Stress as a risk factor for noncompliance with treatment regimens in patients with diabetes and hypertension

BACKGROUND: We have assessed the role of stress on compliance of patients with diabetes mellitus (DM) and hypertension (HTN) with taking prescribed medications and following dietary and exercise regimens. METHODS: A total of 9544 individuals more than 19 years of age were selected from three counties in central Iran. The presence of DM and HTN were asked from participants. We defined treatment adherence (compliance) based on agreement of individual�s self-report behavior with recommendations from a physician. RESULTS: Awareness about DM and HTN was 82.6 and 49.9, respectively. Multivariate analysis showed that odds ratio (OR) of high to low stress level was lower than one for both �usage of medication� and �following exercise regimen� in diabetics even after adjustment for either �age and sex� or �age, sex and education�. In hypertensive patients, OR of high to low stress level was lower than one for �usage of medication� even after adjustment for either �age and sex� or �age, sex and education� and also lower than one for �following exercise regimen� only as crude index. CONCLUSION: Cases with higher stress level had lower compliance for accepting either medication or exercise as a treatment option for their DM or HTN. © 2016, Isfahan University of Medical Sciences(IUMS). All rights reserved

Measuring equity in household's health care payments (Tehran-Iran 2013): Technical points for health policy decision makers

Background: Households' financial protection against health payments and expenditures and equity in utilization of health care services are of the most important tasks of governments. This study aims to measuring equity in household's health care payments according to fairness in financial contribution (FFC) and Kakwani indices in Tehran-Iran, 2013. Methods: This cross-sectional study was conducted in 2014.The study sample size was estimated to be 2200 households. Households were selected using stratified-cluster sampling including typical families who reside in the city of Tehran. The data were analyzed through Excel and Stata v.11software. Recall period for the inpatient care was 1 year and for outpatient1 month. Results: The indicator of FFC for households in health financing was estimated to be 0.68 and the trend of the indicator was ascending by the rise in the ranking of households' financial level. The Kakwani index was estimated to be a negative number (-0.00125) which indicated the descending trend of health financing system. By redistribution of incomes or the exempt of the poorest quintiles from health payments, Kakwani index was estimated to be a positive number (0.090555) which indicated the ascending trend of health financing system. Conclusion: According to this study, the equity indices in health care financing denote injustice and a descending trend in the health care financing system. This finding clearly shows that deliberate policy making in health financing by national health authorities and protecting low-income households against health expenditures are required to improve the equity in health

Effects of pioglitazone on asymmetric dimethylarginine and components of the metabolic syndrome in nondiabetic patients (EPICAMP Study): A double-blind, randomized clinical trial

The present trial aimed to investigate the effects of pioglitazone on the serum level of asymmetric dimethylarginine (ADMA), a marker of endothelial function, and some indices of inflammation and glucose and lipid metabolism in nondiabetic metabolic syndrome patients. 104 eligible participants (57 female; age between 20 and 70) were enrolled in a double-blind placebo-controlled trial and were randomized to receive either pioglitazone (uptitrated to 30 mg/day) or matching placebo for 24 weeks. Participants were clinically examined and a blood sample was obtained at baseline and at the end of the trial. Pioglitazone significantly improved C-reactive protein level irrespective of changes in insulin sensitivity. Compared with the placebo group, alanine and aspartate transaminases were decreased and high-density lipoprotein cholesterol was increased after treatment with pioglitazone. A considerably greater weight gain was also recorded in the intervention group. We failed to observe any significant changes in serum ADMA in either group and between groups with and without adjustment for age, sex, and components of the metabolic syndrome. In a nutshell, pioglitazone seems to have positive effects on lipid profile, liver transaminases, and systemic inflammation. However, its previously demonstrated endothelial function-improving properties do not seem to be mediated by ADMA. © 2013 Pedram Shokouh et al

Antifungal effect of Echinophora platyloba on expression of CDR1 and CDR2 genes in fluconazole-resistant Candida albicans

Background: Several studies examined the effect of the Echinophora platyloba extract in treatment of azole-resistant Candida albicans clinical isolates. Objective: We investigated the effect of E. platyloba extract on expression of CDR1 and CDR2 genes in fluconazole-resistant clinical isolates of C. albicans using real-time PCR. Materials and Methods: The crude extract of E. platyloba was obtained using percolation method. Using serial dilution method, different concentrations of extract were achieved. Two hundred microlitres of fungal suspension (106 CFU/ml) was added to the media and cultured with different concentrations and then incubated at 37 °C for 48 h. The concentration of extract in the first tube, which inhibited the growth of C. albicans, was recorded as the Minimal Inhibitory Concentration (MIC). In order to analyse the expression of CDR1 and CDR2 genes, RNA was extracted from C. albicans isolates before and after treatment with MIC of E. platyloba using glass beads and the denaturing buffer agents in an RNase-free environment and then the cDNA was synthesised and used for real-time PCR assay. Results: Twenty of total of 148 isolates were resistant to fluconazole. The MIC and MFC for the alcoholic extract of E. Platyloba were 64 mg/ml and 128 mg/ml, respectively. Real-time PCR results revealed that the mRNA levels of CDR1 and CDR2 genes significantly declined after incubation with E. Platyloba (both p values < 0.001). Conclusion: E. Platyloba is effective in reducing CDR1 and CDR2 expression which in turn plays an important role in fluconazole resistance in Candida species. © 2016 British Journal of Biomedical Science

Chemical Dispersants: Oil Biodegradation Friend or Foe?

Chemical dispersants were used in response to the Deepwater Horizon oil spill in the Gulf of Mexico, both at the sea surface and the wellhead. Their effect on oil biodegradation is unclear, as studies showed both inhibition and enhancement. This study addresses the effect of Corexit on oil biodegradation by alkane and/or aromatic degrading bacterial culture in artificial seawater at different dispersant to oil ratios (DORs). Our results show that dispersant addition did not enhance oil biodegradation. At DOR 1:20, biodegradation was inhibited, especially when only the alkane degrading culture was present. With a combination of cultures, this inhibition was overcome after 10days. This indicates that initial inhibition of oil biodegradation can be overcome when different bacteria are present in the environment. We conclude that the observed inhibition is related to the enhanced dissolution of aromatic compounds into the water, inhibiting the alkane degrading bacteria