Protocol for preliminary, multicenteric validation of "PoCOsteo device": A point of care tool for proteomic and genomic study of osteoporosis

One of the goals of the HORIZON 2020 project PoCOsteo was to develop a medical device, which would measure and/or quantify proteomic as well as genomic factors as present in whole blood samples collected through finger prick. After validating the tool in the clinical setting, the next step would be its clinical validation based on the existing guidelines. This article presents the protocol of a validation study to be carried out independently at two different centers (Division of Endocrinology and Diabetology at the Medical University of Graz as a clinic-based cohort, and the Endocrinology and Metabolism Research Institute at the Tehran University of Medical Sciences as a population-based cohort). It aims to assess the tool according to the Clinical & Laboratory Standards Institute guidelines, confirming if the proteomics and genomics measurements provided by the tool are accurate and reproducible compared with the existing state-of-the-art tests. This is the first time that such a detailed protocol for lab validation of a medical tool for proteomics and genomic measurement is designed based on the existing guidelines and thus could be used as a template for clinical validation of future point-of-care tools. Moreover, the multicentric cohort design will allow the study of a large number of diverse individuals, which will improve the validity and generalizability of the results for different settings.

Nanomaterials in electrochemical nanobiosensors of miRNAs

Nanomaterial-based biosensors have received significant attention owing to their unique properties, especially enhanced sensitivity. Recent advancements in biomedical diagnosis have highlighted the role of microRNAs (miRNAs) as sensitive prognostic and diagnostic biomarkers for various diseases. Current diagnostics methods, however, need further improvements with regards to their sensitivity, mainly due to the low concentration levels of miRNAs in the body. The low limit of detection of nanomaterial-based biosensors has turned them into powerful tools for detecting and quantifying these biomarkers. Herein, we assemble an overview of recent developments in the application of different nanomaterials and nanostructures as miRNA electrochemical biosensing platforms, along with their pros and cons. The techniques are categorized based on the nanomaterial used.

Novel electrochemical biosensor for breast cancer detection, based on a nanocomposite of carbon nanofiber, metal-organic framework, and magnetic graphene oxide

In this study, we present the newly developed a novel microRNA biosensor based on magnetic rod carbon paste electrodes for breast cancer detection by using a relatively new MOF structure as a substrate. The major goal of manufacturing biosensors, suitable for clinical diagnostics, is to measure very low amount of microRNA 155 in complex environments. Therefore, we used a combination of different materials, including carbon nanofibers, CuBTC-AIA (CuMOF), and Fe@rGO, to improve the electrode surface-to-volume ratio and facilitate the electron transfer process. In this method, 1-pyrenebutyric acid N-hydroxysuccinimide ester was used to bind the microRNAs to the electrode surface. The hybridization process on the modified electrode surface was investigated using cyclic voltammetry, electrochemical impedance spectroscopy, and differential pulse voltammetry across the potential range, in which the accumulated hematoxylin was electroactive. Under optimal conditions, a very low detection limit of 0.08 fM and an adequate dynamic range of 0.2 fM-500 pM were achieved. The fabricated sensor was reported to be reproducible and selective when tested using different types of mismatched target sequences. And finally, the real human serum samples were used to confirm the capability of the nanobiosensor to detect microRNA 155 without any significant interference from other molecules and components.

Multifunctional Poly(2-ethyl-2-oxazoline) Copolymers Containing Dithiolane and Pentafluorophenyl Esters as Effective Reactive Linkers for Gold Surface Coatings

Surface functionalization with biological macromolecules is an important task for the development of sensor materials, whereby the interaction with other biological materials should be suppressed. In this work, we developed a novel multifunctional poly(2-ethyl-2-oxazoline)-dithiolane conjugate as a versatile linker for gold surface immobilization of amine-containing biomolecules, containing poly(2-ethyl-2-oxazoline) as antifouling polymer, dithiolane for surface immobilization, and activated esters for protein conjugation. First, a well-defined carboxylic acid containing copoly(2-ethyl-2-oxazoline) was synthesized by cationic ring-opening copolymerization of 2-ethyl-2-oxazoline with a methyl ester-containing 2-oxazoline monomer, followed by postpolymerization modifications. The side-chain carboxylic groups were then converted to amine-reactive pentafluorophenyl (PFP) ester groups. Part of the PFP groups was used for the attachment of the dithiolane moiety, which can efficiently bind to gold surfaces. The final copolymer contained 1.4 mol% of dithiolane groups and 4.5 mol% of PFP groups. The copolymer structure was confirmed by several analytical techniques, including NMR spectroscopy and size-exclusion chromatography. The kinetics of the PFP ester aminolysis and hydrolysis demonstrated significantly faster amidation compared to hydrolysis, which is essential for subsequent protein conjugation. Successful coating of gold surfaces with the polymer was confirmed by spectroscopic ellipsometry, showing a polymer brush thickness of 4.77 nm. Subsequent modification of the coated surfaces was achieved using bovine serum albumin as a model protein. This study introduces a novel reactive polymer linker for gold surface functionalization and offers a versatile polymer platform for various applications including biosensing and surface functionalization.

The national trend of the burden of Chronic Kidney Disease (CKD) in Iran from 1990 to 2019

Purpose

Chronic Kidney Disease (CKD) has become the 8th leading cause of death in Iran in 2017, 5 steps up from 1990. This is important as hypertension, diabetes, and chronic glomerulonephritis along with exposure to toxins or heavy metals are the main risk factors for the disease. Despite its heavy burden, there are limited studies on the incidence and prevalence of the disease in the Iranian adult population. The present article studies the burden of CKD at the national level in 2019, and its trend over the past three decades.

Methods

In 2019, the Global Burden of Disease (GBD) study provided an annual estimation of the burden of 369 diseases and injuries in 204 countries from 1990 until 2019. The data estimating CKD and related mortality in Iran were collected from the disease registry, survey, and scientific literature. All-ages and age-standardised indices of incidence, prevalence, deaths, years lived with disability, years of life lost, and disability-adjusted life years (DALYs) were extracted for both sexes.

Results

Since 1990, the age-standardized incidence (34.7% (95% uncertainty interval 30.8 - 38.8)) and prevalence (19.6% (17.7 - 21.8)) of CKD have risen, while a 21.5% (-28.8 - -15.4) and 18.0% (-35.4 - -10.8) decrease were noted in age-standardized DALYs and deaths rates, respectively. The lowest prevalence was reported in the eastern and western provinces.

Conclusion

Current study provides comprehensive knowledge about the CKD burden, suggesting the Iranian healthcare system has been more effective in averting deaths rather than managing morbidities. Multi-sectoral action plans are needed to strengthen preventive and early detection programs in high-risk areas.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-023-01298-y.

Nano drug-delivery systems for management of AIDS: liposomes, dendrimers, gold and silver nanoparticles

AIDS causes increasing mortality every year. With advancements in nanomedicine, different nanomaterials (NMs) have been applied to treat AIDS and overcome its limitations. Among different NMs, nanoparticles (NPs) can act as nanocarriers due to their enhanced solubility, sustained release, targeting abilities and facilitation of drug-dose reductions. This review discusses recent advancements in therapeutics for AIDS/HIV using various NMs, mainly focused on three classifications: polymeric, liposomal and inorganic NMs. Polymeric dendrimers, polyethylenimine-NPs, poly(lactic-co-glycolic acid)-NPs, chitosan and the use of liposomal-based delivery systems and inorganic NPs, including gold and silver NPs, are explored. Recent advances, current challenges and future perspectives on the use of these NMs for better management of HIV/AIDS are also discussed.

Effect of vitamins C and E on cancer survival; a systematic review

PURPOSE

Association between vitamins C (VC)/ E (VE) and cancer survival is inconsistent. This systematic review is aimed to summarize trials for effects of VC/VE on cancer survival.

METHODS

Relevant English trials were retrieved from PubMed, Cochrane Library, Embase, Web of Science, Scopus databases, and Clinicaltrials.gov through 21/June/2022. Inclusion criteria were all trials which assessed sole/combinations intake of VC/VE on survival rate, mortality, or remission of any cancer. Exclusion criteria were observational and animal studies.

RESULTS

We reached 30 trials conducted on 38,936 patients with various cancers. Due to severe methodological heterogeneity, meta-analysis was impossible. High dose VC + chemotherapy or radiation was safe with an overall survival (OS) 182 days - 21.5 months. Sole oral or intravenous high dose VC was safe with non-significant change in OS (2.9-8.2 months). VE plus chemotherapy was safe, resulted in stabling diseases for 5 years in 70- 86.7% of patients and OS 109 months. It was found 60% and 16% non-significant reductions in adjusted hazard ratio (HR) deaths or recurrence by 200 mg/d tocotrienol + tamoxifen in breast cancer, respectively. Sole intake of 200-3200 mg/d tocotrienol before resectable pancreatic cancer was safe and significantly increased cancer cells' apoptosis. Combination VC and VE was non-significantly reduced 7% in rate of neoplastic gastric polyp.

CONCLUSION

Although our study is supported improvement of survival and progression rates of cancers by VC/VE, more high quality trials with large sample sizes are required to confirm.

PROSPERO REGISTRATION NUMBER

CRD42020152795.

Alprazolam Detection Using an Electrochemical Nanobiosensor Based on AuNUs/Fe-Ni@rGO Nanocomposite

Despite all the psychological advantages of alprazolam, its long list of toxic properties and interactions has caused concern and highlighted the need for a reliable sensing method. In this study, we developed a simple, highly sensitive electrochemical nanobiosensor to determine the desirable dose of alprazolam, averting the undesirable consequences of overdose. Gold nanourchins (AuNUs) and iron-nickel reduced graphene oxide (Fe-Ni@rGO) were immobilized on a glassy carbon electrode, which was treated beforehand. The electrode surface was characterized using cyclic voltammetry, Fourier transform infrared spectroscopy, scanning electron microscopy/energy-dispersive X-ray spectroscopy, and differential pulse voltammetry. The fabricated sensor showed two linear ranges (4 to 500 µg L^-1 and 1 to 50 mg L^-1), low limit of detection (1 µg L^-1), high sensitivity, good repeatability, and good recovery. Increased -OH and carboxyl (-COOH) groups on the electrode surface, resulting in improved the adsorption of alprazolam and thus lower limit of detection. This nanobiosensor could detect alprazolam powder dissolved in diluted blood serum; we also studied other benzodiazepine drugs (clonazepam, oxazepam, and diazepam) with this nanobiosensor, and results were sensible, with a significant difference.

Regional burden of chronic kidney disease in North Africa and Middle East during 1990-2019; Results from Global Burden of Disease study 2019

Objectives

Updating burden data of chronic kidney disease (CKD) as one of the most prevalent non-communicable diseases is essential for proper provision of healthcare by policymakers. We aimed to estimate the burden of CKD and its attributed burden in North Africa and Middle East region (NAME) during 1990-2019.

Methods

The CKD-related Global Burden of Disease (GBD) 2019 estimates were extracted from Health Metrics and Evaluation (IHME) website.

Results

In 2019, 2,034,879 new CKD cases (95% Uncertainty interval 1,875,830 to 2,202,724) with an age-standardized incidence rate of 447.5 (415.1 to 482.8) per 100,000 was reported, showing a 70.9% increase in the past 30 years. CKD led to 111,812 deaths (96,421 to 130,853) with an age-standardized rate of 30.4 (26.3 to 35.4) per 100,000. The highest increase and decrease in the mortality rate were estimated in Morocco 21.8% (-8.9 to 51.6) and Kuwait -41.5% (-51.2 to -29.1). In 2019, CKD was responsible for 744.4 (646.1 to 851.8) age-standardized disability-adjusted life years (DALYs), mostly contributed to "other and unspecified causes" [237.2 (191.1 to 288.4)], type 2 diabetes [205.9 (162.4 to 253.6)], and hypertension [203.3 (165.8 to 243)]. An increase was noted in DALYs from ages 25-29 and surged with an accelerating pattern by age. Kidney dysfunction, high systolic blood pressure, and high body mass index ranked as the top three risk factors for the disorder.

Conclusions

Our study raised an alarm regarding the increasing CKD burden in NAME. There is an urgency to deal with hypertension and overweight/obesity at the primary care level, implementing CKD screening for at-risk groups, and facilitating the accessibility to appropriate treatments.

Is it time to consider population screening for fracture risk in postmenopausal women? A position paper from the International Osteoporosis Foundation Epidemiology/Quality of Life Working Group

The IOF Epidemiology and Quality of Life Working Group has reviewed the potential role of population screening for high hip fracture risk against well-established criteria. The report concludes that such an approach should strongly be considered in many health care systems to reduce the burden of hip fractures.

INTRODUCTION

The burden of long-term osteoporosis management falls on primary care in most healthcare systems. However, a wide and stable treatment gap exists in many such settings; most of which appears to be secondary to a lack of awareness of fracture risk. Screening is a public health measure for the purpose of identifying individuals who are likely to benefit from further investigations and/or treatment to reduce the risk of a disease or its complications. The purpose of this report was to review the evidence for a potential screening programme to identify postmenopausal women at increased risk of hip fracture.

METHODS

The approach took well-established criteria for the development of a screening program, adapted by the UK National Screening Committee, and sought the opinion of 20 members of the International Osteoporosis Foundation's Working Group on Epidemiology and Quality of Life as to whether each criterion was met (yes, partial or no). For each criterion, the evidence base was then reviewed and summarized.

RESULTS AND CONCLUSION

The report concludes that evidence supports the proposal that screening for high fracture risk in primary care should strongly be considered for incorporation into many health care systems to reduce the burden of fractures, particularly hip fractures. The key remaining hurdles to overcome are engagement with primary care healthcare professionals, and the implementation of systems that facilitate and maintain the screening program.

Association between being metabolically healthy/unhealthy and metabolic syndrome in Iranian adults

Introduction

The prevalence of metabolically healthy obesity (MHO) varies based on different criteria. We assessed the prevalence of MHO and metabolic unhealthiness based on body mass index (BMI) and their association with metabolic syndrome (MetS) in a nation-wide study.

Methods

Data were taken from the STEPs 2016 study, from 18,459 Iranians aged ≥25 years. Demographic, metabolic, and anthropometric data were collected. Subjects were stratified by BMI, metabolic unhealthiness, and having MetS. The latter was defined based on National Cholesterol Education Program Adult Treatment Panel III 2004 (NCEP ATP III), was then assessed.

Results

The prevalence of MHO and metabolic unhealthiness in obese subjects was 7.5% (about 3.6 million) and 18.3% (about 8.9 million), respectively. Most of the metabolic unhealthy individuals were female (53.5%) or urban residents (72.9%). Low physical activity was significantly and positively associated (Odds Ratio: 1.18, 95% CI: 1.04–1.35) with metabolic unhealthiness, while being a rural residence (0.83, 0.74–0.93), and having higher education (0.47, 0.39–0.58) significantly but negatively affected it. Dyslipidemia was the most frequent MetS component with a prevalence rate of 46.6% (42.1–51.1), 62.2% (60.8–63.6), 76.3% (75.1–77.5), and 83.4% (82.1–84.6) among underweight, normal weight, overweight and obese phenotypes, respectively.

Conclusion

BMI aside, an additional set of criteria such as metabolic markers should be taken into account to identify normal weight but metabolically unhealthy individuals. Given the highest prevalence of dyslipidemia among obese subjects, further interventions are required to raise public awareness, promote healthy lifestyles and establish lipid clinics.

Normal Weight Obesity and Cardiometabolic Risk Factors: A Systematic Review and Meta-Analysis

BACKGROUND

Obesity is one of the most significant causes of morbidity and mortality worldwide. Current studies suggest a new type of obesity, normal weight obesity (NWO), which is defined as having a normal body mass index (BMI), but a high-fat percentage increases the risk of cardiometabolic risk factors (CMRFs). This systematic review and meta-analysis aimed to pool the association between NWO with CMRFs.

METHODS

A systematic search of the literature in all available electronic databases, including Scopus, Web of Science, EMBASE, and PubMed, was performed until October 2021. All English studies that assessed the association of NWOs [compared to normal weight non-obese (NWNO)] and the CMRFs were included. Two investigators extracted data and performed a quality assessment. The heterogeneity between studies was assessed with I-squared and Cochran's Q tests. Odds ratio (OR) was used as an effect size to pool the association of NWO with CMRFs.

RESULTS

Twenty-five articles that met the inclusion criteria entered the study. The total number of participants was 177,792, with an age range of 13 to 75 years. Most studies were conducted on the general population (adults) and were from China. The result of fixed-effect model meta-analysis indicated an increased odds of hyperglycemia (OR:1.50, 95%:1.23, 1.76), high TG (OR:1.90, 95% CH:1.44, 2.35), low HDL (OR: 1.28, 95% CI:1.06, 1.49) and diabetes (OR:1.39, 95% CI:1.30, 1.49). Moreover, the random effect meta-analysis showed that NWO increased the odds of dyslipidemia (OR:1.83, 95% CI:1.61, 20.4), HTN (OR:1.40, 95% CI:1.28, 1.51) and metabolic syndrome (OR:1.92, 95% CI:1.58, 2.26). Moreover, the mean of all CMRFs except plasma glucose in NWO subjects was statistically higher than NWNO subjects (p-value<0.05).

CONCLUSION

The present study showed that NWO increased the odds of CMRFs. These findings indicate the inadequacy of the BMI measurement and the need for body fat assessment for a better obesity risk assessment.

Microfluidic-Based Oxygen (O2) Sensors for On-Chip Monitoring of Cell, Tissue and Organ Metabolism

Oxygen (O₂) quantification is essential for assessing cell metabolism, and its consumption in cell culture is an important indicator of cell viability. Recent advances in microfluidics have made O₂ sensing a crucial feature for organ-on-chip (OOC) devices for various biomedical applications. OOC O₂ sensors can be categorized, based on their transducer type, into two main groups, optical and electrochemical. In this review, we provide an overview of on-chip O₂ sensors integrated with the OOC devices and evaluate their advantages and disadvantages. Recent innovations in optical O₂ sensors integrated with OOCs are discussed in four main categories: (i) basic luminescence-based sensors; (ii) microparticle-based sensors; (iii) nano-enabled sensors; and (iv) commercial probes and portable devices. Furthermore, we discuss recent advancements in electrochemical sensors in five main categories: (i) novel configurations in Clark-type sensors; (ii) novel materials (e.g., polymers, O₂ scavenging and passivation materials); (iii) nano-enabled electrochemical sensors; (iv) novel designs and fabrication techniques; and (v) commercial and portable electrochemical readouts. Together, this review provides a comprehensive overview of the current advances in the design, fabrication and application of optical and electrochemical O₂ sensors.

Bone Phenotyping Approaches in Human, Mice and Zebrafish - Expert Overview of the EU Cost Action GEMSTONE ("GEnomics of MusculoSkeletal traits TranslatiOnal NEtwork")

A synoptic overview of scientific methods applied in bone and associated research fields across species has yet to be published. Experts from the EU Cost Action GEMSTONE ("GEnomics of MusculoSkeletal Traits translational Network") Working Group 2 present an overview of the routine techniques as well as clinical and research approaches employed to characterize bone phenotypes in humans and selected animal models (mice and zebrafish) of health and disease. The goal is consolidation of knowledge and a map for future research. This expert paper provides a comprehensive overview of state-of-the-art technologies to investigate bone properties in humans and animals - including their strengths and weaknesses. New research methodologies are outlined and future strategies are discussed to combine phenotypic with rapidly developing -omics data in order to advance musculoskeletal research and move towards "personalised medicine".

Targeting dyslipidemia by herbal medicines: A systematic review of meta-analyses

ETHNOPHARMACOLOGICAL RELEVANCE

The worldwide increasing prevalence of dyslipidemia has become a global health concern. Various herbal remedies have been claimed to be effective for the treatment of dyslipidemia in traditional and folkloric medicine of different regions clinical trials have been conducted to investigate their efficacy. The aim of the current systematic review is to critically assess the meta-analyses of controlled trials (CT) evaluated herb medicines for dyslipidemia.

MATERIALS AND METHODS

Relevant studies from Web of Science, PubMed, Scopus, and Cochrane Library databases based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist until January 2021 have been searched. All meta-analyses which pooled studies on the effect of herbal medicines on lipid profile including total cholesterol (TC), triglyceride (TG), and low- or high-density lipoprotein cholesterol (LDL-C, HDL-C) were also included. Meta-analyses of in vitro, animal or observational studies were excluded.

RESULTS

The overall of 141 meta-analyses were revealed. Vegetable oils, phytosterols, tea, soy protein, nuts, and curcumin have been studied frequently among the herbal medicines. Among 13 meta-analyses on vegetable oils, the greater reduce of TC (18.95 mg/dl), LDL-C (16.24 mg/dl) and TG (13.69 mg/dl) were exhibited from sunflower oil. Furthermore, rice bran oil (6.65 mg/dl) increased HDL-C significantly. Phytosterols in 12 meta-analyses demonstrated significant improvements in reducing TC, LDL-C and TG as 16.4, 23.7, and 8.85 mg/dl, respectively, and rise in HDL-C as 10.6 mg/dl. The highest reduction in serum level of TC, LDL-C and TG was reported while intake Green tea; 27.57, 24.75, and 31.87 mg/dl, accordingly within 9 meta-analyses. Average improvement of lipid profiles by 6 meta-analyses on plant proteins were 23.2, 21.7, 15.06, and 1.55 mg/dl for TC, LDL-C, TG, and HDL-C, respectively. Among 11 meta-analyses on nuts, almond showed better and significant alleviations in TC (10.69 mg/dl), walnut in LDL-C (9.23 mg/dl), pistachio in TG (22.14 mg/dl), and peanut in HDL-C (2.72 mg/dl). Overall, Curcumin, Curcuminoid, and Turmeric have resulted in the reduction of TC (25.13 mg/dl), LDL-C (39.83 mg/dl), TG (33.65 mg/dl), and an increase in the HDL-C (4.31 mg/dl).

CONCLUSION

The current systematic review shed light on the use of herbal medicines for the management of dyslipidemia. However, more well-conducted CTs are required to determine effective doses of herbal medicines.

Protocol for a multicentre, prospective cohort study of clinical, proteomic and genomic patterns associated with osteoporosis to develop a multidimensional fracture assessment tool: the PoCOsteo Study

INTRODUCTION

The HORIZON 2020 project PoCOsteo aims (1) to develop a multidimensional fracture risk assessment tool which would take into account all factors known to be related to an individual's fracture risk. The fracture risk model is intended to be developed in two different populations, namely a European and a Middle Eastern one; (2) to develop a medical device, which would measure and/or quantify proteomic as well as genomic factors as present in whole blood samples collected through finger prick; (3) to test the clinical applicability and the validity of prototypes of the to be developed point of care device at both clinical centres.

METHODS AND ANALYSIS

This article presents the protocol of this prospective cohort that will be carried out independently at two different centres (Division of Endocrinology and Diabetology at the Medical University of Graz (MUG) as a clinic-based cohort, and Endocrinology and Metabolism Research Institute (EMRI) at the Tehran University of Medical Sciences (TUMS) as a population-based cohort). The final aim is to develop a fracture risk assessment model, which would include clinical risk factors, biochemical markers of bone turnover, as well as specific genomic factors. The derivation cohorts will consist of individuals aged 50 years and above. The period of observation for each patient will be 12 months; an extension phase, which would last for another 2 years, is also planned.

ETHICS AND DISSEMINATION

These studies are conducted in accordance with the World Medical Association Declaration of Helsinki. The Iranian part was approved by the Research Ethics Committee of EMRI, TUMS. The Austrian part was approved by the Ethics Committee of the Medical University of Graz. Based on the gathered information, a multidimensional fracture assessment tool will be designed which will later be added to the PoCOsteo device.

Osteoporosis and cognitive impairment interwoven warning signs: community-based study on older adults-Bushehr Elderly Health (BEH) Program

Cognitive impairment and osteoporosis are frequently seen to coincide in clinical practice. Osteoporosis was higher in elderly populations with cognitive impairment, especially in postmenopausal women. Thus, prophylaxis for osteoporosis, falls, and fractures should be considered as part of the treatment of patients with cognitive impairment.

INTRODUCTION

Cognitive impairment and osteoporosis are two important health concerns among older adults that their possible relationship, concurrent occurrence, and linking mechanism have recently been highlighted. The purpose of this study was to assess the sex-independent association of these two conditions.

MATERIALS AND METHODS

From among 2331 individuals aged ≥ 60 years selected in Bushehr Elderly Health (BEH) Program, Iran; data of 1508 participants were analyzed. Cognitive status was assessed using Category Fluency Test and Mini-cog assessment instrument. Association between osteopenia-osteoporosis and cognitive impairment were assessed using uni- and multivariable logistic regression models.

RESULTS

Osteoporosis was diagnosed in 598 (39.6%) of the participants (58.3% female and 21.9% male, P < 0.001). From among them, 677 (44.9%) had evidence of cognitive impairment (64.5% female and 31.0% male, P < 0.001). Multivariate logistic regressions showed spinal and total hip osteoporosis was associated with 1.83 (CI 95% 1.13-2.96) and 2.24-fold (CI 95% 1.28-3.89) increase in the risk of cognitive impairment among female subjects, respectively. Ordinal logistic regression, on the other hand, revealed cognitive impairment to be associated with 1.42-fold (CI 95% 1.04-1.92) increase in the risk of spinal osteopenia-osteoporosis, 1.5-fold increase in total hip osteoporosis (CI 95% 1.09-2.05), and 1.48-fold increase in general osteoporosis (CI 95% 1.06-2.0).

CONCLUSION

Different degrees of bone loss and cognitive impairment may be a risk factor for each other among women but not in men. It is suggested that the screening, adopting preventive measures for the other condition and regular follow-ups, if needed, could be of utmost importance.

The effect of selenium and zinc on CD4(+) count and opportunistic infections in HIV/AIDS patients: a randomized double blind trial

Objectives: We assessed the effect of selenium and zinc supplementation on CD4 cell count and the risk of developing opportunistic infections.Methods: In a double blind clinical trial, 146 HIV(+) patients receiving combination antiretroviral therapy with CD4(+) >200/cubic millimeter were screened for comorbidities and opportunistic infections, and randomized to receive daily selenium (200 µg), zinc (50 mg) or placebo for 6 months, before a 3-month follow-up period. CD4 cell counts were measured in the 3^th, 6^th and 9^th months. The serum selenium and zinc were measured in the 6^th month. The incidence of opportunistic infection was assessed monthly for 6 months and at the end of the 9^th month.Results: The final incidence of supplement deficiency for placebo, zinc and selenium were 46.7%, 44.7% and 50.0%, respectively. Overall compliance with supplementation was 99.42%. Although the changes from baseline were not statistically significant, zinc supplementation was significantly associated with reduced risk of opportunistic infections.Conclusion: Development of the opportunistic infections after zinc supplementation significantly decreased; however, significant improvement in CD4 count was not observed in this group.

Numerical simulation of a multi-inlet microfluidic device for biosensing purposes in osteoporosis management

Objectives

In this paper, the effect of the position of the inlet and outlet microchannels on the flow profile and the geometry of the recognition chamber for sample pre-treatment in an electrochemical biosensor to be used in osteoporosis management were investigated.

Methods

All numerical computation presented in this work were performed using COMSOL Multiphysics and Fluent. Simulation was performed for a three-dimensional, incompressible Navier-Stokes flow and so explicit biphasic volume of fluid (VOF) equations were used.

Results

In the designed microfluidic system, a pressure-driven laminar flow with no-slip boundary condition was responsible for fluid actuation through microchannels in a reproducible approach. Based on the simulation results, the number of outlets was increased and the angel through which the inlets and outlets were attached to the microchamber was changed so that the dead volume would be eliminated and the fluid flow trajectory, the velocity field and pressure were evenly distributed across the chamber. The Re number in the inlets was equal to 4.41, suggesting a laminar flow at this site.

Conclusion

The simulation results along with the fact that the design change was tested using laser ablated tape and a color dye at different steps provided the researchers with the opportunity to study the changes in a fast and accurate but cheap method. The absence of backflow helps with the cross-talk concern in the channels and the lack of bubbles and complete coverage of the chamber helps with a better surface modification and thus better sensing performance.

FRAX-based intervention and assessment thresholds for osteoporosis in Iran

We compared the utility of the current Iranian guidelines that recommend treatment in women with a T-score ≤ - 2.5 SD with a FRAX-based intervention threshold equivalent to women of average BMI with a prior fragility fracture. Whereas the FRAX-based intervention threshold identified women at high fracture probability, the T-score threshold was less sensitive, and the associated fracture risk decreased markedly with age.

INTRODUCTION

The fracture risk assessment algorithm FRAX® has been recently calibrated for Iran, but guidance is needed on how to apply fracture probabilities to clinical practice.

METHODS

The age-specific ten-year probabilities of a major osteoporotic fracture were calculated in women with average BMI to determine fracture probabilities at two potential intervention thresholds. The first comprised the age-specific fracture probabilities associated with a femoral neck T-score of - 2.5 SD, in line with current guidelines in Iran. The second approach determined age-specific fracture probabilities that were equivalent to a woman with a prior fragility fracture, without BMD. The parsimonious use of BMD was additionally explored by the computation of upper and lower assessment thresholds for BMD testing.

RESULTS

When a BMD T-score ≤ - 2.5 SD was used as an intervention threshold, FRAX probabilities in women aged 50 years was approximately two-fold higher than in women of the same age but with an average BMD and no risk factors. The relative increase in risk associated with the BMD threshold decreased progressively with age such that, at the age of 80 years or more, a T-score of - 2.5 SD was actually protective. The 10-year probability of a major osteoporotic fracture by age, equivalent to women with a previous fracture rose with age from 4.9% at the age of 50 years to 17%, at the age of 80 years, and identified women at increased risk at all ages.

CONCLUSION

Intervention thresholds based on BMD alone do not effectively target women at high fracture risk, particularly in the elderly. In contrast, intervention thresholds based on fracture probabilities equivalent to a "fracture threshold" target women at high fracture risk.

Osteoporosis strategic plan for the Middle East and North Africa region

The first step to achieve a world without fragility fractures is to devise a strategic plan to improve research and planning, and assisting member states to acquire the required financial, technical, and other resources. This article aims to outline the first strategic plan devised for the Middle East and North Africa region proposed by the International Osteoporosis Foundation's (IOF) Middle East and North Africa (MENA) Regional Advisory Council (RAC).

PURPOSE

Osteoporosis is no exception in this rising tide of non-communicable diseases, not only sharing common risk factors but also contributing substantially to a heavy social and economic burden on society. During the past decade and after the establishment of the International Osteoporosis Foundation (IOF), a goal-directed movement has started to achieve a world without fragility fractures. In order to achieve this goal, regional councils were formed to maximize the effectiveness of national osteoporosis societies in raising awareness of effective prevention, diagnosis, and treatment strategies.

METHODS AND RESULTS

The first step to achieve this goal is to devise a strategic plan to improve the research and planning, assisting all member states to acquire the financial, technical, and other resources needed in order to achieve a world-class program in the fight against osteoporosis.

CONCLUSION

This article therefore aims to outline the first strategic plan devised by the IOF's MENA RAC for the Middle East and North Africa region.

Childhood Overweight and Obesity and Associated Factors in Iranian Children and Adolescents: A Multilevel Analysis; the CASPIAN-IV Study

Objective: The purpose of this paper is to explore multidimensional factors related to childhood obesity and overweight based on the data gathered on different aspects of the general health status were assessed among a large number of Iranian children and adolescents in the fourth phase of the "Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable disease" survey. It also aims to determine the degree to which each ecological context contributes to childhood overweight/obesity. Method: A total of 14,880 students and their parents were recruited. They filled out a questionnaire on their relationship with peers, body image, and psychosocial environment of school, dietary habits, life-style habits, physical activity pattern and socioeconomic status (SES). Their height, weight, was measured and body mass index (BMI) was calculated. Obesity and overweight was defined based on the WHO growth chart. Multilevel modeling using three-level random intercept logistic regression models were used to assess predictors of overweight and obesity. In our hierarchical models, children (first level) were conceptualized as being nested within provinces (second level) and provinces within quad regions (third level). Result: From among the 13,486 recruited students, 9.7% were overweight and 11.9% were obese. In multivariate model (adjusted model), being boy (OR:1.58), living in urban area (OR:1.58), having positive family history of obesity (OR = 2.04), breakfast skipping (OR: 1.46), socioeconomic status (OR _{moderateSES/lowSES} = 1.44 and OR _{highSES/lowSES} = 1.89), and birth weight (BW) (OR _{normalBW/lowBW} = 1.33 and OR _highBW/lowBW = 1.8) were associated with childhood obesity. Increasing age was the only factor in the obesity model that had a significant preventive effect on the odds of becoming obese (OR = 0.96, P < 0.001). In multivariate model, living in urban area, increasing age, high and moderate SES, high BW and family history of obesity were the significant predictors of overweight. Conclusion: Our findings show that high BW, sociodemographic characteristics, breakfast skipping, and family history of obesity are associated with childhood obesity and overweight. Therefore, developing strategies that consider the effects of diverse sociodemographic and environmental factors on childhood overweight and obesity would be the most effective way to prevent and manage this multifactorial health concern.

Awareness of osteoporosis among female head of household: an Iranian experience

More than 81% of the studied women had a poor knowledge of different aspects of osteoporosis and its complications, suggesting that more educational programs targeting women in particular are needed to help improve the osteoporosis practice in the societies and reduce the burden of the disease.

PURPOSE

The family structure has changed considerably in the past decade. But, women from Iran and many countries in the region and even families with similar cultural background living in other parts of the world are still responsible for childcare as well as the lifestyle adapted by the family. The present study was conducted to assess the awareness of the female head of household of osteoporosis and its complications.

METHODS

As part of a population-based study in two Iranian cities, Arak and Sannandaj, to study osteoporosis and its risk factors, a questionnaire on the knowledge of female head of households of osteoporosis and its complications was completed. The subsample filled out the knowledge survey along with the questionnaire on their demographic data, socioeconomic status (SES), reproductive factors, bone-related lifestyle habits, family and personal medical history, medication use, and compliance with osteoporosis medication (if used) as well as a FFQ filled out for all the 2100 participants. They also underwent a bone mineral density (BMD) test, and their serum levels of vitamin D were calculated. These data were then used to assess the factors affecting their awareness level.

RESULTS

The knowledge of 81.3% (473) of the studied women was found to be poor on different aspects of osteoporosis and its complications. Multivariate analysis revealed that each level increase in vit D intake tertile increases the chance of higher awareness level in K-Total by 1.5 times. Each level increase in physical activity tertile was associated with a 30.6% lower chance of having a good knowledge.

CONCLUSION

Considering the poor awareness level of the studied women and their poor practice of bone healthy behavior, one could conclude that more programs are needed or the content/delivery style of the existing ones should be optimized.

Fabrication and Verification of Conjugated AuNP-Antibody Nanoprobe for Sensitivity Improvement in Electrochemical Biosensors

This study was designed to obtain covalently coupled conjugates as means for achieving higher stability and better coverage of the AuNPs by antibodies on the particle surface suitable for sensor performance enhancement. Starting by using a modified protocol, colloid gold solution, with mean AuNP core size of ~6 nm was synthesized. The protocol used for conjugation of AuNPs to osteocalcin antibody in this study relies on covalent and electrostatic attractions between constituents. Varieties of conjugates with varying combinations of crosslinkers and different concentrations were successfully synthesized. The obtained products were characterized and their properties were studied to determine the best candidate in sense of antibody - antigen reactivity. Using AuNP-GSH-NHS-Ab combination (1:1:1), the tertiary structure of the protein was maintained and thus the antibody remained functional in the future steps. This one-pot method provided a simple method for covalently coupling antibodies on the particle surface while keeping their functionality intact. The AuNP content of the solution also accelerated electron transfer rate and thus amplifies the detection signal. With the developed and discussed technique herein, a simple solution is modeled to be used for measuring serum levels of biomarkers in single and/or multiplexed sensor systems.

A highly sensitive electrochemical biosensor based on AuNP-modified gold electrodes for selective determination of serum levels of crosslaps

This article explains a step-wise protocol to develop an electrochemical sensor to quantify serum levels of C-telopeptide (CTX) crosslinks also known as crosslaps in a matter of minutes and with high level of accuracy. The technique needs only one-step (incubation) and can thus be used for point of care screening. Due to the excellent electrical properties of the as-prepared immunosensor, CTX levels were successfully measured from 1 to 1000 pg/mL. This is while the normal reference of the marker is 50-450 pg/mL, suggesting that the sensor can acceptably detect CTX. The results also showed a good correlation with ECLIA in measuring serum levels of CTX.

Role of Obesity Variables in Detecting Hypertension in an Iranian Population

INTRODUCTION

As the high incidence of hypertension has been in conjunction with dramatic increase in the prevalence of obesity, many studies have suggested obesity as its underlying cause in diverse race and ethnic groups.

AIM

The present study was designed to quantify the relationship between obesity variables and hypertension in Iranian population. A ROC curve analysis was also used to determine an optimal BMI cutoff for obesity with the aim of representing elevated incidence of hypertension in this population.

METHODS

The study population comprised of apparently healthy men and women who participated in the Iranian Multi-centric Osteoporosis Studies (IMOS), a multi-centric cross-sectional study carried out in urban areas of five great cities (Tehran, Tabriz, Mashhad, Shiraz and Bushehr). The anthropometric (weight, height, waist and hip circumferences) and blood pressure measures were reported in some 5724 subjects. The influence of these factors on systolic and diastolic blood pressure was assessed based on a list-wise method.

RESULTS

There was a significant difference in the studied subjects anthropometric (weight classes (BMI), WC and HC, and WHR) and blood pressure variables; age, gender and weight, however, were the only factors significantly influencing SBP and DBP. Furthermore, BMI showed a significant impact on the overall risk of developing hypertension.

CONCLUSION

General obesity rather than abdominal obesity is directly linked with higher blood pressure levels in Iranian population.

Discharge against medical advice from a Tehran emergency department

PURPOSE

The purpose of this paper is to identify the main reasons for discharge against medical advice (DAMA) in the emergency department (ED) of a teaching hospital in Tehran, Iran.

DESIGN/METHODOLOGY/APPROACH

This cross-sectional study was conducted on all the patients who left the ED of a referral teaching hospital against medical advice (AMA) in 2008. A questionnaire was filled out for each patient to determine the reasons behind patient leaving AMA.

FINDINGS

In total, 12.8 percent of the patients left the hospital AMA. Dissatisfaction with being observed in the ED, having a feeling of recovery and hospital personnel encouraging patients to leave the hospital were the main reasons for leaving the hospital AMA.

PRACTICAL IMPLICATIONS

Like many other centers, the results showed that poor communication skill and work overload were the main contributing factors to DAMA. The center managed to improve patient satisfaction and thus lowered DAMA rates following this study. Considering the similarities reported in the reports and that of other studies, it could be concluded that policy makers in other centers can also benefit from the results to adopt effective approaches to reduce DAMA rate.

ORIGINALITY/VALUE

To the knowledge no study has evaluated the rate and the reasons behind DAMA in the Iranian EDs.

New horizons in treatment of osteoporosis

Background

Prevalence of osteoporosis is increasing both in developed and developing countries. Due to rapid growth in the burden and cost of osteoporosis, worldwide, it seems reasonable to focus on the reduction of fractures as the main goal of treatment. Although, efficient pharmacological agents are available for the treatment of osteoporosis, there still remains a need to more specific drugs with less adverse effects.

Main body

This review article provides a brief update on the pathogenesis, presenting current pharmacological products approved by the US Food and Drug Administration (FDA) or Europe, and also newer therapeutic agents to treat osteoporosis according to the clinical trial data available at PubMed, UpToDate, International Osteoporosis Foundation (IOF), and clinical practice guidelines. As well, the effect of combination therapy and recommendations for future research will be further discussed.

Short conclusion

The use of current antiresorptive and anabolic agents alone or in combinations for the treatment of osteoporosis entails several limitations. Mainly, their efficacy on non-vertebral fracture reduction is lower than that observed on vertebral fracture. In addition, they have potential adverse events on long time usage. Development of newer agents such as cathepsin k inhibitor and strontium ranelate not only have increased the available options for treating osteoporosis, but also have opened doors of opportunity to improvements in the effective treatment. However, the high cost of new agents have restricted their usage in selective patients who are at high risk of fracture or whom failed response to first line treatment options. Thus, personalized medicine should be considered for future evaluation of genetic risk score and also for environmental exposure assessment. In addition to permanent attention to early diagnosis of osteoporosis and understanding of the pathophysiology of osteoporosis for novel approach in drug discovery, there seems a need to more well-designed clinical trials with larger sample sizes and longer duration on current as well as on newer agents. Also, continuous research on plant-derived components as the source of discovering new agents, and conducting more clinical trials with combination of two or more synthetic drugs, plants, or drug-plant for the treatment of osteoporosis are recommended.

Graphical Abstract

Summary of treatment modalities for osteoporosis.

Effects of Intrathecal Opioids Use in Cesarean Section on Breastfeeding and Newborns' Weight Gaining

Objective: To assess the association between intrapartum intrathecal opioid use and breastfeeding and weight gain following cesarean section. Materials and methods: The prospective double-blinded study was conducted on term pregnant women, undergoing elective cesarean section under spinal anesthesia. They divided into two groups. In the first group, intrathecal Morphine was used to achieve analgesia during or after the operation. The remainder divided into two subgroups, those who did not receive any opioid or those received systemic opioids. Following labor breastfeeding accessed in a follow-up, two month latter. Results: There was no difference between the demographic variables of the mothers and newborns APGAR score and weight at the time of birth. Breastfeeding rate was similar in intrathecal group in compare with other patents (P value = 0.518). While, the infants' weight at the end of second month was lower in spinal opioid group (P value = 0.036). Conclusion: The present study was the first to suggest that spinal (intrathecal) opioids do not have any impact on breastfeeding. However the relationship between spinal anesthesia on weight gaining needs more investigation.

Biochemical Markers of Bone Turnover and their Role in Osteoporosis Diagnosis: A Narrative Review

Osteoporosis diagnosis, which is nowadays generally made based on bone mineral density (BMD) measurements, suffers from certain limitations. Thus it is believed that bone turnover markers (BTMs) can help improve osteoporosis detection. The shifting interest toward this topic made us perform a review to gather information on existing markers and their role in osteoporosis diagnosis. Based on the results, in this review, a list of existing markers and some of their characteristics is provided. Moreover, a brief explanation of different types of variability met while using these markers is also described. Finally some of the patents provided for the diagnosis of these markers are presented. While the use of BTMs in osteoporosis diagnosis has certain advantages over BMD and clinical risk assessment tools, more studies are needed before they can be used as a separate tool in this regard. It could be concluded that despite the fact that BTMs are better than BMD not only in monitoring treatment but also in identifying those at-risk, the diagnostic value of BTMs in predicting osteoporosis is low, and thus a model is needed to assess several BTMs at the same time with higher accuracy and lower variability to overcome this limitation.

A Suggested Prototype for Assessing Bone Health

BACKGROUND

Osteoporosis is becoming a health concern worldwide. Considering the fact that prevention plays an important role in reducing the burden of this silent disease and in view of the limited resources available, many countries have adopted certain programs to fight osteoporosis through shifting their attention towards at-risk individuals. The Iranian Multicenter Osteoporosis Study (IMOS) is one of these programs. The program aims to assess bone health and the prevalence of vitamin D deficiency in different parts of Iran with various altitudes, latitudes and lifestyle habits in a way that the results could be generalized to the country.

METHOD

The present article presents the protocol used in the third phase of the study. It was designed based on the experiences gathered in the previous phases to overcome the shortcomings particularly subject loss. The questionnaire applied in this study was developed based on a thorough literature review of the risk factors and secondary causes of osteoporosis and was approved by an expert panel.

RESULTS

While the majority of the existing studies aim to study a certain aspect of osteoporosis, the present protocol provides the information needed for policy makers and researchers to study different osteoporosis-related issues.

CONCLUSION

The authors believe the protocol, to be implemented with small modifications, can help policymakers in different parts of the world, particularly developing countries, gather accurate information on different aspects of bone health at the national level.

Community Interventional Trial (CITFOMIST) of Vitamin D Fortified Versus Non-fortified Milk on Serum Levels of 25(OH) D in the Students of Tehran

BACKGROUND

As prevention of osteoporosis becomes more imperative with the global ageing of the population, establishing different measures to fight vitamin D deficiency will also become increasingly important. The aim of this study is to help assess the efficacy of vitamin D-fortified milk on circulating concentrations of 25(OH)D (as the primary outcome), a widely accepted indicator of vitamin D status, in Tehran students. Another objective of the protocol is to help assess the compliance with fortified dairy in students of different socioeconomic classes.

METHOD

The cluster-randomized trial (CITFOMIST) is conducted on 15- to19-year olds guidance and high school students of both genders from different districts of Tehran, in wintertime. The schools enrolled in this study are randomly assigned to receive one of the three groups of milk (whole milk, milk that contained 600 IU Vit D/1000cc, or milk that contained 1000 IU Vit D /1000cc) for a 30-day period. In order to study the effect of vitamin D-fortified milk on the circulating concentrations of 25(OH) D, a serum vitamin D levels are checked in a subgroup before and after the intervention.

CONCLUSION

There are few data on the efficacy of incremental doses of vitamin D from fortified foods among adolescents. This is while developing an optimal model to fight vitamin D deficiency needs further research on bone health outcomes and the safety of vitamin D-fortified products. The modified version of this protocol could be applied in different parts of the country to assess the efficacy of a vitamin-D product.

Vitamin D status and its relationship with bone mineral density in a healthy Iranian population

Objectives

Considering the controversial results regarding the relationship between vitamin D levels and bone mineral density in different populations, the present study was designed to evaluate this correlation in a healthy Iranian population.

Methods

Using a random cluster sample of apparently healthy men and women, this multicenter cross-sectional study was carried out among 4450 individuals living in urban areas of five major cities in Iran. Bone mineral density (BMD) values at different sites were analyzed along with the serum levels of 25(OH)D and PTH. Analysis of variance (ANOVA) was used to estimate the main effects, through comparing the mean values of these markers based on the bone mineral density status of the study group in each sex.

Results

25(OH)D levels were inversely correlated with BMD values at total hip (r = −0.062 in men and r = −0.057 in women) and spine (r = −0.076 in men and r = −0.107 in women). After adjusting the data for age, the inverse correlation was no longer statistically significant.

Conclusion

Serum 25(OH)D levels are inversely correlated with bone mass values in both sexes.

Analgesic Efficacy of Nephrostomy Tract inFiltration of Bupivacaine and Ketamine after Tubeless Percutaneous Nephrolithotomy: A Prospective Randomized Trial

BACKGROUND

Recently, the use of ketamine as a systemic and local analgesic drug in reducing post-operative pain is studied more frequently.

OBJECTIVES

The aim of the present study was to assess the analgesic efficacy of IV ketamine injection inaddition to nephrostomy tract infiltration of ketamine-bupivacaine on postoperative pain relief after tubeless percutaneous nephrolithotomy (PCNL).

PATIENTS AND METHODS

Patients (n = 100), with renal stone who were candidates for PCNL were randomized to five groups with 20 cases in each: Group C, 10 mL of saline solution was infiltrated into the nephrostomy tract; Group B, 10 mL of 0.25% bupivacaine was infiltrated into the nephrostomy tract; Group BK1, 10 mL of 0.25% bupivacaine plus 0.5 mg/kg ketamine was infiltrated into the nephrostomy tract; Group BK2, 10 mL of 0.25% bupivacaine plus 1.5 mg/kg ketamine was infiltrated into the nephrostomy tract; Group K, 10 mL of saline solution containing 0.5 mg/kg ketamine was intravenously administered. Post-operative pain scores were compared between groups as the primary objective. Comparison of Sedation Scores, rescue analgesic consumption, time to the first rescue analgesics administration, hemodynamic and SpO2 values were regarded as the secondary objective.

RESULTS

Mean VAS scores in the first 30 min and total analgesic consumption in the first 24 h of post-operative period were significantly lower in groups BK1 and BK2 in comparison with the other groups (P < 0.05). Also, time to first rescue analgesics administration was longer in the same groups (P < 0.05).

CONCLUSIONS

Infiltration of ketamine plus bupivacaine provides superior analgesic effects in PCNL surgery compared with other methods.

The effect of transdermal nitroglycerin on pain control in diabetic patients with peripheral neuropathy

BACKGROUND

Despite high prevalence of diabetic peripheral neuropathy there is no definite treatment for the condition. The present study was conducted to assess the efficacy of transdermal nitroglycerin patch in pain control of patients with DPN.

METHODS

This randomized, double-blind, crossover study was conducted on 30 patients with symmetric distal peripheral neuropathy and good glycemic control. The patients were randomly assigned to receive nitroglycerin transdermal and placebo patches in two 4-week stages. The severity of pain and other neuropathic sensory symptoms were assessed at the end of each course.

RESULTS

Mean reduction of pain severity was more prominent in the NTG group compared to placebo group of the study (p = 0.048) at least during the first phase of the study. Except for mood and sleep, a significant reduction in all Brief Pain Inventory scores was noted in the drug group (all corrected p < 0.05). SF-MPQ also showed the drug patch to be effective in improving different aspects of pain measured using McGill Pain Questionnaire, except for Role-emotional.

CONCLUSIONS

It could be concluded that nitroglycerin plasters can effectively help alleviate pain in patients with diabetic neuropathy.

TRIAL REGISTRATION

IRCT201308223213N1.

Using 360-degree multi-source feedback to evaluate professionalism in surgery departments: An Iranian perspective

BACKGROUND

Medical professionalism helps physicians adopt a proper and good healing action for the patients based on their particular circumstance. This study was conducted to assess professionalism in surgical residents, using a 360-degree evaluation technique in several teaching hospitals in Tehran, Iran.

METHODS

This study was conducted on all the second and third year surgery residents from three university teaching hospitals in Tehran. Multi-source feedback questionnaire contained 10 questions on the residents' professional behavior and was completed by the faculty and staff members (nurses, operation room staff, and medical assistants) as well as other surgery residents, interns and patients to evaluate each resident. Response rates were used to determine feasibility for each of the respondent groups and the mean and standard deviation score for each question was computed to determine the viability of the items. Reliability was assessed using alpha Cronbach coefficient for each respondent group. The correlation between these scores and the residents' final and OSCE grade was also assessed.

RESULTS

The internal consistency reliability for 360-degree rating was 0.889. There was no significant difference in the residents' score in different hospitals. While male residents obtained higher total score, there was no significant difference between them. The residents, however, obtained lower scores compared to the staff. The highest score was recorded for question 6, suggesting that the residents treated the patients regardless of their socioeconomic status.

CONCLUSION

This study revealed a strong agreement between the results gathered from different respondents, confirming the reliability of the questionnaire and the respondents' unbiased response. It also revealed that the residents did well in the whole test, showing they were conscientious and learning to become medical professionals.

Prevalence of osteoporosis and vitamin D receptor gene polymorphisms (FokI) in an Iranian general population based study (Kurdistan) (IMOS)

BACKGROUND

Osteoporosis, or porous bone, is a disease characterized by low bone mass density (BMD) and structural deterioration of bone tissue, leading to bone fragility and increased risk of hip, spine, and wrist fractures. There are numerous risk factors for osteoporosis. While many of these factors are non-genetic in nature, there is a definite genetic component responsible for this condition. The main aim of this study was to evaluate the association between VDR (Vitamin D receptor gene) polymorphisms (Fok1) A>G (rs2228570) and bone mineral density in an Iranian defined population.

METHODS

The study participants comprised of 1032 Iranians recruited from the city of Sanandaj during IMOS (Iranian Multi Center Osteoporosis Study). Bone mineral density measurement was performed in all the participants with and without osteoporosis. All samples were genotyped for VDR genes (Fok1) polymorphism with polymerase chain reaction, using a predesigned TaqMan allele discrimination assay.

RESULTS

There was a significant association between Fok1 polymorphism and osteoporosis in postmenopausal women, 0.138 (0.025-0.768).

CONCLUSION

It seems that cohort studies, which are more powerful than case-control studies, can be useful in evaluating the roles of genetic variants as risk or protective factors for osteoporosis.

Clinical performance of seven prescreening tools for osteoporosis in Iranian postmenopausal women

This study was designed to evaluate seven prescreening osteoporosis models in postmenopausal Iranian women. This study was performed on 8644 postmenopausal women who have been referred for bone mineral densitometry (BMD) in BMD center of Shariati hospital in Tehran between 2001 and 2011. Diagnostic properties of seven prescreening instruments were evaluated. With regard to area under curve (AUC), these models have low accuracy (AUC ≤ 0.65). Considering only femoral neck or total femur area, these models had low accuracy but were more sensitive. Except for three models with sensitivities of ≤65 % in both osteoporosis and fracture threshold, other models were around 70 % sensitive. However, these models were not considered clinically useful regarding their positive predictive values (PPV) especially in BMDs ≤02.5. With regard to different measures of diagnostic property, none of these models were good screening tools for osteoporosis or fracture threshold. Although some of them are sensitive, considering other measures such as PPV indicates that they are not completely useful for clinical use. Attempts should be made for developing newer prescreening methods and calibration of the existing models with regard to the studied population.

Innovation of a new silicone prosthesis for inguinal hernioplasty: new method for silicone prosthesis production, a preliminary study

PURPOSE

The main strategy in inguinal hernia repair is mesh hernioplasty (specially prolene mesh). Pain in anterior femoral, inguinal and scrotal areas, mainly due to sensory nerve injury in the very regions and vas deferen injury are the main complications reported following repairing inguinal hernia. In this study we decided to use semiliquid silicone in order to form it in an in-vivo prosthesis production method to perform hernioplasty.

METHODS

In this technique, silicone was produced through Room Temperature Vulcanization (RTV) technique, which is feasible in the room temperature. The produced semiliquid polymer was shaped in the inguinal canal in six cadavers.

RESULT

While the prostheses adequately covered all the anatomic area of the canal with an acceptable thickness in all of the cases, a satisfactory shape was developed in four cases. While 15 - 20 cc of silicone was needed to cover all anatomic areas properly, the hardness equal to 15 was achieved after curing process.

CONCLUSION

New silicone prosthesis forms satisfyingly in the inguinal canal and can protect it by encapsulation mechanism. It is soft with no risk of damage to the nerves or vas. It is inert and has no toxicity to the adjacent tissue. This technique of silicone remodeling can also be used in other fields of surgery such as plastic or vascular surgery.

Dual-energy X-ray absorptiometry diagnostic discordance between Z-scores and T-scores in a young Iranian population

BACKGROUND

Dual-energy X-ray Absorptiometry (DXA) is considered the gold standard for non-invasive measurement of bone mass. T-scores and Z-scores are used to present the results of bone mass. The present study was designed to evaluate the discordance between T-scores and Z-scores calculated at a same level and its relation with age, gender and body mass index (BMI) in a representative sample of normal population.

METHODS

This cross-sectional study was conducted as a part of a comprehensive survey, Iranian Multicenter Osteoporosis Study (IMOS), designed to assess bone health among healthy adults. Each individual underwent both L1-L4 antero-posterior lumbar spine and hip DXA scan. The difference between the T- and Z-scores measured at each of the four skeletal sites was then calculated.

RESULTS

A -1.21 to 1.21 point difference was noted in the Z- and T- scores measured at each site. While the difference between the T-and Z-scores was less than 0.5 SD in most of the cases, the difference was higher than 1 SD in about 5% of the subjects.

CONCLUSION

Standardization of Z-score definition and calculation techniques as well as developing an ethnicity-matched reference population is needed to improve the reliability of DXA-generated Z-scores.

Association of the CTLA-4 1722TC polymorphism and systemic lupus erythematosus: a systematic review and meta analysis

BACKGROUND

Cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) is an important negative regulator of Tcell responses. The -1722TC polymorphism of the CTLA-4 gene may be associated with systemic lupus erythematosus (SLE) risk, but related results from previous studies have been inconsistent. We carried out a metaanalysis to assess this association more precisely.

METHODS

A systematic search through PubMed, Science Direct, and OVID, Iran doc, Iranmedex and SID (Scientific Information Database) databases was performed with the last search updated on December 30, 2011. The odds of ratio (OR) and its 95% confidence interval (95%CI) were used to assess the strength of the association. We evaluated both fixed and random effect models, depending on the presence of between-study heterogeneity. The analyses were conducted using STATA software, version 11.0.

RESULTS

A total of 9 independent studies on the CTLA-4 gene -1722TC polymorphism and SLE, including 1422 cases and 1417 controls were used in this meta-analysis. In the present meta-analysis, we found a significant association between -1722TC polymorphism and SLE risk in the overall analysis (TT versus

TC/CC

OR=1.18, 95%CI 0.84-1.66, p= 0.32; TT/TC versus CC: OR = 2.06, 95%CI 1.07-3.99, p= 0.03; TT versus CC: OR = 2.32, 95%CI 1.62-3.32, p< 0.001; TC versus CC: OR = 1.99, 95%CI 1.42-2.78, p<0.001; TT versus TC: OR = 1.2, 95%CI 0.86-1.66,p= 0.28; T versus C: OR = 1.22, 95%CI 0.91-1.64,p= 0.16). In the subgroup analysis by ethnicity, -1722TC polymorphism was significantly associated with SLE risk in Asian population.

CONCLUSION

This meta-analysis suggests a significant association between -1722TC polymorphism and SLE susceptibility. Large-scale and well-designed case-control studies are necessary to validate the risk identified in the present meta-analysis.

The risk of osteoporotic fractures and its associating risk factors according to the FRAX model in the Iranian patients: a follow-up cohort

BACKGROUND

The present study is designed to assess the incidence rate of osteoporotic fracture and its risk factors, particularly those used to predict the 10-year risk of osteoporotic fracture in FRAX based on the data gathered through a follow up cohort initiated in 2000.

METHODS

The present retrospective cohort was conducted on men and women from 40 to 90 years of age enrolled in the IROSTEOPs study. A phone survey was conducted during 2013 and beginning of 2014 to assess the fractures (traumatic/osteoporotic) occurring at the time of inclusion until the date of the telephone survey, its type and mechanism, and the patient's age at the time of accident. Survival analysis using Kaplan-Meier product-limit method was performed with the time of fracture as the study outcome.

RESULTS

Final study population consisted of 1233 individuals, translated in to 9133 person years. The incidence rate of osteoporotic fracture was reported to be 359.1 cases in every 10,000 person years. The 10-year Kaplan-Meier estimate of any kind of major osteoporotic fractures for all the subcohort population was 10.75%. Osteoporosis (HR = 0.75), Discordance between femoral neck and spine (HR = 1.45), Diabetes (HR = 1.81), IBD (HR = 1.84), immobility more than 90 days (HR = 2.19), and personal history of fracture (HR = 7.75) had a considerable effect on the 10-year risk of major osteoporotic fractures.

CONCLUSIONS

Adding new clinical risk factors to FRAX® may help improve fracture prediction in the Iranian population.