The association of osteoporosis and cardiovascular disease risk score based on the Framingham and ACC/AHA risk prediction models: a cross-sectional analysis of Bushehr Elderly Health Program.

Background: The association between osteoporosis and cardiovascular disease, two major health problems, has been reported in some studies. In this study was aimed to investigate the relationship between osteoporosis and the CVD risk score based on Framingham and American College of Cardiology and the American Heart Association (ACC/AHA) prediction models in the population over 60 years old. Methods: A cross-sectional analysis was conducted on data from 2389 men and women participating in the Bushehr Elderly Health (BEH) program. Osteoporosis was defended as T-score ≤ - 2.5 at any site (total hip, femoral neck and lumbar spine (L1-L4). Based on Framingham and ACC/AHA risk scores, participants were categorized as non-high risk (< 20%) or high-risk (≥ 20%). Logistic regression model, was applied to investigate the relationship between osteoporosis and cardiovascular disease risk scores. All comparisons were stratified by sex. Results: Considering the cut point of ≥ 20% for CVD risk, 36.7% of women and 66.2% of men were categorized as having high risk of CVD in ACC/AHA model. These values in women and men based on the Framingham model were 30% and 35.7%, respectively. In general, there was a negative significant correlation between BMD in the femoral neck, total hip and TBS except for the spine with the CVD risk score in both models. After adjusting for confounding variables, a significant positive association was observed between osteoporosis only at femoral neck with CVD risk score ≥ 20% based on ACC/AHA in both genders. Conclusion: The ACC/AHA model is effective in identifying the CVD risk difference between individuals with and without osteoporosis.

Molecular Characteristics of Staphylococcus aureus Strains Isolated from Nasal Cavity and Wound Infections Among Diabetic Patients.

Staphylococcus aureus is the most common pathogen contributing to diabetic foot infections (DFI). Nasal transmission of S. aureus potentially increases the risk of endogenous infection. The aim of this study was to determine the genetic diversity and antibiotic resistance profile of S. aureus isolates in nasal and wound samples from diabetic patients. A cross-sectional study was conducted from July 2018 to September 2019. S. aureus was isolated from the anterior nares and wounds of diabetic patients. All S. aureus isolates were characterized by detection of resistance and virulence genes (mecA, ermA, ermC, hla, hlb, hlg, sea, lukDE, pvl), staphylococcal cassette chromosome mec (SCCmec)-typing and staphylococcal protein A (spa)-typing. A total of 34 S. aureus were isolated from the wounds of 115 diabetic patients with DFI. Twenty-four S. aureus isolates were collected from the anterior nares of patients, and thirteen patients had concurrent S. aureus in nasal and wound specimens. The prevalence of methicillin-resistant S. aureus (MRSA) in nasal specimens was noticeable (41.7%), and the most common spa-type in nasal and wound specimens was t14870. Nearly half of the patients with concurrent S. aureus in wound and nasal specimens had similar isolates from both sites. Our data suggest that detection and screening of S. aureus colonization in the nasal cavity may prevent subsequent endogenous infections, particularly with MRSA strains.

Diabetic foot care course: a quasi-experimental study on E-learning versus interactive workshop.

BACKGROUND: Nurses, as multidisciplinary Diabetic Foot Care (DFC) team members, need to be trained in DF prevention and management. Regarding the increasing use of e-learning educational courses as the new learning strategy with potential benefits among health care providers, this study attempted to evaluate the educational effects of an e-learning course on DFC compared to that of an interactive workshop in the related knowledge attainment. METHODS: This was a quasi-experimental study compared two non-randomized groups consisting of nurses who attended an e-learning course (intervention group) and a face-to-face interactive workshop (control group) on DFC using a pre- and post-test design. The eligible nurses enrolled by convenience sampling. All five e-modules on DF prevention and care were the same for both groups. A P value of <0.05 was considered as significant. RESULTS: The study findings indicated that both e-learning course and interactive workshop increased DFC knowledge among nurses. There is a significant difference between the learning level (after training) in the intervention and control groups (P < 0.01). CONCLUSIONS: The findings suggest that the e-learning course of DF could be as effective as conventional educational methods. However, considering the time, cost savings and providing an opportunity to learn anytime and anywhere, of the e-learning course, it is recommend for the future and required that more health care providers be trained to use of distance learning.

Non-diabetic renal disease with or without diabetic nephropathy in type 2 diabetes: clinical predictors and outcome.

BACKGROUND: Renal involvement in type 2 diabetes is mostly due to diabetic nephropathy (DN), but a subset of diabetic patients could present with pure non-diabetic renal disease (NDRD) or NDRD superimposed on DN. We conducted a prospective cohort study to identify the underline renal pathology in type 2 diabetic patients with defined clinical criteria for renal biopsy. METHODS: A total of 46 patients (27 female, mean age of 48.9 ± 11.9 years) with type 2 diabetes mellitus (DM) and atypical features of DN with unexpected proteinuria, hematuria, and/or renal impairment were enrolled in this study. RESULTS: Of 46 patients with type 2 diabetes, 16 (34.8%) had DN, 20 (43.5%) had NDRD, and 10 (21.7%) had NDRD superimposed on DN. Membranous nephropathy (34%) was the most common NDRD. Patients with NDRD had a lower frequency of diabetic retinopathy (5%), shorter duration of diabetes, higher range of proteinuria, and better kidney survival. In multiple logistic regression analysis, only lack of diabetic retinopathy was independent predictor of NDRD. Positive and negative predictive value of diabetic retinopathy (DR) for diabetic nephropathy was 94 and 68%, respectively. CONCLUSION: Kidney biopsy is strongly recommended for patients with type 2 diabetes and atypical renal presentation for DN, particularly in the absence of DR. This approach could lead to diagnosis of NDRD with better renal survival.

Education and implementing evidence-based nursing practice for diabetic patients.

BACKGROUND: Foot ulceration is one of the most common complications associated with diabetes that needs to be managed. In Iran, prevalence of diabetes foot ulcer is 3%. According to studies, evidence-based nursing (EBN) is an effective alternative to facilitate clinical decision making in patient care and may lead to quality improvement in nursing practice. The aims of this study are to assess the effects of EBN education on the knowledge, attitude, and practice of nurses who take care of patient with diabetes foot ulcer. MATERIALS AND METHODS: A quasi-experimental study (based on IOWA model as a framework to improve nursing practice) was conducted using a before-and-after design. All of nurses (consisted of 19 baccalaureate nurses) who are working in an endocrinology ward were chosen and taught using EBN approach through different workshops. Before and after educational intervention, the data about nurses' knowledge, attitude, and practice were gathered by questionnaire and then compared. The nurses' performance in patient care was evaluated in 3 months by one checklist. The data were analyzed using descriptive and inferential statistics. RESULTS: There were statistically significant differences in knowledge, attitude, and practice of nurses before and after intervention (P = 0.001). The nurses' performance in caring for patient with diabetes foot ulcer, based on clinical guideline, showed the improvement in clinical practice. CONCLUSION: Education of EBN can improve the nurse's knowledge and attitude to EBN, and be used as a basis on which to influence the professional practice of nursing.

Molecular analysis of the RET proto-oncogene key exons in patients with medullary thyroid carcinoma: a comprehensive study of the Iranian population.

BACKGROUND: Germ-line mutations of RET proto-oncogene are the known cause of hereditary medullary thyroid carcinoma (MTC), which account for approximately 25% of all MTC cases and occur as multiple endocrine neoplasia type 2 syndromes. Here, we present the first comprehensive genetic screening and analysis of MTC among Iranian families. METHODS: A total of 55 patients with MTC (male to female ratio=1:1.6; average age of disease onset = 33 ± 13 years) from 53 independent families participated in this study. All of the patients had undergone total thyroidectomy between 1999 and 2006, and 51 of them were clinically characterized as apparently sporadic cases. Genomic DNA samples were obtained and following highly-specific polymerase chain reaction amplification of the 6 RET key exons (10, 11, 13, 14, 15, and 16) were subjected to direct DNA sequencing without a requirement for a purification step. RESULTS: Sequence analysis revealed that 9 (17.6%) of the apparently sporadic cases (from 8 kindreds) carried an RET germ-line mutation. Of the seven different mutations identified among all of the families studied, five were in the cysteine codons, with Cys634Arg having the highest prevalence (45.5%) among the afflicted families. Mutation carriers have an earlier age of onset (21 ± 6) versus the sporadic cases (37 ± 12). CONCLUSIONS: This is the first comprehensive genetic screening and analysis of MTC among Iranian families. The results further confirm the need and advantages of DNA sequencing for identification of hereditary MTC cases. There does not seem to be a meaningful correlation between single nucleotide polymorphism patterns and the average age of disease onset. Geographical distribution of the sporadic cases, however, shows a significant concentration toward the Northern regions of the country, noticeably the provinces situated directly to the south of the Caspian Sea.

A rare association of hyperparathyroidism and Turner's syndrome--a case report.

We present the clinical, laboratory, radiological and pathological findings in the case and review the literature. Our patient, a 37-year-old woman of short stature, was referred because of musculoskeletal pain. After primary evaluation, she underwent treatment with calcium and vitamin D supplement with the diagnosis of osteomalacia in Turner's syndrome. The rise of serum calcium during medical therapy, which was an unusual finding, attracted the clinician's attention to another underlying disorder. Further evaluation revealed primary hyperparathyroidism due to an adenoma of the parathyroid gland. Even though this is a rare diagnosis, its presence should be considered in any patient with Turner's syndrome presenting with severe osteoporosis and a rise in serum calcium during treatment.