Therapeutic effect of oral nicotinamide on refractory uremic pruritus: a randomized, double-blind study.

To determine the efficacy of oral nicotinamide with placebo to ameliorate uremic pruritus (UP), we conducted a prospective, randomized, double-blind, 4-week study in 50 chronic kidney disease patients with refractory UP. The patients were randomly allocated to nicotinamide tablet 500 mg twice/day or placebo. All anti-pruritic agents were discontinued at least two weeks before the study. All the patients completed the period of the study and their severity of pruritus was evaluated before the start of the study and at the end of each week for four weeks by using a traditional Visual Analogue Scale and a modified questionnaire method (pruritus score). The average pruritus score before administration of oral nicotinamide in the study group and that in the placebo group was 2.96 ± 0.45 and 2.72 ± 0.37, respectively. In the nicotinamide group, the average score of pruritus gradually reduced to 1.29 ± 1.08 and in the placebo group it gradually decreased to 1.52 ± 1.61 at the end of the fourth week. There was no significant difference between the reductions of pruritus in both groups, but the interaction effect using a linear mixed model was significant between drug and time (P <0.026). We conclude that increasing the time of application of nicotinamide sodium to more than four weeks may be more effective than placebo in reducing itching in uremic patients.

Incidence, nature, and pattern of injuries to referees in a premier football (soccer) league: a prospective study.

BACKGROUND: Despite the crucial role of referees in a soccer match, few researchers have targeted the injury profile of referees in their studies. Understanding the incidence, nature, and pattern of injuries could provide important information for educational and preventative efforts at the international level. HYPOTHESIS: The incidence rate and patterns of acute injuries to official referees of the Iranian Premier Football League during the 2009-2010 season are similar to those reported among referees in short-term international competitions such as FIFA World Cup. STUDY DESIGN: Prospective cohort study. METHODS: Demographic data for 74 referees, including 30 main referees and 44 assistant referees, were collected at the beginning of the season. To record injuries and refereeing time, weekly contact was made by a physician. RESULTS: In total, 102 injuries were reported by referees during the football season. The incidence rates of injuries among referees during training and matches were 4.6 and 19.6 injuries per 1000 hours, respectively. Muscular and tendon injuries were found to be the most common type of injury, and the most common site of injury was the lower leg followed by the hip and groin. CONCLUSION: The results of this study are consistent with similar prospective studies evaluating injuries to referees over the course of a short-term tournament. CLINICAL RELEVANCE: These findings provide a base for suggesting possible preventive recommendations in future studies.

Family history of the cancer on the survival of the patients with gastrointestinal cancer in northern Iran, using frailty models.

BACKGROUND: Gastrointestinal (GI) tract cancer is one of the common causes of the mortality due to cancer in most developing countries such as Iran. The digestive tract is the major organ involved in the cancer. The northern part of the country, surrounded the Caspian Sea coast, is well known and the region with highest regional incidence of the GI tract cancer. In this paper our aim is to study the most common risk factors affecting the survival of the patients suffering from GI tract cancer using parametric models with frailty. METHODS: This research was a prospective study. Information of 484 cases with GI cancer was collected from Babol Cancer Registration Center during 1990-1991. The risk factors we studied are age, sex, family history of cancer, marital status, smoking status, occupation, race, medication status, education, residence (urban, rural), type of cancer, migration status (indigenous, non-native). The studied cases were followed up until 2006 for 15 years. Hazard ratio was used to interpret the death risk. The effect of the factors in the study on the patients survival are studied under a family of parametric models including Weibull, Exponential, Log-normal, and the Log-logistic model. The models are fitted using with and without frailty. The Akaike information criterion (AIC) was considered to compare between competing models. RESULTS: Out of 484 patients in the study, 321 (66.3%) were males and 163 (33.7%) were females. The average age of the patient at the time of the diagnosis was 59 yr and 55 yr for the males and females respectively. Furthermore, 359 (74.2%) patients suffered from esophageal, 110 (22.7%) patients recognized with gastric, and 15 (3.1%) patients with colon cancer. Survival rates after 1, 3, and 5 years of the diagnosis were 24%, 16%, and 15%, respectively. We found that the family history of the cancer is a significant factor on the death risk under all statistical models in the study. The comparison of AIC using the Cox and parametric models showed that the overall fitting was improved under parametric models (with and without frailty). Among parametric models, we found better performance for the log-logistic model with gamma frailty than the others. Using this model, gender and the family history of the cancer were found as significant predictors. CONCLUSIONS: Results suggested that the early preventative care for patients with family history of the cancer may decrease the risk of the death in the patients with GI cancer. The gender appeared to be an important factor as well so that men experiencing lower risk of death than the women in the study. Since the proportionality assumption of the Cox model was not held (p = 0.0014), the Cox regression model was not an appropriate choice for analysing our data.