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

EFFECTS OF RELAXATION AND CITALOPRAM ON SEVERITY AND FREQUENCY OF THE SYMPTOMS OF IRRITABLE BOWEL SYNDROME WITH DIARRHEA PREDOMINANCE

Objectives: Irritable bowel syndrome (IBS) is the most prevalent functional bowel disorder which is characterized by chronic abdominal pain and altered bowel habit in the absence of any organic disease. This study examined the effects of ``relaxation and citalopram'' in comparison to ``citalopram'' alone on alleviating the symptoms of IBS patients with diarrhea predominance. Methodology: This study was a randomized clinical trial which included 64 IBS patients. The patients were selected according to Rome-III criteria, and were divided into two groups. Bowel Symptoms Severity and Frequency Scale (BSS-FS) was used for evaluation of the patients' symptoms. Data was analyzed using analysis of covariance (ANCOVA). Results: There were significant differences in the severity and frequency of IBS symptoms between two groups after the study period regarding BSS-FS (P 0.05). Conclusion: Relaxation in addition to citalopram in IBS patients with diarrhea predominance can decrease the severity and frequency of symptoms. However, stopping this treatment may lead to recurrence of the symptoms

Effect of relaxation with drug therapy on the psychological symptoms in patients with irritable bowel syndrome-diarrhea dominant (IBS-D)

Background and aim: Irritable bowel syndrome is the most prevalent functional bowel disorder which is characterized by chronic abdominal pain and altered bowel habit in the absence of organic disease. Psychological factors are of the major factors involved in this disease. The aim of this study was comparison of the effect of relaxation with and without drug therapy on the psychological symptoms in patients with irritable bowel syndrome-diarrhea predominant (IBS-D). Methods: This clinical- trial study was performed on 32 IBS-diarrhea dominant patienConclusion: Based on the results of this study Combination of relaxation and drug therapy is effective for reducing the psychological symptoms in irritable bowel syndrome patients.ts. Patients were randomly divided into two groups. One group was treated by using relaxation technique without drug therapy and another group was treated by using relaxation technique combined with drug therapy. Diagnostic characters of Rome-II and III were used for diagnosing the IBS-D patients and SCL-90 test was used for evaluating the psychological symptoms. The study was performed in three steps pretest post test and 4 months after last intervention (follow up group). Data were analyzed using analysis of covariance (ANCOVA) method. Results: The average age of the patients in this study was 37±15.43 years. Our study demonstrated that there was a significant reduction in psychological symptoms scores in post test and follow up groups compared to the pre test group. This reduction was higher in patients receiving relaxation combined to drug therapy compared to the drug therapy group (

The effectiveness of therapy based on the acceptance and commitment in reducing the pain intensity in patients suffering from functional gastrointestinal syndrome

Functional gastrointestinal syndrome is a common disorder characterized by frequent symptoms of the gastrointestinal tract. Suffering from functional gastrointestinal tract syndrome causes several mental disorders in the affected person. To this end, the purpose of this study is to use therapy based on the acceptance and commitment to improve the severity of pain experience in these patients. In this study with semi-experimental approach, 30 women were selected through available sampling method from all women with functional gastrointestinal disorders in Isfahan city, who had referred to Isfahan health center clinic. Then all of the subjects completed the McGill pain questionnaire and then it was performed on the admission and commitment treatment group, at 8-sessions. Analysis of the findings by using covariance test showed that there is a significant difference between test and control groups in the pain experience at a significant level of 0.05 (P &lt;0.05). The chronic course of the disease is associated with significant psychological discomfort, social and occupational dysfunction and extreme behavior in seeking medical assistance. Training or therapy programs based on the improvement of pain experience can reduce the pain of these patients and prevent imposing the extra expenses for treatment.

Clinical librarianship challenges in Iran

This study aims to identify and categorize the challenges of clinical librarianship in Iran. First, based on literature review and opinions of participants, the main challenges were identified and categorized. Then, a questionnaire based on this categorization was distributed among the participants for ranking. According to the results, the four main challenges include educational, cultural, executive and research challenges. These challenges lead to lack of consistency and limited success of clinical librarianship efforts. In order to perform a more generalized identification of these challenges and problems, it is necessary to conduct further studies at national and international levels

Multidisciplinary approach to functional somatic syndromes:study protocol for a population-based prospective cohort study

Introduction Isfahan functional disorders (ISFUN) cohort study aims to describe the interplay of genetic and environmental factors in shaping the characteristics of functional somatic syndromes (FSS). This study is primarily intended to investigate the epidemiology, risk factors, course and prognosis of FSSs in a sample of adult Iranian population. The other aim is to develop a new delimitation of FSSs based on an integrated multidisciplinary approach comprising of phenotypic and multiomics data. Methods and analysis ISFUN is a population-based prospective cohort study designed to follow a population of randomly selected seemingly healthy adults (18-65 years) through annual visits during a 4-year observation period. Structured questionnaires are used for data collection and clinical assessment of the participants. Questionnaire-based diagnosis of FSSs are validated in a medical interview. Human DNA genotyping, microbial amplicon sequencing and urine analysis is under progress for genomics, microbiota and metabolomics profiling, respectively. Enrolment began in September 2017, and study completion is expected in 2022. A total number of 1943 participants were initially recruited. Ethics and dissemination Ethical approval for data collection was granted by the National Research Ethics Committee of the Iranian Ministry of Health and Medical Education and the Research Ethics Committee of Isfahan University of Medical Sciences (IR.MUI.REC.1395.1.149). Following the description of the study procedure, we obtained written informed consent from all study participants. Study findings will be disseminated through peer-reviewed publications and presentations at scientific meetings