An increase in heart rate variability can be an index for end point of resuscitation in trauma patients / 中华创伤杂志(英文版)

PURPOSE@#The measurement of heart rate variability (HRV) is a non-invasive method to analyze the balance of the autonomic nervous system. The aim of this study was to compare the changes of HRV and base deficit (BD) during the treatment of trauma patients.@*METHODS@#Forty-three trauma patients with a low injury severity scores (ISS < 24) and negative base excess on admission were included in this study. Based on the BD changes, patients were divided into three groups: 'end pointed' group (n = 13), patients' BDs instantly cleared after primary hydration; 'needs further resuscitation' group (n = 21), patients' BDs did not reach the end point and thus required further hydration or packed red blood cells transfusion; and 'hydration minimal change' group (n = 9), patients' BDs lower than 2.5 mmol/L at the onset of admission and thereafter had minimal change (near normal range). The changes in HRV during fluid resuscitation were detected and compared to BD changes in their arterial blood gases. All data were analysed using the SPSS software Version 15.0. Repeated measures ANOVA was used to determine the changes in HRV, heart rate, blood pressure, and BD among groups.@*RESULTS@#A significant reverse correlation was found between the BD ratio and the HRV ratio (r = -0.562; p = 0.01). The HRV of patients with aggravated BDs after fluid resuscitation was decreased. There was an increase in HRV at the time of BD clearance. A decrease in HRV after primary crystalloid hydration bore a significant connection with the need for an ICU (p = 0.021) and transfusion of packed red blood cells (p < 0.001).@*CONCLUSION@#Increase in HRV may be a new non-invasive index for the end point of resuscitation in trauma patients.

Complementary and alternative medicine use in Iranian patients with diabetes mellitus / 中西医结合学报

<p><b>OBJECTIVE</b>There is increasing interest in complementary and alternative medicine generally, and especially by those affected by chronic diseases, such as diabetes mellitus. We aimed to determine the prevalence and pattern of complementary and alternative medicine use among patients suffering from diabetes mellitus in Shiraz, southern Iran. Another objective was to explore associated factors for use of complementary and alternative medicine among patients with diabetes mellitus.</p><p><b>METHODS</b>A 19-item semi-structured questionnaire (open- and close-ended) was administered to 239 patients with diabetes mellitus in this cross-sectional study. It was carried out in two outpatient diabetes clinics affiliated with the Shiraz University of Medical Sciences, Shiraz, Iran.</p><p><b>RESULTS</b>One hundred and eighty patients (75.3%) used at least one type of complementary and alternative medicine in the last year prior to the interview. Patients with diabetes mellitus who were living in a large family (≥5 members), not taking insulin, and believed that complementary and alternative medicine have synergistic effects with conventional medicine, were independently and significantly (P values: 0.02, 0.04, and 0.01, respectively) more likely to use complementary and alternative medicine. Most of the users (97.7%) reported use of herbal preparations, and 89.4% of users did not change their medication, neither in medication schedule nor its dosage.</p><p><b>CONCLUSION</b>The use of complementary and alternative medicine, especially herbal remedies, is popular among diabetes patients in Shiraz, Iran. This use is associated with patients' family size, type of conventional medications and their view about concomitant use of complementary and conventional medicine.</p>

Prevalence and incidence of multiple sclerosis in pars province, Southern Iran

Background:: Multiple sclerosis [MS] is a chronic inflammatory and demyelinating disease of the central nervous system, which is accompanied by significant disabilities. Although there are some published data regarding the epidemiological features of MS in other parts of Iran, scarce data are available about the prevalence and demographic characteristics of MS in Pars province. The current study aimed to address the prevalence and incidence rate of MS as well as the temporal trend of the disease in Pars province, southern Iran

Methods: This historical retrospective cohort study was carried out in Pars Multiple Sclerosis Society affiliated with Shiraz University of Medical Sciences. All the consecutive patients who fulfilled 2010 McDonald criteria for definite MS were included in the study. The patients' gender, age at time of diagnosis, education, and clinical course were recorded. The prevalence and incidence rates were also calculated

Results: This study was conducted on 3,354 patients. Among the patients, 2,689 [80.2%] were female and 665 [19.8%] were male. The female/male ratio was 4.04. The point prevalence rate of the disease was 72.1/100,000 persons in October 2013. This index was 116.5 per 100,000 persons in females [95% CI: 113.4-119.6] and 28.3 per 100,000 persons in males [95% CI: 26.8-29.9]. The mean annual incidence rate was 5.2/100,000 from 2002 until 2012

Conclusion: Considering Kurtzke classification, Pars is a high-risk area for MS and women are affected more compared with men. Moreover, the incidence rate sharply increased in the last decade

Breast Cancer Risk Factors in a Defined Population: Weighted Logistic Regression Approach for Rare Events / 한국유방암학회지

PURPOSE: This study aimed to determine out risk factors for female breast cancer in a low socioeconomic population in Iran. METHODS: Between 2007 and 2009, a total of 25,592 women who were ensured by the Imam Khomeini Relief Foundation participated in this screening program. The characteristics of patients diagnosed with breast cancer (n=111) were compared with those of control cases (n=25,481). In this study, we used relogit analysis (rare event logistic regression) with a weighting method using program Zelig. RESULTS: Of 25,592 women, 3.9/1,000 had breast cancer, from which 38 were diagnosed during screening and 73 had already been diagnosed. The mean and standard deviation of age in breast cancer patients and in healthy controls were 49.18+/-8.86 years and 46.65+/-9.40 years, respectively. The findings based on the multivariate model revealed that the past history of ovarian cancer, hormone therapy, and first relatives with breast cancer were associated with increased risk for breast cancer. However, the use of oral contraceptive pills was found to be associated with reduced risk for breast cancer. CONCLUSION: Due to the rarity of the event in the population, relogit with a weighting method was used to investigate the major risk factors for breast cancer. These factors include oral contraceptive pill use, a history of ovarian cancer of the person under study, first relatives with breast cancer and hormone therapy.

Influenza A [H1N1] Pandemic in Iran: report of First Confirmed Cases from June to November 2009

Since the declaration of a swine flu pandemic by the World Health Organization [WHO], the Islamic Republic of Iran has launched a surveillance system to test all suspected cases, both in community and hospital settings. From June 1[st] to November 11[th], 2009, there were 2662 [1307 females and 1355 males] RT-PCR confirmed cases of pandemic influenza A [H1N1] detected in Iran. Of these cases, 75% were 5-40 years-old. During this period, 58 patients [2.18%] died. Of the total number of cases, 33 were pregnant women with no reported mortalities amongst them. The prevalence of death had no significance correlation with sex and age [P=0.720 and 0.194, respectively]. Geographic distribution of the reported cases showed the highest rates in central and eastern provinces of Iran. There were two disease phases until November 2009, including an initial exogenous wave which blended into a second wave of indigenous disease, with a peak of cases after the start of the educational year. A review of the epidemiology of these initial phases of disease in Iran can help for better planning and more efficient action in future phases of the disease. It is of utmost importance to strengthen the surveillance system for this disease and appropriately transfer the resultant knowledge to the medical professionals, stakeholders and the general population, accordingly