[Validity and reliability of a checklist for critical appraisal of the original research abstracts by student peer reviewers in medical student research congresses]

Background: Nowadays, it is of utmost importance to critically appraise the research evidences presented in scientific congresses by the audiences. In addition to improvement in scientific and practical skills of critical appraisal, it is important to use a standard framework as the major tool for peer reviewing. We aimed to assess the validity and reliability of one proposed checklist for critical appraisal of the original research abstracts by student peer reviewers.

Methods and Materials: This study was a part of an educational interventional project that was performed in a setting of a workshop where 40 medical students from the medical faculties of the universities in Tehran were recruited. Participants were selected using a non-probability purposive sampling method. Educational curriculum of the workshop included clarifying explanations on the 31-item checklist for peer reviewing of the abstracts as well as several tips about each item using lectures, simulations and group discussions during 10 hours. Medical students used the checklist twice, at beginning and the end of the workshop to score three sample abstracts. Data were collected and analyzed using Spearman correlation [internal consistency] and Cronbach's' alpha methods to calculate the reliability of different items and domains of the introduced peer reviewing checklist by SPSS software. Moreover, Delphi method was applied to confirm the validity of the instrument by experts' opinion.

Results: A group of experts finally confirmed the validity of this checklist by means of Delphi method. Moreover, internal consistency of the main domains of the checklist consisting of "Introduction", "Methods", "Results" and "Conclusion" were statistically significant [P<0.05]. The coefficient of Cronbach's alpha was calculated as excellent [0.926] in "Methods", and acceptable in two other domains of "Results" [0.650] and "Conclusion" [0.739] in pre-test data.

Conclusion: The introduced checklist was shown to be a structured, valid and reliable tool, which could be used in research congresses to improve the quality of peer reviewing.

Vitamin D[3] concentration correlates with the severity of multiple sclerosis

To investigate the possible association between serum 25[OH] vitamin D[3] concentration and the severity of disease in Iranian patients with multiple sclerosis [MS] and to compare this concentration with a matched control group. This was an analytical cross sectional study performed at Jondishapour Neurology Clinic in Tehran, Iran. Patients with relapsing- remitting MS were categorized by disease severity: mild [0

Anxiety and depression in patients with amputated limbs suffering from phantom pain: a comparative study with non phantom chronic pain

Phantom limb pain [PLP] is approximately a common condition after limb amputation, which potentially affects the quality of life. We aimed to evaluate anxiety and depression in patients with amputated limbs suffering from PLP and to compare these psychological dysfunctions with that of patients with non-phantom chronic pain. A total number of 16 male amputees with PLP and 24 male age-matched patients with non-phantom chronic pain were recruited in this study, which was performed at Khatam-Al-Anbia Pain Clinic, Tehran, Iran. A validated Persian version of the hospital anxiety and depression scale [HADS] was used to compare two psychological dysfunctions - anxiety and depression - between the two groups of study. The mean of total anxiety score was significantly lower in patients with PLP [8.00 +/- 3.93 vs. 11.25 +/- 5.23; P = 0.041] and the prevalence of anxiety caseness [HADS-A score >/= 11] was also lower in the PLP group [25% vs. 58.3%; P = 0.112, power = 31.7%]. The mean of total depression score was 7.69 +/- 5.51 and 9.38 +/- 6.11 in patients of PLP and chronic pain groups, respectively [P = 0.340, power = 15%]. Consequently, the prevalence of depression caseness [HADS D score >/= 11] was lower in PLP patients [37.5% vs. 50%; P = 0.710, power = 8%]. Our results indicate that depression and anxiety are not more common in PLP patients, whereas they are more prevalent in subjects with non phantom chronic pain. These lower levels of anxiety and depression in PLP compared with chronic pain is a new finding that needs to be evaluated further, which may lead to new insights into the pathogenesis of phantom pain in further studies

Factors affecting the efficacy of pramipexole in patients with restless legs syndrome

Dopamine agonists, particularly nonergot dopamine agonists such as pramipexole, have become the mainstay of therapy for patients with symptoms of restless legs syndrome [RLS]. This study was designed to evaluate the factors affecting the efficacy of pramipexole in patients with RLS. Fifty-nine eligible RLS patients referred to neurology clinic of Rasoul-e-Akram Hospital [Tehran, Iran] were recruited in this study. All of the patients received an oral dose of 0. 1 8 mg pramipexole. The severity of RLS symptoms were evaluated including sleep disorder, symptomatic days per week and symptomatic hours per day, both at the beginning and at the end of follow-up time. Different baseline and follow-up variables were also recorded and their relationships with the outcomes were assessed. The mean severity values of different symptoms significantly decreased after treatment with pramipexole [P0.00l]. Female gender [P0.05] and duration of treatment [P0.05] were significant factors to achieve >50% reduction in symptomatic days per week and symptomatic hours per day. Moreover, the cutoff point of 3.5 mo for duration of treatment could potentially differentiate >50% reduction in severity of sleep disorder from the ones with <50% reduction with sensitivity and specificity of 56.8% and 78.6%, respectively. Our findings show that female gender and duration of treatment were the factors affecting the effectiveness of pramipexole in RLS patients. If tolerated by the patients, a longer duration of treatment with pramipexole is more effective in RLS

Soft tissue distraction using pentagonal frame for long-standing traumatic flexion deformity of interphalangeal joints / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>Interphalangeal joint contracture is a challenging complication of hand trauma, which reduces the functional capacity of the entire hand. In this study we evaluated the results of soft tissue distraction with no collateral ligament transection or volar plate removal in comparison with traditional operation of contracture release and partial ligament transection and volar plate removal.</p><p><b>METHODS</b>In this prospective study, a total of 40 patients in two equal groups (A and B) were studied. Patients suffering from chronic flexion contracture of abrasive traumatic nature were included. Group A were treated by soft tissue distraction using pentagonal frame technique and in Group B the contracture release was followed by finger splinting.</p><p><b>RESULTS</b>Analyzed data revealed a significant difference between the two groups for range of motion in the proximal interphalangeal joints (P less than 0.05), while it was not meaningful in the distal interphalangeal joints (P larger than 0.05). There was not a significant difference in the degrees of flexion contracture between groups (P larger than 0.05). Regression analysis showed that using pentagonal frame technique significantly increased the mean improvement in range of motion of proximal interphalangeal joints (P less than 0.001), while the higher the preoperative flexion contracture was observed in proximal interphalangeal joints, the lower improvement was achieved in range of motion of proximal interphalangeal joints after intervention (P less than 0.001).</p><p><b>CONCLUSION</b>Soft tissue distraction using pentagonal frame technique with gradual and continuous collateral ligament and surrounding joint tissues distraction combined with skin Z-plasty significantly improves the range of motion in patients with chronic traumatic flexion deformity of proximal and/or distal interphalangeal joints.</p>

Association Between Irritable Bowel Syndrome and Restless Legs Syndrome: A Comparative Study With Control Group

BACKGROUND/AIMS: As a common gastrointestinal (GI) disorder, irritable bowel syndrome (IBS) has been reported to be associated with some psychological and neurological factors. This study aimed to evaluate the prevalence rate of restless legs syndrome (RLS) in a sample of IBS patients and to compare this prevalence with that of matched healthy controls. METHODS: This prospective comparative study was conducted in Tehran, Iran during 2010-2011. Based on the Rome III criteria, a total number of 225 definite IBS patients and 262 age- and sex-matched healthy controls were recruited in the final assessment to compare the prevalence rate of RLS between the 2 groups. RESULTS: RLS was significantly more frequent in IBS group (25.3% vs 6.5%, P < 0.001) which led to an odds ratio (OR) of 4.89 (95% CI, 2.75-8.70). IBS patients with co-morbid RLS significantly suffered more from stomach pain (96.5% vs 86.3%, OR = 4.36 [95% CI, 1.00-19.12]), nausea (40.4% vs 21.4%, OR = 2.48 [95% CI, 1.30-4.73]) and vomiting (10.5% vs 2.4%, OR = 4.82 [95% CI, 1.31-17.76]). CONCLUSIONS: By enrolling a considerable number of IBS patients and healthy controls, our study showed a significantly higher prevalence of RLS in IBS patients. Surprisingly, a higher prevalence rate of RLS was also accompanied with a more severe discomfort and stomach pain in IBS patients. It seems that screening patients with IBS for RLS may lead to greater identification of RLS and improved treatment for both conditions.

Gender Role in Irritable Bowel Syndrome: A Comparison of Irritable Bowel Syndrome Module (ROME III) Between Male and Female Patients

BACKGROUND/AIMS: Irritable bowel syndrome (IBS) is a widespread chronic health condition which is significantly more prevalent in women. We conducted a gender difference analysis by comparing findings of men and women to determine whether any significant differences exist or not. METHODS: This single-center study was conducted in Tehran, Iran during 2009-2010. IBS was diagnosed on the basis of Rome III criteria. A simple "10 point" objective questionnaire was used. RESULTS: A total number of 144 IBS patients including 44 (30.6%) males and 100 (69.4%) females with the mean age of 37.50 +/- 11.50 years, were assessed. The only differently observed symptom was nausea which was significantly more prevalent in females (49% vs 18.2%, P < 0.001). The commonest subtype of IBS in male patients was diarrhea predominant IBS (38.6%); while, constipation predominant IBS was the most frequent type among females (38%). Moreover, the frequency of loose, mushy or watery stools within the last 3 months was significantly higher among males (2.11 +/- 1.67 vs 1.37 +/- 1.50, P = 0.009). CONCLUSIONS: We report that gender is important in IBS. Although qualitative comparison of different subtypes of IBS between male and female failed to meet the statistically significant level, the answers to the corresponding questions of ROME III IBS module suggest the higher prevalence of bowel movements and looser stool in males. Moreover, nausea was reported more often by females.

New predictors for advanced retinopathy of prematurity among neonates in Tehran/Iran

Since a new epidemic [third wave] of retinopathy of prematurity [ROP] sensed throughout the world in recent years, we aimed to assess newer risk factors for advanced ROP which needs treatment in Iranian neonates as a new target output of various neonatal care for this serious disease of newborn infants especially those born prematurely. In an analytic cross-sectional study all neonates <1500 g birth weight and/or <32 weeks gestational age admitted to our NICU as a tertiary level intensive care unit in Milad Hospital, Tehran, Iran during June 2006-June 2007 were included. All data were extracted from medical records and compared in two groups with or without treatment. Seventy one neonate infants entered our study. Twelve neonates [16.9%] progressed to advanced ROP. Final multivariate analysis model revealed that mean leukocyte counts during first 14 days of life [P=0.04], transfusions number [P=0.01] and hypocapnic episodes during first 14 days of life [P=0.02] were significantly different between the two groups of infants independently, even after simultaneous adjustment. Based on our findings, more amenable risk factors should be approached regarding more careful modulation of such overlooked risk factors which may lessen the burden of prematurity

Evaluation of the possible antioxidative role of bilirubin protecting from free radical related illnesses in neonates

There are disparate data regarding whether bilirubin is protective or toxic during free radical related illness among neonates. Seventy one infants with gestational age [GA] of<32 weeks and/or birth weight [BW] of<1500 g, who survived beyond 4 weeks and completed physical examinations were enrolled in this study. The infants were divided into two groups based on the presence or absence of advanced retinopathy of prematurity [ROP], grade III intraventricular hemorrhage [IVH], grade III necrotizing enterocolitis [NEC], respiratory distress syndrome [RDS], bronchopulmonary dysplasia [BPD], sepsis or severe fungal infection [SFI]. The mean of total serum bilirubin [TSB] of the first 14 days of life were measured and compared between these two groups. A significant lower TSB were found in severe form of ROP [P<0.001], grade III NEC [P=0.008], grade III IVH [P=0.021], SFI [P=0.003] and sepsis [P=0.007] in comparison to mild or disease free status. Moreover, the cut-off point of 5.1 mg/dl for the mean of TSB had the sensitivity of 88.1% and specificity of 84.6% to detect severe grades of ROP. Also the cut-off point of 3.25 mg/dl had 97.2% sensitivity and 100% specificity in order to distinguish SFI. It is concluded that bilirubin may play an antioxidant role in vivo as in vitro; and protect preterm infant against these free radical related disorders. Our findings suggest that not only the upper limits of serum bilirubin, but also the lower limits must be taking into account in order to both preventing from neurotoxic effects and free radical based illnesses, respectively

Serum uric acid level in acute stroke patients

The role of uric acid as a risk factor for vascular disease and acute stroke is controversial and there is little information about it. In this study, we determined serum uric acid levels in patients with acute stroke and assessed its relationship with cerebrovascular risk factors. In this cross sectional study, we assessed patients with acute stroke who were admitted in Firoozgar Hospital from September 2010 to March 2011. Clinical records of patients and their serum uric acid level was investigated. Finally, collected data were analyzed using SPSS software Ver.16. Fifty five patients with acute stroke were evaluated who 25 of these patients [45.5%] were female and 30 of them [54.5%] were male. The mean age of patients was 67 +/- 14 years. Mean serum uric acid levels in the patients studied 5.94 +/- 1.70 mg/dl, and about half of the patients [47.3%] were hyperuricemic. There was a significant negative correlation between age of patients and their serum uric acid level [p=0.04, R =-0.27]. Uric acid level was significantly higher in men than women [p=0.03]. Hyperuricemia was associated with increased amounts of triglycerides and Low-density lipoprotein [LDL] cholesterol [p=0.03, p=0.02]. In patients with acute stroke, there was no significant association between serum uric acid level and diabetes mellitus, hypertension, history of ischemic heart disease, smoking, prescription rTPA, and type of stroke. Due to the high prevalence of hyperuricemia in patients with acute stroke, and its accompanying increase in triglyceride and LDL cholesterol levels, it can be considered as a risk factor for acute stroke

Pulsatility index in aortic coarctation: a possible way to evaluate factors affecting stenting outcome

The pulsatility index [PI] shows continuous blood flow to the end organs and is a significant factor believed to decrease in aortic coarctation. Correction of this factor is of great importance in the treatment ofstenotic lesions of the aorta. However, there are minimal data regarding the trend of changes in the PI after stent implantation. Furthermore, the association between the PI and other echocardiographic indices in patients undergoing stent implantation is unclear. This study was designed to evaluate changes in the PI following stenting and its correlation with other echocardiographic indices. Twenty-three patients with a diagnosis of aortic coarctation consecutively underwent two-dimensional and Doppler echocardiographic imaging modalities twice [before and after stenting]. The patients were divided into two groups based on the percentage of increase in the PI after stenting [ 50%]. The relation between the post-stenting PI and the baseline echocardiographic indices was assessed. The PI was increased from 0.89 [SD = 0.30] to 1.75 [SD = 0.51] after stenting [p value < 0.001]. Baseline diastolic/systolic velocity [D/S velocity] ratio of the abdominal aorta [p value = 0.013], mean velocity [p value = 0.033], and peak gradient of the descending aorta [p value = 0.033] were significantly higher in the patients with >/= 50% increase in the PI after stenting. Our findings showed that elevation in the PI after stenting was a predictable criterion in patients with aortic coarctation: it was predicted by some baseline clinical and echocardiographic indices. Baseline D/S ratio velocity of the abdominal aorta, mean velocity and peak gradient of the descending aorta, and baseline systolic blood pressure were the statistically significant indices to predict >/= 50% increase in the PI in our patients

potential of honey to promote wound healing in periodontology: a pilot randomized clinical trial

Honey has been used as a nutraceutical in many traditional and ancient remedies. Considering well documented benefits of honey to accelerate wound healing, for the first time we aimed to assess intra oral surgical wound healing process with honey. We designed a pilot randomized placebo controlled cross-over clinical trial. Patients who required bilateral Modified Widman Flap [MWF] surgery randomly assigned to receive either 15 cc topical Persian Thymus Vulgaris concentrated honey three times a day or normal saline as placebo with the same amount at the site of the surgery for seven consecutive days. After a 35-day wash-out period the study groups were crossed. The primary efficacy outcome was changes in healing index [Landry index] and the secondary efficacy outcome were changes in gingival and plaque indices [Loe and Sillness, Sillness and Loe indices]. It also includes safety issues consisting of any allergic reaction, delayed healing or wound dehiscence. Ten patients enrolled with the mean age of 36 [ +/- 1.5] ranged between 35-40 yrs. There was a significant improvement in wound healing considering time and treatment effects in both groups, although faster wound healing observed in honey treated patients [P<0.001]. In both groups gingival indices were noticed to be improved by the time during the first phase of the study. Both groups displayed aggravated Plaque formation; nevertheless it was merely statistically significant in the control group [F [3, 27] =12.88, P value < 0.001]. All wounds healed normally and no adverse events recorded. Our study established the safety, efficacy and feasibility of topical honey to promote periodontal surgical wound healing. [IRCT138901192547N2]

Low diagnostic values of ultrasonography and negative appendectomy: still a major problem in university hospitals

Misdiagnosis of the acute appendicitis may increase the rate of negative appendectomies, which involve a huge waste of resources and are sometimes associated with severe complications. Furthermore, false negative result of ultrasonography [US] could lead to perforation of appendix. Since ultrasonography is still the most common imaging technique used in Iranian appendicitis patients, the study focused on evaluate the accuracy of ultrasonograghy in an educational hospital in Iran. We retrospectively reviewed the results of ultrasonograghy in 270 patients who referred to Rasoul-e-Akram hospital in Tehran, Iran, between April 2002 and October 2004 with acute abdominal symptoms suggestive of appendicitis. The results of ultrasonography were compared with the histopathologic reports of biopsies as a gold standard. In data analysis Chi-square, independent t-test and Mann-Whitney U-test were performed. The accuracy of ultrasonograghy in acute appendicitis was 60.4% and the rate of negative appendectomy was 17.4%. Diagnostic values of US were calculated as the sensitivity of 55.4% [95% confidence interval [CI]=48.6-62], specificity of 72.3% [95%CI=57.1-83.9], positive predictable value [PPV] of 90.4% [95%CI=83.9-94.6] and negative predictable value [NPV] 25.6% [95%CI=18.6-34]. Although the results of our study implied that the diagnostic values of ultrasonography were not considerable, but it is still the only imaging techniques available for patients in Iran. In reference to the low NPV, using an alternative technique such as abdominal CT scan is recommended. More attention must be paid on the signs and symptoms related to acute appendicitis in such patients especially in teaching hospitals

Plasma homocysteine level and coronary artery disease in type 2 diabetic patients without nephropathy

Elevated plasma homocysteine [Hcy] is considered to be a novel risk factor for coronary atherosclerosis. Considering the important role of the kidneys in Hcy clearance, the relation, if any, between Hcy and diabetes mellitus [DM] and coronary artery disease [CAD] in diabetic patients is still unclear. The aim of this study was to investigate whether plasma Hcy is a predictor of CAD in patients with type 2 DM without any evidence ofnephropathy. Among type 2 DM patients without nephropathy [cr 50 percent in at least one coronary artery. The extent of CAD was determined by the number of affected coronary arteries. The mean +/- SD Hcy level was 11.35 +/- 3.7 micro mol/l. No significant difference was observed between the CAD and control groups [11.52 +/- 4.01 micro mol/l vs. 11.02 +/- 3.11 micro mol/l, p=0.440]. CAD was related to body mass index [p=0.044], systolic blood pressure [p=0.027], HDL-c level [p=0.06], serum creatinine [p=0.042], and HdA1c level [p=0.001]. A binary logistic regression analysis found systolic blood pressure e[OR: 0.96, p=0.003], creatinine [OR: 24.76, p=0.013], and Hba1c [Or: 2.41, p=0.017] as independent predictors of the presence of CAD. Predictors of the extent of CAD were history of hypertension and current smoking. In the presence of normal renal function, plasma Hcy level cannot predict either presence or extent of CAD in patients with type 2 DM without nephropathy

NPHS2 mutations in children with steroid-resistant nephrotic syndrome

Congenital nephrotic syndrome may be caused by mutations in NPHS1 and NPHS2, which encode nephrin and podocin, respectively. Since the identification of the NPHS2 gene, various investigators have demonstrated that its mutation is an important cause of steroid-resistant nephrotic syndrome. We aimed to evaluate frequency and spectrum of podocin mutations in the Iranian children with steroid-resistant nephritic syndrome. We examined 20 children with steroid-resistant nephritic syndrome referred to Ali Asghar Children's Hospital, in Tehran, Iran. Mutations in the 5th and 7th exons of NPHS2 were assessed. The mutational analysis of NPHS2 was performed by DNA sequencing. The mean age at the onset of proteinuria was 6.4 +/- 3.6 years. None of the children had mutations in the exons 5 or 7. Our study suggests that NPHS2 mutations in exons 5 and 7 are not seen in our children. Therefore, we cannot recommend NPHS2 [exons 5 and 7] mutation for screening in Iranian children with steroid-resistant nephritic syndrome. Other exons of podocin or other podocyte proteins in Iranian children may play a role in pathogenesis of steroid-resistant nephritic syndrome

Management and outcome of steroid-resistant nephrotic syndrome in children

Steroid-resistant nephrotic syndrome [SRNS] is uncommon in children, but often leads to ESRD. We report our experience with SRNS and its treatments and outcomes. We assessed 73 children with SRNS admitted to Ali Asghar Children Hospital in Tehran, Iran. Their clinical presentations, treatment, and disease courses were reviewed. The mean follow-up duration was 6.0 +/- 4.2 years. Moreover, survival times were calculated and the Cox regression method was used to determine variables able to predict survival of the kidneys. Age at the onset of the disease, sex, and hematuria were not predictive of the response to treatment with immunosuppressive drugs in the children with SRNS. The type of resistance [early or late] was associated with the responsiveness to immunosuppressives. Response to any of the immunosuppressive drugs determined the responsiveness to other immunosuppressive drugs. Cyclosporine was more effective than cyclophosphamide as initial therapy. The mean kidney survival time was 11.62 years. Kidney survival rates were 94.6%, 70.0%, 56.0%, and 34.0% at 1, 5, 10, and 15 years, respectively, in patients with initial resistance to steroid, while these were 100%, 100%, 83.0%, and 83.0% in those with late resistance, respectively [P = .03]. We showed that patients with late steroid resistance had better response to immunosuprressive drugs than patients with early resistance. We also showed that resistance to immunosuppressive therapies increased the risk of resistance to other immunosuppressive drugs. Achievement of complete or partial remission with any therapy reduced the risk of ESRD

Delayed versus same-day percutaneous nephrolithotomy in patients with aspirated cloudy urine

We present our experience in continuing percutaneous nephrolithotomy [PCNL] versus delayed PCNL when purulent fluid is aspirated during access to the pyelocaliceal system. This randomized controlled study was carried out on patients who had purulent urine in the pyelocaliceal system at the initial puncturing during PCNL. Patients with recent untreated urinary tract infection, thick or foul pus in aspirated urine, fever, and immunocompromised condition were excluded. Thirty-one patients were randomly divided into 2 groups. In group 1, PCNL was continued, but in group 2, nephrostomy tube was placed and PCNL was performed 10 days later after documented sterile nephrostomy urine. The preoperative and postoperative findings were compared. There were 16 and 15 patients in groups 1 and 2, respectively. All patients had negative urine cultures for microorganisms, preoperatively. The purulent aspirated fluid was infected in 43.8% and 40.0% of the patients in groups 1 and 2, respectively. Postoperative fever was seen in 25.0% and 26.7% of the patients, respectively. No statistical differences were observed between the two groups in terms of bacteriuria, bacteremia, positive calculus cultures, or stone-free rates, and duration of hospitalization between groups 1 and 2, respectively. More analysis with linear regression model showed that postoperative positive blood culture [P < .001], fever [P = .001], and postoperative positive urine culture [P = .02] correlated with duration of hospitalization. In the absence of untreated recent UTI and aspiration of thick or foul pus, continuing PCNL can be safe while purulent urine is encountered

Extensive myocardial infarction in a child with takayasu vasculitis: report of a case and literature review

Takayasu arteritis [TA] is an inflammatory arteritis involving large vessels, predominantly the aorta and its main branches. Angina pectoris or myocardial infarction may occur in 3-5% of patients due to coronary artery ostial narrowing from aortitis or coronary arteritis. We describe the case of an 11-year boy presented with hypertension and severe abdominal pain. After treatment he developed extensive myocardial infarction and died. Takayasu's disease should figure prominently amongst the causes of coronary artery disease in children and coronary arteriography should be undertaken more often during investigation of the arterial lesions of these patients