Health-Related Quality of Life in Osteoporosis Patients with and without Fractures in Tehran, Iran

Background@#This study aimed to measure the health-related quality of life (HRQOL) of patients with osteoporosis with and without fractures in Tehran, the capital city of Iran. @*Methods@#We surveyed a sample of 478 patients with osteoporosis aged over 50 years. Participants with fractures included patients referred to hospitals due to osteoporotic fractures which were alive 6 months after the fracture. Participants without fractures were randomly selected from patients with a definite diagnosis of osteoporosis admitted to 3 outpatient clinics in Tehran. Data were collected using the EuroQol 5-dimensional 5-level questionnaire. Statistical differences between patients with and without fracture were tested with Pearson’s χ2 test, Student’s t-test, and the Mann–Whitney U-test. The association between HRQOL and other variables was evaluated using a multiple linear regression model. @*Results@#The patients’ mean age±standard deviation was 67.3±11.9 years, and 74.1% were women. One hundred and seventeen (23%) patients had hip fractures, 56 (11%) had vertebral fractures, 127 (25%) had forearm fractures, and 178 (40%) had no fractures. The median (interquartile range) values of HRQOL scores of those with hip, vertebral, and forearm fractures and those with no history of fracture were 0.53 (0.22), 0.60 (0.28), 0.64 (0.26), and 0.64 (0.27), respectively. The multiple regression model revealed a significant relationship between the HRQOL scores and sex, marital status, employment status, presence of any chronic illness in addition to osteoporosis, and type of fracture. @*Conclusions@#Osteoporosis and its related fractures can reduce the HRQOL.

Optimization of Ventilation Therapy Prioritization Strategies among Patients with COVID-19: Lessons Learned from Real-World Data of nearly 600,000 Hospitalized Patients

ObjectiveTo investigate the benefit of ventilation therapy among various patient groups with COVID-19 admitted to hospitals, based on the real-world data of hospitalized adult patients. MethodsData used in the longitudinal study included 599,340 records of hospitalized patients. All participants were categorized based on demographics and their date of hospitalization. Two models were used in this study: firstly, participants were assessed by their probability of receiving ventilation therapy during hospitalization using mixed-effects logistic regression. Secondly, the clinical benefit of receiving ventilation therapy among various patient groups was quantified while considering the probability of receiving ventilation therapy during hospital admission, as estimated in the first model. FindingsAmong participants, 60,113 (10.0%) received ventilation therapy, 85,158 (14.2%) passed away due to COVID-19, and 514,182 (85.8%) recovered. Among all groups with sufficient data for analysis, patients aged 40-64 years who had chronic respiratory diseases (CRD) and malignancy benefitted the most from ventilation therapy; followed by patients aged 65+ years who had malignancy, cardiovascular diseases, and diabetes; and patients aged 18-39 years who had malignancy. Patients aged 65+ who had CRD and cardiovascular disease gained the least benefit from ventilation therapy. ConclusionThis study promotes a new aspect of treating patients for ventilators: it could be suggested that rather than focusing on the scarcity of ventilators, guidelines focus on decision-making algorithms to also take the usefulness of the intervention into account, whose beneficial effect is dependent on the selection of the right time in the right patient. FundingThis work was supported by the World Health Organization (WHO) Eastern Mediterranean Regional Office (EMRO) (Grant No. 202693061). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Research in contextO_ST_ABSWhat was already knownC_ST_ABSResearch has been ongoing to investigate the main principles for allocating scarce medical resources during pandemics. Medical experts working at the COVID-19 care units interact with patients of different socioeconomic, clinical, paraclinical, and overall health statuses. While physicians should not be faced with situations where they would be obliged to decide which patient to treat due to the risk of human error as well as the double-burden of life-long emotional toll, the pandemic has increased the likelihood of such dilemmas, especially in settings with limited resources. Serious discussions on the ethical considerations of ventilator allocation were also raised during the pandemic. Utility (maximizing benefits) and equity (distributive justice) were two concerns raised in decision making in such dilemma which has also been considered to be "the toughest triage". What new knowledge the manuscript contributesThis longitudinal study provides new insights on optimizing the strategies for ventilation therapy prioritization among patients with COVID-19, based on the real-world data of nearly 600,000 hospitalized patients with COVID-19. So far, there has been focus on how to prioritize patients with COVID-19 for ventilation therapy. Nevertheless, there has not been much evidence on how much patients of different age groups with various underlying conditions actually benefitted from ventilation therapy based on real-world data. The results of this study could have a significant message: should the prioritization guidelines for ventilators allocation take no notice of the real-world data, patients might be deprived of ventilation therapy, who could benefit the most from it. This would pave the way to capture clearer picture in the possible future pandemics.

Priority setting for research in the field of medical ethics in the Islamic Republic of Iran: a Delphi study

Background: Priority-setting is one way to develop research in a particular field.Aims: We aimed to identify and prioritize the most important medical ethics issues for research in the Islamic Republic of Iran.Methods: A 3-round Delphi survey was conducted using a questionnaire covering 77 medical ethics topics in 10 categories and subcategories (extracted from literature review); this was emailed to 40 experts in medical ethics. The participants rat-ed categories and subcategories for importance on a 5-point Likert scale and ranked the topics based on their research pri-orities. The highest Likert score showed the most important issue and the lowest priority score indicated the first priority. Results: After consensus, the panel identified 6 categories as the highest priority and most important areas: profession-alism [priority score = 2.66, standard deviation (SD) 2.63, importance score = 4.45, SD 0.72], education (priority score= 3.12, SD 1.89, importance score = 4.25, SD 0.84), end of life (priority score = 3.79, SD 1.91, importance score = 4.47, SD 0.66), beginning of life (priority = 4.62, SD 1.68, importance score= 4.26, SD 0.61), public health (priority score = 5.20, SD 2.39, importance score = 4.29, SD 0.75), and ethics in research (priority score = 5.33, SD 1.97, importance score = 4.34, SD 0.64). Conclusion: The rankings for priority and importance was not the same. Our results highlight a lack of applicable knowl-edge in the areas of professionalism and end of life. This study could be used as a foundation for developing further inves-tigations by ensuring the most appropriate use of limited resources.

Contexte : La détermination des priorités constitue l’une des façons pour développer la recherche dans un domaine particulier. Objectifs : La présente étude visait à identifier et à hiérarchiser les questions d’éthique médicale les plus importantes pour la recherche en République islamique d’Iran. Méthodes : Une étude à trois séries d’interrogations selon la méthode de Delphes a été menée en utilisant un questionnaire couvrant 77 thèmes liés à l’éthique médicale dans dix catégories et sous-catégories (extraites d’une revue de la littérature). Ce questionnaire a ensuite été envoyé par courrier électronique à 40 experts de l’éthique médicale. Les participants ont évalué l’importance des catégories et sous-catégories selon une échelle de Likert à cinq points et ont classé les thèmes en fonction de leurs priorités de recherche. Le score le plus élevé sur l’échelle de Likert indiquait la question la plus importante, et le score de priorité le moins élevé indiquait la première priorité. Résultats : Après consensus, le panel a identifié six catégories comme prioritaires et les domaines les plus importants : le professionnalisme [score de priorité = 2,66, écart type (E.T.) 2,63, score d’importance = 4,45, E.T. 0,72], l’éducation (score de priorité = 3,12, E.T. 1,89, score d’importance = 4,25, E.T. 0,84), la fin de vie (score de priorité = 3,79, E.T. 1,91, score d’importance = 4,47, E.T. 0,66), le début de vie (score de priorité = 4,62, E.T. 1,68, score d’importance = 4,26, E.T 0,61), la santé publique (score de priorité = 5,20, E.T. 2,39, score d’importance = 4,29, E.T. 0,75) et l’éthique de la recherche (score de priorité = 5,33, E.T. 1,97, score d’importance = 4,34, E.T. 0,64). Conclusion : Les classements par ordre de priorité et d’importance étaient différents. Nos résultats mettent en lumière un manque de connaissances applicables dans les domaines du professionnalisme et de la fin de vie. Cette étude pourrait servir de base pour mettre au point des recherches plus poussées en garantissant l’utilisation la plus appropriée de ressources limitées.

The necessity for integrating traditional, complementary, and alternative medicine into medical education curricula in Iran / 中西医结合学报

BACKGROUND@#The use of traditional and complementary medicine (T&CM) is increasing in both developed and developing countries. The school of Persian medicine (PM) in Iran is a comprehensive medical school that is rich in history and has its own special principles, elements, philosophy, and diagnostic and treatment options. Many complementary therapy modalities are also popular and in demand among patients and physicians. The aim of this paper is to provide logic for the policymakers in Iranian medical education to make changes in medical education curricula, particularly on integrating T&CM.@*METHODS@#We reviewed the global experience in teaching T&CM to medical students, and highlighting the strengths of PM, described why it is necessary to integrate T&CM into general medicine curricula in Iran.@*RESULTS@#PM is a traditional system of medicine that dates back about 7000 years. Although there are few studies about the safety and effectiveness of PM, research into it has recently been accelerated. There is a suitable opportunity for integrating T&CM with conventional medicine. Physicians should be familiar with T&CM to avoid any contraindications, interactions, and unwanted effects.@*CONCLUSION@#Traditional medicine is part of Iran's heritage and, thus, needs special attention. Familiarization of physicians with T&CM can help them choose the best treatment options for their patients. To integrate T&CM into the medical education curricula of Iran, a two-credit course has been proposed for implementation across the country.

Goiter Frequency Is More Strongly Associated with Gastric Adenocarcinoma than Urine Iodine Level

PURPOSE: We designed our study to evaluate the hypothesis that gastric cancer is correlated with iodine deficiency or thyroid dysfunction. MATERIALS AND METHODS: We investigated the total body iodine reserve, thyroid function status and autoimmune disorder in 40 recently diagnosed gastric adenocarcinoma cases versus 80 healthy controls. The participants came from a region with high gastric cancer rate but sufficient iodine supply due to salt iodination. The investigation included urine iodine level, thyroid gland clinical and ultrasonographic examination, and thyroid function tests. RESULTS: Goiter was detected more frequently in the case group (P=0.001); such a finding, however, was not true for lower than normal urine iodine levels. The free T3 mean level was significantly lower in the case group compared to the control group (P=0.005). CONCLUSIONS: The higher prevalence of goiter rather than low levels of urinary iodine in gastric adenocarcinoma cases suggests that goiter, perhaps due to protracted but currently adjusted iodine deficiency, is more likely to be associated with gastric adenocarcinoma compared to the existing iodine deficiency itself.

Cut-off points of waist circumference and body mass index for detecting diabetes, hypercholesterolemia and hypertension according to National Non-Communicable Disease Risk Factors Surveillance in Iran.

INTRODUCTION: The cut-off points of waist circumference and body mass index (BMI) are varied according to different races. There is a dearth of information on these indices especially in Iranian adults. We sought to estimate the cut-off points of waist circumference and BMI for detecting diabetes, hypercholesterolemia, and hypertension. MATERIAL AND METHODS: The data were gathered by the First Iranian Non-Communicable Disease Survey in 2005. In total, 70,981 participants between 25 and 64 years of old were selected via random multistage cluster sampling. Receiver operating characteristic curves were used to show the cut-off points of waist circumference and BMI for detecting diabetes, hypercholesterolemia, and hypertension. The maximum value the sum of sensitivity and specificity indicated the cut-off point. RESULTS: The cut-off points of waist circumference according to maximum sum of sensitivity and specificity for detecting hypertension, diabetes, and hypercholesterolemia in men were 89.7 cm, 89.4 cm and 88.2 cm and in women were 93.9 cm, 96.2 cm and 90 cm respectively. The cut-off points of BMI according to maximum sum of sensitivity and specificity for detecting hypertension, diabetes, and hypercholesterolemia in men were 25.7 kg/m(2), 24.8 kg/m(2) and 24 kg/m(2) and in women were 26.9 kg/m(2), 26.3 kg/m(2) and 26.1 kg/m(2) respectively. CONCLUSIONS: This was a population-based study on a huge sample on the basis of a national survey. The Iranian BMI was different from the values suggested by the WHO. The waist circumference in Iranian women was higher than that in men.

Diagnostic value of frozen section examination in thyroid nodule--surgery at the Shariati Hospital (1997-2000).

INTRODUCTION: There is controversy regarding the use and accuracy of frozen section (FS) in managing thyroid nodules. We compared the diagnostic value of FS with that of permanent histopathology examination and fine needle aspiration (FNA). MATERIALS AND METHODS: Permanent, FS, and FNA sample reports were compared in 214 patients between 1997 and 2000. FS, FNA, and permanent pathology (gold standard) results were compared using McNemar's test. RESULTS: 160 women and 54 men (mean age: 42.3 +/- 5.4 yr) took part in the study; 163 patients (76%) had benign and 51 (24%) malignant lesions; 76% of our thyroid cancer cases were papillary, 13.5% follicular, 6% medullary carcinoma, 4% Hürthle cell carcinoma, and 0.5% anaplastic carcinoma. FNA yielded definite results in 150 patients (sensitivity 72%, specificity 96%, and precision 90%). In 64 patients with equivocal FNA, FS was performed (sensitivity 36%, specificity 73%, and precision 85%). The observed difference between FNA and FS was not statistically significant. DISCUSSION: When FNA results are inconclusive, FS does not provide any further information. In suspected cases of papillary, undifferentiated, or medullary carcinomas, FS can confirm FNA findings and guide surgical therapy.