Genetic polymorphisms in calcitonin receptor gene and risk for recurrent kidney calcium stone disease.

INTRODUCTION: In this study the full sequence of the calcitonin receptor gene (CALCR) in a group of Iranian males suffering from recurrent calcium urinary stones was compared with that of a control group. METHODS: Serum and urinary biochemistry related to urolithiasis were evaluated in 105 males diagnosed with recurrent kidney calcium stones and 101 age-matched healthy control males. The polymerase chain reaction single-strand conformation polymorphism method was used to detect new polymorphisms in the CALCR. RESULTS: Nine polymorphisms were detected; seven were in the non-coding and two in the coding region. The T allele associated with the 3'UTR+18C>T polymorphism was observed exclusively in the stone formers. The exact odds ratio for the T allele in this locus for those at risk of stone formation was 36.72 (95% CI 4.95-272.0) (p < 0.001). The mean (standard deviation) urine calcium concentration was 117 (60) mg/l in patients with the C allele and 152 (72) mg/l in those with the T allele (p = 0.03). In addition, IVS1-6T>C and IVS1insA polymorphisms in intron 1 were associated with kidney stone disease (p < 0.001). Regarding single nucleotide polymorphism 447, mean (standard deviation) of serum calcitonin levels were 16.7 (18.7) pg/ml, 10.5 (11.0) pg/ml and 9.94 (9.7) pg/ml in subjects with TT, TC and CC genotypes, respectively (p = 0.01). CONCLUSION: Our data indicate a potential association between 3'UTR+18C>T and intron 1 polymorphisms in the CALCR and the risk of kidney stone disease.

Omega-3 fatty acids are protective against paclitaxel-induced peripheral neuropathy: a randomized double-blind placebo controlled trial.

BACKGROUND: Axonal sensory peripheral neuropathy is the major dose-limiting side effect of paclitaxel.Omega-3 fatty acids have beneficial effects on neurological disorders from their effects on neurons cells and inhibition of the formation of proinflammatory cytokines involved in peripheral neuropathy. METHODS: This study was a randomized double blind placebo controlled trial to investigate the efficacy of omega-3 fatty acids in reducing incidence and severity of paclitaxel-induced peripheral neuropathy (PIPN). Eligible patients with breast cancer randomly assigned to take omega-3 fatty acid pearls, 640 mg t.i.d during chemotherapy with paclitaxel and one month after the end of the treatment or placebo. Clinical and electrophysiological studies were performed before the onset of chemotherapy and one month after cessation of therapy to evaluate PIPN based on "reduced Total Neuropathy Score". RESULTS: Twenty one patients (70%) of the group taking omega-3 fatty acid supplement (n = 30) did not develop PN while it was 40.7%( 11 patients) in the placebo group(n = 27). A significant difference was seen in PN incidence (OR = 0.3, .95% CI = (0.10-0.88), p = 0.029). There was a non-significant trend for differences of PIPN severity between the two study groups but the frequencies of PN in all scoring categories were higher in the placebo group (0.95% CI = (-2.06 -0.02), p = 0.054). CONCLUSIONS: Omega-3 fatty acids may be an efficient neuroprotective agent for prophylaxis against PIPN. Patients with breast cancer have a longer disease free survival rate with the aid of therapeutical agents. Finding a way to solve the disabling effects of PIPN would significantly improve the patients' quality of life. TRIAL REGISTRATION: This trial was registered at ClinicalTrials.gov (NCT01049295).

Coding region analysis of vitamin D receptor gene and its association with active calcium stone disease.

The purpose of this study was to evaluate the impact of vitamin D receptor (VDR) gene polymorphisms on the status of active renal calcium stone formation. Male active renal calcium stone formers (ASF, final N = 106) with two episodes of stone relapse in the past 5 years were enrolled from December 2008 to April 2009. Controls (N = 109) were selected from age range- and gender-matched individuals who had no evidence or history of stone disease. Sequencing and single-strand conformational polymorphism were used to determine VDR polymorphisms in the patients and controls. Three polymorphisms were identified in the VDR gene: (1) start codon polymorphism (rs2228570T>C; p.M1T); (2) C/T polymorphism in the second intron (NT-029419.12: g.10416049C>T); (3) a silent polymorphism in exon 9 (rs731236T>C; p.I352I). Start codon polymorphism was the only one that was associated with the status of calcium stone formation (p < 0.05). We performed a complete coding genome analysis of VDR gene and observed that only start codon polymorphism was related to the status of active calcium stone formation.

Effects of oral magnesium supplementation on inflammatory markers in middle-aged overweight women.

BACKGROUND: This study aimed to investigate whether magnesium supplementation might affect serum magnesium, high sensitive C-reactive protein (hs-CRP), plasma fibrinogen, and interleukin 6 (IL-6) levels in healthy middle-aged overweight women. The relationships, if any, between serum magnesium and the inflammatory markers were also examined cross-sectionally in the entire participants at the beginning of the study. MATERIALS AND METHODS: This double-blinded, placebo-controlled, randomized trial included 74 middle-aged overweight women. Participants were randomly assigned to receive either 250 mg magnesium as magnesium oxide or placebo daily for 8 weeks. Serum magnesium, hs-CRP, fibrinogen and IL-6 concentrations were measured before and after the intervention. RESULTS: Serum magnesium was found to be inversely correlated with hs-CRP (rs =-0.22, P=0.05) in the entire participants at baseline. Serum hs-CRP declined significantly in both groups as compared with baseline values (median change=0.8 mg/L; PMagnesium= 0.03, PPlacebo < 0.001). Plasma fibrinogen decreased significantly, by 9%, in the magnesium group at the end of week 8 compared to baseline (P=0.001). Mean concentration of IL-6 was significantly increased in the magnesium group comparing the baseline value(P=0.001). However hs-CRP, fibrinogen and IL-6 levels at week 8 or any changes during the study were not statistically different between the two groups. Serum magnesium showed no significant changes in any groups. CONCLUSIONS: Serum magnesium had a significant inverse correlation with hs-CRP. In the present study, magnesium as magnesium oxide, 250 mg/day, for 8 weeks did not significantly attenuate inflammatory markers in the magnesium group as compared to the placebo.

CAG repeats and one polymorphism in androgen receptor gene are associated with renal calcium stone disease.

PURPOSE: Evidence suggests that androgens can be involved in the pathogenesis of renal stones. This study aimed at investigating coding region polymorphisms and CAG repeats in androgen receptor (AR) and their association with active renal calcium stone disease. MATERIALS AND METHODS: Male patients with calcium kidney stones (N = 106) with at least two episodes of stone recurrence or size increase during the past 5 years (ASF) were enrolled from December 2008 to April 2009. Control individuals were recruited after matching for age and gender from healthy individuals without current stone or history of stone disease. Genetic sequencing and single strand conformational polymorphism (SSCP) were used to determine AR polymorphisms in the patients and controls. RESULTS: Two polymorphisms were identified in the AR gene: Silent G to A polymorphism in the first exon of the AR gene and C to G polymorphism in intron 4. CAG repeats ranged from 12 to 37. The C/G polymorphism in intron 4 and CAG repeats were associated with the status of active renal calcium stone disease (all p < 0.05). The CC variant of C/G polymorphism was not observed in patients with stone disease. CAG repeats less than 20 and more than 28 were mostly observed in ASF patients (p < 0.05). CONCLUSIONS: CAG repeats and intron 4 C/G polymorphism in the AR gene have an association with renal calcium stone disease.

An assessment of parathyroid hormone, calcitonin, 1,25 (OH)2 vitamin D3, estradiol and testosterone in men with active calcium stone disease and evaluation of its biochemical risk factors.

The aim of this study is to investigate the serum levels of parathyroid hormone (PTH), calcitonin, 1,25 (OH)(2) vitamin D3, estradiol and testosterone in male patients with active renal calcium stone disease compared with controls and investigate their relationship with serum/urinary biochemistry. Male active renal calcium stone formers (ASF) were enrolled from December 2008 to April 2009. Controls were selected from age and sex matched individuals. Two 24-h urine samples and a blood sample were withdrawn from each participant while they were on free diet. Serum 1,25 (OH)(2) vitamin D3 levels in the ASF and control groups were 127 ± 40 and 93 ± 35 pmol/l (p < 0.001). Serum levels of PTH, calcitonin, estradiol and testosterone were not statistically different between the ASF and control groups (all p > 0.05). Serum 1,25 (OH)(2) vitamin D3 was associated with higher urinary excretion of calcium and phosphorus in ASF patients. Serum levels of calcitonin were related to less urinary excretion of calcium in the control group. Serum testosterone was related to higher urinary excretion of uric acid in ASF patients and to higher urinary excretion of oxalate in the control group. 1,25 (OH)(2) Vitamin D3 is an important hormone in the pathogenesis of recurrent renal calcium stone disease and could increase renal stone risk by increasing the urinary excretion of calcium and phosphorus. There is a possibility of testosterone involvement in the pathogenesis of renal stones through higher urinary uric acid and oxalate excretion.

The hidden epidemic of urinary incontinence in women: a population-based study with emphasis on preventive strategies.

INTRODUCTION AND HYPOTHESIS: Urinary incontinence (UI) is a prevalent clinical condition especially among women aged 40 years and above. It is not often reported as it is considered an age-related problem. This study attempts to estimate UI among women above 40 years and its determinants in an area zone of Tehran, Iran. METHODS: In this cross-sectional study, a total of 800 women were selected from residents of area zone 17 of Tehran. RESULTS: Prevalence of UI is estimated to be 38.4% (95% CI, 0.35-0.42). Our findings show that those who suffer from osteoarthritis or chronic cough, had any type of internal surgery, had rupture during delivery, and had no regular exercise are significantly at higher risk of UI. CONCLUSION: The rather high prevalence of UI among middle-aged women has negative impact on women's quality of life; therefore, strategies regarding prevention and management, medical education, and research programs have been proposed.

Association between calcium-sensing receptor gene polymorphisms and recurrent calcium kidney stone disease: a comprehensive gene analysis.

OBJECTIVE: Comprehensive sequencing of the coding exons of the calcium-sensing receptor gene (CASR) was performed in a group of Iranian recurrent calcium kidney stone-formers and the results were compared with a control group. MATERIAL AND METHODS: Serum and urine parameters were evaluated in 99 males aged between 30 and 55 years old with idiopathic recurrent calcium urolithiasis and in 107 men as a control group. Products of polymerase chain reaction were sequenced using forward primer until a mutation was found in that exon. Then, other cases were analysed by single-strand conformation polymorphism. RESULTS: Four polymorphisms were detected in CASR exons, all in the coding region of exon 7. These polymorphisms and their minor allele frequency were P748P (100%), A986S (1%), R990G (3%) and E1011Q (98%). There was a significantly higher count of 986S (p = 0.006), 990G (p = 0.006) and E1011 (p = 0.02) alleles in patients. The odds ratio (95% confidence interval) was 2.55 (1.31-4.96) in those at risk of stone disease for the 986S allele and 8.06 (1.80-35.9) for the 990G allele. Men with the RR genotype at R990G showed a significantly higher serum ionized calcium than the RG or GG group (p = 0.03). A significantly lower serum total calcium was found in subjects with the QQ than the EQ genotype with respect to the 1011 locus (p = 0.005). Furthermore, the 1011Q allele was marginally associated with hypercalciuria (p = 0.05). CONCLUSION: The 986S, 990G and 1011Q alleles were associated with a recurrent calcium kidney stone-forming state. 986S and 1011Q alleles, but not 986S, were associated with hypercalcaemia.

A comparative study of two root-coverage techniques with regard to interdental papilla dimension as a prognostic factor.

This study was designed to evaluate the effectiveness of subepithelial connective tissue graft (SCTG) and acellular dermal matrix allograft (ADMA) in root coverage procedures and to examine the effect of interdental papilla dimensions on the outcome of root coverage using a new approach. This randomized controlled clinical study included 32 gingival recession defects of at least 2 mm classified as Miller Class I or II. Clinical parameters were measured at baseline and 6, 12, and 24 weeks postsurgery. At baseline, all measured clinical parameters were statistically equivalent between the two groups. With regard to the amount of mean root coverage, no significant difference was found between ADMA (85.42%) and SCTG (69.05%) groups. However, the percentage of complete root coverage was significantly greater in the ADMA group (75.0%, versus 31.3% in the SCTG group). Significant positive correlations were found between papilla height and papilla width and mean root coverage, and papilla height of at least 5 mm was associated with complete root coverage. ADMA seems to be a good substitute for SCTG to treat shallow to moderate gingival recessions. In addition, papilla dimensions, as measured using the new method, can help predict the success of future root coverage.

Effects of Qigong exercises on 3 different parameters of human saliva.

OBJECTIVE: To analyze the effects of a Qigong program on various parameters of unstimulated saliva, including volume, pH and secretory immunoglobulin A (S-IgA) level. METHODS: Twice a day from the beginning of Fall 2005, twenty-three healthy volunteers aged 22-24 did special Qigong exercises and massage of acupuncture points which stimulated the energy cycle and increased body water energy. The unstimulated saliva volume and pH were recorded every week in Spring (April, May, June) 2005 before the volunteers started to learn and exercise Qigong, and after Qigong intervention in Spring (April, May, June) 2006. During the period of study, saliva was collected in the same location and on similar dates at the Dental Faculty of Tehran University of Medical Sciences. The S-IgA levels of the last samples of the last week of Spring 2005 and 2006 were measured. RESULTS: The unstimulated saliva volume after Qigong exercises (2.94 + or - 0.20 mL/5min) was significantly higher as compared to the pre-Qigong phase (1.65 + or -0.102 mL/5min, P<0.05). The S-IgA level was 105.45 + or - 9.41 mg/mL before doing Qigong exercises, and 156.23 + or - 88.56 mg/mL after doing Qigong exercises, and a statistically significant difference was seen between the two measurements (P=0.005). The change in pH was not statistically significant. CONCLUSIONS: The application of Qigong is beneficial for increasing salivary volume and other parameters. Moreover, the results suggest that Qigong may be a useful medication for patients with salivary hyposecretion. Further research is recommended in examining the long-term effects of Qigong on improving salivary volume and other parameters in individuals with salivary hyposecretion.

Anatomic and visual outcomes of scleral buckling versus primary vitrectomy in pseudophakic and aphakic retinal detachment: six-month follow-up results of a single operation--report no. 1.

PURPOSE: To compare the anatomic and visual results and complications of conventional scleral buckling versus primary vitrectomy for management of pseudophakic and aphakic retinal detachment. DESIGN: Prospective, randomized, multicenter clinical trial. PARTICIPANTS: Two hundred twenty-five eyes of 225 patients with pseudophakic or aphakic retinal detachment. INTERVENTION: Eligible eyes were assigned randomly either to conventional scleral buckling or primary vitrectomy without any buckle. MAIN OUTCOME MEASURES: Visual results, retinal reattachment rate, proliferative vitreoretinopathy, macular pucker, cystoid macular edema, choroidal detachment, intraocular pressure, extraocular muscle dysfunction, and anisometropia. RESULTS: There were no statistically significant differences between the 2 treatment groups regarding the single-operation retinal reattachment rate at the 1-, 2-, 4-, and 6-month follow-up examinations. Patients in the buckle group had 28% greater likelihood of anatomic success compared with those in the vitrectomy group (odds ratio, 1.28; 95% confidence interval, 0.73-2.24), indicating no statistically significant difference. Proliferative vitreoretinopathy was the main cause of anatomic failure in both groups and occurred independent of the surgical technique used. Best-corrected visual acuity at the 1-, 2-, 4-, and 6-month postoperative follow-up examinations showed no statistically significant difference between the 2 groups. Six months after surgery, 12.8% of eyes in the buckle group and 11.3% of eyes in the vitrectomy group achieved visual acuity of 20/40 or better. The difference between the 2 groups was not statistically significant. Corresponding figures were 66.3% and 64.5% for visual acuity of 20/200 or better in the buckle and vitrectomy groups, respectively, again with no statistically significant difference. There were no statistically significant differences in rates of complications. CONCLUSIONS: Scleral buckling and primary vitrectomy without an encircling band have comparable results in pseudophakic and aphakic retinal detachment. The choice of surgical technique depends on various factors, including patient compliance, cost of surgery, experience and capability of surgeons, and availability of appropriate instrumentation.

Effects of CoQ10 Supplementation on Lipid Profiles and Glycemic Control in Patients with Type 2 Diabetes: a randomized, double blind, placebo-controlled trial.

BACKGROUND: Low grade inflammation and oxidative stress are the key factors in the pathogenesis and development of diabetes and its complications. Coenzyme Q10 (CoQ10) is known as an antioxidant and has a vital role in generation of cellular energy providing. This study was undertaken to evaluate the effects of CoQ10 supplementation on lipid profiles and glycemic controls in patients with diabetes. METHODS: Fifty patients with diabetes were randomly allocated into two groups to receive either 150 mg CoQ10 or placebo daily for 12 weeks. Before and after supplementation, fasting venous blood samples were collected and lipid profiles containing triglyceride, total cholesterol, low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) and glycemic indices comprising of fasting plasma glucose (FPG), insulin and hemoglobin A1C (HbA1C) were measured. Insulin resistance was calculated using HOMA-IR index. RESULTS: Forty patients completed the study. After intervention FPG and HbA1C were significantly lower in the CoQ10 group compared to the placebo group, but there were no significant differences in serum insulin and HOMA-IR between the two groups. Although total cholesterol did not change in the Q10 group after supplementation, triglyceride and HDL-C significantly decreased and LDL-C significantly increased in the CoQ10 group. CONCLUSION: The present study showed that treatment with Q10 may improve glycemic control with no favorable effects on lipid profiles in type 2 patients with diabetes. TRIAL REGISTRATION: IRCT registry number: IRCT138806102394N1.

What are Differences between Non-injecting and Injecting Drug Addicts?

BACKGROUND: This study aims to identify the differences between Injecting Drug Users (IDUs) and non-IDUs, with regard to some potential factors. This could be useful to design effective interventions for harm reduction, which is one of the priority areas in reducing the burden of addiction. METHODS: Sixty cases and 60 controls participated in this pair-matched case-control study, which was conducted in Tehran. The cases were IDUs who were asked to introduce two friends; one IDU and the other non-IDU as the paired control. In addition to demographic variables, onset age of cigarette smoking, dropping out of school, imprisonment, history of being sexually abused for money, and family history of using illegal drugs were obtained from the cases and controls via an interview. Pair Odds Ratio (OR) was estimated through McNemar and conditional multivariable logistic regression analysis. RESULTS: Eighty-three % of the IDUs and 92% the controls were male. The mean for onset age of cigarette smoking was 16 in the cases and 20 in the controls, which was significantly different between cases and controls (P<0.001). In the multivariate analysis, dropping out from school was significantly different between cases and controls (OR=4.22 95% CI: 2.23 - 14.0). Imprisonment was more frequent in IDUs compared to non-IDUs (OR=3.70 95% CI: 1.09 - 11.08). The cases had more sexual relationship for earning money compared to the controls (OR=3.14 95% CI: 1.24 - 13.70). Onset age of cigarette smoking was significantly (P<0.001) sooner in the IDUs compared to the non-IDUs (15.9 and 20.1 years, respectively). IDUs reported 5.5 times more that non-IDUs of having an addict in their family (P value=0.04). CONCLUSION: The finding of this study can be useful in identifying the persons who are at risk of IDU. Therefore, people who involve with risk factors recognized in this study should be triggered for harm reduction prevention strategies.

Decomposing socioeconomic inequality in self-rated health in Tehran.

BACKGROUND: Measuring the distribution of health is a part of assessing health system performance. This study aims to estimate health inequality between different socioeconomic groups and its determinants in Tehran, the capital of Iran. METHODS: Self-rated health (SRH) and demographic characteristics, including gender, age, marital status, educational years, and assets, were measured by structured interviews of 2464 residents of Tehran in 2008. A concentration index was calculated to measure health inequality by economic status. The association of potential determinants and SRH was assessed through multivariate logistic regression. The contribution to concentration index of level of education, marital status and other determining factors was assessed by decomposition. RESULTS: The mean age of respondents was 41.4 years (SD 17.7) and 49% of them were men. The mean score of SRH status was 3.72 (range: 1-5; SD 0.93). 282 respondents (11.5%) rated their health status as poor or very poor. The concentration index was -0.29 (SE 0.03; p<0.001). Age, marital status, level of education and household economic status were significantly associated with SRH in both the crude and adjusted analyses. The main contributors to inequality in SRH were economic status (47.8%), level of education (29.2%) and age (23.0%). CONCLUSIONS: Sub-optimal SRH was more in lower than in higher economic status. After controlling for age, the levels of education and household wealth have the greatest contributions to SRH inequality.

The effect of platelet-rich plasma on healing of palatal donor site following connective tissue harvesting: a pilot study in dogs.

BACKGROUND: Peri-implant plastic surgery includes soft tissue enhancement by connective tissue grafting. The palatal donor site provides peri-implant keratinized mucosa and soft tissue height. Platelet-rich plasma (PRP) contains growth factors that may enhance early healing. PURPOSE: The present animal study investigated the effect of PRP on wound healing of palatal donor site after connective tissue harvesting. MATERIALS AND METHODS: In 12 mongrel dogs, bilateral palatal connective tissues of 10 × 15 mm were harvested. At test site, PRP was applied into the wound, and the contralateral site served as control. The healing was evaluated clinically and histologically at 1 week, 2 weeks, and 4 weeks after surgeries. Exact binomial probability and Wilcoxon signed-rank test were used to compare the clinical and histologic measurements. RESULTS: No statistically significant differences between PRP and control sites were measured with regard to clinical healing (p = 1.000) and histologic variables, including inflammatory cells (p = .750), collagen fibers (p = .375), and granulation tissue (p = .500) at any time interval. CONCLUSION: The addition of PRP to palatal mucosal wound sites did not accelerate wound healing.

Reasons for smoking among male teenagers in tehran, iran: two case-control studies using snowball sampling.

OBJECTIVES: Identifying the underlying factors contributing to smoking among teenagers is important in establishing smoking control programs. The present study was designed to identify and compare factors revealed in a preceding qualitative study conducted on 13-15 year-old boys living in two different socio-economic districts in the Northern and Southern parts of Tehran. METHODS: Two completely similar case-control studies, each with 200 subjects, were conducted using a snowball sampling. The case and control subjects were matched based on the intimacy relations, i.e. six smokers were recruited in each of the Northern and Southern districts; they were then asked to introduce one of their smoker friends as a case and a non-smoker one as a control. RESULTS: Multi-variable conditional logistic regression revealed that having a smoker father is the single effective factor in the two districts. As for boys living in the Northern (wealthier) part of the city, social capital (OR: 0.59, 95% CI: 0.43-0.81) played a protective role against smoking, whereas quitting home after a quarrel (OR: 15.07, 95% CI: 1.54-147.25), monthly allowance (OR: 2.22, 95% CI: 1.29-3.82) and hyperactivity (OR: 1.69, 95% CI: 2.64-240.45) were associated with a higher risk of becoming a smoker. CONCLUSIONS: The studied variables can be classified as personal, familial, and school-level factors. Familial intervention is effective for all the factors which revealed to be influential on the risk of becoming a smoker. It could be concluded that interventions on the family level should be used to prevent the cigarette use in Tehran.

Comparison of onset age and pattern of male adolescent smoking in two different socioeconomic districts of tehran, iran.

OBJECTIVES: One of the main strategies to prevent smoking is delaying onset of smoking in adolescents. Thus, identifying the age of smoking and smoking pattern in adolescents gives important knowledge for planning the intervention programs on smoking. METHODS: Students aged 13-15 years old living in the Northern and the Southern Tehran were selected through two separate snowball samplings. In each area six smokers were considered as the seeds and were asked to introduce a smoker friend. The sampling continued until one hundred study subjects were recruited in each area. RESULTS: Although in the area with wealthier socioeconomic status the age at which smoking started was one year more, the number of days of smoking, number of consumed cigarettes, not willingness to quit smoking, ease of access to cigarettes, mother and siblings smoking were more frequent. In contrast, seeing anti-smoking advertisements, father smoking, teachers smoking and education about the adverse effects of smoking were lower than the area with poorer socioeconomic status. CONCLUSIONS: The community level interventions such as not selling cigarettes to juniors, quit smoking help and support, and education of families must be revised. The role of families, through the supervision and control over their children, and parents' avoidance of smoking should be emphasized.

Comparison of Generalized Estimating Equations and Quadratic Inference Functions in superior versus inferior Ahmed Glaucoma Valve implantation.

BACKGROUND: The celebrated generalized estimating equations (GEE) approach is often used in longitudinal data analysis While this method behaves robustly against misspecification of the working correlation structure, it has some limitations on efficacy of estimators, goodness-of-fit tests and model selection criteria The quadratic inference functions (QIF) is a new statistical methodology that overcomes these limitations. METHODS: We administered the use of QIF and GEE in comparing the superior and inferior Ahmed glaucoma valve (AGV) implantation, while our focus was on the efficiency of estimation and using model selection criteria, we compared the effect of implant location on intraocular pressure (IOP) in refractory glaucoma patients We modeled the relationship between IOP and implant location, patient's sex and age, best corrected visual acuity, history of cataract surgery, preoperative IOP and months after surgery with assuming unstructured working correlation. RESULTS: 63 eyes of 63 patients were included in this study, 28 eyes in inferior group and 35 eyes in superior group The GEE analysis revealed that preoperative IOP has a significant effect on IOP (p = 0 011) However, QIF showed that preoperative IOP, months after surgery and squared months are significantly associated with IOP after surgery (p < 0 05) Overall, estimates from QIF are more efficient than GEE (RE = 1 272). CONCLUSIONS: In the case of unstructured working correlation, the QIF is more efficient than GEE There were no considerable difference between these locations, our results confirmed previously published works which mentioned it is better that glaucoma patients undergo superior AGV implantation.

Can criteria for identifying educational influentials in developed countries be applied to other countries? A study in Iran.

INTRODUCTION: There are published criteria for identifying educational influentials (EIs). These criteria are based on studies that have been performed in developed countries. This study was performed to identify criteria and characteristics of EIs in Iran. METHODS: The study was conducted on residents, interns, and clerks at a major educational hospital in Iran. This study had 3 stages: (1) preparation of an inclusive list of EI characteristics through 3 focus group discussions with 22 individuals, in which 30 primary characteristics of EIs were found; (2) reducing the number of characteristics by examining 154 individuals for exploratory factor analysis and internal consistency evaluation by Cronbach's alpha, after which the characteristics were reduced to 25; (3) finalizing the criteria through discriminant validity. RESULTS: Fifteen characteristics were identified in 4 domains: (1) knowledge (high level of clinical knowledge, being up-to-date and an expert, high level of clinical skills); (2) communication skills (good communication with others, easily accessible, good public relations, and oratory); (3) taking into account the stakeholders (involving patients in decision making, allowing students to identify problems, delivering decisions to others, and interest in transfer of material); and (4) professional ethics (pursuing the patients' maximum benefit, observing ethics in education and research). Overall, they have a sensitivity and specificity of 87% and 74%, respectively. DISCUSSION: Three of the four domains we found were already identified in other studies; however, the "taking into account the stakeholders" domain has not been previously reported. The other domains and criteria were similar to those found in developed countries.