سال:1396 | دوره: | شماره: |تعداد مقالات:13

BACKGROUND: There is scarce data on the effects of omega-3 fatty acids and vitamin E co-supplementation on metabolic status in patients with fibrocystic breast disease (FBD). The current study was carried out to determine the effects of omega-3 fatty acids and vitamin E co-supplementation on metabolic status in patients with FBD.METHODS: A randomized clinical trial was conducted on 56 patients with FBD. Participants were randomly divided into two groups to receive either 1000 mg omega-3 fatty acids plus 400 mg vitamin E (n=28) or placebo (n=28) for 12 weeks. Fasting blood samples were taken at the beginning of the study and after 12 weeks of intervention to determine inflammatory factors, biomarkers of oxidative stress, and metabolic profiles.RESULTS: After 12 weeks of intervention, changes in serum high-sensitivity C-reactive protein (-2171.4 ± 3189.1 vs.+696.9 ± 2774.8 ng/mL, P=0.001) and plasma nitric oxide (+1.8 ± 4.0 vs. -0.1 ± 2.4 mmol/L, P=0.04) in supplemented women were significantly different from those in the placebo group. In addition, compared to the placebo group, subjects who consumed omega-3 fatty acids plus vitamin E supplements had significantly decreased serum insulin concentrations (-3.2 ± 6.5 vs. -0.2 ± 1.7 mIU/mL, P=0.01), the homeostasis model of assessment-estimated insulin resistance (-0.8 ± 1.7 vs. -0.02 ± 0.4, P=0.03), serum triglycerides levels (-11.5 ± 47.3 vs.+10.6 ± 24.3 mg/dL, P=0.03) and VLDL-cholesterol (-2.3 ± 9.5 vs.+2.1 ± 4.9 mg/dL, P=0.03), as well as increased quantitative insulin sensitivity check index (+0.01 ± 0.01 vs.+0.001 ± 0.007, P=0.001) and HDL-cholesterol (+3.4 ± 6.0 vs. -1.3 ± 4.3 mg/dL, P=0.001).CONCLUSION: Overall, omega-3 fatty acids and vitamin E co-supplementation for 12 weeks had beneficial effects on inflammatory markers and metabolic profiles in patients with FBD.

BACKGROUND: Patients with chronic kidney disease (CKD) have specific dietary needs due to recommended dietary restrictions. However, there is no specific index for evaluating the quality of diet in patients with CKD. OBJECTIVE: To define and compare three specific diet quality indices in patients with CKD.METHODS: Two hundred twenty-one subjects with CKD were selected for this cross-sectional study. The patients' Dietary intake was assessed with a validated food frequency questionnaire. Total protein intake per body weight (TP/BW), animal protein intake per body weight (AP/BW) and animal protein to vegetable protein ratio (AP/VP) were defined as diet quality indices. Renal function was measured by blood urea nitrogen (BUN) and serum creatinine (Cr).RESULTS: Patients in the highest tertile of TP/BW and tertile of AP/BW consumed more amounts of nutrients which should be limited in CKD (i.e., sodium, potassium and phosphorus). Subjects in the last tertile of AP/BW had higher BUN and Cr. A marginally significant increased risk of higher stage of CKD across the tertiles of AP/BW was observed after adjusting for potential confounders (OR=2.20, 95% CI: 1.06, 4.56; P=0.08).CONCLUSION: The results showed that AP/BW is a good diet quality index and is marginally associated with being in higher stages of CKD.

INTRODUCTION: Armored removable connector tubes are not always available in operating rooms for routine Altemir submental intubation (SMI) technique. The present study addresses a fiber-optic glidos copy assisted 2-tubes modification of Green & Moore sequence for submandibular intubation.METHODS: The sample was composed of 11 patients (8 males and 3 females) with panfacial fractures where neither the oral and nasal intubation techniques nor tracheostomy were feasible. The inter-operative procedure duration was recorded and a comparison was made between the present results with those obtained in similar studies. Moreover, postoperative complications were assessed over a duration of 6 months.RESULTS: The average duration of this modified procedure was 8-13 min. (Mean, 10.54 ± 1.75 min). No perioperative or postoperative complications were observed. Based on the findings in this study, it is suggested that this new technique is safe, quick and reliable for submandibular intubation.CONCLUSION: This modification establishes a secure airway for treatment of maxillofacial panfacial fractures, where traditional methods are impossible due to non-detachable connector tubes. No perioperative or postoperative complications were observed. This study suggests that this new technique is safe, quick and reliable for submandibular intubation.

BACKGROUND: Laparoscopic cholecystectomy (LC) -related bile duct injuries remains a challenging issue with major implications for patient's outcome.METHODS: Between January 2008 and December 2012, we retrospectively analyzed the management and treatment outcomes of 90 patients with bile duct injury following LC.RESULTS: Forty-seven patients (52.2%) were treated surgically while the remaining 43 patients (47.8%) underwent non-surgical intervention. Injuries of Strasberg Type A and C were significantly more frequent in the non-surgical intervention group (P=0.016, P=0.044) whereas Type E2 was more frequent in the definitive surgery group (P<0.001). The success rate of non-surgical intervention decreased as the waiting time increased whereas the success of definitive surgery was not time-dependent (P=0.048). Initial jaundice (direct biluribin>1.3 gr/dL) significantly reduced the success rate of non-surgical interventions (P=0.017). Presence of intraabdominal abscess significantly increased the complication rate after both definitive surgery and non-surgical interventions (P=0.04, P=0.023). Treatment success rates were similar in both surgery and non-surgical intervention groups according to the distribution of Strasberg injury types.CONCLUSION: A multimodality approach is recommended in planning for patient-based treatment. Delayed referral reduces the success of nonsurgical interventions while it does not seem to significantly affect the success of surgical interventions when intraabdominal sepsis is under control.

BACKGROUND: Spinal cord injury (SCI) is one of the most disabling consequences of trauma with unparalleled economic, social, and personal burden. Any attempt aimed at improving quality of care should be based on comprehensive and reliable data. This pilot investigation studied the feasibility of implementing the National Spinal Cord and Column Injury Registry of Iran (NSCIR-IR) and scrutinized the quality of the registered data.METHODS: From October 2015 to May 2016, over an 8-month period, 65 eligible trauma patients who were admitted to hospitals in three academic centers in mainland Iran were included in this pilot study. Certified registered nurses and neurosurgeons were in charge of data collection, quality verification, and registration.RESULTS: Sixty-five patients with vertebral column fracture dislocations were registered in the study, of whom 14 (21.5%) patients had evidence of SCI. Mechanisms of injury included mechanical falls in 30 patients (46.2%) and motor vehicle accidents in 29 (44.6%). The case identification rate i.e. clinical and radiographic confirmation of spine and SCI, ranged from 10.0% to 88.9% in different registry centers. The completion rate of all data items was 100%, except for five data elements in patients who could not provide clinical information because of their medical status. Consistency i.e. identification of the same elements by all the registrars, was 100% and accuracy of identification of the same pathology ranged from 66.6% to 100%.CONCLUSIONS: Our pilot study showed both the feasibility and acceptable data quality of the NSCIR-IR. However, effective and successful implementation of NSCIR-IR data use requires some modifications such as presence of a dedicated registrar in each center, verification of data by a neurosurgeon, and continuous assessment of patients' neurological status and complications.

BACKGROUND: Squamous cell carcinoma is the most common histological subtype of head and neck cancers.METHODS: In a retrospective longitudinal study, we assessed the risk of local or metastatic recurrence and death in 140 patients with head and neck squamous cell carcinoma (HNSCC). Multivariate and shared frailty models were used for survival analysis with sex, primary tumor site, grade and stage of the tumor, and treatment modalities as contributing factors. RESULTS: The most frequent site for HNSCC was the oral cavity (30%), followed by the tongue (26.4%). For most primary sites, men were at nearly 2-fold higher risk of local recurrence than women, but there was no difference by sex in the risk of metastatic recurrence. Undifferentiated HNSCC was associated with a higher risk of local recurrence (nearly 4-fold) and metastasis (6–15-fold based on the primary site) than well-differentiated tumors. In early months after surgical resection alone, the risk of local recurrence was higher compared to other treatment modalities. There was a strong dependency between the risk of local and metastatic recurrence. CONCLUSION: In conclusion, men diagnosed with HNSCC, those with higher grade or advanced state tumor, and those treated by surgery alone are at higher risk of unfavorable outcomes than others and may need more frequent follow-up visits.

BACKGROUND: Proper reporting of medical errors helps healthcare providers learn from adverse incidents and improve patient safety. A well-designed and functioning confidential reporting system is an essential component to this process. There are many error reporting methods; however, web-based systems are often preferred because they can provide comprehensive and more easily analyzed information. This study addresses the use of a web-based error reporting system. METHODS: This interventional study involved the application of an in-house designed "voluntary web-based medical error reporting system." The system has been used since July 2014 in Nemazee Hospital, Shiraz University of Medical Sciences. The rate and severity of errors reported during the year prior and a year after system launch were compared. RESULTS: The slope of the error report trend line was steep during the first 12 months (B=105.727, P=0.00). However, it slowed following launch of the web-based reporting system and was no longer statistically significant (B=15.27, P=0.81) by the end of the second year. Most recorded errors were no-harm laboratory types and were due to inattention. Usually, they were reported by nurses and other permanent employees. Most reported errors occurred during morning shifts. DISCUSSION: Using a standardized web-based error reporting system can be beneficial. This study reports on the performance of an in-house designed reporting system, which appeared to properly detect and analyze medical errors. The system also generated follow-up reports in a timely and accurate manner. Detection of near-miss errors could play a significant role in identifying areas of system defects.

PURPOSE: Merger and acquisitions (M& A) widen access to higher education, improve quality of teaching and research, and increase efficiency of higher education institutions. Three big medical universities in Iran merged in 2010. The purpose of this study was to highlight the impact of this acquisition on the performance of Tehran University of Medical Sciences.METHODS: This qualitative study was conducted using semi-structured in-depth interviews with 60 participants from April 2015 to November 2015. Purposeful sampling was used to recruit participants. Data analysis was performed using MAXQDA software (V.10).FINDINGS: The reasons for acquisition of IUMS by TUMS were to enhance the position of TUMS worldwide, and to increase its efficiency. The acquisition improved the organization and management of the newly formed TUMS, enhanced its academic position and market recognition. However, the achieved benefits did not come without shortcomings and unanticipated consequences.CONCLUSION: The merger and acquisition in higher education has some advantages and disadvantages. A well planned and carefully implemented M& A gives cutting edge to the higher education institutes.

Age-related macular degeneration as the major cause of blindness in the elderly population has remained at the epicenter of clinical research in ophthalmology. This retinal disorder is characterized by the photoreceptor and retinal pigment epithelial cells loss, occurring within the macula. The disease represents a spectrum of clinical manifestations. It is a multifactorial disease resulting from a combination of genetic predispositions and environmental risk factors. AMD is classified into two different types, dry and wet. Wet AMD is in close relation with angiogenesis and inflammatory processes.A variety of anti-angiogenesis and anti-inflammatory drugs have been proposed for the treatment of the disease. The purpose of this paper is to briefly review the pharmacological therapies of the wet form of AMD and focus on new drugs that are currently in different stages of research and development.

The aim of this study was to investigate the effect of Syrian refugees on the pharmaceutical sector in Jordan. Based on a standardized methodology developed by the WHO, Level II Facility (2009) structured questionnaires (including: medicine access [availability, affordability and geographical accessibility], quality, and rational use of medicines) were used to investigate the effect of Syrian refugees influx on the pharmaceutical sector in Jordan. Lists of essential medicines (N = 50) were included in the survey forms. The results showed more progress in all indicators for the public sector compared with the previous results in the 2009 survey and in comparison to the private sector. For example, access to medicines improved in the public sector while it decreased (if it did not remain the same) in the private sector. Also, average stock out duration time decreased dramatically in both public and private sectors. As indicated by the median price ratio (MPR), brand prices increased much in the public health facilities while they decreased by 23%-30% in the private sector. In northern areas where most Syrian refugees stay, a significant decrease in availability was noticed, in addition to the dramatic decrease in days of average stock out and adequate inventory record percentage of those medicines. In conclusion, despite the international help received to support health care provision and medications procurement for the refugees, more support is needed immediately.

Cell therapy, a promising method for treatment of incurable diseases, has been moving fast from basic research laboratories to clinical practice in recent years. Defining clear and strict regulations for manufacturing of cell therapy products in clinical applications is the best way to give assurance to the public sector for safe usage, harmonizing research projects, and placing barriers for unqualified products from entering this market. To achieve this goal, the Iranian Council for Stem cell Science and Technologies sponsored a project in 2013 to develop a national cell therapy guideline for research and clinical trials. To prepare the preliminary guideline, a comprehensive literature and document review was performed by an expert team. The draft was subsequently revised and approved in May 2014 by a large group of experts who were practically involved in basic and clinical fields of regenerative medicine. The final guideline covered all aspects of cell manufacturing, including ethical issues, manufacturing process, quality controls, transportation, harvesting, storage, and release of cell-based products. The optimal infrastructure of the cell manufacturing facility as well as the eligibilities of man-power working in the facility were also described. After adoption in the Council, the guideline was sent to the Ministry of Health and Medical Education for confirmation and final approval. In this report, we introduce the main topics and mention some of the important items of this guideline. The complete draft of the guideline is available as a supplement in this issue.

A 14-year-old single urban girl was referred to the emergency department of Shahid Mohammadi Hospital, Bandar Abbas, Hormozgan Province, Iran, with pain in epigastric and periumbilical regions. She had a history of abdominal pain and frequent vomiting that began two months ago...

Dr. Marcel Baltazard (1908–1971), French scientist and former director of Pasteur Institute of Iran, is known in the international arena due to his research on the control of infectious diseases such as plague, rabies, relapsing fever, leprosy, smallpox and tuberculosis. Dr. Baltazard also played a significant role in the launch of vaccination against tuberculosis, cholera and smallpox. Dr. Baltazard’s spent the first 13 years of academic life at Pasteur Institute of Casablanca, Morocco, and then 20 years at Pasteur Institute of Iran and over the last five years at Pasteur Institute of Paris.In this paper, the activities of this important and influential researcher in the field of health and medicine are addressed.