Study of waterpipe smoking topography in Fars province of Iran

Despite a sharp increase in the use of the waterpipe (WP) has been noted recently in Iran, no information is available for the smoking behavior and topography parameters. The present study is intended to obtain the inhalation and smoking topography parameters for the Iranian WP smokers. The smoking data collected from 122 smoking sessions, including 192 WP smokers in the Iranian Fars province have been used to perform smoking topography assessments. The influence of demographic and smoking parameters on puffing data is obtained. Results have indicated that gender and tobacco type strongly affect puff volume and duration. Women smokers inhale smaller volume of smoke than men and puff duration is significantly increased for regular smokers than occasional smokers. However, the results of the present study have not revealed a major effect of age, residence and setting on the puffing behavior.

Comparing infusion-related reactions of the first full dose (600 mg) biosimilar ocrelizumab administration with the standard divided protocol in multiple sclerosis patients: a randomized controlled trial study

BACKGROUND

Ocrelizumab is a humanized antiCD20, thought to be a highly effective disease-modifying therapy (DMT). Its most frequent adverse effects are infusion-related reactions (IRRs). To reduce these reactions, the first dose of ocrelizumab is administered as two 300 mg infusions separated by two weeks. However, in the phase II trial of ocrelizumab, severe IRRs were not significantly different between two doses of 600 mg dose (two separate 300 mg doses) and 2000 mg dose (two separate 1000 mg doses). We compared the IRRs in undivided full (one 600 mg) and divided (two 300 mg) doses of ocrelizumab which is the standard protocol.

METHODS

MS patients (relapsing or primary progressive MS) who are selected to receive ocrelizumab by neurologist or MS fellowship were enrolled in an open-label randomized controlled trial. Iranian biosimilar of the drug (Xacrel® by Cinnagen, approved by the Iranian Food and Drug Administration in 2021) was used. The participants received the first dose of ocrelizumab as either one 600 mg dose in one session or two 300 mg doses in two weeks apart. IRRs during or in the first 24 h after infusion were recorded.

RESULTS

Of 332 participants, 150 received two 300 mg doses, and 182 received one 600 mg dose (by random selection). Life-threatening adverse effects were not observed in both groups. Overnight admission or permanent drug discontinuation was not needed. Temporary drug discontinuation was significantly higher in the one 600 mg dose group (p-value < 0.001). During the infusions, malaise (p-value: 0.003), skin reactions (p-value: 0.04), throat swelling (p-value: 0.03), and dyspnea (p-value: 0.01) were significantly increased in the intervention group. However, in the first 24 h, there was no significant difference between two different treatment protocols (one 600 mg dose or two 300 mg doses) in the onset of IRRS (p-value: 0.12).

CONCLUSION

These findings suggest one 600 mg dose of ocrelizumab administration for the first dose is relatively safe. With some protocol modifications, it could lead to fewer patient referrals, saving time and cost and improvement the access for patients.

Evaluation of Continuing Professional Development for Physicians - Time for Change: A Scoping Review

Introduction

Evaluation of education interventions is essential for continuous improvement as it provides insights into how and why outcomes occur. Specifically, for physicians' continuing professional development (CPD) programs, which aim to upskill physicians in a range of practice-essential domains, evaluations are crucial to assure physicians' continuous development, enhanced patient care and safety. However, evaluations of health professions education (HPE) interventions tend to be outcomes focused, failing to capture how and why outcomes occur. This scoping review aimed to identify evaluation techniques used to evaluate CPD programs for physicians, and to determine how these techniques are being implemented as well as the their quality.

Methods

We searched PubMed, Embase, Web of Science, among others for English publications on evaluation of CPD programs for physicians, in the past decade. We used a data charting template to extract study details regarding the evaluation techniques and produced a checklist to assess the quality of the evaluations.

Results

101 studies were included; of which 91 studies did not use an evaluation framework. Our findings revealed shortcomings in the evaluations of CPD programs including lack of attention to: intervention processes; unintended outcomes and contextual factors; use of theory; evaluation framework use; and rationale for chosen evaluation method.

Discussion

Our findings highlighted major gaps in the evaluation techniques employed in physicians' CPD. Attention needs to be paid to evaluating both program processes and outcomes to illuminate how and why impacts are or are not occurring.

Exploring the association between religious participation and memory in middle- and older-aged adults in the Canadian Longitudinal Study on Aging

To investigate the association between religious participation and memory in persons aged 45-85 years. Using the Canadian Longitudinal Study on Aging, frequency of religious participation was measured from "daily" to "never"; immediate and delayed recall memory were assessed with the Rey Auditory Verbal Learning Test. We regressed memory onto religious participation for persons aged < 65 years and persons aged ≥ 65 years. We found some evidence of effect modification: among persons < 65 years, monthly to yearly participation versus never attending was positively associated with immediate and delayed recall memory; among persons aged ≥ 65 years, weekly or more participation versus never attending was negatively associated with immediate and delayed recall memory. However, regression coefficients were small (-0.09 ≤ B ≤ 0.06) and most were not statistically significant (p < 0.05). Insufficient evidence existed to conclude that religious participation was associated with memory in our sample.

Family Physicians with Certificates of Added Competence in Palliative Care Contribute to Comprehensive Care in Their Communities: A Qualitative Descriptive Study

Background

Since 2015, the College of Family Physicians of Canada has certified enhanced skills in palliative care (PC) with a certificate of added competence.

Aim

This study aimed to describe the ways family physicians with enhanced skills in PC contribute within their communities, the factors that influence ways of practicing, and the perceived impacts.

Design

Secondary analysis of data from a multiple case study on the role and impacts of family physicians with enhanced skills (i.e., PC physicians) was undertaken.

Setting/Participants

Interviews were conducted in 2018 to 2019 with PC and generalist family physicians and residents associated with six family medicine practice cases across Canada. An unconstrained qualitative content analysis was performed.

Results

Twenty-one participants (nine PC physicians, five generalist family physicians, two residents, and five physicians with enhanced skills in other domains) contributed data. PC physicians worked by enhancing their own family practice or as focused PC physicians. Roles included collaborating with other physicians through consultations, comanaging patients (shared care), or assuming care of the patient as the main provider (takeover). PC physicians increased capacity among their colleagues, with some patient care and education activities not being remunerated. Funding models and other structures were perceived as incentivizing the takeover model.

Conclusion

Family physicians with enhanced skills in PC contribute to comprehensive care through the end of life. Remuneration should support system capacity and relationships that enable family physicians to provide primary PC especially outside the takeover model.

EVALUATING THE EFFECTIVENESS OF AN ONLINE TRAINING COURSE FOR MEETING NEEDS ASSOCIATED WITH CAREGIVING BURDEN

Informal caregivers make up a critical part of long-term support in the communities due to their important role in caring for older adults living at home. Modern-day caregivers are facing greater responsibility and burden for managing their care recipients. The present study aimed to explore the effect of a caregiving training program in alleviating caregiver burden. This program included four standalone online modules each with specific foci. Completion of activities across the modules allowed for the creation of a Caregiver Action Plan which offered a personal and practical resource to the informal caregivers. This evaluation study was qualitative and a used thematic analysis method of data analysis. Data stemmed from semi-structured interviews with the caregivers and their reflections on the program’s discussion board. Most caregivers provided care for persons with dementia. Interviews with the family caregivers were conducted, transcribed, and thematically analyzed. Themes were identified through constant comparison and in an iterative process. The family caregivers demonstrated consensus on the efficacy of the program in raising competence and confidence and contributing to ameliorating burden levels. Important themes were identified in association with areas for which the caregivers needed support: Early dementia education, planning for future care, learning about navigating healthcare systems, peer support, enhancing self-care, and coping with emotional burden and self-blame. The findings will be informative in shaping the program based on the caregiver’s identified needs through addressing those areas that they would need support. These findings may offer recommendations to other programs designed to support the family caregivers.

Program evaluation: An educator's portal into academic scholarship

Program evaluation is an "essential responsibility" but is often not seen as a scholarly pursuit. While Boyer expanded what qualifies as educational scholarship, many still need to engage in processes that are rigorous and of a requisite academic standard to be labelled as scholarly. Many medical educators may feel that scholarly program evaluation is a daunting task due to the competing interests of curricular change, remediation, and clinical care. This paper explores how educators can take their questions around outcomes and efficacy of our programs and efficiently engage in education scholarship. The authors outline how educators can examine whether training programs have a desired impact and outcomes, and then how they might leverage this process into education scholarship.

Outcome of Heart Transplant Candidates Based on a High Volume Heart Transplant Center Experience in Iran

Background

The waiting list for heart transplants is a valuable data registry that would offer very useful information on the characteristics of patients who have various outcomes while waiting in the list.

Objective

The purpose of this study was to look at the prognosis of those waiting for heart transplants as well as the factors that increase mortality.

Methods

Advanced heart failure patients' demographic, clinical, hemodynamic, and echocardiographic results, as well as their prognosis, were retrieved from the national registry for heart transplantation between 2011 and 2018. The study population was defined and compared in four groups: 1) Death while awaiting HTX, 2) Death after HTX, 3) Alive without a transplant, 4) Transplanted and alive.

Results

The data of 207 patients [75% male, mean (SD) age of 34(10) years] were analyzed. The most common etiology of heart failure was idiopathic dilated cardiomyopathy. A total of 86 patients (41%) were successfully transplanted, with a median (IQR) time between listing and transplantation of 84 (30¬219) days, 54 patients (26.1%) were dead and 32% were still alive. The multivariate analysis showed right atrial pressure, pulmonary capillary wedge pressure, cardiac index, and systolic blood pressure at the time of listing as independent predictors of death.

Conclusion

The study on HTX waiting list is very useful for both allocation strategies and administrative planning for patients with advanced heart failure by development of accurate models and scoring systems using predictors of death in the waiting list.

Evaluating a Geriatric Educational Program: Exploring Opportunities for Increasing Impact and Scale

The geriatric population is rapidly growing, and this growth is beyond the pace of increase in the number of healthcare professionals who are qualified to care for and tend to the various needs of this significant subgroup of the population. The current university curricula have not been sufficient in terms of quantity as well as their ability to address the ageism inherent in the perspectives of students from across the educational spectrum. In recognition of the absence of standardized geriatric guidelines, medical associations across Canada and the United States have established geriatric learning competencies for medical programs. Nevertheless, there are exiting gaps regarding the development and evaluation of geriatric-focused didactic programs that adequately train and build competency among the students interested in pursuing careers with geriatric-specific elements. A university-wide program was developed to enhance aging education and build competency through sparking interest, providing better education related to aging, and building better relationships between future healthcare professionals and older adults. To evaluate the impact of this program, a logical framework was developed a-priori and revised through constant iterations and following discussion with the program’s multidisciplinary stakeholder group. Quantitative measures are being augmented with in-depth qualitative interviews to explore elements influencing students’ experiences with the program and the effect on their interests in and attitudes towards geriatrics. The results will inform our conclusions regarding program effectiveness in enhancing interest in geriatric-focused education among the students and trainees and assist with recommending future directions regarding impact and large-scale dissemination and implementation.

Impact of the Iranian Registry of Infective Endocarditis (IRIE) and multidisciplinary team approach on patient management

BACKGROUNDS

The last 30 years have witnessed major improvements in understanding of all aspects of infective endocarditis (IE). The Iranian Registry of Infective Endocarditis (IRIE) was formed to address epidemiological aspects of IE vis-à-vis its main pathogens and underlying heart diseases over a 12-year period. Indeed, a multidisciplinary team (MDT) for IE was developed alongside.

METHODS

In a longitudinal observational study, data of adult patients with definite or possible IE based on modified Duke criteria were collected from 2007 to 2016 in our tertiary centre, Iran. From 2016 until 2019, we run a prospective observational study using formation of an IE MDT to provide better patient management and compared data before and after this.

RESULTS

Totally, 645 patients with mean age of 48 ± 17 years were enrolled. Data of 445 and 200 patients were compared before and after IRIE and MDT formation, respectively. We found significantly reduced type and number of applied antibiotics (p = 0.04) and higher rate of positive blood culture (p = 0.001). Hospital length of stay increased significantly after formation of the IRIE and IE MDT (p = 0.02). The rate of heart failure, new abscess formation and cerebral emboli were significantly decreased after IRIE and IE MDT (p < 0.001) and consequently in-hospital mortality reduced significantly (p = 0.05).

CONCLUSION

Developing national registries and MDTs has potential to enhance patient management and reduce IE burden. Our results demonstrated that establishment of the Iranian IRIE and IE MDT conferred better diagnoses, standardised treatments and significantly reduced cardiac and extra cardiac morbidity.

3D right ventricular ejection fraction and longitudinal strain are independent predictors of major adverse cardiovascular events in patients with rrhythmogenic right ventricular cardiomyopathy

Introduction

Evaluation of right ventricular (RV) function is essential in the follow up of patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). Role of advance echocardiography including 3D transthoracic echocardiography (3DTTE) for evaluation of 3D RV function and RV longitudinal strain in predicting prognosis in ARVC patients, has not been well investigated.

Purpose

We aimed to evaluate 3DTTE parameters in predicting major advance cardiovascular events (MACE) defined as ventricular arrhythmia, cardiac hospitalization, heart transplantation, and death in ARVC patients.

Methods

Forty-eight definite ARVC subjects based on the 2010 Task force criteria were evaluated with standard 2D transthoracic echocardiography (2DTTE) and 3DTTE. Patients with poor image quality were excluded. RV function was evaluated by 2D and 3D TTE including: fractional area change (FAC), RV global and free wall longitudinal strain (RV2DGLS and RV2DFWLS) and 3D RV ejection fraction (RV3DEF), RV global and free wall longitudinal strain (RV3DGLS, and RV3DFWLS). The patients were followed up for a median period of 12 months (6–18 months) to record MACE.

Results

Forty-eight patients with mean age =38.5±14 years; 79.2% male, and mean RV3DEF =30.33%, were included. During the mean follow up 12 months, 12 patients (25%, with mean RV3DEF = 24.8±9%) experienced MACE whereas mean RV3EF in patient without any cardiovascular events during follow up was 34.21±9%. The most common causes of hospitalization were arrhythmia, right-sided heart failure, and RV clot as the following: Ventricular arrhythmia in 7 patients (14.6%, with mean RV3DEF = 29.01±8.82%), RV clot in 2 cases (4.2%, with mean RV3DEF = 20.2%), right-sided heart failure in 3 patients (6.3%, with mean RV3DEF = 16.83±3.6%) that 2 of them (2.1%, with mean RV3DEF = 14.58±0.63) underwent heart transplantation.

Logistic regression analysis revealed RV3DTTE (p-value = 0.03, OR=0.90, CI: 0.82–0.99), RV3DGLS (p-value = 0.05, OR=1.27, CI: 0.99–1.61) and RV3DFWLS (p-value = 0.01, OR=1.29, CI: 1.05–1.59), predicted cardiac adverse events, but there were no significant association between RV2DGLS, RV2DEWLS and FAC with MACE.

Conclusion

RV3DEF, RV3DGLS, and RV3DFWLS were powerful predictors of morbidity and mortality and can be useful as a valuable method in the prediction of major cardiovascular complications in ARVC patients.

Funding Acknowledgement

Type of funding source: None

Rivaroxaban in patients undergoing surgical mitral valve repair

Background

The role of the non-vitamin K antagonist oral anticoagulants has here been scarcely studied In patients undergoing mitral valve repair (MVre).

Methods

In the present mixed cohort study, the safety and efficacy of rivaroxaban (prospective analysis) were compared with those of warfarin (retrospective analysis) in patients undergoing MVre.

Results

Study flow chart were presented In Figure. Dissimilarities in baseline characteristics necessitated propensity score matching, in which 104 patients in each group were compared. No major bleeding or cerebrovascular accident occurred during the 1-year follow-up. Clinically relevant non-major bleeding was reported in 2 patients in the rivaroxaban group and 4 patients in the warfarin group, a difference non-statistically significant before and after propensity score matching (P=0.371 and P=0.407, respectively). The type of anticoagulation did not predict the 1-year outcome (HR: 2.165, 95% CI: 0.376 to 12.460; P=0.387).

Conclusion

In this mixed cohort study, rivaroxaban was both safe and efficient in patients with MVre. Such preliminary results should prompt larger randomized controlled trials.

Cohort flow chart

Funding Acknowledgement

Type of funding source: None

Use of Artificial Neural Networks and PCA to Predict Results of Infertility Treatment in the ICSI Method

Background:

Intracytoplasmic sperm injection (ICSI) or microinjection is one of the most commonly used assisted reproductive technologies (ART) in the treatment of patients with infertility problems. At each stage of this treatment cycle, many dependent and independent variables may affect the results, according to which, estimating the accuracy of fertility rate for physicians will be difficult

Objective:

This study aims to evaluate the efficiency of artificial neural networks (ANN) and principal component analysis (PCA) to predict results of infertility treatment in the ICSI method

Material and Methods:

In the present research that is an analytical study, multilayer perceptron (MLP) artificial neural networks were designed and evaluated to predict results of infertility treatment using the ICSI method. In addition, the PCA method was used before the process of training the neural network for extracting information from data and improving the efficiency of generated models. The network has 11 to 17 inputs and 2 outputs.

Results:

The area under ROC curve (AUC) values were derived from modeling the results of the ICSI technique for the test data and the total data. The AUC for total data vary from 0.7670 to 0.9796 for two neurons, 0.9394 to 0.9990 for three neurons and 0.9540 to 0.9906 for four neurons in hidden layers

Conclusion:

The proposed MLP neural network can model the specialist performance in predicting treatment results with a high degree of accuracy and reliability

Family Physicians' satisfaction with factors affecting the dynamism of the urban family physician program in the Fars and Mazandaran provinces of Iran

BACKGROUND AND OBJECTIVE

A successful family physician program needs ongoing and full cooperation between people and the organizations in charge. Ensuring the satisfaction of family physicians through improvement of the underlying factors could motivate them to provide high-quality services. This study aimed to determine the family physicians' satisfaction level with the factors affecting the dynamism of the urban family physicians program in the Fars and Mazandaran provinces of Iran.

METHOD

This cross-sectional study was carried out in urban areas in the Fars and Mazandaran provinces in 2016. The sample consisted of 143 and 96 family physicians, respectively, in Fars and Mazandaran provinces and was selected using the stratified random sampling method. Data were collected using a questionnaire and included both sociodemographic variables and factors assessing the family physicians' satisfaction levels. Each factor was scored based on a Likert scale from 0 to 5 points, and any satisfaction level higher than 3 out of 5 was equated with being satisfied.

RESULTS

The overall satisfaction levels among family physicians in Fars and Mazandaran provinces were 2.77±0.53 and 3.37±0.56, respectively, revealing a statistically significant difference between provinces (p<0.001). Moreover, the mean satisfaction scores for the performances of healthcare centers, insurance companies, specialists, healthcare workers, and the population covered were 2.78±0.1, 2.54±0.9, 2.52±0.8, 4.24±0.07, and 2.96±0.8, respectively. The family physicians' levels of satisfaction were significantly correlated with population size (p=0.02, r= -0.106), and willingness to stay in an urban family physician program (p<0.001, r= +0.398).

CONCLUSION

This study revealed that family physicians exhibited a low level of satisfaction with the urban family physician program. Given the direct association between family physicians' satisfaction levels and retention in the program, it is expected that family physicians will no longer stay in the program, and it is likely to have subsequent executive problems.

P3689Association of echocardiographic progression and genetic profile in arrhythmogenic right ventricular cardiomyopathy

Background

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is frequently associated with mutations in genes coding for desmosomal proteins. In this study, we investigated the association of genetic status with ARVC progression as defined by echocardiographic parameters.

Methods

We tested 62 ARVC patients for their genetic profile. Accordingly, they were grouped in mutation positive (48 (77%) patients; median age 48.5 years; 33 (69%) males), and mutation negative (14 (23%) patients; median age 45 years; 10 (71%) males). Prevalent mutations were Desmoglein-2 (DSG2) in 16 (26%), Desmoplakin (DSP) in 14 (23%), and Plakophilin-2 (PKP2) in 9 (15%) patients.

Results

At baseline, there were no significant differences in clinical characteristics between the two groups. Patients were followed-up for a median time period of 1420 days, and there was no significant difference in the duration of follow-up between the two groups (p=0.05).

In the mutation positive group, there was a significant increase in right ventricular end-diastolic area (p=0.002), right atrial short (p=0.008) and long (p=0.002) diameter, left atrial diameter (p=0.014), and a decrease in left ventricular ejection fraction (p=0.014) during follow up. Right ventricular functial parameters did not change significantly (tricuspid annular plane systolic excursion: p=0.24; fractional area change: p=0.088).

In the mutation negative group, none of the aforementioned echocardiographic findings exhibited any significant difference during follow-up: right ventricular end-diastolic area (p=0.1); right atrial short (p=0.7) and long (p=0.9) diameter, left atrial diameter (p=0.6), and left ventricular ejection fraction (p=0.3). Similarly, right ventricular functional parameters did not change significantly (tricuspid annular plane systolic excursion: p=0.77; fractional area change: p=0.80. Results are summarized in the figure.

Change in echocardiographic findings.

Conclusions

There is a strong association between echocardiographic progression of ARVC phenotype and the presence of a pathogenic mutation. Such mutations should be searched in all patients with an ARVC phenotype, and mutation positive individuals should be followed-up in shorter intervals.

HLA-DRB1*01:01, but not HLA-DRB1:1503 or HLA-DRB1*11, is associated with decreased inhibitor risk in Iranian hemophilia A patients

BACKGROUND/OBJECTIVE

Hemophilia A is a genetic disorder through which patients suffer from recurrent bleeding. This can be caused by a defect in human plasma coagulation factor VIII. High incidence of FVIII inhibitors in some severe hemophilia A patients after FVIII therapy is a considerable complication. Determination of good predictive factors can improve the safety of this treatment. HLA-II have been shown as a predictive element for inhibitor development. The goal of this study is to determine the association between HLA-DRB1*15:03, HLA-DRB1*11 and HLA-DRB1*01:01 alleles and FVIII inhibitors in severe hemophilia A patients in Iran.

MATERIALS/METHODS

HLA-DRB1 genotyping was performed using Multiplex sequences Specific Primers (PCR-SSP) in two groups of severe hemophilia A patients comprising 51 and 50 individuals with and without FVIII inhibitors respectively. The levels of inhibitor were determined through Nijmegen-modified Bethesda assay. HLA-DRB1 allele frequencies were compared between groups by using multiple logistic regression models.

RESULTS

HLA-DRB1*01:01 allele frequency was significantly higher in patients without inhibitor OR_adj: 2.7 (95%CI: 1.08, 6.97; P = 0.034). There wasn't any statistically significant difference in HLA-DRB1*11 allele frequency between groups OR_adj: 0.7 (95%CI: 0.27, 1.82; P = 0.47). There was no connection between HLA-DRB1*15:03 and inhibitor development OR_adj: 0.94 (95%CI: 0.38, 2.35; P = 0.94).

CONCLUSION

An association between HLA-DRB1*01:01 and paucity of FVIII inhibitor showed that this allele has probably a protective effect in severe hemophilia A patients in Iran. Determination of the predictive and protective alleles are beneficial in pre-treatment activities and decrease the risk of unsuccessful therapy with FVIII in each population.

The Effect of Religion and Spirituality on Cognitive Function: A Systematic Review

PURPOSE OF THE STUDY

The maintenance of cognitive health is an important component of healthy aging. Abnormal cognitive decline can signal the onset of dementing disorders such as Alzheimer's disease (AD). Normal cognitive decline can also adversely affect the health of aging populations. We investigated the association between religious/spiritual involvement (R/SI) and cognitive function in adults of any age and any setting. We also examined whether social engagement acts as a mediator or moderator of the effect of R/SI on cognitive function, and whether the association between R/SI and cognitive function differs according to how each of these constructs is measured.

DESIGN AND METHODS

We conducted a systematic review of articles published between 1990 and September 2016 by searching OVID MEDLINE, PSYCHINFO, EMBASE, and Google Advanced Search. We included studies with a comparison group (cohort, case-control, cross-sectional) that reported on R/SI (exposure) and cognitive function (outcome).

RESULTS

Of the 6,300 citations obtained in the literature search, 17 met our eligibility criteria and were included in the review. Most of the included studies (82%) reported positive associations between R/SI and cognitive function. R/SI appears to be protective against cognitive decline in middle- and old-age adults.

IMPLICATIONS

Public health practitioners should not overlook the benefits of enabling religious/spiritual practices among religious adults (i.e., offering ride programs could help isolated elders attend religious gatherings).

The Effect of Age of Initiation of Cannabis Use on Psychosis, Depression, and Anxiety among Youth under 25 Years

OBJECTIVES

This study was conducted to review the current state of evidence on the association between age of initiation of cannabis use and symptoms of psychosis, depression, or anxiety among youth under 25 years of age.

METHODS

We conducted a systematic review of articles published prior to March 2018 by searching OVID MEDLINE, PsycINFO, EMBASE, and the references of included studies. We included comparative studies (cohort, case-control, cross-sectional) that reported on cannabis use in persons <25 years of age (exposure) and symptoms of psychosis, depression, or anxiety (outcome). We narratively synthesized the studies according to design (cohort, etc.) and psychiatric outcome. We used the Newcastle-Ottawa Scale to assess risk of bias.

RESULTS

Of the 534 citations identified through the literature search, 23 met the eligibility criteria and were included in this review. With psychosis as the outcome, all except one study found that earlier cannabis use was generally associated with higher risks. With depression/anxiety as the outcome, 6 of the 11 included studies reported findings indicating that earlier use of cannabis was linked to higher symptom levels.

CONCLUSION

In persons <25 years old, greater cannabis use is associated with more psychological symptoms, especially among those with a predisposition or existing vulnerability to such outcomes (Oxford Centre for Evidence-Based Medicine level 3 or 4). Policy makers need to consider the adverse effects of cannabis use in youth when planning a public health approach to cannabis legalization.

The Genetic Spectrum of Familial Hypercholesterolemia (FH) in the Iranian Population

Familial hypercholesterolemia (FH) is an autosomal dominant disorder associated with premature cardiovascular disease (CVD). Mutations in the LDLR, APOB, and PCSK9 genes are known to cause FH. In this study, we analysed the genetic spectrum of the disease in subjects from the Iranian population with a clinical diagnosis of FH. Samples were collected from 16 children and family members from five different cities of Iran. Probands were screened for mutations in the LDLR, APOB, and PCSK9 genes using next generation sequencing, with results confirmed by Sanger sequencing. The likely pathology of identified variants was examined using in silico tools. Of the probands, 14 had a clinical diagnosis of homozygous FH and two of heterozygous FH. No mutations were found in either APOB or PCSK9, but nine probands were homozygous for seven different LDLR mutations, with p.(Trp577Arg) occurring in three and p.Val806Glyfs*11 occurring in two patients. Two mutations were novel: p.(Leu479Gln) and p.(Glu668*). Seven probands with a clinical diagnosis of FH were mutation negative. This pilot study, integrating clinical and molecular-based techniques, begins to elucidate the FH heterogeneity and the mutation spectrum in the Iranian population. Such information is important for future disease management and cost savings.

Effect of religious involvement on cognition from a life-course perspective: protocol for a systematic review and meta-analysis

INTRODUCTION

Preserving cognitive health is a crucial aspect of healthy ageing. Both abnormal and normal cognitive decline can adversely affect the health of ageing populations. Evidence suggests religious involvement (RI) can preserve cognition in ageing populations. The primary purpose of this review is to examine the evidence regarding the association between RI and cognition from a life-course perspective.

METHODS AND ANALYSIS

This systematic review and meta-analysis has been registered with PROSPERO (registration number CRD42016032331). We will search MEDLINE, PSYCHINFO and EMBASE, and include primary studies with a comparison group, for example, cohort, cross-sectional and case-control studies. To supplement the database search, we will also search the grey literature and the reference lists of included studies. Two reviewers will independently assess and extract data from the articles. Risk of bias and the strength of evidence will be assessed. For sufficiently homogeneous data in domains such as study methods and measures of RI and cognition, we will pool the results using DerSimonian and Laird meta-analysis.

ETHICS AND DISSEMINATION

Since this is a protocol for a systematic review, ethics approval is not required. The findings of this review will be extensively disseminated through peer-reviewed publications and conference presentations.

Can preoperative thyroglobulin antibody levels be used as a marker for well differentiated thyroid cancer?

Background

It has been reported that thyroglobulin antibody are more frequently elevated in patients with thyroid cancercompared to general population. This study aims at evaluating whether preoperative thyroglobulin antibody (TgAb) levels increase the likelihood that a thyroid nodule is malignant.

Methods

A retrospective review of 586 patients who underwent thyroidectomy was conducted. Demographic data, TgAb levels, and final histopathology were recorded. Patients were divided into two groups: TgAb positive (defined as TgAb ≥ 30 IU/ml) and TgAb low/negative (defined as TgAb < 30).

Results

Preoperative TgAb levels were available in 405 patients. There were 353 (87 %) patients in the TgAblow/negative group (malignancy rate: 50.42 %) and 52 (13 %) patients in the TgAb positive group (malignancy rate: 65.38 %). The sensitivity, specificity, positive predictive value and negative predictive value of TgAb ≥ 30 IU/ml for thyroid malignancy were 16.04 %, 90.67 %, 65.38 % and 49.58 %, respectively. The relative risk of having a malignant thyroid nodule when the TgAb titers were≥30 IU/ml was 1.30 (CI1.04-1.62) and the odds ratio was 1.86 (CI 1.01-3.41). Both the Pearson chi-square test (p = 0.024) and Fisher’s exact test (p = 0.017) yielded statistical significance between the two groups.

Conclusions

In this study, patients with preoperative TgAb ≥ 30 IU/ml had a higher rate of malignancy when compared topatients with TgAb < 30 IU/ml. This suggests that an elevated TgAb level may indicate that a thyroid nodule is at an increased risk for malignancy.

Prevalence and risk factors of diabetes mellitus in a central district in Islamic Republic of Iran: a population-based study on adults aged 40-80 years

Previous studies on type 2 diabetes mellitus in the Islamic Republic of Iran were mainly performed in provinces with large populations. This study determined the prevalence and risk factors of diabetes mellitus in an adult population (40-80 years old) from Yazd district. Multistage, systematic cluster random sampling was used in a crosssectional, population-based survey. Demographic, clinical and anthropometric data were collected, with diabetes defined as fasting blood sugar ≥ 7 mmol/L or a positive medical history of diabetes. The age- and sex-standardized prevalence of diabetes in 2090 individuals participants was 24.5% (95% CI: 22.2-26.8%), including 10.5% new cases. For each year of ageing, the prevalence of diabetes increased significantly by 4% and this trend was more pronounced in females than males. Low education and hypertension were significantly associated with diabetes prevalence. The prevalence of diabetes mellitus in Yazd is greater than the average levels nationwide and those of nearby countries.

Insulin resistance via modification of PGC1α function identifying a possible preventive role of vitamin D analogues in chronic inflammatory state of obesity. A double blind clinical trial study

AIM

Obesity-induced chronic inflammation is a key component of the pathogenesis of insulin resistance. Mounting evidence has demonstrated anti-inflammatory characteristics for vitamin D. Although analogues of vitamin D3 have extensively been used in the treatment of various chronic inflammatory diseases, to our knowledge, no such research is conducted in regards with obesity. The aim of this double blind clinical trial study is to investigate whether alphacalcidol treatment in obese subjects can affect the cytokine profile and insulin resistance. Moreover, we evaluated the pathways of vitamin D receptor (VDR), PPARγ and PGC1α gene expressions which may lead to insulin resistance following treatment with either alphacalcidol or placebo.

METHODS

A total of 94 obese participants (BMI≥30) were recruited for the current double blind clinical trial study. Patients were divided into two intervention (N.=40) and control groups (N.=54) based on the stratified randomized method. One-Alpha® Capsules 1 microgram: alfacalcidol (1-α hydroxyvitamin D3) and placebo were given to subjects once a day for 8 weeks. Analysis of body composition was performed with use of Body Composition Analyzer. The circulating levels of TNF-α, IL-1β, IL-4, IL-6, IL-10, IL-13, IL-17, PTH, and 25-Hydroxy Vi-tamin D were measured with the use of EIA method. The PBMCs were separated from whole blood by Ficoll-hypaque technique. Total cellular RNA was extracted and the cDNA was synthesized. The real-time PCR using specific primer pairs for VDR, PGC1α, PPARγ, and β-actin was performed.

RESULTS

The FPG, fat percent and PTH levels were decreased and the levels of HDL-cholesterol and 25-hydroxy vitamin D were significantly increased after treatment with Alfacalcidol. Regarding to cytokines levels, the levels of IL6 were significantly decreased and IL10 were significantly increased in Alfacalcidol group in comparison with the control group. The relative expressions of VDR, PGC1α, and PPARγ genes significantly increased in Alfacalcidol group. We found also significant positive correlation between circulating 25-OH vitamin D and relative PGC1α gene expression in participants with insulin resistance.

CONCLUSION

It seems that Alfacalcidol treatment may be effective in amelioration of the inflammatory state in obesity. This supplement might also improve resistance to insulin through enhancement of relative VDR and its downstream genes expression, which are demonstrated to be involved in glucose homeostasis pathways.

Contraceptive use by Iranian women with hypertension, diabetes or obesity

Women with chronic medical conditions require careful contraceptive management. The aim of this cross-sectional study in Tehran was to determine the pattern of contraception use by women with diabetes, hypertension or obesity. A sample of 264 women aged 18-53 years old was recruited; 81 (30.7%) had diabetes type 2,100 (37.9%) were obese/overweight (BMI > 25 kg/m2) and 83 (31.5%) had hypertension. Across all 3 groups, the rate of use of contraceptive methods was significantly different before and after diagnosis. Before diagnosis of disease the most common method was hormonal contraception in all women (55.0%, 71.6% and 78.3% of diabetic, overweight and hypertensive women respectively), whereas after diagnosis coital withdrawal was the most common method in diabetic and obese/overweight women (41.2% and 28.0% respectively) and almost the most common method for hypertensive women (35.4%). Use of safe and modern methods of contraception in women with certain chronic medical conditions was low and needs more attention.