Predictive factors of death in patients with tuberculosis: a nested case-control study

Tuberculosis is one of the main causes of death worldwide. This study aimed to determine predictive factors for death in patients with tuberculosis to set priorities for public heath interventions to reduce mortality in these patients. This nested case-control study was carried out in Mazandaran province of Islamic Republic of Iran among tuberculosis patients who were treated during 2002-2009. Each deceased patient was individually matched with a control patient according to sex, age, area of involvement and time of follow-up. Potential risk factors for death were evaluated using multivariate conditional logistic regression models. From 2206 patients 376 cases and 376 matched controls were selected. Only positive serology for HIV [OR = 19.1], history of kidney disease [OR = 6.81] and use of immunosuppressant drugs [OR = 3.96] significantly increased the risk of death in tuberculosis patients. These potentially modifiable risk factors could be taken into account in preventive interventions for tuberculosis patients in our country

[Physiologic changes in serum T4, TSH during the neonatal period in suspected babies at hypothyroidism screening in Isfahan, Iran in 2009-2010]

Significant changes in thyroid hormones occur during the first weeks after birth. We assessed the degree of changes in thyroid-stimulating hormone [TSH] and total thyroxin [T4] concentrations in neonates screened seven days after the first high serum TSH levels, just before starting treatment. This prospective study was carried out on newborns referred for their high TSH concentrations on heel blood spot in hypothyroidism screening tests [5- 20 miu/ml], between December 2009 and December 2010. First, serum TSH and T4 were assessed by radioimmunoassay. One week later, in neonates with the first serum TSH >/= 10, serum TSH and T4 were rechecked before starting treatment. Any definite decision to continue treatment was based on the second test results. The results showed a significant decrease in serum TSH level after one week [p<0.01]. Serum T4 level increased significantly in neonates with the first serum TSH >/= 40 [p<0.05], while no significant difference was observed in other infants with the first serum TSH<40. Incidence rate of Congenital Hypothyroidism [CH] reduced from 1/329 to 1/851, during the study. It may be appropriate to repeat serum T4 and TSH concentrations after 2 and 4 weeks in neonates with normal serum T4 but elevated TSH. In the case of persistent TSH elevation, the infant should be treated as this can prevent unnecessary treatments, family stress and iatrogenic hyperthyroidism in these patients

trend of governmental support from post-graduated Iranian students in medical fields to study abroad

To explore the trend and composition of post-graduate Iranian students who received governmental scholarship during the last two decades. Detailed information about the awarded scholarships and also about the number of post graduate students in clinical and basic sciences in domestic universities were collected from the related offices within the ministry of health and medical education and their trends were triangulated. A sharp drop was observed in the number of awarded scholarships, from 263 in 1992 to 46 in 2009. In the beginning, almost all of scholarships fully supported students for a whole academic course; while in recent years most of scholarships supported students for a short fellowship or complementary course [more than 80%]. Students studied in a wide range of colleges within 30 countries; more than 50% in Europe. Although one third of students studied in UK in the first years, only 4% of students selected this country in recent years. conversely, the number of scholarships to Germany and sweden have increased more than 10 and 3 times during this period. In parallel, the capacity of domestic universities for training of post-graduate students has been expanded dramatically. Although expanding post-graduate education has been one of the main strategic objectives of the ministry of health and medical education in last two decades, it was obtained using different approaches. By time, more attention was to expanding the capacities of Iranian universities, and choosing less but more targeted students to continue their studies abroad

Coronary artery disease risk factors in an urban and peri-urban setting, Kerman, Southeastern Iran [KERCADR study]: methodology and preliminary report

This article was to present the sampling and measurements methods and the main preliminary findings of the KERCADR cohort study [first round] in an urban and peri-urban setting, Kerman, southeastern Iran2009-11. 5900 [3238 female] people aged between 15 to 75 years were recruited in the household survey by non-proportional to size one-stage cluster sampling. Trained internal specialists, general practitioners, clinical psychologists and dentists have assessed the study subjects by person-assisted questionnaires regarding different NCD risk factors including cigarette and opium smoking, physical activity, nutrition habits, anxiety, depression, obesity, hypertension and oral health. Blood samples were also collected for determining FBS, HbA1c, cholesterol and triglyceride. Weighted standardized prevalence estimates were calculated by STATA 10 survey analysis package. The participation rate was more than 95% in all subgroups. Cigarette smoking [18.4% vs. 1.2%], opium use [17.8% vs. 3.0%] and triglyceridemia [16.1% vs. 12.0%] were significantly higher among men than women. In contrast, women were presented with higher level of sever anxiety [29.1% vs. 16.7%], obesity [16.8% vs. 9.2%], low-physical activity [45.1% vs. 39.2%] and uncontrolled diabetes [60.2% vs. 31.0%]. More than 68% of all subjects have presented with moderate to severe gingival index scores. The first round of the KERCADR cohort with sufficient sample size and response rate provided precise estimates for the main clinical and para-clinical NCD risk factors. These evidences need to be translated into public health interventions and monitored in the next rounds of the cohort

effect of dietary bovine colostrum supplementation on serum malondialdehyde levels and antioxidant activity in alloxan-induced diabetic rats

Due to the range of its constituents, colostrum has been considered as a supplement for various diverse purposes. This study was conducted to examine the effect of supplementary bovine colostrum on serum malondialdehyde [MDA], antioxidant activity [AOA] and glucose in a diabetic rodent model. Sixty male Wistar rats were divided into 10 groups of six rats each for 40 days as follows: non-diabetic; diabetic; diabetic with 10%, 20% or 30% colostrum intake; non-diabetic with 10%, 20% or 30% colostrum intake; diabetic treated with insulin; and diabetic treated with glibenclamide. Although serum MDA levels showed a significant decrease in response to insulin [2.56 +/- 0.31 umol/L] and 10%, 20% or 30% colostrum intake [0.46 +/- 0.04, 0.29 +/- 0.06, 0.37 +/- 0.09 jumol/L, respectively], the decrease was greater in the diabetic rats [3.92 +/- 0.29 umol/L] [p < 0.01]. Significant changes were seen in the AOA of both insulin [0.78 +/- 0.11 mmol/L] and glibenclamide [0.7 +/- 0.08 mmol/L] treated rats compared to the diabetic rats [0.69 +/- 0.1 mmol/L]; however, AOA showed a significant increase in response to 10% [1.78 +/- 0.11 mmol/L], 20% [1.57 +/- 0.02 mmol/L] and 30% [1.75 +/- 0.02 mmol/L] colostrum [p < 0.001]. All treated groups showed a significant decrease in serum glucose levels compared to the diabetic group [391 +/- 39.79 mg/dL] [p < 0.01]. It seems that colostrum might be a beneficial dietary supplement for reducing serum MDA and glucose levels while increasing serum AOA in type 1 diabetes mellitus

[Prevalence of lower limb amputation in patients with diabetic foot ulcer in Imam Khomeini and Shariati Hospitals, 1979-2001]

Diabetes Mellitus is a common disorder with numerous disabling complications, which can be largely prevented by simple, inexpensive interventions. The prevention of diabetic foot ulceration [DFU] is especially important because besides the morbidity and mortality it entails time and a heavy financial burden. In order to study the prevalence of lower limb amputations, this study was designed in patients admitted with diabetic foot ulcerations. This retrospective descriptive study was carried out at Imam Khomeini and Dr. Shariati University Hospitals in Tehran. Data pertaining to 28 1 patients admitted between 1979 and 2001 for treatment of diabetic foot ulceration was collected and analyzed using SPSS software. Over the 22-year period of the study, 28l patients [61% men and 39% women] were hospitalized for DFU. The overall lower limb amputation rate was 30%. Mean hospital stay was significantly longer in patients who eventually underwent amputation than in those who did not. The rate of lower limb amputation secondary to DFU is higher in Iran than the global average. This necessitates greater attention and better planning with regards to the prevention and treatment of DFU