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

Evaluating the protective effect of resveratrol, Q10, and alpha-lipoic acid on radiation-induced mice spermatogenesis injury: A histopathological study

Background: Testis is one of the most sensitive organs against the toxic effect of ionizing radiation. Exposure to even a low dose of radiation during radiotherapy, diagnostic radiology, or a radiological event could pose a threat to spermatogenesis. This may lead to temporary or permanent infertility or even transfer of genomic instability to the next generations. Objective: In this study, we evaluated the protective effect of treatment with three natural antioxidants; resveratrol, alpha lipoic acid, and coenzyme Q10 on radiation-induced spermatogenesis injury. Materials and Methods: 30 NMRI mice (6-8 wk, 30 ± 5 gr) were randomly divided into six groups (n=5/each) as 1) control; 2) radiation; 3) radiation + resveratrol; 4) radiation + alpha lipoic acid; 5) radiation + resveratrol + alpha lipoic acid; and 6) radiation+ Q10. Mice were treated with 100 mg/kg resveratrol or 200 mg/kg alpha lipoic acid or a combination of these drugs. Also, Q10 was administered at 200 mg/kg. All treatments were performed daily from two days before to 30 min before irradiation. Afterward, mice were exposed to 2 Gy 60Co gamma rays; 37 days after irradiation, the testicular samples were collected and evaluated for histopathological parameters. Results: Results showed that these agents are able to alleviate some toxicological parameters such as basal lamina and epididymis decreased sperm density. Also, all agents were able to increase Johnsen score. However, they could not protect against radiation-induced edema, atrophy of seminiferous tubules, and hyperplasia in Leydig cells. Conclusion: This study indicates that resveratrol, alpha-lipoic acid, and Q10 have the potential to reduce some of the side effects of radiation on mice spermatogenesis. However, they cannot protect Leydig cells as a source of testosterone and seminiferous tubules as the location of sperm maturation. Key words: Radiation, Spermatogenesis, Resveratrol, Alpha-Lipoic Acid, Coenzyme Q10

Linkage between prostate cancer occurrence and Y-chromosomal DYS loci in Malaysian subjects..

Purpose: Prostate cancer differs markedly in incidence across ethnic groups. Since this disease is influenced by complex genetics, it is many genetic factors may affect the level of susceptibility to development of the disease. In this study, four Y-linked short tandem repeats (STRs), DYS388, DYS435, DYS437, and DYS439, were genotyped to compare Malaysian prostate cancer patients and normal control males. Materials and methods: A total of 175 subjects comprising 84 patients and 91 healthy individuals were recruited. Multiplex PCR was optimized to co-amplify DYS388, DYS435, DYS437, and DYS439 loci. All samples were genotyped for alleles of four DYS loci using a Genetic Analysis System. Results: Of all DYS loci, allele 10 (A) of DYS388 had a significantly lower incidence of disease in compare with other alleles of this locus, while a higher incidence of disease was found among males who had either allele 12 (C) of DYS388 or allele 14 (E) of DYS439. Moreover, a total of 47 different haplotypes comprising different alleles of four DYS loci were found among the whole study samples, of which haplotypes AABC and CAAA showed a lower and higher frequency among cases than controls, respectively. Conclusions: It is likely that Malaysian males who belong to Y-lineages with either allele 12 of DYS388, allele 14 of DYS439, or haplotype CAAA are more susceptible to develop prostate cancer, while those belonging to lineages with allele 10 of DYS388 or haplotype AABC are more resistant to the disease

Urine and milk iodine concentrations in healthy and congenitally hypothyroid neonates and their mothers

Wstęp: Częste występowanie wrodzonej niedoczynności tarczycy (CH, congenital hypothyroidism) w Iranie skłoniło autorów do oceny roli jodu w etiologii CH, opierając się na porównaniu jego stężenia w moczu zdrowych noworodków i noworodków z wrodzoną niedoczynnością tarczycy oraz w mleku i moczu ich matek. Materiał i metody: W tym przekrojowym badaniu zmierzono stężenie jodu w moczu (UIC, urinary iodine concentration) noworodków z CH oraz UIC i stężenie jodu w mleku (MIC, milk iodine concentration) ich matek, a następnie porównano je z wynikami otrzymanymi w grupie kontrolnej. Wartości UIC zmierzone u noworodków i karmiących matek podzielono na 3 kategorie: niskie UIC < 150 mg/l, średnie - 150-230 mg/l i wysokie > 230 mg/l. Analogiczne kategorie przyjęto dla MIC: niskie 180 mg/l. Wyniki: Mediana UIC u noworodków z CH (n = 68) i u zdrowych noworodków (n = 179) wynosiła odpowiednio 300,5 i 290,5 mg/dl, (P > 0,05). Mediana UIC w grupach badanej i kontrolnej wynosiła odpowiednio 150 i 130 mg/l (P > 0,05). Mediana MIC w grupie badanej była większa niż w grupie kontrolnej (210 mg/l v. 170 mg/l, P < 0,05). Stwierdzono dodatnią korelację między UIC u noworodków i MIC u ich matek. Nie wykazano wyraźnej zależności między UIC i stężeniem TSH w surowicy u noworodków oraz UIC I MIC u matek. Wnioski: Spożycie sodu w badanej populacji było prawidłowe. Nadmierna podaż sodu może być czynnikiem ryzyka CH, jednak w badaniu wykazano brak korelacji między MIC I UIC u matek i podobne wartości mediany UIC u noworodków w obu grupach, dlatego do sformułowania jednoznacznych wniosków potrzebne są dalsze badania. (Endokrynol Pol 2010; 61 (4): 371-376)Introduction: In view of the high prevalence of Congenital Hypothyroidism (CH) in Iran, in this study we evaluated the role of iodine in the aetiology of CH by comparing urine and milk iodine concentrations in healthy and congenitally hypothyroid neonates and their mothers. Material and methods: In a cross-sectional study, urinary iodine concentrations (UIC) in newborns with CH, as well as UIC and the milk iodine concentrations (MIC) of their mothers, were measured and compared with a control group. The lower, mid, and upper range of UIC for neonates and lactating mothers was considered to be 230 mg/L, and lower, mid, and upper range of MIC was considered to be 180 mg/L, respectively. Results: The median UICs in subjects with CH (n = 68) and healthy subjects (n = 179) were 300.5 and 290.5 mg/L, respectively (P > 0.05). The median UICs in the case and control groups were 150 and 130 mg/L, respectively (P > 0.05). The median MIC in the case group was higher than in the control group (210 mg/L v. 170 mg/L, P < 0.05).There was a positive correlation between newborn UIC and MIC. There was no significant correlation between newborn UIC and serum TSH, maternal UIC and maternal MIC, or newborn UIC and serum TSH. Conclusions: There is no inadequacy in iodine intake in the studied population. Iodine excess could be a possible risk factor for CH, but there were findings, such as lack of correlation between maternal MIC and UIC, and the median neonatal UIC, which was similar in the two groups, so, drawing conclusions should be done with some caution and requires further studies. (Pol J Endocrinol 2010; 61 (4): 371-376

Evaluating the Protective Effect of a Combination of Curcumin and Selenium-L-Methionine on Radiation Induced Dual Oxidase Upregulation

Background: Epidemiological studies have shown an increased incidence of heart diseases among survivors of Chernobyl disaster as well as Hiroshima and Nagasaki atomic bomb explosion. Similar results were observed for lung and left breast cancer patients. Experimental studies have proposed the chronic upregulation of some pro-inflammatory and pro-fibrotic cytokines. Recent studies have shown that upregulation of pro-oxidant enzymes play a key role in the development of late effects of ionizing radiation such as fibrosis. Interleukin-4 (IL-4) and Interleukin-13 (IL-13) are two important cytokines that have shown ability to induce production of free radicals through dual oxidases (Duox) i.e. Duox1 and Duox2. In this study, we aimed to detect the expression of IL-4 receptor-a1 (IL-4Ra1), IL-13 receptor-a2 (IL-13Ra2), Duox1 and Duox2 genes following irradiation of rat’s heart. In addition, we evaluated the possible role of the combination of curcumin and selenium-L-methionine on the regulation of these genes. Methods: Twenty rats were divided into 4 groups as follows; G1: control; G2: treatment with the combination of curcumin and selenium-L-methionine; G3: radiation; G4: radiation plus treatment with the combination of curcumin and selenium-L-methionine. Rats were sacrificed 10 weeks after irradiation for detecting the expression of IL-4Ra1, IL-13Ra2, Duox1 and Duox2. Results: Results showed that exposure to ionizing radiation caused upregulation of IL-4Ra1 by more than 4-fold as well as Duox1 and Duox2 by more than 5-fold. However, results showed no detectable expression for IL-13Ra2. Treatment with the combination of curcumin and selenium-L-methionine could attenuate the upregulation of all genes. Conclusion: This study has shown that exposing rat’s heart tissues to radiation leads to chronic upregulation of IL-4Ra1, Duox1 and Duox2 as well as pro-oxidant enzymes. Treatment with the combination of curcumin and selenium-L-methionine showed ability to attenuate the upregulation of these genes

Ivermectin-Induced Clinical Improvement and Alleviation of Significant Symptoms of COVID-19 Outpatients: A Cross-Sectional Study

Although several drugs have been proposed and used to treat the COVID-19 virus, but recent clinical trials have concentrated on ivermectin. It appears that ivermectin can potentially act against COVID-19 and stop the development in its infancy. The purpose of this study was to determine the effect of ivermectin on the recovery of outpatients with COVID-19. In this cross-sectional study, we compared the symptoms reduction in COVID-19 disease in two groups of patients by administering ivermectin. A total of 347 mild outpatients in the Iranian provinces of Qazvin and Khuzestan with a conrmed PCR were enrolled. The symptoms of outpatients with COVID-19 were analyzed using SPSS (V23). In this cross-sectional study, the sex ratio was 0.64 (female/male: 37.9/59.8) and most patients were under 50 years old (72.8%). The results of this study demonstrated a signicant decrease in several COVID-19 disease symptoms, including fever, chills, dyspnea, headache, cough, fatigue, and myalgia in the group administered ivermectin compared to the control group. In addition, the odds ratio of the above symptoms was signicantly lower in patients who received ivermectin than in patients who did not receive the drug (OR = 0.16, 95% CI = 0.09, 0.27). Keywords COVID-19 Ivermectin Cross-sectional study Outpatients Sympto

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

Ethnicity influences disease characteristics and symptom severity in allergic rhinitis patients in Malaysia

Background: The number of available reports regarding the influence of ethnicity on clinical features of allergic rhinitis (AR), especially disease severity in tropical climates, is limited. We aimed to compare clinical parameters and disease severity in AR patients of different ethnicities. Methods: Malay, Chinese, and Indian AR patients (n = 138) with confirmed sensitivity to Dermatophagoides pteronyssinus, Dematophagoides farinae, and Blomia tropicalis were tested for mite-specific immunoglobulin E (sIgE) levels. A detailed questionnaire was used to collect data on nasal symptom score (NSS), ocular symptom score (OSS), sum of symptoms score (SSS), quality of life score (QLS), symptomatic control score (SCS), and total sum of scores (TSS) and correlate the derived data with patients' demography, mite-polysensitivity, and sIgE levels. Results: AR-related symptoms were most severe in Malays and least in Chinese (p < 0.01). Age (r = 0.516 to 0.673, p < 0.05) and duration of AR (r = 0.635 to 0.726, p < 0.01) correlated positively with severity domains (NSS, SSS, QLS, and TSS) in Chinese. Duration of concurrent allergies was highest in Malays (p < 0.05). Polysensitivity predicted increased sIgE levels in Malays (r = 0.464 to 0.551, p < 0.01) and Indians (r = 0.541 to 0.645, p < 0.05) but affected NSS, SSS, and TSS only in Indians (r = 0.216 to 0.376, p < 0.05). sIgE levels were lowest among Chinese but correlated strongly with NSS, OSS, SSS, and TSS (r = 0408 to 0.898, p < 0.05). Conclusion: Clinical parameters in AR may be influenced by race. Symptoms were most severe among Malays but did not correlate with other variables examined. Although Indian ethnicity did not impact disease severity, duration of concurrent allergies and mite-polysensitivity was associated with more severe disease. Age, duration of disease, and sIgE levels may be useful indicators of disease severity in Chinese

Metformin Protects against Radiation-Induced Pneumonitis and Fibrosis and Attenuates Upregulation of Dual Oxidase Genes Expression

Purpose: Lung tissue is one of the most sensitive organs to ionizing radiation (IR). Early and late side effects of exposure to IR can limit the radiation doses delivered to tumors that are within or adjacent to this organ. Pneumonitis and fibrosis are the main side effects of radiotherapy for this organ. IL-4 and IL-13 have a key role in the development of pneumonitis and fibrosis. Metformin is a potent anti-fibrosis and redox modulatory agent that has shown radioprotective effects. In this study, we aimed to evaluate possible upregulation of these cytokines and subsequent cascades such as IL4-R1, IL-13R1, Dual oxidase 1 (DUOX1) and DUOX2. In addition, we examined the potential protective effect of metformin in these cytokines and genes, as well as histopathological changes in rat’s lung tissues. Methods: 20 rats were divided into 4 groups: control; metformin treated; radiation + metformin; and radiation. Irradiation was performed with a 60Co source delivering 15 Gray (Gy) to the chest area. After 10 weeks, rats were sacrificed and their lung tissues were removed for histopathological, real-time PCR and ELISA assays. Results: Irradiation of lung was associated with an increase in IL-4 cytokine level, as well as the expression of IL-4 receptor-a1 (IL4ra1) and DUOX2 genes. However, there was no change in the level of IL-13 and its downstream gene including IL-13 receptor-a2 (IL13ra2). Moreover, histopathological evaluations showed significant infiltration of lymphocytes and macrophages, fibrosis, as well as vascular and alveolar damages. Treatment with metformin caused suppression of upregulated genes and IL-4 cytokine level, associated with amelioration of pathological changes. Conclusion: Results of this study showed remarkable pathological damages, an increase in the levels of IL-4, IL4Ra1 and Duox2, while that of IL-13 decreased. Treatment with metformin showed ability to attenuate upregulation of IL-4–DUOX2 pathway and other pathological damages to the lung after exposure to a high dose of IR