Dyslipidaemia and its management in diabetic patients in an academic centre in Iran

Introduction: Dyslipidaemia is accompanied with increased cardiovascular events in diabetic patients. Today there have been some improvements in the management of dyslipidaemia using lifestyle modification and medications. In this study we evaluate the management of dyslipidaemia in an academic centre. Material and methods: This is a descriptive study, from January 2003 until December 2007. All type 2 diabetic patients who were more than 30 years old and had at least 2 visits per year were eligible for including. Results: Overall, 1179 patients (70.2% women) were assessed. Mean LDL-C in 2003 was 124.6 &#177; 34.6 mg/dL, and decreased to 109.7 &#177; 28.9 mg/dL in 2007 (p < 0.05). 21.0% of patients in 2003 and 40.5% of them in 2007 had LDL-C < 100 mg/dL. TG did not change during these years. There was an increase in the use of statins from 76.3% to 84.3% (p-value < 0.05) during the 5 years since 2003, but a decrease in the use of fibrates. Conslusions: Although recently we have made improvements in the control of dyslipidaemia in diabetic patients, we have not reached our goals. Of late, physicians have emphasized the use of statins in diabetic patients, which has resulted in much better levels of LDL-C, but still less than half of the patients are at ideal levels. In conclusion, we should revise our point of view to begin and intensify treatment of dyslipidaemia in diabetic patients, to achieve the goal of treatment and prevent cardiovascular events optimally.Wstęp: Dyslipidemia u chorych na cukrzycę wiąże się ze zwiększoną częstością zdarzeń sercowo-naczyniowych. W leczeniu dyslipidemii obejmującym modyfikację stylu życia i farmakoterapię nastąpił znaczny postęp. Celem niniejszego badania była ocena leczenia dyslipidemii w ośrodku akademickim. Materiał i metody: Badanie obejmowało okres od stycznia 2003 roku do grudnia 2007 roku. Do badania włączono wszystkich chorych na cukrzycę typu 2 w wieku powyżej 30 lat, którzy odbywali co najmniej 2 wizyty rocznie. Wyniki: Oceniono łącznie 1179 chorych (70,2% stanowiły kobiety). Średnie stężenie cholesterolu frakcji LDL w 2003 roku wynosiło 124,6 &#177; 34,6 mg/dl. Uległo ono obniżeniu i wynosiło 109,7 &#177; 28,9 mg/dl w 2007 roku (p < 0,05). Odsetek chorych, u których stężenie cholesterolu frakcji LDL było niższe niż 100 mg/dl wynosił 21,0% w 2003 roku i 40,5% w 2007 roku. Stężenie triglicerydów nie zmieniło się w tym okresie. W okresie 5 lat od 2003 roku nastąpiło zwiększenie częstości stosowania statyn z 76,3% do 84,3% (p < 0,05), zmniejszyło się natomiast zużycie fibratów. Wnioski: Mimo że w ostatnich latach nastąpiła poprawa w zakresie kontroli stężenia lipidów u chorych na cukrzycę, nadal rzadko udaje się osiągnąć cele terapii. W najnowszych doniesieniach podkreśla się, że stosowanie statyn u chorych na cukrzycę powoduje znaczne obniżenie stężenia cholesterolu frakcji LDL, jednak docelowe wartości uzyskuje nadal mniej niż połowa pacjentów. Podsumowując, należy zrewidować dotychczasowe poglądy na temat leków hipolipemizujacych i wcześniej rozpoczynać intensywną terapię dyslipidemii u chorych na cukrzycę, aby osiągnąć cele leczenia i zapewnić optymalną prewencję zdarzeń sercowo-naczyniowych

Helicobacter pylori in Iran: a systematic review on the association of genotypes and gastroduodenal diseases

Background: Helicobacter pylori (H. pylori) infection is known as a major etiologic factor for a variety of gastroduodenal diseases. In Iran, with a high rate of H. pylori infection close to 90%, numerous studies have revealed many aspects of interaction between the bacterium, mucosal surface and induction of disease outcome. The organism is genetically diverse and several virulence factors are attributed to the more virulent strains. The well-characterized virulence factors of H. pylori are cytotoxin associated gene A and vacuolating cytotoxin gene A. The distribution pattern of H. pylori genotypes and its association with disease status varies geographically. The present review focused on the virulence factors and genotyping of H. pylori in relation to gastroduodenal disorders in different regions of Iran. Methods: In total, 398 studies were reported on different aspects related to H. pylori in our electronic search from 1995-2011. H. pylori infection and its virulence factors in association with disease status were investigated in 159 reports. Looking specifically at the gastrointestinal tract disorders, the most relevant reports including 37 papers were selected. Results: We found no correlation of cagA genotype and disease status in the majority of studies, whereas vacA was demonstrated as a useful marker in predicting the disease outcome. The results of reports on other virulence factors of H. pylori such as blood group antigen-binding adhesion gene A, the induced by contact with epithelium gene A, the outer inflammatory protein A, the duodenal ulcer promoting gene A, and Helicobacter outer membrane gene and their relation with disease status were contradictory. Conclusions: Although different markers of H. pylori were emphasized as useful when predicting disease outcomes in some studies, the inconsistent researches and the scarcity of data made any conclusion or even comparison impossible. Considering the gap of information observed during our search relating to genotyping and other aspects of H. pylori infection, further investigations are suggested

Antimicrobial activity of three different endodontic sealers on the enterococcus faecalis and lactobacillus (in vitro)

Introduction: Growth and proliferation of the remaining microorganisms within the root canals may destroy the surrounding tissue of the root and leads to periapical lesion. Consequently, the complete elimination of microorganisms from the root canal is an important goal of endodontic therapy. Endodontic sealers do not provide complete seal in root canal system, and micro spaces have always remained between the material and canal walls that lead to penetration of these spaces, so, an antibacterial activity is essential for sealers. The aim of the present study was the in vitro evaluation of antimicrobial activity of the three endodontic sealers on two microorganisms. Methods: To study the effect of each sealer; AH26, MTA Fillapex and ADseal on Enterococcus Faecalis and Lactobacillus bacteria 10 samples were considered. In this experimental study, 60 plates were exposed to bacteria and 10 plates were considered for control group. Sealer antibacterial effect on bacterial growth was studied after 48 hours. Firstly, the freshly prepared sealers were poured inside the micro tube and diffused in the wall of the micro tube. Then solution of nutrient broth was poured into a micro tube and the determined volume of solution of bacterial suspension was added into a microtube and was kept 24 hours in the incubator to grow the bacteria. Then, it was poured in the plates of blood agar and cultured after 24 hours and then the colonies grown on the plates were counted in sufficient light. The data were analyzed with MANOVA statistical test and SPSS Version 18. Results: Most bacteria grew in the plates of ADseal sealer and MTA fillapex sealer with means of 5113.00CFU and 3077.00CFU respectively, while the lowest number of bacteria grew in the plates of AH26 sealer with a mean of 1345.15CFU. Conclusions: Most antibacterial activities of each enterococcus faecalis and lactobacillus bacteria sample was for AH26 sealer and MTA fillapex sealer. The lowest antibacterial activity was for ADseal sealer

Sonographic and functional characteristics of thyroid nodules in a population of adult people in Isfahan

Wstęp: Celem badania była ocena cech sonograficznych zmian ogniskowych tarczycy u mieszkańców Isfahanu, obszaru w cenralnym Iranie, który wcześniej charakteryzował się niedoborem jodu. Materiał i metody: W przekrojowym badaniu przeprowadzonym w 2006 roku wybrano próbę liczącą 2523 dorosłych osób (wiek > 20 lat) metodą wielostopniowego losowania grupowego. Spośród tej grupy, 263 ochotników poddano badaniom sonograficznym. Badanie tarczycy przeprowadzili doświadczeni specjaliści w zakresie ultrasonografii. Ponadto oznaczono stężenia T3, T4, T3RU, TSH, TPO Ab i Tg Ab w surowicy oraz wydalanie jodu z moczem. Wyniki: Kobiety stanowiły 46% grupy poddanej badaniom sonograficznym (n = 263). Średnia wieku wynosiła 35,5 lat (zakres 20-64 lat). Mediana stężenia jodu w moczu wynosiła 19.4 &#956;g/dl. Obecność zmian ogniskowych tarczycy wykazano w badaniu sonograficznym u 22,4% osób z badanej grupy; u 30% kobiet i 16,3% mężczyzn (OR = 2,2; p = 0,01). Częstość występowania zmian ogniskowych tarczycy zwiększała się z wiekiem (p = 0,006). Zmiany ogniskowe tarczycy występowały częściej u osób z niedoczynnością tarczycy niż w grupie z eutyreozą (35,1% v. 20,5%, OR = 2,1; p = 0,04). Nie stwierdzono korelacji między stężeniem jodu w moczu ani stężeniem autoprzeciwciał a występowaniem zmian ogniskowych tarczycy w badaniu sonograficznym. Wnioski: Częstość występowania zmian ogniskowych tarczycy oceniana na podstawie wyników badania sonograficznego jest nadal duża w badanej populacji, mimo prawidłowego stężenia jodu w moczu. (Endokrynol Pol 2010; 61 (2): 188-191)Introduction: The aim of this study was to investigate the current status of sonographic characteristics of thyroid nodules in Isfahan, a previously iodine deficient area in central Iran. Material and methods: In a cross-sectional study conducted in 2006, 2523 adult people (age > 20 years) were selected by a multistage clustering sampling method. Of these people, 263 volunteered persons were underwent sonographic evaluation. Thyroid examination was done by two expert sonographers. Serum T3, T3, T3RU, TSH, TPO Ab and Tg Ab, and urinary iodine were measured. Results: Forty-six per cent of the 263 people were women. Their mean age was 35.5 years with a range of 20-64 years. Median urinary iodine was 19.4 &#956;g/dL. The prevalence of thyroid nodules on sonography was 22.4% in the whole group; 30% in women and 16.3% in men (OR = 2.2, P = 0.01). The prevalence of thyroid nodules increased with age (P = 0.006). The prevalence of thyroid nodules was higher in hypothyroid people than in euthyroid people (35.1% v. 20.5%, OR = 2.1, P = 0.04). Neither urinary iodine nor autoantibody concentrations correlated with the prevalence of thyroid nodules in sonography. Conclusions: The prevalence of thyroid nodule by sonography is still high despite relatively normal urinary iodine in this population. (Pol J Endocrinol 2010; 61 (2): 188-191

An innovative method to assess clinical reasoning skills: Clinical reasoning tests in the second national medical science Olympiad in Iran

BACKGROUND: Clinical reasoning plays a major role in the ability of doctors to make a diagnosis and reach treatment decisions. This paper describes the use of four clinical reasoning tests in the second National Medical Science Olympiad in Iran: key features (KF), script concordance (SCT), clinical reasoning problems (CRP) and comprehensive integrative puzzles (CIP). The purpose of the study was to design a multi instrument for multiple roles approach in clinical reasoning field based on the theoretical framework, KF was used to measure data gathering, CRP was used to measure hypothesis formation, SCT and CIP were used to measure hypothesis evaluation and investigating the combined use of these tests in the Olympiad. A bank of clinical reasoning test items was developed for emergency medicine by a scientific expert committee representing all the medical schools in the country. These items were pretested by a reference group and the results were analyzed to select items that could be omitted. Then 135 top-ranked medical students from 45 medical universities in Iran participated in the clinical domain of the Olympiad. The reliability of each test was calculated by Cronbach's alpha. Item difficulty and the correlation between each item and the total score were measured. The correlation between the students' final grade and each of the clinical reasoning tests was calculated, as was the correlation between final grades and another measure of knowledge, i.e., the students' grade point average. RESULTS: The combined reliability for all four clinical reasoning tests was 0.91. Of the four clinical reasoning tests we compared, reliability was highest for CIP (0.91). The reliability was 0.83 for KF, 0.78 for SCT and 0.71 for CRP. Most of the tests had an acceptable item difficulty level between 0.2 and 0.8. The correlation between the score for each item and the total test score for each of the four tests was positive. The correlations between scores for each test and total score were highest for KF and CIP. The correlation between scores for each test and grade point average was low to intermediate for all four of the tests. CONCLUSION: The combination of these four clinical reasoning tests is a reliable evaluation tool that can be implemented to assess clinical reasoning skills in talented undergraduate medical students, however these data may not generalizable to whole medical students population. The CIP and KF tests showed the greatest potential to measure clinical reasoning skills. Grade point averages did not necessarily predict performance in the clinical domain of the national competitive examination for medical school students

Evaluating the efficacy of Salsalate on prediabetic and diabetic patients with fatty liver: A randomized clinical trial

Objective: Nearly two-third of the patients with type 2 diabetes have degrees of fatty liver; this may induce some side effects in them. This study aimed to find effect of salsalate on treatment of steatohepatitis and correlation of fatty liver with metabolic syndrome in the setting of impaired glucose metabolism. Methods: In a double-blind randomized trial within two distinct groups, i.e., recently diagnosed diabetics and prediabetic cases allocated in two arms of the intervention to receive 3 g salsalate or placebo. All cases underwent glucose and lipid level studies and liver ultrasound study. Findings: Out of 46 patients with diabetes, 34 (74%) had fatty liver in ultrasound; this ratio was 75% in 113 prediabetic cases. Relative frequency of fatty liver stages did not differ between diabetics and prediabetics. Within diabetics, mean aspartate aminotransferase (AST) level of fatty liver cases (23 ± 7 IU/dl) was higher than others (18 ± 3 IU/dl) (P < 0.05). Changes in transaminase levels following intervention did not significantly differ, comparing drug and placebo arms in two subgroups. Conclusion: According to the findings, if diabetes could be assumed as the logical consequence of prediabetic state, it seems that fatty liver did develop before this preliminary status. In this study, salsalate could not change biochemical markers of fatty liver significantly

Adaptation of Clinical Practice Guideline for Colorectal Cancer Screening in People with Average Risk in Isfahan Province

Background: Colorectal cancer (CRC) is the third most common cancer among adults in Iran. The aim of colorectal cancer screening is to reduce the cancer burden in the population by diagnosing the disease in its early stages. Methods: We adapted this guideline for the moderate CRC risk population for Isfahan to determine how to screen them and when to start and end the CRC screening. This guideline was developed by clinical appraisal and review of the evidence, available clinical guidelines, and in consultation with members of the Isfahan Chamber of Iranian association of gastroenterology and hepatology. Results: In screening people with average risk for CRC who use personal resources and personally pay all the costs, colonoscopy is recommended as the first choice to be done every 10 years. In case of negative colonoscopy, we recommend FIT test to prevention of interval cancer every 5 years. In screening of people with average risk of CRC, FIT is suggested to be done every 2 years as a first-choice method test for those who use public resources and do not pay for this service personally. In screening individuals with average risk for CRC, g-FOBT is not recommended as the first method of choice. Repeating positive guaiac test is not recommended and if positive, colonoscopy is suggested

Dyssynergic Defecation: A Comprehensive Review on Diagnosis and Management

About one-third of chronically constipated patients have an evacuation disorder, and dyssynergic defecation is a common cause of the evacuation disorder. In dyssynergic defecation, the coordination between abdominal and pelvic floor muscles during defecation is disrupted and patients cannot produce a normal bowel movement. The etiology of dyssynergic defecation is still unknown. Although a detailed history taking and a careful examination including digital rectal examination could be useful, other modalities such as anorectal manometry and balloon expulsion test are necessary for the diagnosis. Biofeedback therapy is one of the most effective and safe treatments. Here, we provide an overview of dyssynergic defecation as well as how to diagnose and manage this condition

Using TOSCE (Team Objective Structured Clinical Examination) in the second national medical sciences olympiad in Iran

Introduction: Second National Medical Sciences Olympiad was done in Shiraz in August 2010 with aim of indentifying scientifically talented individuals, motivating students and orienting extracurricular activities. This Olympiad was done in 3 areas, basic sciences, clinical sciences and management. In clinical sciences, we used TOSCE (Team Objective Structured Clinical Examination). In this article we report the details of this exam and participants′ satisfaction. Materials and Methods: This Olympiad in Clinical Medical Sciences was held in 2 levels: Individual and team. In the team stage, 9 teams from 9 universities participated. We used TOSCE for measuring clinical competency of teams. Each team consisted of 3 students. We designed 12 stations based on emergency medicine in medical and surgical fields. The time considered for each station was 15 min, after doing this exam the view of students was measured using a valid and reliable questionnaire. Results: Most of the students believed that TOSCE was a useful examination for measuring competency. More than 50% of students reported that success in this exam needs clinical competency, team work and problem solving ability. Nearly, half (48.1%) of students believed that 15 min is not enough for each station and they need more time. Conclusion: The results of this study showed that this kind of exam is useful for measuring clinical competency from students′ viewpoint