Association of Pro-inflammatory Dietary Intake and Non-Alcoholic Fatty Liver Disease: Findings from Iranian case-control study.

Background: Non-Alcoholic Fatty Liver Disease (NAFLD) is considered as a major health problem in the world. There is much evidence that diet and dietary factors play an important role in inflammation, and consequently pathogenesis of NAFLD. To investigate the role of diet in the development of inflammation, we can use the Dietary Inflammatory Index (DII), which has been shown to be predictive of levels of inflammatory markers. Methods: 295 incident cases were selected using the convenience-sampling procedure, and 704 controls randomly were selected from the same clinic and among the patients who had no hepatic steatosis and were frequency-matched on age (±5 years) and sex. The DII was computed based on dietary intake from 168-item FFQ. Logistic regression models were used to estimate multivariable ORs. Results: Subjects in tertile 3 had 1.57 (95% CI: 1.13-2.20), 1.78 (95% CI: 1.19-2.67), and 2.02 (95% CI: 1.32-3.09) times higher odds of developing NAFLD, compared to subjects in tertile 1 in models 1 (adjusted for age), 2 (model 1 + BMI, education, smoking, alcohol, diabetes, low density lipoprotein, triglycerides) and 3 (model 2 + aspartate transaminase/alanine transaminase), respectively. When used as a continuous variable, one unit increase in DII was associated with 1.16 (95% CI: 1.05, 1.29), 1.21 (95% CI: 1.107, 1.37) and 1.25 (95% CI: 1.10, 1.43) increase in odds of NAFLD in models one, 2 and 3 respectively. Conclusion: Subjects who consumed a more pro-inflammatory diet were at increased odds of NAFLD.

Adherence to the Dietary Approaches to Stop Hypertension (DASH) and risk of Nonalcoholic Fatty Liver Disease.

This case-control study was conducted to examine the association between adherence to the Dietary Approaches to Stop Hypertension (DASH) diet and risk of Nonalcoholic Fatty Liver Disease (NAFLD) development in 102 patients with newly diagnosed NAFLD and 204 controls. Adherence to DASH-style diet was assessed using a validated food frequency questionnaire, and a DASH diet score based on food and nutrients emphasized or minimized in the DASH diet. Participants in the top quartile of DASH diet score were 30% less likely to have NAFLD (OR: 0.0.70; 95% CI: 0.61, 0.80); however, more adjustment for dyslipidemia and body mass index changed the association to non-significant (OR: 0.92; 95% CI: 0.73, 1.12). In conclusion, we found an inverse relationship between the DASH-style diet and risk of NAFLD. Prospective studies are needed to confirm this association.

Rare retro-patellar multiple osteochondromas in patellar tendon: A case report.

Osteochondromas (OCs) are developmental anomalies that originate from the periosteum and typically form during enchondral ossification near the joints. Retro-patellar OC caused by exostosis forms in various intracapsular, intra-tendon, and joint-adjacent positions within the knee joint. In this case, a 19-year-old male presented with swelling and a mass in his left knee, which raised suspicion of bone tumors. After evaluating x-ray images and conducting histopathological examinations, the diagnosis was confirmed as retro-patellar OC.

Clinical audit of emergency unit before and after establishment of the emergency medicine department.

OBJECTIVE: To assess the deficiencies and potential areas through a medical audit of the emergency departments, in six general hospitals affiliated to Shahid Beheshti University of Medical Sciences at Tehran, Iran, after preparing specific wards-based international standards. METHODS: A checklist was completed for all hospitals which met our eligibility criteria mainly observation and interviews with head nurses and managers of the emergency medicine unit of the hospitals before (2003) and after (2008) the establishment of emergency departments there. Domains studied included staffing, education and continuing professional development (CPD), facility (design), equipment, ancillary services, medical records, manuals and references, research, administration, pre-hospital care, information systems, disaster planning, bench-marking and hospital accreditation. RESULTS: Education and CPD (p = 0.042), design and facility (p = 0.027), equipment (p = 0.028), and disaster (p = 0.026) had significantly improved after the establishment of emergency departments. Nearly all domains showed a positive change though it was non-significant in a few. In terms of observation, better improvement was seen in disaster, security, design, and research. According to the score for each domain compared to what it was in the earlier phase, better improvement was observed in hospital accreditation, information systems, security, disaster planning, and research. CONCLUSION: Security, disaster planning, research, design and facility had improved in hospitals that wave studied, while equipment, records, ancillary services, administration and bench-marking had the lowest improvement even after the establishment of emergency department, and, hence, needed specific attention.

How Trustworthy Are Clinical Examinations and Plain Radiographs for Diagnosis of Scaphoid Fractures?

BACKGROUND: Sometimes patients with a scaphoid fracture, especially in an acute phase of injury, can have normal radiographs and, therefore, initial diagnosis of the scaphoid fracture may be neglected. In this study, we determined the value in of clinical examination and a radiograph in the diagnosis of scaphoid fracture based on the results of a two-week follow-up magnetic resonance imaging (MRI). OBJECTIVES: In this study, sought to assess the value of using both a clinical examination (tenderness of scaphoid tubercle, tenderness of anatomical snuffbox, and compression test) and radiographic imaging in the diagnosis of scaphoid fractures based on the results after a two-week follow-up MRI. PATIENTS AND METHODS: From December 2012 to February 2013, we enrolled 48 patients with suspected scaphoid fractures who had been referred to the emergency department of Baqiyatallah hospital, Tehran, Iran. Patients with negative results for clinical and radiographic examinations were excluded from the study. Cast immobilization was done for patients who had at least one positive finding during a physical examination test and who had normal radiographs. Patients who had a normal physical examination, but abnormal radiographs were referred to the orthopedic clinic after cast or split treatment. These patients also had a follow-up MRI two weeks after wrist trauma; the MRI was used to determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the clinical and radiographic examinations. RESULTS: Scaphoid tubercle tenderness had a sensitivity of 95.23% and a specificity of 74.07% in the diagnosis of scaphoid fracture. This test did not show a statistically difference with MRI results (P = 0.05). The results of the tenderness of the anatomical snuff box (sensitivity = 85.71%, specificity = 29.62%) was statistically different from the MRI results (P = 0.000). The results for the sensitivity (42.85%) and specificity (29.62%) for a compression test were not statistically different from the MRI results (P = 0.05). All of the radiographic tests that we applied in our project had 100% specificity for the diagnosis of a scaphoid fracture. However, the results were significantly different from the MRI results (P = 0.000). CONCLUSIONS: A clinical examination combined with a plain radiograph should be considered to improve the diagnostic precision for patients presenting with scaphoid fractures in an emergency department. In this way, both overtreatment and undertreatment of patients can be avoided.

Evaluation of Teaching Methods in Mass CPCR Training in Different Groups of the Society, an Observational Study.

To determine the efficacy of different methods of cardiopulmonary resuscitation (CPCR) training in 3 different groups of the society. In a prospective and observational study of 2000 individuals in 3 different groups including G1, G2, and G3 4 different protocols of CPCR training were applied and their efficacy was compared between the groups. Also, 12 months after the study course, 460 participants from 3 groups were asked to take apart in a theoretical and practical examination to evaluate the long-term efficacy of the 4 protocols. Among 2000 individuals took a parted in the study, 950 (47.5%) were G1, 600 (30%) were G2, and 450 (22.5%) were G3. G1 in 4 groups were 2.37 and 2.65 times more successful in pretest theoretical and 2.61 and 18.20 times more successful in practical examinations compared with G2 and G3 and gained highest improvement in CPCR skills. Other groups also showed significantly improved CPCR skills. Comparison of different methods of CPCR learning showed that the workshop using interactive lecture as well as human model, educational film, and reference CPCR book has the highest efficacy in all groups. This protocol of CPCR training showed more efficacy in long-term postdelayed evaluation. On the contrary, medical students had better long-term outcomes from the course. Although G1 and G2 obtained better results in learning CPCR skills, in G3 also the theoretical and practical knowledge were improved significantly. This course increased confidence for doing CPCR in all groups of the study. Considering that the most of the bystanders at emergency states are general population, training this group of the society and increasing their confidence about performing CPCR can be so effective and lifesaving at emergency states. (Clinical trial. Gov registration: NCT02120573).

Insights into Avicenna's knowledge of the science of orthopedics.

The art of orthopedics traces its history back to ancient civilizations like those of the Egyptians. The evolution of this branch of medicine is indebted to investigations of many scientists, including Greek, Roman and Persian scholars. The Persian physician Avicenna (980-1037 AD) is one such scientist who investigated different aspects of orthopedics. It is possible to analyze Avicenna's knowledge of orthopedics and his contributions to this branch of medicine by an examination of his epic encyclopedia of medicine, Al-Qanun fi al-Tibb (The Canon of Medicine).

Effects of Triage Education on Knowledge, Practice and Qualitative Index of Emergency Room Staff: A Quasi-Interventional Study.

OBJECTIVE: To determine the effects of triage education based on emergency severity index (ESI) on promoting the knowledge and performance of nurses and qualitative indices of emergency department. METHODS: This study was a quasi-interventional study being performed in Vali Asr Hospital of Fasa University of Medical Sciences during 2012. For this purpose, 50 members of staff including nurses and technicians of emergency medicine in the Emergency department with the inclusion criteria for participation were selected. Data collection instruments included a questionnaire consisting of two parts, (personal characteristics, and knowledge) and the performance assessment checklist was prepared. Content validity was used to determine the validity. The test-retest method and quder-Richardson 20 were applied to determine the reliability of the questionnaire. Interobserver reliability and the correlation between the two observers and imaging modalities were measured to determine the reliability of the performance checklist. The questionnaires and checklist were completed by the participants before, 2 days and 6 weeks after completion of the training. Workshop in two 9-hour sessions was provided which consisted of lectures, questions and answers. RESULTS: The triage scores were 10.7±3.1, 17.8± 1.6 and 16.1±2.3 before, 2 days and 6 weeks after training, respectively. Triage performance score increased from 48.9 ± 9.9 before training to 59.8 ± 7.6, two days after training and to 59.7 ± 8.1 six weeks later (p=0.001). In addition to triage training of the nurses the emergency department qualitative indices were impressively upgraded. Other results showed that there was no significant correlation between individual characteristics and personal knowledge of triage score 6-week after training (r=0.018, p=0.126). However, significant positive correlation was found between nursing work experience, work experience in emergency ward and type of employment and performance scores 6 weeks after training (r=0.258, p=0.032). CONCLUSION: The results of the present study showed that triage education influences the practice and knowledge of nurses and improves the qualitative indices of emergency department. Therefore, it is recommended to include theoretical and practical training of triage for nurses in hospitals.