Effect of atorvastatin on delirium status of patients in the intensive care unit: a randomized controlled trial.

INTRODUCTION: Delirium is one of the most prevalent complications in intensive care unit (ICU) patients, which is related to worse clinical outcomes including a longer ICU stay, longer duration of mechanical ventilation, higher mortality rates and increased risk of cognitive impairment. Observational studies have suggested that statins might have a positive effect on delirium status of hospitalized patients. To date, there has been no trial assessing the effect of atorvastatin on delirium status in critically ill patients. Thus, the aim of the current study was to determine the efficacy of atorvastatin on delirium status of patients in the ICU. METHODS: In this randomized, double-blind and controlled trial, a total of 90 patients in the general ICU who had delirium for at least 2 days were randomly divided into atorvastatin (40 mg/day) (n = 40) and control (n = 50) groups. Delirium status of the patients was determined twice a day at 10:00 a.m. and 18:00 p.m. using the Richmond Agitation-Sedation Scale (RASS). RESULTS: Administration 40 mg/day of atorvastatin significantly reduced the mean RASS score and increased delirium-free days at both morning and afternoon time points compared to the control group (p < 0.05). CONCLUSIONS: Administration of atorvastatin had a significant positive effect on delirium status in patients admitted to the ICU.

Towards developing a model for the evaluation of hospital disaster resilience: a systematic review.

BACKGROUND: Hospitals play a vital role in disaster stricken regions. The resilient hospitals will be able to provide essential services to affected people and it can mitigate the risk of injuries during and after disasters. This study aimed to obtain the indicators required for the evaluation of hospital resilience. METHODS: This systematic review was conducted in 2018. Through this systematic review, international electronic databases were investigated for the research studies published in English. The exclusion and inclusion criteria were determined to extract the hospital resilience indicators. These indicators will be used in order to develop a model to keep the system performance at an acceptable level during disasters. RESULTS: Out of 1794 research studies published until September 2018, 89 articles and guidelines with full text were surveyed. Thirty-two articles and guidelines were then selected and analyzed to collect the indicators related to hospital disaster resilience (HDR). The domains and the indicators were extracted from these selected research studies. The authors collected and categorized them into three domains and twenty seven subdomains. The three domains included constructive, infrastructural, and administrative resilience. The relevant indicators were designed for each subdomain to assess HDR. CONCLUSION: Since diverse indicators affect hospital resilience, other studies should be conducted to propose some models or tools to quantify the hospital resilience in different countries and scopes with an all hazards approach.

Socioeconomic gradient in physical activity: findings from the PERSIAN cohort study.

BACKGROUND: The level of socioeconomic-related inequality in physical activity in Iran is largely unknown. This study investigates socioeconomic-related inequality in poor-physical activity (PPA) among Iranian adults. METHODS: A total of 129,257 adult participants enrolled in the PERSIAN (Prospective Epidemiological Research Studies in IrAN) Cohort were included in this study. Physical activity of adults was measured using metabolic equivalent rates (METs). Physical activity less than 41 METs/hour/day was considered PPA. The Concentration index (C) was used to quantify socioeconomic-related inequality in PPA. Moreover, the C was decomposed to identify the relative contribution of explanatory variables to inequality in PPA. RESULTS: There were significant regional variations in physical activity level among Iranian adults (29.8-76.5%). The positive value of C (0.098, 95% CI = 0.092 to 0.104) suggested that the higher concentration of PPA among higher socioeconomic status (SES) adults in Iran which was consistently observed in all cohort sites. CONCLUSIONS: The higher prevalence of PPA among Iranian adults, especially, women and older adults, warrant further public health attention. Since PPA is concentrated more among the high-SES population in Iran, strategies for the promotion of physical activity should focus more on economically well-off population.

Development and multi-cohort validation of a clinical score for predicting type 2 diabetes mellitus.

BACKGROUND AND AIMS: Many countries lack resources to identify patients at risk of developing Type 2 diabetes mellitus (diabetes). We aimed to develop and validate a diabetes risk score based on easily accessible clinical data. METHODS: Prospective study including 5277 participants (55.0% women, 51.8±10.5 years) free of diabetes at baseline. Comparison with two other published diabetes risk scores (Balkau and Kahn clinical, respectively 5 and 8 variables) and validation on three cohorts (Europe, Iran and Mexico) was performed. RESULTS: After a mean follow-up of 10.9 years, 405 participants (7.7%) developed diabetes. Our score was based on age, gender, waist circumference, diabetes family history, hypertension and physical activity. The area under the curve (AUC) was 0.772 for our score, vs. 0.748 (p<0.001) and 0.774 (p = 0.668) for the other two. Using a 13-point threshold, sensitivity, specificity, positive and negative predictive values (95% CI) of our score were 60.5 (55.5-65.3), 77.1 (75.8-78.2), 18.0 (16.0-20.1) and 95.9 (95.2-96.5) percent, respectively. Our score performed equally well or better than the other two in the Iranian [AUC 0.542 vs. 0.564 (p = 0.476) and 0.513 (p = 0.300)] and Mexican [AUC 0.791 vs. 0.672 (p<0.001) and 0.778 (p = 0.575)] cohorts. In the European cohort, it performed similarly to the Balkau score but worse than the Kahn clinical [AUC 0.788 vs. 0.793 (p = 0.091) and 0.816 (p<0.001)]. Diagnostic capacity of our score was better than the Balkau score and comparable to the Kahn clinical one. CONCLUSION: Our clinically-based score shows encouraging results compared to other scores and can be used in populations with differing diabetes prevalence.

Comparative assessment of the diagnostic value of transbronchial lung biopsy and bronchoalveolar lavage fluid cytology in lung cancer.

BACKGROUND: This study was designed to determine the accuracy of bronchoalveolar lavage fluid cytology (BAL) using histopathologic examination of transbronchial biopsy specimens as the gold standard in diagnosis of lung carcinoma at our center. MATERIALS AND METHODS: A retrospective study was conducted to investigate a total of 388 patients who were suspected of having lung cancer and had undergone fiberoptic bronchoscopy in Shahid Sadoughi hospital from 2006 to 2011. Lung masses were proven to be malignant by histology. RESULTS: Transbronchial lung biopsy (TBLB) identified malignancy in 183 of the 388 cases, including 48 cases (26.2%) with adenocarcinoma, 4(2.1%) with bronchioloalveolar carcinoma, 47(25.6%)with squamous cell carcinoma, 34(18.5%) with well-diffentiated neuroendocrine carcinoma, 35(19.1%) with small cell carcinoma, 14 (7.6%) with non-small cell carcinoma, and 1 (0.54%) with large cell carcinoma. A total of 205 cases were correctly classified as negative. BAL was also performed in 388 patients; 86/103 cases were consistent with the final diagnosis of lung cancer and 188/285 cases were correctly classified as negative. The sensitivity of BAL was 46.9%(CI:41.9%, 51.8%)) and its specificity was 91.6%(CI:88.8%, 94.3%). BAL had a positive predictive value (PPV) of 83.4%(CI:79.7%, 87.1%) and a negative predictive value (NPV) of 65.8%(CI:61%, 70.5%). The overall accuracy of BAL was 70.5% and the exact concordance was 39%. CONCLUSIONS: Our findings suggest that BAL cytology is not sensitive but is a specific test for diagnosis of lung carcinoma. If transbronchial lung biopsy is combined with bronchoalveolar lavage, the positive diagnostic rate will be further elevated.

The effect of vitamin D supplementation on blood pressure in patients with elevated blood pressure and vitamin D deficiency: a randomized, double-blind, placebo-controlled trial.

OBJECTIVES: The present evidence indicates a reverse correlation between vitamin D status and blood pressure (BP). The present study determined the effect of oral vitamin D supplementation on BP in patients with elevated BP and vitamin D deficiency. MATERIALS AND METHODS: In this randomized, double-blind, placebo-controlled trial, 42 outpatients with elevated BP and vitamin D deficiency were assigned randomly to two groups: the vitamin D-supplemented group (VDG), who received one capsule containing 50 000 IU of cholecalciferol weekly, and the placebo group (PG), who received one similar capsule containing oral liquid paraffin as placebo for 8 weeks. The systolic (SBP) and diastolic (DBP) blood pressures, mean arterial blood pressure (MAP), pulse pressure, serum 25-hydroxyvitamin D, parathormone, calcium, phosphorus, magnesium, sodium, and potassium were measured before and after the intervention. RESULTS: In all, 92.7% of the VDG recovered from vitamin D deficiency. At the end of the intervention, the mean SBP and DBP, and the MAP decreased significantly in VDG compared with the PG, whereas at the beginning of the intervention, there was no significant difference between the two groups. The mean changes in SBP (-6.4±5.3 vs. 0.9±3.7 mmHg, P(V)<0.001), DBP (-2.4±3.7 vs. 1.0±2.7 mmHg, P(V)=0.003), and MAP (-3.7±3.6 vs. 0.9±2.5 mmHg, P(V)<0.001) were lower in the VDG than PG. CONCLUSION: The findings of the study showed that the weekly administration of 50 000 IU of oral vitamin D for 8 weeks as an adjunct supplement of antihypertensive drugs in patients with vitamin D deficiency could help prevent vitamin D deficiency and aid control of SBP, DBP, and MAP.

Primary bony Hodgkin's lymphoma.

Hodgkin's lymphoma most commonly presents with progressive painless enlargement of peripheral lymph nodes, especially around the cervical region. At the time of diagnosis osseous involvement is uncommon and even in the late stages only 9-35% of cases have any bony involvement. Rarely Hodgkin's lymphoma presents as an osseous lesion without involvement of lymph nodes, therefore the histological diagnosis of osseous Hodgkin's lymphoma can be problematic. Here, the authors present a rare case of primary osseous Hodgkin's lymphoma and a review of the literature.