP profiles. Regression analyses were used to explore associations between FPP profiles, sociodemographic variables (race, sex and education) and children's …

Mitochondrial Distribution Of Glycine Receptors In Motor Neuron Cell Lines, Katsiaryna Milashevich

Student Theses and Dissertations

Although non-essential, glycine plays an important role in major metabolic reactions and is most known for its anti-inflammatory effects. An accumulation of contemporary research has shown that glycine is able to stabilize membrane potential using glycine receptors at the cellular level and to protect mitochondrial function directly, whether it is from inflammation, heavy metal poisoning, or ischemia-induced neuroinflammation. In this research, the existence of a hypothetical mitochondrial glycine receptor is examined. Immunofluorescence imaging was used to examine the presence of the glycine receptor subunits alpha 1 and alpha 2 in both non- differentiated and differentiated neuroblastoma cell lines. The preliminary …

Sodium Pyruvate Ameliorates Influenza A Virus Infection In Vitro And In Vivo, Jessica M. Reel

Graduate Theses/Dissertations

Pyruvate is produced in duplicate at the end of glycolysis in addition to ATP and NADH. Pyruvate is the metabolite of choice in most cells, whether obtained exogenously or endogenously. Recently we found that the addition of pyruvate’s conjugate base, sodium pyruvate, to cell culture media dampened the immune response to influenza A virus (IAV) infection in cultured innate immune cells. Thus, I decided to investigate the mechanism and potential for treatment of IAV. In vitro using bone marrow derived macrophages that were infected with IAV we found that adding sodium pyruvate to the media decreased immune signaling pathways through …

Assessing And Comparing Quality Of Life Scores In Patients With Irritable Bowel Syndrome-Diarrhea, Irritable Irritable Bowel Syndrome-Constipation, And Irritable Bowel Syndrome-Mixed, Hailey Rentz

Master's Theses

Irritable bowel syndrome (IBS) is a common gastrointestinal (GI) disorder that affects an estimated 1 in 10 people globally (Black & Ford, 2020). Since IBS is such a common GI disorder worldwide it is important to understand that impact it has on quality of life. This study assessed the differences in the effects of IBS on the quality of life in patients with each of the three types of IBS: IBS-D, IBS-C, and IBS-M. Potential respondents were recruited via social media using an online survey, which collected demographics and assessed the effects of IBS on quality of life. The survey …

Përdorimi I Vitaminës D Në Regjionin E Ferizajit, Ermelinda Neziri

Theses and Dissertations

Njohurite për vitaminat janë një çështje që secili njeri duhet t’i ketë, dhe që çdo infermier duhet që të informojë pacientët dhe të tregojë një kujdes të veçantë. Objektivi i temës do të jetë zgjerimi i njohurive rreth rolit dhe rëndësisë së përdorimit të vitaminës D. Një vend të posaqëm do te kete shqyrtimi i mungesës dhe përdorimi jo adekuat të vitaminës D duke pasur për fokus pasojat të cilat rezultojnë në këto raste. Duke zgjeruar këto njohuri, synoj që të njejtat të përdoren nga infermieret në mënyrë që një numër i madh i keqformimeve si rezultat i deficeinces së …