The association between iron deficiency and outcomes: a secondary analysis of the intravenous iron therapy to treat iron deficiency anaemia in patients undergoing major abdominal surgery (PREVENTT) trial

In the intravenous iron therapy to treat iron deficiency anaemia in patients undergoing major abdominal surgery (PREVENTT) trial, the use of intravenous iron did not reduce the need for blood transfusion or reduce patient complications or length of hospital stay. As part of the trial protocol, serum was collected at randomisation and on the day of surgery. These samples were analysed in a central laboratory for markers of iron deficiency. We performed a secondary analysis to explore the potential interactions between pre-operative markers of iron deficiency and intervention status on the trial outcome measures. Absolute iron deficiency was defined as ferritin <30 μg.l^-1 ; functional iron deficiency as ferritin 30-100 μg.l^-1 or transferrin saturation < 20%; and the remainder as non-iron deficient. Interactions were estimated using generalised linear models that included different subgroup indicators of baseline iron status. Co-primary endpoints were blood transfusion or death and number of blood transfusions, from randomisation to 30 days postoperatively. Secondary endpoints included peri-operative change in haemoglobin, postoperative complications and length of hospital stay. Most patients had iron deficiency (369/452 [82%]) at randomisation; one-third had absolute iron deficiency (144/452 [32%]) and half had functional iron deficiency (225/452 [50%]). The change in pre-operative haemoglobin with intravenous iron compared with placebo was greatest in patients with absolute iron deficiency, mean difference 8.9 g.l^-1 , 95%CI 5.3-12.5; moderate in functional iron deficiency, mean difference 2.8 g.l^-1 , 95%CI -0.1 to 5.7; and with little change seen in those patients who were non-iron deficient. Subgroup analyses did not suggest that intravenous iron compared with placebo reduced the likelihood of death or blood transfusion at 30 days differentially across subgroups according to baseline ferritin (p = 0.33 for interaction), transferrin saturation (p = 0.13) or in combination (p = 0.45), or for the number of blood transfusions (p = 0.06, 0.29, and 0.39, respectively). There was no beneficial effect of the use of intravenous iron compared with placebo, regardless of the metrics to diagnose iron deficiency, on postoperative complications or length of hospital stay.

Priorities of continuing training for global practitioners in Kashan University of Medical Sciences 2013

Introduction: Continuing the medical education has already been a concern, as a universal principle and necessity in the universe, so that the World Health Organization (WHO) has specified it as an urgent necessity. This research objective was the assay of priorities of continuing training for global practitioners at Kashan University of Medical Sciences. Methods and Materials: In this cross-sectional study, 212 out of 600 general practitioners take parting in the keeping on the medical education programmes held by KUMS were covered. After being interviewed about their needs and interest in the programmers, a survey including demographic information such as the education needed, way of teaching, etc., was given to them. The data were then analyzed by SPSS v 11.5. Results: 137 (64.6%) cases were males and 75 (48.3%) were women. Also, 38 (17.9%) individuals were working in emergency wards. Findings indicated that the first priority of the programs was the internal diseases emergency, and then the pediatric common diseases. The third priority was the infectious common diseases. Conclusions: The needs of the CME and the use of the appropriate methods to match the content of the training needed the assessment of the GP training program design painting by the learners, thus enhancing quality and the efficiency of CME applications.

Road traffic injuries in Karachi: the disproportionate role of buses and trucks

Road traffic accidents result in substantial injury and death in Karachi. We reviewed the patient logs of the two largest government hospitals in Karachi between December 1993 and February 1994 to identify those persons most likely to be injured in a road traffic accident and to identify the vehicle types which were most likely to be involved. 86% of 727 road injury victims were male. Their mean age was 31 years. One hundred of thirty-one (18%) died. Pedestrians and motorcyclists were the most common victims accounting for 46% all injuries and 51% of deaths. Although buses and trucks were less than 4% of the registered vehicles in Karachi they were the striking vehicle among 49% of all injuries and 65% of the deaths. Road traffic accidents disproportionately affect wage earners. Specific interventions to improve the road safety of trucks and buses are needed.

Tetracycline prophylaxis in families of cholera patients

The evaluation of tetracycline as a chemoprophylactic agent for cholera is described. Families of cholera patients were divided into 4 groups by strict rotation. The first group received multivitamin preparations and served as the control. The second received 1.0 g of tetracycline, divided into 4 doses, daily for 5 days, the third received 1.0 g of tetracycline in a single dose daily for 5 days, and the fourth received a single dose of 1.0 g of tetracycline. All families were visited daily for 10 days, a rectal swab being taken from each family member on each occasion. Tetracycline given daily for 5 days, either in divided doses or in a single daily dose, was effective in preventing subsequent infection. A single dose of tetracycline was less effective. The indications for chemoprophylaxis in cholera are discussed.