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This a randomized controlled trial study with a cost-effectiveness analysis that aimed to compare the cost-effectiveness of group nutrition education with that of Web-Tel nutrition education in the glycemic control of patients with non-insulin-dependent type 2 diabetes mellitus (T2DM). The study was conducted on 105 patients with T2DM for 3 months in Quds health centre of Bushehr province, Iran. The participants were classified based on age and disease severity (hemoglobin A1c level); then, they were randomly assigned to one of the three groups: group education, Web-Tel education, and the control group using block randomization method. The clinical (intermediate) outcome was changes in hemoglobin A1c (HbA1c). Patients' perspective was adopted, and a deterministic one-way sensitivity analysis was conducted to identify the effects of uncertainties. The results indicated that the expected effectiveness was 0.46, 0.63, and 0.4; the mean costs was 27,188, 5,335, and 634 purchasing power parity (PPP) dollars for group education, Web-Tel education, and the control group, respectively. The incremental cost-effectiveness ratio (ICER) of Web-Tel education vs. the control group was positive and equal to $21, 613.04 PPP; since it was less than three times of the threshold, the Web-Tel education method was considered as a more cost-effective method than the control group. On the other hand, the ICER of group education vs. control group was $447,067 PPP and above the threshold, so group education was considered as a dominated method compared with the control group. In conclusion, considering the ICER, Web-Tel education is a more cost-effective method than the other two and can be used as the first priority in educating patients with T2DM. The present study was registered in Thailand Clinical Trials Registry (TCTR20210331001).
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OBJECTIVES: To determine the epidemiological aspect of mucormycosis, the nature of malignancies complicated by mucormycosis, the initial site of involvement and the subsequent outcome. METHODS: This was a cross-sectional study which was performed by reviewing the medical records of 95 patients with leukemia complicated with biopsy-proven mucormycosis admitted to the educational hospitals affiliated with Shiraz University of Medical Sciences over a 21-year period. We recorded demographic information including age and sex and disease characteristics such as type of leukemia, site of involvement, paraclinical findings at the time of admission and the outcome of the patients. The incidence of mucormycosis in leukemia was determined by identifying the number of leukemia patients diagnosed within the last 17 years. RESULTS: The male to female ratio was 2.39:1 in of 95 patients studied. The overall incidence rate of mucormycosis was 4.27 per 100 leukemic patients in last 17 years which showed a decreasing trend from 2001 to 2011. The most frequent type of leukemia was acute myelogenous leukemia (AML) which was found in 58 patients (61.5%). The most common site of initial tumor involvement was sinonasal (90.16%). The mortality rate was about 54%, compared to the mortality rate of about 43.24% in patients with best prognosis of AML. CONCLUSION: The incidence of mucormycosis in leukemia showed a decreasing trend in our country and its recent incidence is comparable to that of other regions. The best preventive method against this lethal infection is to modify and control the environment which reduces the risk of exposure to air-born fungal spores.
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OBJECTIVES: To determine the prevalence and predisposing factors of mucormycosis in patients with diabetes mellitus (DM) in a Shiraz referral centers. METHODS: This retrospective case control study, reviewed the medical records of 162 patients with pathologically confirmed diagnosis of mucormycosis hospitalized in two major Shiraz University hospitals during the last 21 years. For each diabetic patient, two patients with diabetic ketoacidosis (DKA) matched for age, sex and the date of admission was selected as control group. Age, type of diabetes mellitus (DM) and duration of involvement as well as paraclinical findings were compared between cases and controls. RESULTS: There were 162 patients with murormycosis of which 30 (18.5%) had DM as predisposing factor. Diabetes was the second common predisposing disease next to leukemia. There were 19 (63.3%) women and 11 (36.7%) men among the patients. The overall mortality rate was 53.33% mortality rate. The mean age of the patients was 45.3 ± 17.6 years. The mean duration of diabetes in case and control groups were 5.75 ± 5.43 and 7.2 ± 7.85 years respectively, without any statistical significance between them (p=0.063). Blood sugar in patients was lower than control group (p=0.012). Serum bicarbonate level in case group was higher than in control group (p<0.001). Arterial pH in control group was more acidic than case group (p<0.001). Insulin dependent DM was significantly more prevalent in control group compared to case group (73.4% vs. 36.6%; p=0.002). CONCLUSION: Our study showed that the number of hospitalized patients with mucormycosis over the last 7 years has been decreased which is due to better control of infection in diabetics. In addition to hyperglycemia and acidosis, several other unknown factors like immune defects may predispose diabetics to this fungal infection.
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INTRODUCTION: Patients with diabetes play an important role in management of their illness. They should be involved in the intervention program to be able to improve their quality of life. This study investigated the effect of a self-management program based on 5A (assess, advise, agree, assist, arrange) model on metabolic control indicators of diabetic patients. MATERIAL AND METHOD: In this randomized, controlled trial, 70 diabetic insulin dependent patients who referred to Nader Kazemi clinic in Shiraz participated. They were randomly assigned to two groups of experiment and control. Then a self-management program based on 5A model was performed for the experiment group during 3-mounths and the indicators of metabolic control including hemoglobin A1c, cholesterol, triglyceride and also body mass index were measured pre- and post- intervention in both groups. Data were analyzed using SPSS ver 11.5. RESULTS: Data analysis revealed a significant reduction in mean fasting blood sugar (69 units) and HbA1c (1.16 units) in the experimental group . Pre- to post-changes in hemoglobin A1c, fasting blood sugar, and high density lipoprotein were significant between the two groups of study. However, there was no significant difference in cholesterol, triglyceride, low-density lipoprotein, and body mass index between the two groups. DISCUSSION: Regarding the results, it can be concluded that a 3-month self-management program based on 5A model is effective in reducing the fasting blood sugar, hemoglobin A1c. Application of self management program based on 5A model in diabetic clinics is recommended.