Comparison of Framingham Cardiovascular Risk Criteria and ASCVD Score in Iranian Obese Patients

Background: Calculating and predicting the risk of disease plays an important role in preventive medicine. Today, some risk scores have been designed to estimate the risk of cardiovascular diseases (CVDs) by assessing different factors. Obesity is associated with an increased risk of cardiovascular disease, so we decided to calculate the possible risk of heart disease in obese Iranian people to suggest a more accurate calculator. Methods: In this cross-sectional study, we compared the data of 289 people from Framingham Risk Score and ASCVD Risk Score calculations who had been referred to Shariati Hospital Obesity Clinic, Tehran, Iran from 2016 to 2019. In the form of sub-goals, we examined other factors such as blood pressure and hepatic aminotransferases, etc. Results: The mean age of participants was 51.20±7.58 years, 86.2% being women. Of the whole, 19.72%, 31.83%, 21.11%, and 27.34% were categorized as overweight, Obese I, II, and III, respectively. According to the ASCVD score 80.3%, 4.8%, and 14.9%, and according to the Framingham score 95.5%, 3.5%, and 1% were classified as low-risk, intermediate-risk, and high-risk. Moreover, a fair agreement was observed between the two-risk score in the whole (Kappa=0.236; P<0.001), overweight (Kappa=0.304; P=0.028), Obese I (Kappa=0.210; P=0.048), Obese II (Kappa=0.268; P=0.015), and obese III (Kappa=0.202; P=0.023). Conclusion: Despite its age limit, ASCVD has a higher risk of CVDs, causing statin care (which has a protective role for cardiovascular disease) to be given to a larger population.  

The effects of colchicine on hospitalized COVID-19 patients: A randomized, double-blind, placebo-controlled clinical trial

This study was designed to evaluate the effects of colchicine in the improvement of clinical outcomes of hospitalized COVID-19 patients. This prospective, randomized, double-blind, placebo-controlled clinical trial was conducted on adult patients (>18 years) with severe COVID-19. The included patients were randomly (1:1) assigned to the colchicine (2 mg loading dose followed by 0.5 mg twice daily for 7 days) or placebo group. Both groups received remdesivir and interferon beta-1b. The primary outcome of the study was to receive clinical response as ordinal scale of 1 or 2. Secondary outcomes were hospital complications and 28-day mortality. Between February and May 2021, 110 patients were included and 106 of them were analyzed. Baseline clinical characteristics and demographics were not significantly different. According to the ordinal scale, 30 patients in the control group (58.8%) responded to treatment within 7 days, while 35 patients (63.6%) in the colchicine group showed the same response (p = 0.61, odds ratio (OR) = 1.23, 95% CI [0.560-2.68]). On the 14th day, 87.3% of the colchicine group (n = 48) and 82.4% of the control group (n = 42) responded (p = 0.48, OR = 1.47, 95% CI [0.50.3-4.29]. In addition, 28-day mortality, intensive care unit admission, and hospital duration were not different between the groups (p = 0.99, 0.59, 0.06). Diarrhea and nausea were the major side effects dominant in the colchicine group. Colchicine showed no beneficial effects on clinical improvement and hospital complications in patients with COVID-19. Moreover, in case of prescription, the safety concerns of colchicine, specially gastrointestinal side effects, should be taken into account.

Association of plasma acylcarnitines and amino acids with hypertension: A nationwide metabolomics study

BACKGROUND

Identification of metabolomics profile in subjects with different blood pressure, including normal blood pressure, elevated blood pressure, stage 1 hypertension, and stage 2 hypertension, would be a promising strategy to understand the pathogenesis of hypertension. Thus, we conducted this study to investigate the association of plasma acylcarnitines and amino acids with hypertension in a large Iranian population.

METHODS

1200 randomly selected subjects from the national survey on the Surveillance of Risk Factors of Non-Communicable Diseases in Iran (STEPs 2016) were divided into four groups based on the ACC/AHA hypertension criteria: normal blood pressure (n = 293), elevated blood pressure (n = 135), stage 1 hypertension (n = 325), and stage 2 hypertension (n = 447). Plasma concentrations of 30 acylcarnitines and 20 amino acids were measured using a targeted approach with flow-injection tandem mass spectrometry. Univariate and multivariate logistic regression analysis was applied to estimate the association between metabolites level and the risk of hypertension. Age, sex, BMI, total cholesterol, triglyceride, HDL cholesterol, fasting plasma glucose, use of oral glucose-lowering drugs, statins, and antihypertensive drugs were adjusted in regression analysis.

RESULTS

Of 50 metabolites, 34 were associated with an increased likelihood of stage 2 hypertension and 5 with a decreased likelihood of stage 2 hypertension. After full adjustment for potential confounders, 5 metabolites were still significant risk markers for stage 2 hypertension including C0 (OR = 0.75; 95%CI: 0.63, 0.90), C12 (OR = 1.18; 95%CI: 1.00, 1.40), C14:1 (OR = 1.20; 95%CI: 1.01, 1.42), C14:2 (OR = 1.19; 95%CI: 1.01, 1.41), and glycine (OR = 0.81; 95%CI: 0.68, 0.96). An index that included glycine and serine also showed significant predictive value for stage 2 hypertension after full adjustment (OR = 0.86; 95%CI: 0.75, 0.98).

CONCLUSIONS

Five metabolites were identified as potentially valuable predictors of stage 2 hypertension.

The association between acylcarnitine and amino acids profile and metabolic syndrome and its components in Iranian adults: Data from STEPs 2016

BACKGROUND

Evidence, albeit with conflicting results, has suggested that cardiometabolic risk factors, including obesity, type 2 diabetes (T2D), dyslipidemia, and hypertension, are highly associated with changes in metabolic signature, especially plasma amino acids and acylcarnitines levels. Here, we aimed to evaluate the association of circulating levels of amino acids and acylcarnitines with metabolic syndrome (MetS) and its components in Iranian adults.

METHODS

This cross-sectional study was performed on 1192 participants from the large-scale cross-sectional study of Surveillance of Risk Factors of non-communicable diseases (NCDs) in Iran (STEP 2016). The circulating levels of amino acids and acylcarnitines were measured using liquid chromatography-tandem mass spectrometry (LC-MS/MS) in individuals with MetS (n=529) and without MetS (n=663).

RESULTS

The higher plasma levels of branched-chain amino acids (Val, Leu), aromatic amino acids (Phe, Tyr), Pro, Ala, Glu, and the ratio of Asp to Asn were significantly associated with MetS, whereas lower circulating levels of Gly, Ser, His, Asn, and citrulline were significantly associated with MetS. As for plasma levels of free carnitine and acylcarnitines, higher levels of short-chain acylcarnitines (C2, C3, C4DC), free carnitine (C0), and long-chain acylcarnitines (C16, C18OH) were significantly associated with MetS. Principal component analysis (PCA) showed that factor 3 (Tyr, Leu, Val, Met, Trp, Phe, Thr) [OR:1.165, 95% CI: 1.121-1.210, P<0.001], factor 7 (C0, C3, C4) [OR:1.257, 95% CI: 1.150-1.374, P<0.001], factor 8 (Gly, Ser) [OR:0.718, 95% CI: 0.651-0.793, P< 0.001], factor 9 (Ala, Pro, C4DC) [OR:1.883, 95% CI: 1.669-2.124, P<0.001], factor 10 (Glu, Asp, C18:2OH) [OR:1.132, 95% CI: 1.032-1.242, P= 0.009], factor 11 (citrulline, ornithine) [OR:0.862, 95% CI: 0.778-0.955, P= 0.004] and 13 (C18OH, C18:1 OH) [OR: 1.242, 95% CI: 1.042-1.480, P= 0.016] were independently correlated with metabolic syndrome.

CONCLUSION

Change in amino acid, and acylcarnitines profiles were seen in patients with MetS. Moreover, the alteration in the circulating levels of amino acids and acylcarnitines is along with an increase in MetS component number. It also seems that amino acid and acylcarnitines profiles can provide valuable information on evaluating and monitoring MetS risk. However, further studies are needed to establish this concept.

Torsion among Women with Acute Lower Abdominal Pain: A Retrospective Cross-Sectional Study

Background: Lower abdominal or pelvic pain is a common complaint among women and one of the most challenging findings to evaluate. We performed the present study to construct a new algorithm for predicting the chance of ovarian torsion among women with acute lower abdominal pain. Methods: This diagnostic retrospective cross-sectional study was performed on all female individuals who were referred to Imam Hossein Medical Center, Tehran, Iran, with the chief complaint of acute lower abdominal pain, and underwent laparotomy between 2010 and 2016. Clinical and paraclinical findings were evaluated to construct a predictive model for ovarian torsion. The variables were compared in 2 groups. The first group included individuals with a final diagnosis of ovarian torsion and the second group included those individuals with any diagnosis other than ovarian torsion. All data were compared between these 2 groups using SPSS software Version 21 to find the related findings with a predictive value for ovarian torsion. Results: A total of 372 participants were evaluated, of whom 116 participants (31.2%) had ovarian torsion (case group) and 256 participants had other diagnoses for their lower abdominal pain (control group). Nausea and vomiting (p < 0.001), tenderness (p < 0.001), the size of ovarian mass (p = 0.004), and the percentage of polymorphonuclear (p < 0.001) showed significant relationships with ovarian torsion as the final diagnosis. Multiple logistic regression models were constructed to predict the factors affecting ovarian torsion, and a scoring system was designed to predict ovarian torsion, with a sensitivity of 77.59% (68.9%- 84.8%) and specificity of 74.61% (68.8% 79.8%). Conclusion: The proposed model is suitable for predicting ovarian torsion and its necessary information is readily available from individuals' history, examination findings, laboratory results, and an ultrasound exam.

Estimating short-term and long-term survival in rectal cancer patients using cure model

Background

A large number of rectal cancer patients are cured after treatment. In such cases, cure models are used for survival analysis. This study aims to investigate factors that affect survival in rectal cancer using the Cox mixture cure model.

Methods

Following a retrospective design, medical documents and pathological findings of newly diagnosed rectal cancer cases hospitalized at Imam Hossein Hospital, Tehran, Iran, from 2005 to 2013 were reviewed. The patients were followed up with until May 2018. The Cox mixture cure model was used. Data analysis was carried out using Statistical Analysis System (SAS) version 9.4. The statistical significance level was considered to be 0.05.

Results

Four hundred nine patients were included in this study. The mean of disease-free survival was 87.08 ± 3.2 months. The hazard of the event for the patients who were drug abusers was 2.37 (95% CI: 1.30-4.31) times more than the other cases (P = 0.005). The odds ratio of the event for patients of stage III was 3.04 (95% CI: 1.51-6.12) times more than the cases of stage I (P = 0.002), and for the patients of stage IV, it was 12.42 (95% CI: 4.17-37.01) times more than patients of stage I (P < 0.001).

Conclusions

The results of this cure model indicate that the tumor stage, tumor grade, and history of drug abuse are the risk factors for the survival of patients with rectal cancer. These results can attract the attention of doctors and patients who want to be aware of their physical status and prognosis.

Metabolic signatures of insulin resistance in non-diabetic individuals

BACKGROUND

Insulin resistance (IR) evolved from excessive energy intake and poor energy expenditure, affecting the patient's quality of life. Amino acid and acylcarnitine metabolomic profiles have identified consistent patterns associated with metabolic disease and insulin sensitivity. Here, we have measured a wide array of metabolites (30 acylcarnitines and 20 amino acids) with the MS/MS and investigated the association of metabolic profile with insulin resistance.

METHODS

The study population (n = 403) was randomly chosen from non-diabetic participants of the Surveillance of Risk Factors of NCDs in Iran Study (STEPS 2016). STEPS 2016 is a population-based cross-sectional study conducted periodically on adults aged 18-75 years in 30 provinces of Iran. Participants were divided into two groups according to the optimal cut-off point determined by the Youden index of HOMA-IR for the diagnosis of metabolic syndrome. Associations were investigated using regression models adjusted for age, sex, and body mass index (BMI).

RESULTS

People with high IR were significantly younger, and had higher education level, BMI, waist circumference, FPG, HbA1c, ALT, triglyceride, cholesterol, non-HDL cholesterol, uric acid, and a lower HDL-C level. We observed a strong positive association of serum BCAA (valine and leucine), AAA (tyrosine, tryptophan, and phenylalanine), alanine, and C0 (free carnitine) with IR (HOMA-IR); while C18:1 (oleoyl L-carnitine) was inversely correlated with IR.

CONCLUSIONS

In the present study, we identified specific metabolites linked to HOMA-IR that improved IR prediction. In summary, our study adds more evidence that a particular metabolomic profile perturbation is associated with metabolic disease and reemphasizes the significance of understanding the biochemistry and physiology which lead to these associations.

Targeted metabolomics analysis of amino acids and acylcarnitines as risk markers for diabetes by LC-MS/MS technique

Diabetes is a common chronic disease affecting millions of people worldwide. It underlies various complications and imposes many costs on individuals and society. Discovering early diagnostic biomarkers takes excellent insight into preventive plans and the best use of interventions. Therefore, in the present study, we aimed to evaluate the association between the level of amino acids and acylcarnitines and diabetes to develop diabetes predictive models. Using the targeted LC-MS/MS technique, we analyzed fasting plasma samples of 206 cases and 206 controls that were matched by age, sex, and BMI. The association between metabolites and diabetes was evaluated using univariate and multivariate regression analysis with adjustment for systolic and diastolic blood pressure and lipid profile. To deal with multiple comparisons, factor analysis was used. Participants' average age and BMI were 61.6 years, 28.9 kg/m2, and 55% were female. After adjustment, Factor 3 (tyrosine, valine, leucine, methionine, tryptophan, phenylalanine), 5 (C3DC, C5, C5OH, C5:1), 6 (C14OH, C16OH, C18OH, C18:1OH), 8 (C2, C4OH, C8:1), 10 (alanine, proline) and 11 (glutamic acid, C18:2OH) were positively associated with diabetes. Inline, factor 9 (C4DC, serine, glycine, threonine) and 12 (citrulline, ornithine) showed a reverse trend. Some amino acids and acylcarnitines were found as potential risk markers for diabetes incidents that reflected the disturbances in the several metabolic pathways among the diabetic population and could be targeted to prevent, diagnose, and treat diabetes.

Impact of educational level on incident chronic kidney disease during 13 years of follow-up: a prospective cohort study

OBJECTIVES

To examine the association between educational level and chronic kidney disease (CKD) among the Iranian population.

STUDY DESIGN

This is a prospective cohort study conducted in the framework of the Tehran Lipid and Glucose Study.

METHODS

A total of 8173 Iranians (men = 3659) aged ≥20 years were included in the study. CKD was defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m². The association between educational status and CKD was explored using multivariate Cox proportional regression analyses, adjusted for age, gender, current smoking, marital status, body mass index, waist circumference, baseline eGFR, diabetes, hypertension, physical activity, history of cardiovascular diseases and dyslipidaemia.

RESULTS

During a median follow-up of 13.14 years, 2609 cases of incident CKD were identified; the corresponding incidence rate was 26.35 (range 25.39-27.34) per 1000 person-years. Compared to low educational level, middle and high educational levels showed lower risks for incident CKD in the crude model [hazard ratio (HR) 0.37 (95% confidence interval {CI} 0.34-0.40) and HR 0.40 (95% CI 0.35-0.45), respectively]; however, these HRs changed direction after further adjustment for age and gender [HR 1.26 (95% CI 1.14-1.39) and HR 1.40 (95% CI 1.22-1.61), respectively]. The increased risk of incident CKD for those at higher educational levels remained significant in the fully adjusted model. In addition, results from the gender stratified analyses were in the same direction as those found among the whole study population (P-value for interaction of gender and education >0.8).

CONCLUSIONS

Higher educational levels were associated with incident CKD during more than a decade of follow-up; this finding may be attributed to unhealthy lifestyle behaviours among this population group.

A new decision making model for diagnosing acute appendicitis among non-pregnant women and its comparison with alvarado scoring system

Background: Although acute appendicitis is a common problem, it remains a difficult diagnosis to establish, particularly among females of reproductive age. The present study was conducted to devise a new decision making model for diagnosing acute appendicitis in non-pregnant women.

Methods: The present study was a retrospective study consisting of women who had undergone an appendectomy between 2007 and 2015 at the emergency department of Imam Hossein Medical Center, Tehran, Iran. The inclusion criteria were being a female, presenting with abdominal pain, being a suspected case of acute appendicitis, and undergoing an emergency appendectomy. A classification and regression tree (CART) analysis was performed to partition exam and laboratory data obtained from these patients into homogeneous groups in order to develop a prediction rule for appendicitis diagnosis.

Results: The study population included 433 non pregnant women who underwent emergency operations with a preliminary diagnosis of acute appendicis. Out of these patients, 295 patients (68.1%) were appendicitis positive based on the pathology exam results, while 138 patients had a normal appendix, indicating a negative appendectomy rate of 31.8%. The final devised CART model included hemoglobin level, PMN count, age, and history of abdominal incision and yielded a sensitivity of 82.7% and specificity of 55.8%, which were better than Alvarado prediction results for the Asian population.

Conclusion: We have devised a simple and cost effective prediction model for predicting the outcome among non-pregnant women undergoing emergency appendectomy operation with good sensitivity and specificity compared to the Alvarado model.

Effect of antioxidant supplementation containing L-carnitine on semen parameters: a prospective interventional study

Objective:

One of the remarkable causes of infertility in men is oxidative stress having a reducing effect on their reproductive function. In the present study, we investigated the efficacy of supplementation with antioxidants and L-Carnitine (contained in Androferti) on semen parameters.

Methods:

We included 180 infertile male patients diagnosed with idiopathic oligoastenoteratozoospermia (OAT) in this study, and we analyzed the semen sample from 59 patients before and after oral antioxidant treatment, with the commercial name of Androferti (containing 1500 mg of L-Carnitine, 60 mg of vitamin C, 20 mg of coenzyme Q10, 10 mg of vitamin E, 10 mg of zinc, 200 µg of vitamin B9, 50 µg of selenium, 1 µg of vitamin B12). All of the patients received Androferti twice a day for 3 months.

Results:

There were significant improvements in the sperm concentration (p=0.004) after the antioxidant supplementation. There was also a meaningfully improvement in sperm morphology (p=0.01) after treatment. However, sperm motility was not significantly altered after antioxidant treatment (p=0.2).

Conclusions:

Antioxidants supplementation containing 1500 mg L-carnitine can improve the semen quality in infertile men diagnosed with idiopathic OAT. However, further studies are required to determine the antioxidant effects on reproduction function.

Preoperative Smoking Cessation and its Association with Postoperative Complications and Length of Hospital Stay in Patients Undergoing Herniorrhaphy

BACKGROUND

To assess the effect of preoperative smoking cessation on postoperative complications in patients undergoing herniorrhaphy.

MATERIALS AND METHODS

This prospective study was conducted on 163 consecutive patients, undergoing herniorrhaphy. Demographic characteristics and postoperative complications were compared between smokers (group A), patients who reduced smoking by 50% (group B), and patients who completely quit smoking (group C).

RESULTS

The mean age of the patients was 42.9 (SD=10.3) years. Group A (n=77), group B (n=27), and group C (n=59) were not significantly different in terms of age, body mass index (BMI), medical history, laboratory data, smoking habit, type of hernia, type of anesthesia, the American Society of Anesthesiologists (ASA) class, repair method, surgery approach, and duration surgery (P>0.05 for all). However, significant differences were observed between group B and group A, group C and group A, and group C and group B regarding postoperative complications, such as wound healing complications and length of hospital stay (LOS) (P<0.05 for all).

CONCLUSION

Decreased preoperative smoking is associated with the reduced risk of respiratory, cardiovascular, and wound healing complications and decreased LOS in patients undergoing herniorrhaphy.

Effect of myo-inositol supplementation on ICSI outcomes among poor ovarian responder patients: A randomized controlled trial

PURPOSE

This study has evaluated the use of myo-inositol supplementation for improving reproductive outcomes in poor responders undergoing intracytoplasmic sperm injection (ICSI).

METHODS

One hundred and twelve poor responder patients were included in the study and randomly categorized into two groups using a permuted block randomization method. Group A included 56 patients who received myo-inositol (4 g) and folic acid (400 μg) daily from one month before starting the ICSI cycle continuing until the ovulation triggering day. Group B included 56 patients consuming only folic acid (400 μg) daily for the same period. The outcome measures were the number of retrieved oocytes, embryo quality, Ovarian Sensitivity Index (OSI: number of oocytes retrieved/total Gonadotropins units × 1000), fertilization, implantation, and ongoing pregnancy rates.

RESULTS

No significant difference was observed between the two groups regarding the total dose of gonadotropin used, OSI, and the number of total retrieved and mature oocytes. Grad A embryos and fertilization rate were significantly increased in group A. Implantation and pregnancy rates showed statistically insignificant changes.

CONCLUSION

Treatment of poor responders with myo-inositol from one month before starting ICSI cycle continuing until ovulation trigger can improve fertilization rate and embryo quality, and may enhance the cumulative pregnancy rate in poor responders.

Clinicopathological features and survival of colorectal cancer patients younger than 50 years: a retrospective comparative study

BACKGROUND

Colorectal cancer (CRC) is a disease of old age, but its incidence has been rising among younger population compared to older ones. Nevertheless, there is a controversy over survival of younger patients compared to the older ones. Therefore, in the current study, we investigated the clinicopathological features and survival of the younger (< 50 years) versus older (≥ 50 years) CRC patients.

RESULTS

The younger and older groups consisted of 39.4% and 60.6% of patients, respectively. Both age groups were comparable regarding the symptom presentation and duration, and pre-operative carcinoembryonic antigen (CEA). The younger patients were diagnosed with a higher proportion of poorly differentiated (14.7% vs. 8.3%; p < 0.001) and more advanced tumors (53.2% vs. 45.9%; p = 0.266). The rectum tumor site was significantly more common among the younger patients (p = 0.021). The overall survival (OS) (p = 0.278), the cancer-specific survival (CSS) (p = 0.233), and the disease-free survival (DFS) (p = 0.497) did not differ significantly between the two groups. Based on Cox regression model, elevated pre-operative CEA level (HR = 1.41; 95%CI of 1.01-1.97), advanced tumor stage (6.06; 95%CI of 3.03-12.15), and poorly differentiated tumor (HR = 1.69; 95%CI of 1.05-2.71) were associated with decreased survival.

CONCLUSIONS

The younger patients did not have poor prognosis compared to the older ones despite having an advanced tumor stage and a poor tumor differentiation.

A peer support intervention in improving glycemic control in patients with type 2 diabetes

OBJECTIVE

This study aims to assess the effectiveness of a peer support intervention, in which patients with T2DM were provided ongoing self-management support by trained peers with diabetes directed at improving self-care behaviors, self-efficacy and life quality.

METHODS

In this randomized controlled trial, 200 patients referred to a diabetes specialty clinic were allocated to peer support or control group. Participants in both groups received usual education by diabetes educators. Intervention participants worked with the trained volunteer peers who encouraged participants to engage in daily self-management and to discuss and share their experiences and challenges of diabetes management. The primary outcomes were HbA1c, BMI, self-care behaviors, self-efficacy and life quality RESULTS: After 6 months, patients in the peer support group experienced a significant decline in mean A1c value (P=0.045). Also, mean diabetes self-management scores, mean self-efficacy scores and mean quality of life scores significantly improved in peer support group compared to control group (P values <0.001).

CONCLUSION

Peer support activities can be successfully applied in diabetes self-management, especially in areas with a shortage of professionals and economic resources.

PRACTICE IMPLICATIONS

Peer support strategies should be integrated into our healthcare system to meet minimum needs of people with T2DM in Iran.

Effect of treatment of iron deficiency anemia onhemoglobin A1c in type 2 diabetic patients

Background/aim: Iron deficiency anemia (IDA) affects hemoglobin A1c (HbA1c) levels. This study aimed to evaluate the effect of treatment of iron deficiency anemia on hemoglobin A1c in type 2 diabetic patients.Materials and methods: Ninety type 2 diabetes mellitus (T2DM) patients with IDA were included in a randomized, placebo-controlled, single-blind clinical trial. The intervention group (n = 45) received 200 mg/day oral iron for 3 months and the control group (n = 45) received an oral placebo for the same period. Fasting blood sugar, complete blood count, and HbA1c were measured for all subjects at the beginning and the end of the trial.Results: The mean age of the treatment and control group was 51.47 ± 1.05 and 52 ± 1.1 years, respectively. The two groups were not statistically significantly different with regard to diabetes duration (P = 0.436) and age (P = 0.617). Hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin, serum iron, ferritin, total iron-binding capacity, and HbA1c were significantly improved in the intervention group in comparison with the control group (P = 0.005).Conclusion: Iron status should be considered during the interpretation of the HbA1c concentrations in diabetes mellitus. Iron replacement therapy can decrease HbA1c in anemic patients with IDA and T2DM.

Iran diabetes research roadmap (IDRR) study: a preliminary study on diabetes research in the world and Iran

Backgrounds

Diabetes is one of the most common metabolic disorders worldwide. This study aim was to provide detail analysis of diabetes research output and its trend in Iran as well as in the world and compare them.

Methods

Data was retrieved from PubMed database using a suitable search strategy and application of proper operator “AND”, “OR” and “NOT”. All English documents published from 2008 to 2012 were included. Meeting abstract, letter to the editor, guidelines, consensus and reviews were excluded. Obtained documents for Iran and world were categorized in eleven groups including diabetes management, education, paediatrics, nutrition, epidemiology, diabetes complications, stem cells, gestational diabetes mellitus (GDM), psychiatrics, genetics and prevention and were compared.

Results

Total number of DM publications was 59513 for world and 648 for Iran. Trend of DM publications was increasing during the 5 years with a growth rate of 22.5% for world and 23.4% for Iran. Contribution of Iran in the world diabetes output reached 1.08 in 2012. The most and the least number of DM documents were related to complications and preventions, respectively both in Iran and the world. Three leading countries with highest proportion of RCTs (randomized clinical trial) to their total DM publications were Italy, Germany and Iran.

Conclusion

The most number of diabetes research was in the field of diabetes complication, management and genetics in the world as well as in Iran. During the 5-year period, despite of the world sanctions against Iran, diabetes research trend was increasing in Iran relatively parallel to the world research and sanction had no significant effect on Iran.

Once Versus Thrice Daily Colistin in Critically Ill Ptients with Multi-Drug Resistant Infections

The aim of this study was to evaluate the procalcitonin (PCT) changes in two different high-dose colistin regimens in the treatment of multi-drug resistant MDR gram negative infections in ICU patients. This is a prospective study of adult ICU patients with bacteremia and ventilator associated pneumonia (VAP) caused by MDR gram negative pathogens. Patients were assigned to two colistin administration groups. Group A received 9 and group B received 3 million international units every 24 and 8 h respectively. Baseline characteristics and measurements of PCT concentrations at the start, the 3^rd and the 5^th day of the antibiotic therapy and their trends between the two groups were recorded and compared. of 40 patients enrolled, 34 completed the study protocol, of whom 30 (88.2%) had (VAP) and 4 (11.8%) had bacteremia. There were no statistically significant differences in the baseline characteristics between the two groups. The mean PCT levels in two study groups were; 2.34, 1.24, and 0.95 in group A and 5.89, 1.24 and 0.8 in group B at the baseline, 3^rd and 5^th day of colistin administration respectively (P=0.47). The ICU length of stay (LOS) in days and ICU mortality were; 31.31, 35.3% and 32.06, 22.2% in groups A and B (P=0.39, 0.87), respectively.

CONCLUSION

We did not find any statistically significant differences in the serum PCT levels, ICU LOS or ICU mortality, between the two groups, who received maximum recommended dose of CMS with 2 different intervals of every 8 or 24 h.

Effectiveness of short message service-based intervention (SMS) on self-care in type 2 diabetes: A feasibility study

AIM

The objective of the current study is to assess the effectiveness of Mobile Short Message Service (SMS) intervention on education of basic self-care skills in patients with type 2 diabetes. Moreover, we aimed to determine whether delivering individually-tailored educational messages can be more effective than general educational messages.

METHODS

A total of 150 patients with diabetes type 2 were randomized into three groups: tailored SMS group, non-tailored SMS group, and the control group. Biochemical parameters including HbA1c, FBS, lipid profile were evaluated for the three groups at baseline and after 12 weeks. Moreover, self-care Inventory (SCI), Diabetes Management Self-Efficacy Scale (DMSES) and Diabetes Self-Care Barriers assessment scale for Older Adults (DSCB-OA) were completed. In the tailored SMS group, each person received 75% of their messages based on the top two barriers to adherence that they had experienced and reported in their scale. In the non-tailored SMS group, random messages were sent to every patient.

RESULTS

After 12 weeks, although HgA1c levels did not significantly change, significant decline was observed in FBS and mean BMI in both intervention groups. Mean SCI-R scores significantly increased and mean DSCB and DMSES scores significantly decreased in both tailored and non-tailored SMS groups. In the control group, mean SCI-R scores decreased and mean DSCB and DMSES scores significantly increased (P<0.001).

CONCLUSION

Sending short text messages as a method of education in conjunction with conventional diabetes treatment can improve glycemic control and positively influence other aspects of diabetes self-care. According to our findings, sending SMS regularly in particular times appears to be as effective as sending individually tailored messages.

Model for End stage Liver Disease (MELD) and Child-Turcotte-Pugh (CTP) scores: Ability to predict mortality and removal from liver transplantation waiting list due to poor medical conditions

BACKGROUND

There are many patients awaiting liver transplantation with only few donors providing the organ. The Child-Turcotte-Pugh score (CTP) and the Model for End stage Liver Disease (MELD) are the most common scores for prioritizing patients on waiting lists. In this study, we compared the ability of these scores to predict mortality or removal from the waiting list due to poor medical conditions.

METHODS

A total of 257 patients were included in our study and we observed their status in the waiting list over a 9-month period. MELD and CTP of the patients at the time of listing were calculated. We used both ROC-curve and Area Under the Curve (AUC) to calculate the predictive ability of these scores.

RESULTS

During follow up, 22 patients died and 9 patients were removed from the waiting list due to poor medical conditions. Comparing the predictive ability of CTP and MELD, the AUC for CTP was larger than that of MELD (0.75 versus 0.69; P-value = 0.065). The best cutoff point for discriminating mortality or removal from the waiting list due to severe deterioration is 8 for CTP and 13.67 for MELD. The sensitivity and specificity was 0.74 and 0.67, respectively for CTP and 0.74 and 0.58, respectively for MELD.

CONCLUSION

The CTP score can predict mortality or removal from the liver transplantation waiting list better than the MELD over a 9-month period. However, better improved models need to be developed for prioritization of patients in the waiting list.