Type 2 diabetes remission after Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and one anastomosis gastric bypass (OAGB): results of the longitudinal assessment of bariatric surgery study.

BACKGROUND: Several studies on various bariatric surgeries involving patients with type 2 diabetes mellitus (T2DM) showed an overall rate of remission of hyperglycemia. However, there is little known about predictive factors on remission after different types of surgeries. The aim of this study was to identify the T2DM remission rate and to determine the effects of preoperative factors characteristics of remission of type 2 diabetes in Iran. METHODS: We conducted a retrospective analysis of 1351 patients with T2DM operated by three different types of surgeries (Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and One Anastomosis Gastric Bypass (OAGB)). Diabetes remission was defined according to the American Diabetes Association (ADA) criteria. Binary logistic regression analyses were employed. RESULTS: A total of 1351 patients, 675 patients (50.0%) undergoing OAGB, 475 (35.2%) RYGB, and 201 (14.9%) SG. 80.6%, 84.2% of OAGB, 81.7%, 82.6% of RYGB, and 77.1%, 81.5% of SG participants were in T2DM remission after 1 and 3 years, respectively. 1- and 3-year remission were associated with preoperative age, duration of T2DM, FBS and HbA1c, BMI, insulin therapy, and a family history of obesity (p < 0.05). CONCLUSION: The remission of T2DM after RYGB, SG, and OAGB surgery is dependent on various preoperative factors. Patients with younger age, shorter duration of T2DM, lower preoperative HbA1c and FBS, higher BMI, who were not on insulin therapy, and not having a family history of obesity were the best candidates to achieve a prolonged diabetes remission.

Evaluation of the effect of vitamin E on pelvic pain reduction in women suffering from primary dysmenorrhea.

OBJECTIVE: To evaluate the effect of vitamin E on the reduction of pelvic pain in women with primary dysmenorrhea and to compare its effect with placebo. STUDY DESIGN: A double-blind randomized clinical trial was performed on 120 women suffering from primary dysmenorrhea. They were randomly assigned into 2 groups, and 94 women finished the study. In the study group (n = 42) 400 IU/day of vitamin E was prescribed starting 2 days before the beginning of menstruation and continuing for a total of 5 days, for 2 consecutive cycles. In the control group (n = 52) a placebo was prescribed. Pain severity was evaluated using the Visual Analogue Scale for 1 month before the study and during the 2 months of study. RESULTS: Pain severity during the first month of the study was 5.41 +/- 2.4 in the study group and 5.76 +/- 2.08 in the control group and 4.73 +/- 1.89 and 5.35 +/- 2.05 in the study and control groups, respectively, during the second month of the study. Pain severity during the first and second months of treatment with vitamin E and placebo was lower than the pain severity before treatment. The mean reduction of pain in the study group (-2.7 +/- 2.1) was greater than that in the control group (-1.8 +/- 2.4) during the second month of the study. CONCLUSION: Both vitamin E and placebo may reduce the pelvic pain of dysmenorrhea, but vitamin E seems to cause a more significant reduction in pain. With regard to its safety, the study indicates it can be a simple and safe option for the treatment of dysmenorrhea.

Quality of spirometry tests and pulmonary function changes among industrial company workers in Iran: a two-year before-and-after study following an intensive training intervention.

BACKGROUND: Quality improvement, standardisation of spirometry testing, and interpretation of results are critically important in the occupational setting. AIMS: To determine the quality of spirometry tests and pulmonary function changes in two consecutive years among the personnel of an industrial company. METHODS: This study was performed in an oil refinery in Iran in 2011. Data on 1,004 male personnel were evaluated before and after a training course conducted according to the National Institute for Occupational Safety and Health guidelines. American Thoracic Society/European Respiratory Society guidelines were used for assessment of the acceptability and repeatability criteria. RESULTS: The most common error in the first year of evaluation was forced vital capacity >6 seconds or a 1 second plateau. Acceptability and proper interpretation significantly improved after the course (p<0.05), but repeatability did not change significantly (p>0.05). CONCLUSIONS: The results of this study show that the validity and quality of spirometric tests conducted in the studied company in Iran were unacceptable, but these improved significantly after the training intervention. The study demonstrated the lack of a systematic guideline for conducting spirometry and interpreting the results in the occupational setting in Iran, and emphasises the need for a nationwide programme to improve the quality of spirometry tests in this setting.

Pulmonary survival study in 91 patients with systemic sclerosis.

In systemic sclerosis (SSc), major determinant of morbidity and mortality is pulmonary complication including pulmonary interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH). In this study, the natural course of pulmonary involvement in SSc patients was investigated. This was a historical cohort study of SSc patients at a referral center for SSc in Iran between February 1998 and December 2007. Patients had a standardized initial evaluation, and interstitial pulmonary involvement was established by high-resolution CT scan (HRCT). Pulmonary hypertension was assessed by tricuspid gradient on echocardiography. Development of abnormal FVC or DLCO was considered as secondary outcome. Analysis of pulmonary survival was performed for primary and secondary outcomes. Ninety-one SSc patients were included in the study with the mean age of 44.1 (14.8). Among these, 65 (71.4%) patients were classified as limited subtype (lcSSc) and 84 (93.3%) were women. PAH was investigated in 8 (8.2%) patients, 1 (6.7%) in dcSSc and 7 (15.9%) in lcSSc subtype of disease. ILD had developed after a median of 107 (SE = 24.4) months after the first symptom of SSc, and 29 patients (31.9%) developed pulmonary fibrosis. Alveolitis and fibrosis had developed after a median of 129.0 (22.9) and 259.0 (74.2) months, respectively. There was a significant difference in Alveolitis-free pulmonary survival between two subgroups of the disease, which showed pulmonary alveolitis developed later in limited SSc (P = 0.03). The difference was not significant in two subtypes when Cox regression model was used to identify the effect of other prognostic factors on pulmonary survival in patients. In the present study, clinical manifestations of two subtypes of disease were divergent at first; however they became convergent in late stages, and this was the same as results in previous studies. Echocardiography for evaluation of pulmonary hypertension and pulmonary function tests for early detection of ILD and PAH is recommended for SSc patients to detect early stages of pulmonary involvement before significant vascular and fibrotic changes occur.

The GlideScope facilitates nasogastric tube insertion: a randomized clinical trial.

BACKGROUND: The GlideScope (Saturn Biomedical Systems, B.C., Canada) is a reusable videolaryngoscope and is considered an effective device for tracheal intubation. We designed this study to evaluate the application of this device in nasogastric tube (NGT) insertion. METHODS: This randomized clinical trial was performed at a teaching hospital on 80 adult patients who required intraoperative placement of an NGT. The patients were divided into 2 groups (the control and the GlideScope group) using computerized, random allocation software. In the control group, the NGT was inserted blindly as commonly performed in operating rooms; however, in the GlideScope group, the tube was inserted with the assistance of a GlideScope. The number of attempts for NGT insertion and the time required for inserting the NGT properly along with the occurrence of possible complications were recorded. RESULTS: The mean intubation time in the GlideScope group was 27.7 +/- 20.7 s shorter than that in the control group. NGT insertion in the first attempt was successful in approximately 85% of the patients in the GlideScope group; in the control group, however, the tubes were inserted successfully after the first attempt in 57.5% of the patients. Complications were reported in 14 patients (35%) of the control group and 8 patients (20%) of the GlideScope group. CONCLUSION: GlideScope facilitates NGT insertion and reduces the duration of the procedure.

Sequestrectomy Versus Conventional Microdiscectomy for the Treatment of a Lumbar Disc Herniation: A Systematic Review.

STUDY DESIGN: A systematic review. OBJECTIVE: The aim of this study was to compare the effects of sequestrectomy versus conventional microdiscectomy for lumbar disc herniation (LDH). SUMMARY OF BACKGROUND DATA: Open surgery for LDH can be performed by sequestrectomy (removal of disc fragments) or conventional discectomy (removal of disc fragments and disc). Sequestrectomy might be associated with a higher risk of recurrence but less low back pain (LBP) after surgery. METHODS: We searched MEDLINE and EMBASE from 1980 to November 2014. We selected randomized controlled trials (RCTs) and nonrandomized prospective studies of conventional discectomy versus sequestrectomy for adult patients with LDH that evaluated the following primary outcomes: radicular pain or LBP as measured by a visual analog scale, or neurological deficits of the lower extremity. We also evaluated the following secondary outcomes: complications of surgery, reherniation rate, duration of hospital stay, postoperative analgesic use, and health-related quality-of-life measures. Two authors independently reviewed citations and articles for inclusion. We assessed the risk of bias, synthesized data, and the level evidence using standard methodological procedures as recommended by the Cochrane Back Review Group. RESULTS: We identified 5 studies (746 participants) of sequestrectomy versus microdiscectomy. One study was RCT and the other 4 were nonrandomized prospective comparisons; all studies were assessed as being at a high risk of bias. There were no significant differences for leg pain, LBP, functional outcomes, complications, and hospital stay or recurrence rate for 2 years (level of evidence: Low). Sequestrectomy was associated with less analgesic consumption versus discectomy (level of evidence: Very low). CONCLUSION: Sequestrectomy and standard microdiscectomy were associated with similar effects on pain after surgery, recurrence rate, functional outcome, and complications; more evidence is needed to determine whether sequestrectomy is associated with less postoperative analgesic consumption. LEVEL OF EVIDENCE: 2.

Preliminary study of cardiovascular manifestations and cardiac severity scale in 58 patients with systemic sclerosis in iran using the medsger scale.

BACKGROUND: Cardiac involvement in systemic sclerosis (SSc) is more prevalent than previously thought. In this study, the frequency and severity of cardiovascular involvement were assessed in SSc patients referred to Firouzgar Hospital. METHODS: Fifty-eight patients with SSc, selected from the data bank of SSc patients, were reviewed for the frequency and severity of 8 organ involvements in this case series. The preliminary severity scale, published by international SSc study groups, was employed for the determination of the severity grade in the cardiovascular system. In the cardiac scoring scale, grade 0 represents normal heart (no cardiac involvement), grade 1 denotes mild involvement [electrocardiography (ECG) conduction defect and a left ventricular ejection fraction (LVEF) of 45-49%)], grade 2 signifies moderate involvement (arrhythmia, LVEF = 40-44%), grade 3 indicates severe involvement (LVEF <40%)], and grade 4 stands for end stage (congestive heart failure and arrhythmia requiring treatment). RESULTS: In this study, 24 (41.4%) patients were in the diffuse cutaneous (dcSSc) subset. The female to male ratio was 10.5:1, and the mean duration from symptom onset to diagnosis was 7.35 years for the dcSSc subset and 8.41 years for the limited cutaneous (lcSSc) subset of disease, there being no significant difference. Cardiac involvement in this series was seen in 13 (22.4%) cases; and there was no significant difference in terms of frequency and severity between the two disease subgroups (p value = 0.96 and p value = 0.46 respectively). CONCLUSION: Our findings showed that the cardiac involvement in this series was infrequent and that there was no significant difference in the severity of cardiovascular involvement between the two subtypes of SSc in the late stage of the disease.