A Woman with Normotensive Primary Hyperaldosteronism

Normotensive hyperaldosteronism is a rare disorder. It is usually diagnosed with hypokalemia or an adrenal mass. Our patient was a 27-year-old female presented with weakness. She had normal blood pressure, hypokalemia, high plasma aldosterone level and suppressed plasma renin activity. After the saline load, test aldosterone didn’t show suppression. Adrenal computed tomography revealed a left adrenal mass. The patient was treated with spironolactone and potassium supplement. Surgical adrenalectomy was done. Final pathologic diagnosis was benign adrenocortical adenoma without capsular invasion. In postoperative course serum, potassium was normal

Comparison of optimal cardiovascular risk factor management in patients with Type 2 diabetes who attended urban medical health center with those attended a tertiary care center: Experiences from Tehran, Iran

Background: Diabetes is a leading cause of cardiovascular disease (CVD). Moreover, CVD accounts for primary cause of death among diabetic patients. Physicians, especially in the primary care setting, have effective role in the management of cardiovascular risk factors. Therefore, we aimed to compare the prevalence of modifiable cardiovascular risk factors in Type 2 diabetic patients attending to an urban health center as a primary care center with Institute of Endocrinology and Metabolism Diabetes Clinic (IEMDC) as a tertiary center. Methods: This cross-sectional study was performed on 200 adult diabetic patients attending urban health center (Abouzar Health Center) and 201 diabetic patients in a tertiary center. The patients′ cardiovascular risk factors including lipid profile, systolic and diastolic blood pressure (BP), and smoking history were recorded. The number of patients who did not achieve the target according to the American Diabetes Association guidelines was determined and compared. Results: The patients in urban health center were older than those who attending IEMDC (P = 0.004). The duration of diabetes was longer among urban center patients (P < 0.001). Comparison of cardiovascular risk factors between two groups of patients showed a significant number of patients with poor-controlled low-density lipoprotein (75% vs. 44.7%) and triglyceride (74% vs. 51.7%) in patients attending primary center (P < 0.001). However, the prevalence of high diastolic BP (60.6% vs. 44.5%) was significantly higher in patients attending IEMDC (P = 0.001). There was no significant difference between the two centers′ findings in glycosylated hemoglobin level, high-density lipoprotein level, and systolic BP. Conclusions: Both centers have failure in target achievement in some risk factors; however, the inability of the primary care center in controlling hyperlipidemia in comparison with the tertiary center is a serious warning to provide training about managing dyslipidemia in these centers

Effect of Dentin Surface Treatment Using a Non-Thermal Argon Plasma Brush on the Bond Strength of a Self-Adhesive Resin Composite

Background and Aim: Improving the bond strength at the resin-dentin interface is an important challenge in adhesive dentistry. This study examined the effect of low-power, non-thermal atmospheric pressure plasma (NT-APP) treatments on the adhesion of a self-adhesive resin composite to dentin. Materials and Methods: In this experimental in-vitro study, buccal enamel of extracted bovine incisors was removed using a high-speed diamond bur. The specimens were randomly divided into two groups according to the plasma treatment and thermocy-cling. The non-thermal atmospheric argon plasma brush was used in this study. One subgroup was subjected to the microshear bond strength (µSBS) test after 24 hours, whereas the other subgroup was subjected to artificial aging with thermocycling for 5000 cycles before being tested. Each specimen was attached to a testing jig and loaded at a crosshead speed of 1.0 mm/minute in a universal testing machine until failure occurred. Data were analyzed using two-factor repeated measures analysis of variance (ANOVA). Results: The results of μSBS testing showed that with plasma treatment, the average μSBS increased to 34.20±12.12 MPa compared to 19.47±7.4 MPa in the controls (P=0.002). After 5000 cycles of thermocycling, the adhesive-dentin bonding strengths of the plasma-treated specimens slightly decreased from 34.20±12.12 MPa to 33.64±5.6 MPa (P=0.886), while the strengths of the untreated specimens reduced from 19.47±7.4 MPa to 19.10±5.1 MPa (P=0.461). Plasma treatment improved the µSBS compared to the control group. After thermocycling, the µSBS did not decrease in the plasma and control (non-plasma) groups. Conclusion: Plasma treatment using NT-APP improves the adhesion of self-adhesive flowable resin composites to dentin

The Prevalence of Pre-hypertension in Children with Type 1 Diabetes Mellitus

Background: Hypertension is more common in adults with type 1 diabetes mellitus (T1DM) than the general population. The aim of this study was to detect the pre-hypertensive stage in children with T1D and to evaluate its correlation with diabetic nephropathy compared to non-diabetic children. Methods: This was a prospective cross-sectional study in an out-patient clinic of a university hospital. A total of 62 which consists of 36 males and 26 females patients with stable T1D with a median age of 13 year and 42 age - sex-matched healthy children were entered in the study between September 2008 and February 2011. Three readings of blood pressure were recorded. Fasting blood sample was drawn for hemoglobin A1C (HbA 1 C), creatinine and a 24 h urine aliquot was collected to measure microalbumin, creatinine and volume to estimate glomerular filtration rate (eGFR). Results: From 62 children with T1DM, 25.8% were in pre-hypertensive stage, 4.8% Stage 1, and 1.6% Stage 2. In controls, 1 (2.4%) out of 42 children was in pre-hypertensive stage (P < 0.0001). Abnormal blood pressures were correlated with eGFR and the duration of disease (P < 0.05), but there were not associated with microalbominuria or HbA 1 C level. Conclusions: There was a higher rate of early stage of high normal blood pressure in children with T1DM compared with the healthy controls and this abnormality was only correlated with puberty stage and glomerular filtration rate

How effective is diluted povidone-iodine in preventing periprosthetic joint infection in total joint arthroplasty (TJA)? An updated systematic review and meta-analysis

Abstract Purpose Periprosthetic joint infection (PJI) is a serious complication with total joint arthroplasty (TJA), that necessitates reoperation. Pre-closure irrigation with dilute povidone-iodine (PI) is among the preventive measures, but its efficiency is still controversial. As a result, the focus of this systematic review and meta-analysis is on the effect of dilute PI wound irrigation in the prevention of PJI following TJA. Methods We systematically reviewed and analyzed articles that compared PI with other agents in terms of PJI rate after TJA, searching Medline, Scopus, Web of science, and Cochrane databases. A number of 13 papers including 63,950 patients in total, were finally considered in qualitative and quantitative assessments. We have also further assessed review articles. Results In comparison with normal saline (NS), PI reduced post-operative infection rate (OR: 0.44; CI 95%: 0.34–0.56). However, there was no difference between PI and chlorhexidine (CHG) (OR: 1.61; CI 95%: 0.83–3.09)) or undetermined comparators (OR: 1.08; CI 95%: 0.67–1.76). Conclusion PI irrigation seems an efficient preventive measure for post-operative PJI and would seem to be the most feasible for TJA protocol

The effect of oral clonidine pre-medication prior to anesthesia on bleeding during tympanoplasty

Background: Intraoperative bleeding is one of the most important complications of surgery. Different techniques and methods have been used to decline this problem. In this study, the effect of oral preanesthetic clonidine on producing a bloodless surgical area was examined on patients undergoing tympanoplasty. Materials and Methods: A randomized, triple blind clinical trial was carried out 88 patients candidates for tympanoplasty. The patients were randomly divided into two groups. 44 patients received oral clonidine 300 µgr, 90min before arriving at the operating room, and 44 patients received placebo. The method of anesthesia was similar in both groups. Interaoperating bleeding assessed on a four –point scale from 3 (abundant bleeding) to 0 (no bleeding). Moreover, surgeon’s satisfaction in the field of surgery and the homodynamic changes were assessed and recorded in data collecting sheets. Results: There were no statistically significant differences regarding gender and age between two groups. The homodynamic changes in the group that had received clonidine were fewer in comparison with those in the control group. In addition, the bleeding amount in the group receiving clonidine was 54.6 times less than in the control group, and the surgeon,s satisfaction in the clonidine group was 54.6 times more than that in the control group. The statistical analysis using independent sample t test showed significant difference between these two groups. Conclusion: Oral clonidine as a premeditation reduces bleeding in tympanopalsty and improves surgeon’s satisfaction

The association between the number of office visits and the control of cardiovascular risk factors in Iranian patients with type2 diabetes

<div><p>Introduction</p><p>Patients with diabetes type2 should receive regular medical care. We aimed at investigating the association between the number of office visits and improvement of their cardiovascular-risk factors.</p><p>Methods</p><p>Four hundred and ninety patients with type 2 diabetes mellitus who were followed in a tertiary center were enrolled in this longitudinal study. The minimum follow up period was 3 years. Patient data were extracted from manual or electronic records.</p><p>Results</p><p>Sixty- four percent of cases were females, the mean age was 61 ± 12.45 years, and the mean disease duration was 6.5 ±7.9 years. The mean number of office visits was 2.69 ± 0.91 per year. Comparing the means of each of the cardio-vascular risk factors showed a significant decrease in all cardiovascular risk factors, while there was a significant weight gain over the same period. The association between changes in these parameters and the number of patients’ office visits per year were not statistically significant. In patients with disease duration less than 5 years, each additional office visits by one visit per year was associated with a decrease in serum total cholesterol by 6.94 mg/dl. The mean number of office visits per year in patients older than 60 years old was more than younger patient (p = 0.001).</p><p>Conclusion</p><p>The decrease in the mean values of the investigated parameters was statistically significant between the first year of follow up and the following years. Yet, these changes were not related to the mean number of patients’ office visits per year, which may reflect the poor compliance of patients to treatment regardless of the number of their office visits.</p></div

Prevalence and Factors Related to SelfMedication for COVID-19 Prevention in the Elderly

Objectives: The Coronavirus Disease 2019 (COVID-19) crisis and health outcomes are among the major human social events of the 21st century. The unknown nature of the disease and the fear of contagion have caused emotional reactions, including the self-consumption of drugs in the elderly. Therefore, this study investigated factors affecting the self-consumption of drugs for COVID-19 prevention in the elderly. Methods & Materials: This descriptive and cross-sectional study was performed on 342 elderly in Sabzevar City, Iran, in 2020. The research units were selected as clusters from 16 health centers. The necessary data were collected by an online self-medication questionnaire. Data analysis was performed in SPSS. Results: The Mean±SD age of the study participants was 66.2±5.67 years. The frequency of self-medication to prevent COVID-19 was 190(55.5%); analgesics, vitamins, anti-cold, and antibiotics were the most common drugs used. The major factors associated with self-medication in the COVID-19 pandemic were disease prevention, home quarantine, financial problems, experiencing previous self-medication, and others’ advice. There was a significant relationship between self-medication and education and insurance coverage. No significant relationship was observed between gender, occupation, and marital status, and self-medication. Conclusion: Self-Medication in the COVID-19 epidemic is notable as a crisis threatening the elderly’s health. Controlling and monitoring how the drug is used is among the requirements for protection and health promotion in the elderly