Regression of nonalcoholic fatty liver disease detected by sonography: Results of a four years prospective adult population-based study

Background: Today, nonalcoholic fatty liver disease (NAFLD) has become a major health problem owing to its high prevalence. Literature evidence about regression of NAFLD are not as high as its development or progression. Objectives: This cohort study was conducted to reveal the factors influencing the regression of the NAFLD. Methods: A population-based study conducted in Shiraz, Iran. Adults older than 18 years were recruited by multistage randomized sampling in 2012, and then in 2017. Demographic, anthropometric, nutritional, and medical characteristics of each interviewee were entered into a valid and reliable questionnaire. Interviewees were categorized into three groups according to the changing of their NAFLD status between two stages of this study; no change, regressed and progressed. Results: Of the 537 participants, 163 (30.3%) showed regression of their NAFLD compared to 93 (17.3%) that their NAFLD was progressed. Multinomial regression showed that each unit of decrease in BMI (∆ BMI=-1 kg/m2 ) augmented the relative risk (RR) of improvement of NAFLD by 13.3% (RR: 0.867; 95% CI: 0.776-0.969; P = 0.012) and reduced the relative risk of NAFLD deterioration by 14.3% (RR: 1.143; 95% CI: 1.009-1.294; P = 0.035). Conclusions: A significant portion of patients showed regression of their NAFLD by decreasing their BMI. Therefore, BMI as a modifiable variable should be regarded in the management of NAFLD patients Keywords: Non-Alcoholic Fatty Liver, Regression, Progression, Cohort Stud

Association between rs2303861 polymorphism in CD82 gene and nonalcoholic fatty liver disease: a preliminary case-control study

Aim To investigate the genetic factors involved in the development of non-alcoholic fatty liver disease (NAFLD) and its sequelae in a Middle Eastern population. Methods This genetic case-control association study, conducted in 2018, enrolled 30 patients with NAFLD and 30 control individuals matched for age, sex, and body mass index. After quality control measures, entire exonic regions of 3654 genes associated with human diseases were sequenced. Allelic association test and enrichment analysis of the significant genetic variants were performed. Results The association analysis was conducted on 27 NAFLD patients and 28 controls. When Bonferroni correction was applied, NAFLD was significantly associated with rs2303861, a variant located in the CD82 gene (P = 2.49 × 10−7, adjusted P = 0.0059). When we used Benjamini- Hochberg adjustment for correction, NAFLD was significantly associated with six more variants. Enrichment analysis of the genes corresponding to all the seven variants showed significant enrichment for miR-193b-5p (P = 0.00004, adjusted P = 0.00922). Conclusion A variant on CD82 gene and a miR-193b expression dysregulation may have a role in the development and progression of NAFLD and its sequela

Determinant components of newly onset versus improved metabolic syndrome in a population of Iran

This study aimed to determine the risk factors related to regression and progression of metabolic syndrome, in a 4-year cohort study. A total of 540 individuals (≥ 18 years old) participated in both phase of the study. Participants were categorized into 3 categories of regressed, progressed and unchanged metabolic syndrome (MetS). Demographic, anthropometric and biochemical parameters were assessed for each individual in both phase. Variables differences (delta: Δ) between the two phase of study were calculated. Unchanged group was considered as baseline category. Based on IDF, MetS had been regressed and progressed in 42 participants (7.7%) and 112 (20.7%) participants respectively, in the second phase. More than 47% of people, whose MetS regressed, experienced also NAFLD regression. Results of multiple variable analysis revealed that increased age, positive Δ-TG, and Δ-FBS, significantly increased the odds of MetS progression based on IDF and ATP III definitions, while negative Δ-HDL and Δ-neutrophil to lymph ration increased the odds of progression. On the other hand, negative Δ-TG and positive Δ-HDL significantly increased the odds of Mets regression based of both IDF and ATP III. Management of hypertriglyceridemia, hyperglycemia, and HDL is a critical, non-invasive and accessible approach to change the trend of Met

Violence against Nurses: A Neglected and Health-threatening Epidemic in the University Affiliated Public Hospitals in Shiraz, Iran.

BACKGROUND: Nurses are more likely to be exposed to violence at their workplace in comparison with other employees. OBJECTIVE: To determine various aspects of violence against nurses in Shiraz public hospitals. METHODS: This cross-sectional study was conducted from 2017 to 2018, using a multistage random sampling method. Violence including verbal threats, verbal abuse, physical and sexual abuse as well as ethnical types, violence from patients, patients' companions and coworkers, and causes of violence were investigated using a checklist. RESULTS: 405 nurses with a mean age of 30.2 (SD 7.1) years and female to male ratio of 4.2 were interviewed. 363 (89.6%) nurses had experienced at least one kind of violence; 68.4% suffered from more than one type of violence. Verbal abuse (83.9%), verbal threats (27.6%), physical violence (21.4%), sexual abuse (10.8%), and ethnical harassment (6.1%) were the most common types of violence experienced by the nurses. Patients' companions, patients, and physicians were reported as the sources of violence in 70.6%, 43.1%, and 4.1% of cases, respectively. Nurses with non-official employment status and non-Farsi ethnicity, having a disease, with non-evening shift work, and those with short or long employment period were more affected. Unrealistic expectations by patients' companions and long working hours were the most common attributing factors. CONCLUSION: Violence against nurses, as a strenuous and health-threatening crisis, has become epidemic in public hospitals in our region. Effective interventions are warranted to sort out these problems. KEYWORDS: Hospitals; Nurses; Patients; Physicians; Violenc

The challenges of urban family physician program over the past decade in Iran: a scoping review and qualitative study with policy-makers

Introduction: Despite all the advantages of urban family physician program (UFPP), there is still a gap between UFPP and what is actually achieved by the community after its implementation in Iran. In response, this study attempted to review published studies related to the barriers to the implementation of the UFPP in Iran as well as potential solutions to improve it. Further, a qualitative study was conducted to learn the perspectives of experts at the national level and in the Fars province in order to better understand the program's challenges. Methods: This study was conducted in two phases. First, a scoping review was done, aiming to identify the common barriers and potential solutions to implementing UFPP in Iran. Second, a qualitative study using semi-structured interviews was conducted to investigate the views of decision- and policy-makers regarding barriers to and solutions for implementing the UFPP in the Fars province over the last decade. The findings were classified using the five control knobs framework (Organization, financing, payment, regulation, and behavior).  Results: The most common barriers to UFPP were: 1) organization (ununited stewardship function of the Ministry of Health, weak management and planning, inadequate training of human resources, and a weak referral system); 2) financing (fragmented insurance funds, insufficient financial resources, and instability of financial resources); 3) payment (inappropriate payment mechanisms and delay in payments); 4) regulation (cumbersome laws and unclear laws); and 5) behavior (cultural problems and conflict of interests). On the other hand, several solutions were identified to improve the implementation of UFPP, including: enhancing the role of government; improving the referral system; providing comprehensive training for UFPP providers; considering sustainable financial resources; moving towards mixed-payment mechanisms; employing appropriate legal and regulatory frameworks; enhancing community awareness; and elevating incentive mechanisms. Conclusion: Our research found that, despite the UFPP having been in place for a decade in Iran, there are still significant challenges in all five components. Therefore, the promotion of this program requires solving the existing implementation challenges in order to achieve the predetermined goals. The ideas in this study can be used to improve the current program in Fars Province and bring it to other cities in Iran

The Association Between Serum Vitamin D Level and Nonalcoholic Fatty Liver Disease

Background: Nonalcoholic fatty liver disease (NAFLD) is a condition, in which triglyceride accumulates in hepatic cells without a history of alcohol consumption and is strongly associated with insulin resistance, obesity, diabetes mellitus, hypertension and dyslipidemia. The potential role of vitamin D in the pathogenesis of NAFLD has been reported. Objectives: The aim of this study was to determine the optimal vitamin D levels for prevention of NAFLD. Methods: In a cross-sectional study, 2,160 cases who referred to a university-affiliated health center were randomly selected and their demographic information, anthropometric and metabolic indices and also vitamin D levels were collected. Fatty liver was assessed by fatty liver index (FLI) and confirmed by FibroScan using controlled attenuation parameter (CAP). Based on the NAFLD score, the subjects were divided into two groups and the vitamin D cutoff point was calculated by ROC curve. Results: Based on the results, 745 patients (34.5%) had different degrees of fatty liver. Significant differences in the stiffness of liver tissue were observed between vitamin D categories (285.10 +/- 30.56 for severe, 251.82 +/- 42.63 for moderate and 201.02 +/- 36.08 for mild deficiency). According to the multivariate analysis, age, fasting insulin and vitamin D levels were found as the most significant factors in NAFLD pathogenesis. Vitamin D cutoff point was obtained 18 nmol/L in women and 21 nmol/L in men. Conclusions: The results indicated a significant association between vitamin D level and NAFLD score. Accordingly, increasing the public awareness to maintain a proper level of vitamin D may be a preventative strategy against NAFLD. Keywords Author Keywords:25-Hydroxyvitamin D; Nonalcoholic Fatty Liver Disease; Nonalcoholic Steatohepatitis; Obesity; Vitamin D Deficiency KeyWords Plus:25-HYDROXYVITAMIN D-3; INSULIN-RESISTANCE; STEATOHEPATITIS; EXPRESSION; SEVERITY; ALPHA; NAFLD; HISTOLOGY; CHILDREN; IMPAC

Predictors of Death in the Liver Transplantation Adult Candidates: An Artificial Neural Networks and Support Vector Machine Hybrid-Based Cohort Study

Background: Model for end-stage liver disease (MELD) is currently used for liver transplantation (LT) allocation, however, it is not a sufficient criterion. Objective: This current study aims to perform a hybrid neural network analysis of different data, make a decision tree and finally design a decision support system for improving LT prioritization.Material and Methods: In this cohort follow-up-based study, baseline characteristics of 1947 adult patients, who were candidates for LT in Shiraz Organ Transplant Center, Iran, were assessed and followed for two years and those who died before LT due to the end-stage liver disease were considered as dead cases, while others considered as alive cases. A well-organized checklist was filled for each patient. Analysis of the data was performed using artificial neural networks (ANN) and support vector machines (SVM). Finally, a decision tree was illustrated and a user friendly decision support system was designed to assist physicians in LT prioritization. Results: Between all MELD types, MELD-Na was a stronger determinant of LT candidates’ survival. Both ANN and SVM showed that besides MELD-Na, age and ALP (alkaline phosphatase) are the most important factors, resulting in death in LT candidates. It was cleared that MELD-Na <23, age <53 and ALP <257 IU/L were the best predictors of survival in LT candidates. An applicable decision support system was designed in this study using the above three factors.  Conclusion: Therefore, Meld-Na, age and ALP should be used for LT allocation. The presented decision support system in this study will be helpful in LT prioritization by LT allocators

Impact of neuraminidase inhibitors on influenza A(H1N1)pdm09‐related pneumonia: an individual participant data meta‐analysis

BACKGROUND: The impact of neuraminidase inhibitors (NAIs) on influenza‐related pneumonia (IRP) is not established. Our objective was to investigate the association between NAI treatment and IRP incidence and outcomes in patients hospitalised with A(H1N1)pdm09 virus infection. METHODS: A worldwide meta‐analysis of individual participant data from 20 634 hospitalised patients with laboratory‐confirmed A(H1N1)pdm09 (n = 20 021) or clinically diagnosed (n = 613) ‘pandemic influenza’. The primary outcome was radiologically confirmed IRP. Odds ratios (OR) were estimated using generalised linear mixed modelling, adjusting for NAI treatment propensity, antibiotics and corticosteroids. RESULTS: Of 20 634 included participants, 5978 (29·0%) had IRP; conversely, 3349 (16·2%) had confirmed the absence of radiographic pneumonia (the comparator). Early NAI treatment (within 2 days of symptom onset) versus no NAI was not significantly associated with IRP [adj. OR 0·83 (95% CI 0·64–1·06; P = 0·136)]. Among the 5978 patients with IRP, early NAI treatment versus none did not impact on mortality [adj. OR = 0·72 (0·44–1·17; P = 0·180)] or likelihood of requiring ventilatory support [adj. OR = 1·17 (0·71–1·92; P = 0·537)], but early treatment versus later significantly reduced mortality [adj. OR = 0·70 (0·55–0·88; P = 0·003)] and likelihood of requiring ventilatory support [adj. OR = 0·68 (0·54–0·85; P = 0·001)]. CONCLUSIONS: Early NAI treatment of patients hospitalised with A(H1N1)pdm09 virus infection versus no treatment did not reduce the likelihood of IRP. However, in patients who developed IRP, early NAI treatment versus later reduced the likelihood of mortality and needing ventilatory support

The Knowledge, Attitude and Behavior of HIV/AIDS Patients’ Family toward Their Patients before and after Counseling

Background: Acquired immunodeficiency may impose considerableconsequences on patients’ family behaviors towardthem. The objective of the present study was to investigatewhether a counseling program at Behavioral Counseling Centerin the city of Shiraz, Iran could change the attitude, knowledgeand behavior of patients' family members.Methods: 125 HIV/AIDS patients’ family members were interviewed,using a valid and reliable questionnaire before andafter performing counseling sessions at Behavioral CounselingCenter. The findings were analyzed using nonparametric tests.Results: The age of the participants was 40±13 years. Sixty fivepercent were female, 63% married and 79% educated. Forty fourpercent of participants had spousal relationships with their patients.Their knowledge about the main routes of HIV transmissionwere 9.76 ± 2.59 and10.64±0.88 before and after counseling,respectively (P=0.028). Supportive behaviors of families towardtheir patients reached to 79% after counseling compared with 44% before that (P=0.004). Belief to isolate the patients and thepractice of this approach at home dropped from 71% to 15% andfrom 29% to 7% after counseling, respectively (P<0.05). In 30%of participants fear of getting HIV from patients was not changedby counseling, and 24% of patients’ spouses did report to avoidprotected sex with their HIV infected husbands even after takingpart in the counseling program (P>0.05).Conclusion: Ongoing counseling for HIV/AIDS patients’ familiesat Behavioral Counseling Center of Shiraz did advance theirknowledge about AIDS and improved their attitude and behaviortoward their patients However, the counseling program didnot show remarkable success in some aspects such as the removalof fear about HIV spread in the family or the change ofthe patients’ wives attitude to have protected sex with their HIVinfected husbands.Iran J Med Sci 2010; 35(4): 287-292