Factors increasing mortality of the elderly following hip fracture surgery: role of body mass index, age, and smoking.

OBJECTIVES: Hip fracture is one of the most common public health problems with a significant financial burden on the patient and on the healthcare system. This study was conducted to assess the 3-month and 1-year mortality rates of patients with operated hip fractures and to determine the influence of predictors of mortality. METHODS: In this prospective cross-sectional study, all admitted patients aged more than 50 years with hip fracture at Chamran Hospital from January 2008 to August 2013 were enrolled. The characteristic data obtained included demographic information, body mass index (BMI), smoking, any previous history of osteoporotic fracture, and comorbidities. In addition, the mechanism of fracture, fracture type, and treatment method were recorded. A follow-up with the patients was conducted at 3 months and 1 year through a telephonic interview to ask about possible mortalities. Statistical analyses were performed using SPSS software version 17.0 for Windows. RESULTS: A total of 1015 patients aged 50 years and older with hip fracture underwent surgery. Only 724 patients (71.3 %) completed the survey and the 1-year follow-up interview. The mean age was 75.7 ± 10.6 years. Overall, the 3-month and 1-year mortality rates were 14.5 and 22.4 %, respectively. Multivariate logistic regression analysis recognized age (OR 1.08; 95 % CI 1.05, 1.11, p < 0.001), BMI (OR 0.88; 95 % CI 0.82, 0.96, p = 0.003), and smoking (OR 1.76; 95 % CI 1.05, 2.96, p = 0.03) as major independent risk factors for mortality. CONCLUSION: It is clear that modifiable factors like quitting the habit of smoking and gaining more energy with better nutrition could reduce the mortality rate if hip fracture occurs in the elderly.

The involvement of the HLA-DQB1 alleles in the risk and the severity of Iranian coeliac disease patients.

Coeliac disease (CD) is a highly prevalent autoimmune disorder that is triggered by the ingestion of wheat gluten and related proteins in genetically susceptible individuals. The CD is associated with human leucocyte antigen (HLA) genes particularly with HLA-DQ alleles encoding HLA-DQ2 and DQ8 proteins. To define risk and severity alleles for CD, a total of 120 definite CD patients and 100 healthy controls were genotyped for HLA-DQB1 gene. HLA-DQB1 genotyping was performed in all patients and controls using PCR-SSP technique, and to evaluate the clinical relevance of testing for HLA-DQB1 and determining absolute risk of disease, prevalence-corrected positive predictive value and prevalence-corrected negative predictive value (PcPPV and PcNPV) were calculated. Our results for a first time show that DQB1*02:00 and DQB1*03:02 alleles and DQB1*02:01/03:02 genotype very significantly associated with increased risk of patients with CD, and DQB1*03:01,4 allele provides protection against CD in Iranian patients. Furthermore, the PcPPV for DQB*02:01 and 03:02 alleles in CD were 0.014 and 0.012, respectively, and the highest absolute risk presented by DQB*0201/0302 genotype (PcPPV = 0.079) and 98% of patients with CD carried DQB1*02:01/x or DQB1*03:02/x genotype. The results also clearly demonstrated that the DQB1*02:01 allele significantly associated with severity of CD, while DQB1*03:02 allele associated with mild form of CD. These results suggest that clinically suspected individuals for CD and first-degree relatives of patients with CD to be screened for HLA-DQB*0201 and DQB*0302 alleles for possible early diagnosis and treatments.

A study of the effect of cardiac rehabilitation on heart failure patients' life quality.

INTRODUCTION: Cardiac rehabilitation is a way of improving the quality life of heart failure patients. AIM: Determining the effect of physical activity on the quality of life of patients with heart failure. METHODS: This study was conducted on 34 patients affected by heart failure with an ejection fraction of less than 40%. The patients followed both psychological and nutritional consultations in the beginning of the program. The patients participated in 24-32 sessions of physical activity three times a week, each time lasting 1-1.5 h. Each session consisted of 20 min of warming up, 20-40 min of aerobic exercises, 5 min of cooling down, and 20 min of relaxation. Physician's visit, exercise test, echocardiography, fat and blood sugar profile tests were conducted for all patients before and after the rehabilitation program. The Life Quality Form SF-36 was filled out for them and the data were analyzed using the SPSS. RESULTS: Our findings showed that there was a statistically significant increase in the mean score of the patients' life quality after rehabilitation. Also, the comparison of the scores of the eight aspects of patients' life quality before and after rehabilitation revealed that life quality improved in the following directions: physical functioning, limitation of physical health, limitation of psychological health, energy, social functioning, and physical pain. All differences were statistically significant yet, the difference regarding the aspects of psychological health and general well-being were not significant. CONCLUSION: Cardiac rehabilitation is effective on improving the life quality of cardiac failure patients.

Chemical composition, cell wall features and degradability of stem, leaf blade and sheath in untreated and alkali-treated rice straw.

Three dominant morphological fractions (i.e. leaf blade (LB), leaf sheath (LS) and stem) were analysed for chemical composition and ruminal degradability in three rice straw varieties. In one variety treated with alkali, cell wall features were also characterized using Fourier Transform Infrared Spectroscopy (FTIR) and Scanning Electron Microscopy. The highest concentrations of cell wall carbohydrates (hemicellulose and cellulose) were observed in LS, whereas the highest concentrations of non-fibre (silica, phenolic compounds and CP) and lignin were recorded for LB. The stem had the lowest silica and hemicellulose contents but intermediate levels of other components. In terms of ruminal degradability, stem ranked higher than LB, which was followed by LS. Hemicellulose was found to be less degradable than either dry matter or cellulose in all the three fractions investigated. FTIR results indicated that the highest levels of hydrogen bonding, esterification and crystallinity within the cell wall components belonged to LS. In the alkaline treatment, these indices decreased to a larger extent for leaf fractions and a greater improvement was achieved in the degradability of LB and LS compared with that of stem. In the 24-h ruminal incubation, the silicified layer of epidermis and the underlying cell walls showed a rigid structure in the control fractions, whereas the treatment with NaOH resulted in crimping of the silicified cuticle layer and the loss of integrity in cell structure. Despite the highest silica and lignin contents observed in LB, LS showed the lowest degradability, which might be due to its high level of hydrogen bonding, crystallinity and esterification within its cell wall components as well as its high hemicellulose content.

Isolation of keratinophilic fungi from soil in Isfahan province, Iran.

OBJECTIVE: To evaluate the epidemiology of keratophilic fungi in Isfahan province, Iran. MATERIAL AND METHODS: The present research has been conducted on soil samples collected from 16 townships of Isfahan province. For isolate geophilic dermatophytes and keratinophilic fungi, the keratin baiting technique has been applied. RESULTS: Of 800 soil samples examined, 588 (73.5%) keratinophilic fungi were isolated. The present studied recognized 727 isolates including 16 species of 11 genus, as follows: Chrysosporium keratinophilum (31.4%), C. pannicola (16.9%), C. tropicum (15.4%), Microsporum gypseum (12.4%), Chrysosporium spp. (9.9%), C. indicum (7%), Sepedonium spp. (3.3%), Malbranchia spp. (1%), Trichophyton terrestre (0.8%), T. ajelloi and Paecilomyces lilacinus (0.4%), Engyodontium album and Acremonium spp. (0.3%), Curvularia spp., Fusarium spp. and Ulocladium spp. (0.1%). In this study, E. album was isolated for the first time in this country (Iran). The frequency these keratinophilic fungi are discussed in relation to different agents such as soil pH. CONCLUSION: This study contributes to the knowledge of keratophilic fungi in Iran.

Prevention of arthrofibrosis by monoclonal antibody against vascular endothelial growth factor: a novel use of bevacizumab in rabbits.

BACKGROUND: Prevention of arthrofibrosis by different drugs and surgical techniques is an essential issue in modern orthopedics. HYPOTHESIS: Intra-articular injection of bevacizumab can reduce arthrofibrosis on the rabbit's stifle joint model. MATERIALS AND METHODS: Arthrofibrosis was induced in the right stifle joint of thirty male New Zealand white rabbits by removing the cortical bone of the medial femoral condyle under general anesthesia. The rabbits were randomly divided into three equal groups. The control group received intra-articular injection of saline; the one-injection group received a single dose of bevacizumab (2.5mg/kg), and the two-injection group received two intra-articular injections; the operation day and 14 days later. Forty-five days after surgery, animals were sacrificed. The severity of fibrosis was assessed based on the range of motion of the joint, a macroscopic adhesion score, and histopathologic variables such as the number of fibroblasts and of inflammatory cells, collagenous matrix deposition, synovial hyperplasia, granulation tissue formation, vascular proliferation, and presence of giant cells. RESULTS: Although no statistically significant differences were found between the range of motion (P=0.222) and the macroscopic evaluation (P=0.067) of the control group and the one-injection group, all microscopic variables regarding the prevention of arthrofibrosis were significantly superior in the one-injection group except granulation tissue (P=0.347). Compared to the one-injection group, the two-injection group had better results not only in terms of macroscopic evaluation (P=0.001 for range of motion and 0.012 for visual adhesion score) but also in most of the histopathologic variables especially the number of fibroblasts (P=0.002), vascularity (P=0.028) and collagenous matrix deposition (P=0.039). CONCLUSION: A single intra-articular injection of bevacizumab was effective for prevention of microscopically detected arthrofibrosis in the rabbit. Compared to single injection, two injections of bevacizumab improved the clinical outcome. LEVEL OF EVIDENCE: Level II.

Compliance of Iranian dentists with safety standards of oral radiology.

OBJECTIVES: Dentists use radiographs in their daily practice. Their knowledge and behaviour towards radiographic examination can affect patients' exposure to radiation. The aim of this study was to survey the knowledge and behaviour of Iranian dentists regarding oral radiology safety standards. METHODS: 1000 questionnaires were given to the participants of the 48th Annual Congress of the Iranian Dental Association, of which 700 were returned. The participants were asked about demographic data, primary knowledge of radiation protection, selection criteria, radiographic equipment and technique, methods of patient and personnel protection and management of radiographic waste. Descriptive analysis of data was performed. RESULTS: 44% of respondents said the initial radiograph they took was of the periapical view of a limited area. 12% preferred the periapical paralleling technique. F-speed film was used by 9% and E-speed film by 62%. Only 2% had digital receptors. Proper exposure time was selected by 26.5%. The use of long and rectangular collimators was 15% and 6%, respectively. 34% occasionally covered their patients with both thyroid shields and lead aprons. 36% used the position and distance rule correctly for their own protection. Proper disposal of the used processing solutions and the lead foils were done by only 1% and 3%, respectively. CONCLUSIONS: It can be concluded that the majority of dentists in the study group did not select the proper method, material and equipment in order to minimize the exposure of their patient to unnecessary radiation in dental radiography.

Effect of rs6983267 polymorphism in the 8q24 region and rs4444903 polymorphism in EGF gene on the risk of sporadic colorectal cancer in Iranian population.

Colorectal cancer (CRC) is among the major causes of cancer-related morbidity, mortality, and human health problem worldwide. Single-nucleotide polymorphisms (SNPs) in different genes are reported to be effective in increased risk of CRC in different ethnic population. We conducted a case-control study in patients diagnosed with sporadic colorectal cancer (n = 115) and healthy controls based on colonoscopy evidences (n = 120).In this replicative study, we aimed to investigate the association of two previously reported polymorphisms, rs6983267 and rs4444903, with sporadic colorectal cancer in a subset of Iranian patients. Genotyping was performed via polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) assay. A significant relation was found between rs6983267 variant in the 8q24 region and colorectal cancer. The distribution of G/G genotypes among sporadic CRC patients was more frequent than that in the control group (P value = 0.001). The frequency of the G allele in the colorectal cancer patient group was also higher than that in the control group (65% vs. 48%; P value = 0.001). Compared with GG genotype, individuals with G/T and T/T genotypes had lower risk to develop sporadic CRC (OR = 0.357, 95% CI = 0.201-0.635). For the rs4444903 SNP, no significant association (P value = 0.149) was found with colorectal cancer risk. In conclusion, our findings suggest that the 8q24 rs6983267 SNP may play a pivotal role in the development of sporadic CRC in Iranian population. Therefore, it may be included as a potential genetic susceptibility marker for sporadic CRC.

Methylation pattern of SFRP1 promoter in stool sample is a potential marker for early detection of colorectal cancer.

BACKGROUND: To setup a non-invasive genetic screening method for colorectal cancer, we evaluated the promoter methylation status of secreted frizzled-related protein1 (sfrp1) in stool samples of colorectal cancer with respect to a series of healthy individuals, using methylation-specific polymerase chain reaction. MATERIALS AND METHODS: In stool samples from 25 patients with colorectal cancer and 25 healthy control subjects, isolated DNA was treated with sodium bisulfite and analyzed by methylation-specific polymerase chain reaction with primers specific for methylated or unmethylated promoter sequences of the SFRP1 gene. RESULT: Methylation of the SFRP1 promoter was present in the stool DNA of patients with colorectal cancer. A sensitivity of 52% and specificity of 92% were achieved in the detection of colorectal neoplasia. The difference in methylation status of the SFRP1 promoter between the patients with colorectal neoplasia and the control group was statistically highly significant (P = 0.006). CONCLUSIONS: The results indicate that this DNA stool test of methylation of the SFRP1 promoter is a sensitive and specific method. It is assumed that the test is potentially useful for the early detection of colorectal cancer.

Diversity and frequency of Nocardia spp. in the soil of Isfahan province, Iran.

OBJECTIVE: To isolate and identify Nocardia spp. from soil in different regions of Isfahan province in the center of Iran. METHODS: This study was conducted in 32 districts (16 cities and 16 villages) in Isfahan province during two years. A total of 800 soil samples from these regions were studied by using kanamycin. The isolated Nocardia species were examined by gram and acid-fast staining and were identified biochemically and morphologically. The frequency and distribution of Nocardia spp. were determined in relation to different factors such as soil pH and temperate climate. RESULTS: From 153 (19.1%) Nocardia isolates identified, Nocardia asteroids (N. asteroids) complex (45.5%) and Nocardia brasiliensis (N. brasiliensis) (24.7%) were the most frequently isolated species, followed by Nocardia otitidiscaviarum (2.2%), Nocardiopsis dassonvillei, Actinomadura actinomadura (each 1.7%) and Nocardia transvalensis (1.1%) and also unknown spp. (23.0%). In this study, most species (54.4%) of Nocardia, especially N. asteroides complex were isolated from soils with pH: 7.01-8, whereas in pH: 8.01-9 more N. brasiliensis was isolated. The most Nocardia spp. was detected from regions with semi-nomadic and temperate climate (41.1%). CONCLUSIONS: N. asteroids complex is more prevalent in Isfahan province and soil can be a potential source of nocardiosis infections. It is to be considering that climate and soil pH are involved in the frequency and diversity of aerobic Actinomycetes.

Prevalence of fungal infection among Iranian patients with chronic sinusitis.

Chronic sinusitis is a major cause of morbidity today. Regional variations in the incidence of this disease have been reported. The aim of this study was to evaluate the incidence of fungal infection as the causative agent of chronic sinusitis among Iranian patients. A cross sectional hospital based study was designed; the patients underwent paranasal sinus washing and maxillary sinus biopsy. All specimens were studied by light microscopy. Fungal culturing was employed to confirm diagnosis. The patients underwent Computed Tomography for sinus evaluation. Of 162 participants, 12 samples from patients showed fungal elements, 2 of them Aspergillus fulvous (1.2%), 9 of them Alternaria species (5.56%) and 1 of them Psilomysis (0.6%). All patients presented radiologic evidence of sinusitis, ranging from mucosal thickening to total opacity. In conclusion, results obtained showed a low prevalence of fungal sinusitis among Iranian patients with chronic sinusitis. Findings also showed that Alternaria is the most causative agent.

Precision and long-term stability of different estradiol immunoassays assessed in a multi-center quality control study.

BACKGROUND: Because of the vast range of physiological relevant estradiol concentrations the requirements to be met by an estradiol assay are high. In the present study the performance of various commercially available estradiol assays was evaluated with regard to imprecision and long-term stability. METHODS: Precision and long-term stability of 7 commercially available estradiol immunoassays were assessed in a multi-centre quality control study based on the repeated measurement of liquid BIOREF estradiol control sera by 18 laboratories during a 14-month study period. RESULTS: The mean estradiol concentrations determined in 594 runs performed for each control level were 71 pg/ml, 349 pg/ml and 676 pg/ml. A high variation was found for the method specific mean values calculated from all results measured with the same method, which ranged between 32 - 90 pg/ml, 187 - 392 pg/ml and 373 - 790 pg/ml, resulting in a similar high inter-laboratory variation with coefficients of variation (CVs) of 25.0%, 16.7% and 17.5%. In contrast, the intra-laboratory variation of estradiol values as well as the variation of values measured with the same method were found to be considerably lower with coefficients of variation < 10% for most laboratories and methods; only the low control level was measured with CV values > 10% by the majority of laboratories and methods. For none of the laboratories a tendency was observed in the results from beginning to end of the 14 month study period indicating a high uniformity in assay production and a good long-term stability of the control material used. CONCLUSIONS: The present data demonstrate that also with the currently available estradiol immunoassays the comparability of results measured with different methods is limited. With most assays very low estradiol concentrations, as observed in postmenopausal women, can be determined only with a precision which is not adequate for clinical assessment.

Efficacy of Olyset long-lasting bednets to control transmission of cutaneous leishmaniasis in Iran.

A large-scale intervention field trial of the effect of Olyset long-lasting insecticide-treated bednets on transmission of cutaneous leishmaniasis was carried out in 2 cities in the Islamic Republic of Iran from October 2003 to July 2005. We enrolled 8620 individuals in 3000 households in 6 pairs of sectors in each city. Epidemiological and entomological surveys were carried out pre- and post-intervention. In both cities a statistically significant reduction was found in the incidence of new cases in intervention sectors who received bednets compared with control areas. Entomological surveys showed a reduction in numbers of female Phlebotomus sergenti captured indoors in intervention sectors.

Efficacy of Olyset long-lasting bednets to control transmission of cutaneous leishmaniasis in Iran

A large-scale intervention field trial of the effect of Olyset long-lasting insecticide-treated bednets on transmission of cutaneous leishmaniasis was carried out in 2 cities in the Islamic Republic of Iran from October 2003 to July 2005. We enrolled 8620 individuals in 3000 households in 6 pairs of sectors in each city. Epidemiological and entomological surveys were carried out pre- and post-intervention. In both cities a statistically significant reduction was found in the incidence of new cases in intervention sectors who received bednets compared with control areas. Entomological surveys showed a reduction in numbers of female Phlebotomus sergenti captured indoors in intervention sectors

Safety and efficacy of new glyceryl trinitrate suppository formula: first double blind placebo-controlled clinical trial.

PURPOSE: This study was designed to assess the safety and efficacy of 0.2 percent glyceryl trinitrate suppository form in the healing of chronic anal fissure. METHODS: Thirty-four patients with symptomatic chronic anal fissures were assigned to 0.2 percent glyceryl trinitrate suppository (n = 21) or placebo (n = 13) in a double blind design. Patient's symptom scores were registered at first visit. A validated daily chart was given to assess their symptoms on a daily basis. Both groups received psyllium from the beginning of the study. They were assessed at two-week intervals for six weeks. Then, they started a washout period of one month and after that were crossed over for another six weeks. Chi-squared, t-tests, and analysis of variance were used for statistical analysis. RESULTS: Complete healing at six weeks was achieved in 12 of 21 patients (57 percent) in the glyceryl trinitrate group and 5 of 13 patients (38 percent) in the placebo (P < 0.05). The overall healing rates at the end of study were 15 of 21 (71 percent) vs. 11 of 13 (84 percent) in the glyceryl trinitrate and placebo groups, respectively (P > 0.05). CONCLUSIONS: Application of 0.2 percent glyceryl trinitrate suppository form represents a new, promising, and effective treatment for chronic anal fissure.

Drug-related hospital admissions in a generic pharmaceutical system.

1. Generically based pharmaceutical systems exist in a few countries of the world, such as Iran. Most developed countries have free market pharmaceutical systems. Drug-related problems (DRP) have been reported mostly in the Western world but few data are available for generic systems. In this study, we tried to measure the prevalence of drug-related problems leading to hospital admissions in Isfahan, Iran. 2. One thousand consecutive hospital admissions in three major teaching hospitals were studied for a period of 6 months for the presence of DRP as a cause of hospital admissions. Two subcategories of DRP were considered: (i) drug therapy failure; and (ii) adverse drug reactions. Preventability and outcome measures were also assessed. Medications responsible for DRP were classified according to the Anatomic Therapeutic Chemical (ATC) classification of the World Health Organization. 3. Of the 1000 admissions studied, 115 (11.5%) were owing to DRP, 81% as a result of drug therapy failure and 19% as adverse drug reactions. A total of 106 out of the 115 DRP cases (92%) were either preventable or probably preventable, most of which had to do with either prescriber or patient error. An overview of DRP showed that 58.3% resulted in complete recovery, 33.9% in relative recovery and 7.8% in death. Close to 1% of hospital admissions resulted in DRP-related deaths. 4. The overall prevalence of hospital admissions caused by DRP is similar to that in free market pharmaceutical systems. The high preventability rate of these problems should alert clinicians and policy makers to design strategies to curtail this. Also, reasons for differences in subtypes of DRP between the results of this study and those of the literature from free market systems needs to be investigated further.

Home administration of high-dose oral busulfan in patients undergoing hematopoietic stem cell transplantation.

We report our experience with oral busulfan (BU) in 159 consecutive patients to evaluate the safety of home administration. Patients received a myeloablative BU-containing regimen, including oral anticonvulsant and antiemetic prophylaxis, followed by hematopoietic stem cell transplantation. Comprehensive verbal and written education was provided. Pharmacokinetic monitoring was performed and dose adjustments were made to target an area under the plasma concentration-time curve (AUC) of 900-1500 micromol.min/l. Safety was assessed by evaluating therapy-related toxicities, including seizures, venoocclusive disease (VOD) and patient tolerability. The utilization of pharmacokinetic monitoring was reviewed as a secondary end point. Of the 143 patients evaluated for BU-related seizures and VOD, only two (1.4%) experienced a generalized seizure and four patients (3%) were diagnosed with VOD. VOD resolved in three patients and was a contributing cause of death in one patient. Additional BU dosing owing to nausea and/or vomiting occurred in 28 patients (18%) and five patients (3%) were hospitalized. The median measured AUC was 1405 micromol.min/l, 68% of patients required a dose adjustment, and the median total administered BU dose was 13.6 mg/kg. In conclusion, high-dose oral BU can be safely administered on an outpatient basis.

The results of grade IV cystocele repair using mesh.

PURPOSE: To evaluate the results of grade IV cystocele repair by 4-corner bladder and bladder neck suspension technique, using prolene mesh. MATERIAL AND METHODS: Thirty-one women with a median age of 61 years and severe anterior vaginal wall prolapse (grade IV cystocele) were treated by 4-corner bladder and bladder neck suspension technique, using prolene mesh. Of these, 3 had associated uterine prolapse, rectocele, and enterocele, one had rectocele and enterocele, and 18 had rectocele only. In these cases, pelvic floor defects were also repaired simultaneously and in 3, vaginal hysterectomy was done. Twelve patients had a previous failed cystocele repair. In a 32-month follow-up, the patients were evaluated with vaginal examination and upright cystography. Urinary continence during increased intra-abdominal pressure was also assessed, based on subjective symptoms. RESULTS: None of the patients had cystocele recurrence. Urinary continence during increased intra-abdominal pressure was seen in all of the patients. Intraoperative rectal or bladder injury did not occur. Transfusion was not required in any of the cases. Early complications (6 to 8 weeks postoperatively) included irritative urinary symptom in 17 patients, of whom, 8 had documented urinary tract infection that were treated successfully. Late complications were spotting in 3 cases (two were treated with topical estrogen and vaginal mucosal repair was done in one), dyspareunia in 4 sexually active patients, changes in urination pattern in 28 (improved significantly with behavioral therapy), long-term urge incontinence (>8 weeks) in 5 (medical treatment was successful in these patients), and prolonged intermittent catheterization in 1. Pelvic abscess and migration of mesh were not observed. CONCLUSION: According to our findings, using mesh in patients with grade IV cystocele, who had a previous failed surgery or weakness in supportive pelvic tissue, is an appropriate treatment modality.