Synergistic Role of Quantitative Diffusion Magnetic Resonance Imaging and Structural Magnetic Resonance Imaging in Predicting Outcomes After Traumatic Brain Injury.

OBJECTIVE: This study aimed to assess if quantitative diffusion magnetic resonance imaging analysis would improve prognostication of individual patients with severe traumatic brain injury. METHODS: We analyzed images of 30 healthy controls to extract normal fractional anisotropy ranges along 18 white-matter tracts. Then, we analyzed images of 33 patients, compared their fractional anisotropy values with normal ranges extracted from controls, and computed severity of injury to white-matter tracts. We also asked 2 neuroradiologists to rate severity of injury to different brain regions on fluid-attenuated inversion recovery and susceptibility-weighted imaging. Finally, we built 3 models: (1) fed with neuroradiologists' ratings, (2) fed with white-matter injury measures, and (3) fed with both input types. RESULTS: The 3 models respectively predicted survival at 1 year with accuracies of 70%, 73%, and 88%. The accuracy with both input types was significantly better (P < 0.05). CONCLUSIONS: Quantifying severity of injury to white-matter tracts complements qualitative imaging findings and improves outcome prediction in severe traumatic brain injury.

3D MR Neurography.

High-resolution isotropic volumetric three-dimensional (3D) magnetic resonance neurography (MRN) techniques enable multiplanar depiction of peripheral nerves. In addition, 3D MRN provides anatomical and functional tissue characterization of different disease conditions affecting the peripheral nerves. In this review article, we summarize clinically relevant technical considerations of 3D MRN image acquisition and review clinical applications of 3D MRN to assess peripheral nerve diseases, such as entrapments, trauma, inflammatory or infectious neuropathies, and neoplasms.

Current Applications and Future Impact of Machine Learning in Radiology.

Recent advances and future perspectives of machine learning techniques offer promising applications in medical imaging. Machine learning has the potential to improve different steps of the radiology workflow including order scheduling and triage, clinical decision support systems, detection and interpretation of findings, postprocessing and dose estimation, examination quality control, and radiology reporting. In this article, the authors review examples of current applications of machine learning and artificial intelligence techniques in diagnostic radiology. In addition, the future impact and natural extension of these techniques in radiology practice are discussed.

Proposal of a New Adverse Event Classification by the Society of Interventional Radiology Standards of Practice Committee.

PURPOSE: To develop a new adverse event (AE) classification for the interventional radiology (IR) procedures and evaluate its clinical, research, and educational value compared with the existing Society of Interventional Radiology (SIR) classification via an SIR member survey. MATERIALS AND METHODS: A new AE classification was developed by members of the Standards of Practice Committee of the SIR. Subsequently, a survey was created by a group of 18 members from the SIR Standards of Practice Committee and Service Lines. Twelve clinical AE case scenarios were generated that encompassed a broad spectrum of IR procedures and potential AEs. Survey questions were designed to evaluate the following domains: educational and research values, accountability for intraprocedural challenges, consistency of AE reporting, unambiguity, and potential for incorporation into existing quality-assurance framework. For each AE scenario, the survey participants were instructed to answer questions about the proposed and existing SIR classifications. SIR members were invited via online survey links, and 68 members participated among 140 surveyed. Answers on new and existing classifications were evaluated and compared statistically. Overall comparison between the two surveys was performed by generalized linear modeling. RESULTS: The proposed AE classification received superior evaluations in terms of consistency of reporting (P < .05) and potential for incorporation into existing quality-assurance framework (P < .05). Respondents gave a higher overall rating to the educational and research value of the new compared with the existing classification (P < .05). CONCLUSIONS: This study proposed an AE classification system that outperformed the existing SIR classification in the studied domains.

Hospital Evaluations by Social Media: A Comparative Analysis of Facebook Ratings among Performance Outliers.

BACKGROUND: An increasing number of hospitals and health systems utilize social media to allow users to provide feedback and ratings. The correlation between ratings on social media and more conventional hospital quality metrics remains largely unclear, raising concern that healthcare consumers may make decisions on inaccurate or inappropriate information regarding quality. OBJECTIVES: The purpose of this study was to examine the extent to which hospitals utilize social media and whether user-generated metrics on Facebook(®) correlate with a Hospital Compare(®) metric, specifically 30-day all cause unplanned hospital readmission rates. DESIGN AND PARTICIPANTS: This was a retrospective cross-sectional study conducted among all U.S. hospitals performing outside the confidence interval for the national average on 30-day hospital readmission rates as reported on Hospital Compare. Participants were 315 hospitals performing better than U.S. national rate on 30-day readmissions and 364 hospitals performing worse than the U.S. national rate. MAIN MEASURES: The study analyzed ratings of hospitals on Facebook's five-star rating scale, 30-day readmission rates, and hospital characteristics including beds, teaching status, urban vs. rural location, and ownership type. KEY RESULTS: Hospitals performing better than the national average on 30-day readmissions were more likely to use Facebook than lower-performing hospitals (93.3 % vs. 83.5 %; p < 0.01). The average rating for hospitals with low readmission rates (4.15 ± 0.31) was higher than that for hospitals with higher readmission rates (4.05 ± 0.41, p < 0.01). Major teaching hospitals were 14.3 times more likely to be in the high readmission rate group. A one-star increase in Facebook rating was associated with increased odds of the hospital belonging to the low readmission rate group by a factor of 5.0 (CI: 2.6-10.3, p < 0.01), when controlling for hospital characteristics and Facebook-related variables. CONCLUSIONS: Hospitals with lower rates of 30-day hospital-wide unplanned readmissions have higher ratings on Facebook than hospitals with higher readmission rates. These findings add strength to the concept that aggregate measures of patient satisfaction on social media correlate with more traditionally accepted measures of hospital quality.

White matter changes in comatose survivors of anoxic ischemic encephalopathy and traumatic brain injury: comparative diffusion-tensor imaging study.

PURPOSE: To analyze white matter pathologic abnormalities by using diffusion-tensor (DT) imaging in a multicenter prospective cohort of comatose patients following cardiac arrest or traumatic brain injury (TBI). MATERIALS AND METHODS: Institutional review board approval and informed consent from proxies and control subjects were obtained. DT imaging was performed 5-57 days after insult in 49 cardiac arrest and 40 TBI patients. To control for DT imaging-processing variability, patients' values were normalized to those of 111 control subjects. Automated segmentation software calculated normalized axial diffusivity (λ1) and radial diffusivity (λ⊥) in 19 predefined white matter regions of interest (ROIs). DT imaging variables were compared by using general linear modeling, and side-to-side Pearson correlation coefficients were calculated. P values were corrected for multiple testing (Bonferroni). RESULTS: In central white matter, λ1 differed from that in control subjects in six of seven TBI ROIs and five of seven cardiac arrest ROIs (all P < .01). The λ⊥ differed from that in control subjects in all ROIs in both patient groups (P < .01). In hemispheres, λ1 was decreased compared with that in control subjects in three of 12 TBI ROIs (P < .05) and nine of 12 cardiac arrest ROIs (P < .01). The λ⊥ was increased in all TBI ROIs (P < .01) and in seven of 12 cardiac arrest ROIs (P < .05). Cerebral hemisphere λ1 was lower in cardiac arrest than in TBI in six of 12 ROIs (P < .01), while λ⊥ was higher in TBI than in cardiac arrest in eight of 12 ROIs (P < .01). Diffusivity values were symmetrically distributed in cardiac arrest (P < .001 for side-to-side correlation) but not in TBI patients. CONCLUSION: DT imaging findings are consistent with the known predominance of cerebral hemisphere axonal injury in cardiac arrest and chiefly central myelin injury in TBI. This consistency supports the validity of DT imaging for differentiating axon and myelin damage in vivo in humans.

Coronary artery calcification is often not reported in pulmonary CT angiography in patients with suspected pulmonary embolism: an opportunity to improve diagnosis of acute coronary syndrome.

OBJECTIVE: In patients with suspected pulmonary thromboembolism (PTE), coronary artery calcification (CAC) can be an incidental finding on pulmonary CT angiography. We evaluated the frequency of CAC not being reported and its association with a diagnosis of acute coronary syndrome (ACS). MATERIALS AND METHODS: Data of 469 consecutive patients who were referred to the emergency radiology department for pulmonary CT angiography of suspected PTE were reviewed. Radiology reports were rechecked and positive CAC findings were recorded. All pulmonary CT angiograms were reevaluated by one radiologist and CAC findings were recorded. The rates of ACS and PTE as final diagnoses for that hospital admission were calculated. The association between CAC and ACS diagnosis was assessed in different subgroups of patients. RESULTS: Approximately 11.1% of patients had PTE and 43.8% had CAC. The incidence of CAC was significantly higher in patients with an ACS diagnosis than in those without ACS (56.2% vs 40.4%, respectively; odds ratio [OR] = 1.9). There was a strong positive association (OR = 3.5) between CAC and ACS in younger patients (men ≤ 45 years and women ≤ 55 years), patients without PTE (OR = 2.2), and those without cardiometabolic risk factors (OR = 3.8). CAC was not reported in 45% of patients (n = 98) with positive CAC findings on imaging. ACS was the final diagnosis in 31.6% of patients with unreported CAC. There was a significant association between CAC and ACS in patients with unreported CAC (OR = 2.2). This association was more prominent in the subgroups described. CONCLUSION: CAC is often not reported in pulmonary CT angiography studies. CAC is a significant predictor of ACS particularly in younger patients, patients without PTE, and those without cardiometabolic risk factors. Especially in these subgroups, radiologists should assess CAC findings.

Patterns of fruit and vegetable consumption among Iranian adults: a SuRFNCD-2007 study.

The aim of the present study was to describe the patterns of fruit and vegetable (F&V) intake in a nationally representative sample of the Iranian population. The data collected in the Third National Surveillance of Risk Factors of Non-communicable Diseases (SuRFNCD-2007) were used. In a sample of 3702 Iranian adult participants, patterns of F&V consumption were assessed using the WHO STEPwise method. Low F&V consumption was defined as intake of less than five servings of fruit and/or vegetable daily according to the WHO guidelines. F&V consumption was compared among different age groups, sex and urban/rural areas using complex sample analysis. On average, 1·26 servings of fruit and 1·32 servings of vegetables were consumed daily. Taken together, Iranian adults consumed 2·58 F&V servings per d, with females eating more than males (P ≤ 0·001). Moreover, there was a trend towards lower consumption rates in older-age categories (P = 0·003). Prevalence of low F&V intake (less than five servings daily) was 87·5 % and also tended to be higher in older-age categories (P = 0·004). Prevalence of low intake did not differ significantly among men and women or urban and rural areas. A high prevalence of low F&V consumption in the Iranian adult population was documented. These findings may guide health policy makers in developing specific plans to encourage adequate F&V intake.

Color Doppler ultrasound for evaluation of vasomotor activity in patients with carpal tunnel syndrome.

BACKGROUND: Patients with carpal tunnel syndrome (CTS) have a variety of vasomotor symptoms. Here, we aimed to study the vasomotor activity of the radialis indicis (RI) artery (median nerve territory) and the radial palmar digital (RPD) artery of the little finger (ulnar nerve territory) before and after sympathetic stimulation in CTS patients using color Doppler ultrasound. METHODS: We performed a cross-sectional study of 46 consecutive CTS patients plus 36 healthy controls. All patients underwent electromyography studies and were classified into mild and moderate/severe groups according to electrodiagnostic findings. Color Doppler examination of the RI artery and the RPD artery of the little finger were performed with the participants in a relaxed sitting position and after a deep breath followed by a cough (sympathetic stimulation). The pulsatility index (PI) was recorded at the point of maximal change in waveform, before and after this stimulus. RESULTS: The PI of RI artery was significantly lower (p < 0.01) in CTS patients than healthy controls, both before and after stimulation. The changes in PI of RI artery after stimulation were significantly lower in CTS patients than healthy controls (1.18 ± 0.37 vs. 5.41 ± 0.87; p < 0.001). The same pattern was seen for PI of RI artery when comparing patients with mild vs. moderate/severe CTS. No difference was found in PI of RPD artery of the 5th finger between patients vs. controls and between patients with mild vs. moderate/severe CTS, both before and after stimulation. CONCLUSIONS: We showed that color Doppler ultrasound can readily determine impaired vasomotor activity in CTS patients.

Physical inactivity is correlated with levels of quantitative C-reactive protein in serum, independent of obesity: results of the national surveillance of risk factors of non-communicable diseases in Iran.

Increased C-reactive protein (CRP) levels are associated with coronary heart disease, stroke, and mortality. Physical activity prevents cardiovascular disorders, which can be partly mediated through reducing inflammation, including serum CRP levels. The association of different intensities of physical activity, sedentary behaviours, and C-reactive protein (CRP) levels in serum was examined after adjustment for markers of adiposity, including waist-circumference and body mass index (BMI), in a large population-based study. Using data of the SuRFNCD-2007 study, a large national representative population-based study in Iran, the relationship between quantitative CRP concentrations in serum and physical activity was examined in a sample of 3,001 Iranian adults. The global physical activity questionnaire (GPAQ) was used for evaluating the duration and intensity of physical activity. Total physical activity (TPA) was calculated using metabolic equivalents for the intensity of physical activity. Quantitative CRP concentrations in serum were measured with high-sensitivity enzyme immunoassay. The CRP levels in serum significantly correlated with TPA (r=-0.103, p=0.021 in men and r=-0.114, p=0.017 in women), duration of vigorous-intensity activity (r=-0.122, p=0.019 in men and r=-0.109, p=0.026 in women), duration of moderate-intensity activity (r=-0.107, p=0.031 in men and r=-0.118, p=0.020 in women), and duration of sedentary behaviours (r=0.092, p=0.029 in men and r=0.101, p=0.022 in women) after multiple adjustments for age, area of residence, BMI, waist-circumference, smoking, and diabetes mellitus. Physical activity (of both moderate and vigorous intensity) is inversely associated with the quantitative CRP levels in serum, independent of diabetes and body adiposity.

Appropriate BMI cut-off values for identification of metabolic risk factors: third national surveillance of risk factors of non-communicable diseases in Iran (SuRFNCD-2007).

AIM: To determine the appropriate threshold of body mass index (BMI) associated with increased risk of cardiovascular diseases in a large representative sample of an Iranian population. SUBJECTS AND METHODS: Data of third national surveillance of risk factors of non-communicable diseases (SuRFNCD-2007) were used in this study. Sensitivity, specificity, and shortest distance on the receiver-operating characteristic (ROC) curves were used to determine gender-specific optimal cut-offs of BMI for cardiometabolic risk factors including elevated blood pressure, low high-density lipoprotein cholesterol, high triglycerides, high fasting plasma glucose and for ≥ 2 of the aforementioned risk factors. RESULTS: There was a continuous increase in the prevalence of cardiometabolic risk factors with increasing BMI (p < 0.001). At the BMI of 25-29 kg/m(2) men were at higher risk of cardiovascular diseases compared to women (p < 0.001). The appropriate BMI cut-offs ranged from 24.6-26.1 kg/m(2) for men and from 26.9-28.8 kg/m(2) for women. The optimal BMI cut-offs for identifying any two or more of those risk factors were 25.2 and 27.3 kg/m(2) in men and women, respectively. CONCLUSION: In men the appropriate BMI cut-offs are ~25 kg/m(2), while in women higher BMI values are associated with risk of cardiovascular diseases.

Diffusion-weighted magnetic resonance imaging for diagnosis of liver fibrosis and inflammation in chronic viral hepatitis: the performance of low or high B values and small or large regions of interest.

OBJECTIVE: To investigate the performance of different b values and regions of interest (ROI) for diagnosing liver fibrosis in patients with chronic viral hepatitis by using diffusion-weighted (DW) magnetic resonance imaging (MRI). METHODS: Eleven healthy participants and 33 patients with viral hepatitis B or C were enrolled. The stage of liver fibrosis and the grade of necroinflammation were determined by using a histologic activity index. Single-shot spin-echo echo-planar DW-MRI was performed in all participants at b values of 0-500, 0-700, and 0-1000 s/mm(2) by using 2 circular small and large ROIs of 100 and 200 mm(2). To evaluate the performance of different b values for determining cirrhosis, the receiver-operating characteristic curves were depicted, and the areas under the curves were compared. RESULTS: The average values of apparent diffusion coefficients significantly decreased with increasing stage or grade categories at all the 3 b values and for both small and large ROIs. The performance at b = 500 s/mm(2) was significantly better than b = 1000 s/mm(2) for determining cirrhosis or bridging fibrosis. The cut point of 153.4 for apparent diffusion coefficient (×10(-5) mm(2)/s) at b = 500 s/mm(2) could determine cirrhosis or bridging fibrosis with a sensitivity of 96% and specificity of 82%. No difference was found between the average apparent diffusion coefficient values of large or small ROIs. Also, there was no difference in performance of large or small ROIs in the diagnosis of liver fibrosis. CONCLUSIONS: This study provided beneficial data for clinical utilisation of DW-MRI in diagnosing liver fibrosis: b = 500 s/mm(2) is better in performance than b = 1000 s/mm(2), and a small ROI of 100 mm(2) is sufficient for determining cirrhosis or bridging fibrosis.

Color and power Doppler US for diagnosing carpal tunnel syndrome and determining its severity: a quantitative image processing method.

PURPOSE: To determine whether intraneural vascularity seen at color Doppler ultrasonography (US) can be used to diagnose carpal tunnel syndrome (CTS) and to evaluate an image processing method for quantifying the severity of CTS on the basis of this vascularity. MATERIALS AND METHODS: This study was approved by the university ethics review committee. One hundred one patients with clinical evidence of CTS and 55 healthy control subjects were enrolled. Electrodiagnostic testing (EDT) was performed in all participants, and the presence of intraneural vascularity was evaluated with color Doppler US. An image processing program was designed by using software to determine the sum of pixels in the intraneural vascular area on power Doppler US scans of the median nerve. The relationship between the number of pixels and the severity of the abnormality at EDT was determined. RESULTS: The sensitivity (83%) and specificity (89%) of intraneural vascularity in the diagnosis of CTS were similar to those of EDT (81% and 84%, respectively). Intraneural vascularity was seen in 91.4% of patients with mild CTS and 100% of patients with moderate or severe CTS. In participants with positive intraneural vascularity, the sum of pixels in the intraneural vascular area was significantly higher in patients than in control subjects and paralleled the severity of the abnormality at EDT (P < .01). CONCLUSION: Color Doppler US can be used to accurately diagnose CTS. By processing the recorded power Doppler images and determining the number of pixels in the intraneural vascular area, the severity of CTS can be assessed. 2011 SUPPLEMENTAL MATERIAL: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11110150/-/DC1.

Association of serum cortisol levels with parameters of metabolic syndrome in men and women.

PURPOSE: Central fat distribution is significantly associated with an increased cortisol levels. We hypothesized that men with metabolic syndrome have a higher serum cortisol levels compared to women. The purpose of this study was to compare serum cortisol levels, and its correlation with serum leptin levels, between men and women with and without metabolic syndrome. METHODS: A cross sectional study was performed with 120 untreated patients with metabolic syndrome and 165 healthy volunteers as controls. Serum lipid profile, fasting blood sugar, insulin, cortisol and leptin levels were measured for both groups. RESULTS: Men with metabolic syndrome had a higher serum cortisol levels, while serum leptin levels were significantly higher in women. The higher serum cortisol level in men with metabolic syndrome was significant after multiple adjustments for age, BMI and waist circumference (17.74±5.1 vs 14.07±4.3; p < 0.05) using general linear model; however, these difference were no longer significant when the waist-to-hip ratio was added as one of the adjustment factors (16.7±1.2 vs. 14.9±0.5; p < 0.2). Serum cortisol levels was significantly correlated with serum leptin (r=0.33, p < 0.05), cholesterol (r=0.35, p < 0.05), triglyceride (r=0.25, p < 0.05), waist circumference (r=0.41, p < 0.01) and waist-to-hip ratio (r=0.32, p < 0.01) in women with metabolic syndrome, after controlling for age and BMI. CONCLUSION: Serum cortisol levels are significantly higher in men with metabolic syndrome. This effect is independent of waist circumference.

Combination of high-resolution and color Doppler ultrasound in diagnosis of carpal tunnel syndrome.

BACKGROUND: Ultrasound has recently emerged as a diagnostic tool in carpal tunnel syndrome (CTS). PURPOSE: To evaluate the utility of a combination of high-resolution and color Doppler ultrasound as an alternative to electrodiagnostic tests (EDT), in CTS diagnosis, and to define an ultrasonographic prediction model for CTS. MATERIAL AND METHODS: A total of 85 patients with certain clinical diagnosis of CTS and 49 healthy controls were enrolled. High-resolution and color Doppler ultrasound were performed and the cross-sectional area (CSA), hypoechogenicity, and hypervascularity of the median nerve were evaluated. Receiver-operating characteristic curves were used to determine the optimal cut-off point of median nerve CSA in diagnosis of CTS. Multivariate logistic regression analysis was used to formulate a prediction model for CTS. RESULTS: The optimal cut-off point of median CSA in wrist was 10.5 mm(2). Hypervascularity (OR = 37.95), hypoechogenicity (OR = 12.30), and high CSA (OR = 34.79) of median nerve were significantly (P < 0.001) higher in CTS patients than in controls. No significant difference was found between the sensitivity and specificity of EDT and any of the above indices in prediction of CTS. An ultrasonographic model for prediction of CTS, comprised hypervascularity and/or high CSA of median nerve, could predict the CTS probability between 87-99%. The sensitivity and specificity of this model (86% and 84%) was not different from EDT (80% and 84%). CONCLUSION: A combination of high-resolution and color Doppler ultrasound can be used as a non-invasive alternative to EDT in diagnosis of CTS.

Comparison of the exposure rate of wrapped hydroxyapatite (Bio-Eye) versus unwrapped porous polyethylene (Medpor) orbital implants in enucleated patients.

PURPOSE: To compare the exposure rate of wrapped hydroxyapatite versus unwrapped porous polyethylene orbital implants in enucleated patients. METHODS: Medical records of the patients who underwent primary placement of hydroxyapatite (Bio-Eye) or porous polyethylene (Medpor) orbital implants after enucleation between 2002 and 2005 in Farabi Eye Hospital were reviewed, and the occurrence of implant exposure during follow-up visits was recorded. The exclusion criteria were secondary implantation, evisceration, or follow up of less than 1 year unless the exposure had occurred in the year after surgery. In the hydroxyapatite group, the implants were wrapped either in Mersilene mesh (65%) or in donor sclera (35%). Wrapping was not performed for any patient in the porous polyethylene group. RESULTS: A total of 198 cases with hydroxyapatite and 53 cases with porous polyethylene implant were identified. The most common causes of enucleation in both groups were globe trauma and painful blind eye. Rate of exposure was significantly higher [odds ratio (OR) = 7.97, p < 0.001] in patients with porous polyethylene (34.0%) than in those with hydroxyapatite implant (6.1%). This association remained significant after adjustment for potential confounders. Mean time of exposure after surgery was significantly (p < 0.001) longer in patients with porous polyethylene implant. Kaplan-Meier plots depicted a significantly (p < 0.001) higher rate of exposure in patients with porous polyethylene implant during the follow-up time. CONCLUSION: Unwrapped porous polyethylene implants demonstrated a higher rate of exposure, and longer time interval to exposure, compared with wrapped hydroxyapatite implants.

Imaging Assessment of Thoracic Outlet Syndrome.

Imaging studies play a significant role in assessment of thoracic outlet syndrome. In this article, we discuss the etiology and definition of thoracic outlet syndrome and review the spectrum of imaging findings seen in patients with thoracic outlet syndrome. We then discuss an optimized technique for computed tomography and MRI of patients with thoracic outlet syndrome, based on the experience at our institution and present some representative examples. Based on our experience, a combination of computed tomography angiography and MRI (with postural maneuvers) effectively demonstrate thoracic outlet syndrome abnormalities.

Pattern of tobacco use among the Iranian adult population: results of the national Survey of Risk Factors of Non-Communicable Diseases (SuRFNCD-2007).

BACKGROUND: Previous studies report on smoking in Iran but recent national data on tobacco use (including cigarette, water-pipe and pipe) have not been reported. METHODS: In 2007, 5287 Iranians aged 15-64 years were sampled from all provinces as part of a national cross-sectional survey of non-communicable disease (NCD) risk factors. Data were collected using the standardised stepwise protocol for NCD risk factor surveillance of the World Health Organization. Use of tobacco products was calculated as the sum of smoking cigarettes/cigars (smoking currently or daily any amount of factory/hand-made cigarettes or cigars), pipes (daily) and water pipes (daily). RESULTS: Total current and daily tobacco use was 14.8% (burden 7.3 million) and 13.7% (burden 6.7 million) when extrapolated to the Iranian population aged 15-64. The prevalence of current and daily cigarette smoking was 12.5% (6.1 million; 23.4% males and 1.4% females) and 11.3% (5.6 million; 21.4 males and 1.4 females); former smokers comprised 1.7 million or 3.4% of the Iranian population (6.2% males and 0.6% females; mean cessation age 34.1). The mean age of starting to smoke was 20.5 years (24.2 males and 20.4 females). The prevalence of water-pipe smoking was 2.7% (burden 1.3 million; 3.5% males and 1.9% females). Water-pipe smokers used the water-pipe on average 3.5 times a day (2.8 males and 4.5 females). CONCLUSION: The prevalence of tobacco use has not escalated over the past two decades. Nonetheless, the burden is high and therefore warrants preventive public health policies.

Comparison of colchicine versus prednisolone in recurrent aphthous stomatitis: A double-blind randomized clinical trial.

PURPOSE: Recurrent aphthous stomatitis (RAS) is one of the most common ulcers of the oral cavity with a reported prevalence of 5- 50%. There is still no definitive treatment for RAS; however, immunosuppressive and immunomodulant agents have been proposed. In this study, we compared the therapeutic effects of 5 mg/d prednisolone with 0.5 mg/d colchicine in the treatment of RAS. METHODS: In a double-blind randomized clinical trial, 34 patients with RAS were randomly divided into two groups for treatment with prednisolone or colchicine. All patients took the medication for three months and were assessed at two weeks intervals. The groups were compared for size and number of lesions, severity of pain and burning sensation, duration of pain-free episodes and any side effects of the prescribed medicines. Both colchicine and prednisolone treatments significantly reduced RAS (p < 0.001). No significant differences in size and number of lesions, recurrence and severity of pain and duration of pain-free period were seen between the two treatment groups. Colchicine (52.9%) had significantly more side effects than prednisolone (11.8%). CONCLUSION: Low dose prednisolone and colchicine were both effective in treating RAS. Given that the two therapies had similar efficacy, yet colchicine was associated with more side effects, , 5mg/d of prednisolone seems to be a better alternative in reducing the signs and symptoms of the disease.

Association between physical activity and insulin resistance in Iranian adults: National Surveillance of Risk Factors of Non-Communicable Diseases (SuRFNCD-2007).

BACKGROUND: Insulin resistance is an underlying mechanism of metabolic syndrome. We attempted to determine the association between physical activity and insulin resistance in Iranian adults. METHODS: The data of the third national Surveillance of Risk Factors of Non-Communicable Diseases (SuRFNCD-2007) in Iran were used. We ran the Global Physical Activity Questionnaire (GPAQ) over a nationally representative sample of 3101 adults. Total physical activity (TPA) was calculated using metabolic equivalents (MET) for intensity of physical activities. Insulin resistance was measured by the homeostasis model assessment of insulin resistance (HOMA-IR). RESULTS: When physical activity was classified into high, moderate, and low categories, HOMA-IR values significantly increased from the high category to the moderate and low categories (p<0.01). After adjustment for age, area of residence, smoking, and body mass index (BMI), TPA (r=-0.26, p<0.01 in males and r=-0.21, p<0.01 in females), duration of vigorous-intensity activity (r=-0.28, p<0.01 in males and r=-0.18, p=0.01 in females), duration of moderate-intensity activity (r=-0.16, p=0.01 in males and r=-0.17, p<0.01 in females), and the time spent on sedentary behaviors (r=0.16, p=0.01 in males and r=-0.22, p<0.01 in females) were significantly correlated to HOMA-IR. The prevalence of physical inactivity increased linearly with increasing HOMA-IR quintiles. CONCLUSIONS: Our findings indicate a significant relationship between physical inactivity and insulin resistance. For communities in a transition phase of lifestyle, encouraging physical activity may help prevent insulin resistance and its adverse consequences.