The Efficacy and Safety of Rapamycin in Children with Tuberous Sclerosis: A Cross-sectional Study.

Objectives: Mutations in TSC1 or TSC2 genes have been proposed as the main causative factors responsible for developing Tuberous Sclerosis Complex (TSC). Given the effect of these two genes on the mTOR pathway, rapamycin has emerged as a novel therapeutic agent. The present study evaluated the effectiveness and safety of rapamycin on the multiple manifestations of TSC. Materials & Methods: Twenty-three eligible children were enrolled in the present cross-sectional study. They were prescribed rapamycin 1mg tablet twice daily for the first two weeks of treatment and then once daily for at least one year. Periodic evaluations through follow-up visits were performed. Besides, growth and developmental statuses were evaluated. All data, including the number and size of brain tuberomas, size of renal angiomyolipomas, and skin lesions, were gathered and recorded, and then analyzed. Results: During the study period, the mean number of epileptic episodes significantly reduced (p<0.0001), and nine cases were seizure-free at the final visit. The mean number of brain tuberomas decreased from 19.3±11.0 at the initial visit to 11.1±5.6 and 8.2±3.2 in the subsequent visits (p<0.001). The mean size of brain tuberomas similarly decreased from 17.9±18.5 cm at enrollment to 13.7±5.1 cm and 6.9±5.1 cm in the second and third visits, respectively (p=0.029). The mean size of renal angiomyolipomas significantly decreased (p<0.001). A significant trend toward a decrease in the number of skin lesions was observed (p<0.0001). No relationship was observed between the effects of rapamycin and the patient's age or sex (p>0.05). Changes in patients' growth and developmental features were not statistically significant through subsequent visits (p=0.507). Conclusion: This study revealed the effectiveness and safety of rapamycin on TSC among our patients.

Efficacy and safety of hydrogen peroxide topical solution in treating actinic keratosis: A randomized controlled trial.

Actinic keratosis (AK) is a precancerous skin lesion associated with the development of squamous cell carcinoma. Approved topical treatments for AK are unmet needs. To evaluate the safety and efficacy of hydrogen peroxide topical solution 35% (H2 O2 ) with cryosurgery for the treatment of AKs. Eligible subjects were randomly assigned to receive H2 O2 and cryosurgery on each side of their scalp/face. Patients were assessed at baseline and after 3 months of follow-up. Efficacy was evaluated based on the Actinic Keratosis Area and Severity Index (AKASI) and dermoscopic assessments. Fifteen patients with 98 lesions completed the study. At the follow-up visit, the mean improvement of AKASI from baseline was 1.7 ± 0.9 for H2 O2 and 1.7 ± 0.8 for cryosurgery (p < 0.001, both). Both treatments significantly improved dermoscopic features of yellow scale, white scale, linear-wavy vessels, pigmented dots, and rosette at the end of the 3-month follow-up. Complete dermoscopic response occurred in 57.7% and 73.9% of lesions treated with H2 O2 and cryosurgery, respectively (p > 0.05). Regarding safety, hypopigmentation occurred more frequently in the cryosurgery group (28.3% vs. 9.6%; p = 0.017). Moreover, patients endured more pain with cryosurgery application than H2 O2 (p < 0.001). The effect of H2 O2 solution was comparable to cryosurgery. This treatment was well tolerated and had a favorable safety in patients with AKs.

Determining effectiveness of EBM education in otolaryngology residents using modified fresno test.

OBJECTIVE: To determine the effectiveness of education in evidence-based medicine (EBM) on the knowledge, competency, and skills of otolaryngology residents of Tehran University of Medical Sciences (TUMS) at Amir-Alam and Imam Khomeini Hospitals. METHODS: In a quasi-experimental (before-and-after) study, all ear, nose, and throat residents of TUMS (n = 41) entered the study. The residents underwent the modified Fresno test. Then, two EBM workshops with a similar content were held on 2 separate days in each hospital, with each session lasting 6 hours. The learned material was practiced in weekly journal clubs. Six months after the workshop, the modified Fresno test was applied again, and the results were analyzed. RESULTS: A significant improvement in the modified Fresno test score was observed. The mean score of the modified Fresno test was 57.43 ± 22.07 before the workshop and 79.26 ± 22.48 after the workshop (P < 0.001). CONCLUSION: The results of the study show that EBM education and practice of the learned materials in journal clubs can improve the knowledge and skills of residents. Further research with larger samples is needed to improve the precision of our findings and to increase confidence in the results. LEVEL OF EVIDENCE: 2 Laryngoscope, 129:2291-2294, 2019.

Are Osteopontin and Ki67 Expressions Different in Various Histologic Grades of Meningioma? An Iranian Experience.

BACKGROUND: Meningioma is among the most common slow growing central nervous neoplasms, which recurs locally despite the benign histologic features. The aim of this study was to evaluate osteopontin and ki67 expressions in different histologic grades of meningioma in a group of Iranian people. METHODS: In this cross-sectional study, first, the paraffin blocks with the definite pathological diagnosis of meningioma in 70 patients were cut by microtome, in 4-5 micron sizes and stained for immunohistochemical markers of osteopontin and ki67. Then, all samples were evaluated for positive immunoreactivity and contributing factors. RESULTS: Among 70 pateints studied, the mean for the Ki67 level was 8.6±12.3 and the mean for the osteopontinm IHC score was 45.2±77.9. There was a high correlation between markers, tumor recurrence and grade (P<0.001). In addition, there was a significant direct correlation between ki67 and osteopontin levels (P<0.001, r=0.760). In other words, as OPN and ki67 expressions increased, the chance of tumor recurrence increased. CONCLUSION: ki67 and osteopontin expressions in patients with meningioma can be used as good prognostic markers for tumor recurrence and for distinguishing the grade of meningiomas.

Are andropause symptoms related to depression?

BACKGROUND: Andropause is a middle-age condition in which men experience changes in their physical, spiritual and emotional health. The association between andropause and psychological symptoms such as depression are not very clear yet. AIMS: The objective of this study was therefore to determine the association between the 'Aging Males Symptoms Scale' (AMS) and depression. METHODS: A cross sectional study was conducted among 521 old men. To collect data, the AMS and the Patient Health Questionnaires 2 and 9 were used to screen depression, in addition to questions on background and fertility. Multiple linear regression analysis was used to assess the association between andropause symptoms and depression. RESULTS: Based on our results and the AMS score, 51.5% of the study population had clinical symptoms of androgen disorder, 3.7% of which had severe symptoms. There was a strong correlation between the AMS score and depression. Depression, diabetes, cigarette smoking and spousal age retained their significant associations even after entering the relevant demographic, anthropometric, smoking and disease variables in the multivariable model. As a positive predictive factor, depression had the strongest association with AMS. CONCLUSIONS: Based on our results, there is a direct association between andropause symptoms and depression, where the increasing AMS score corresponds with the severity of depression. DISCUSSION: Our results show the need of screening for depression when evaluating andropause symptoms.

Evaluation of pediatric voice handicap index and pediatric voice related quality of life before and after adenotonsillectomy in pediatric population.

OBJECTIVE: To study changes in Pediatric Voice Handicap Index (PVHI) and Pediatric Voice Related Quality of Life (PVRQOL) before and after adenotonsillectomy in short term follow up. METHODS: Quasi-experimental (before and after study). Eighty-six children aged 3-13 years (58 boys, 28 girls) with adenotonsillar problems (whether with obstructive or infectious surgical indications) who were admitted for adenotonsillectomy procedure. Parents of children were asked to complete PVHI and PVRQOL questionnaires prior to surgery and 1 month after it. RESULTS: Reliability of the PVRQOL and PVHI was established by evaluation of Cronbach α value. Cronbach α for PVHI was 0.92 and for PVRQOL it was 0.83. Preoperative values for the PVHI were: mean±SD; 14.39±14.65. Preoperative values for the PVRQOL were: mean±SD; 92.60±10.82. PVHI showed significant improvement after surgery: mean±SD; 2.93±6.98 (P<0.001). Postoperative PVRQOL had a significant improvement: mean±SD; 98.11±5.82 (P<0.001). CONCLUSION: Adenotonsillectomy improved PVHI and PVRQOL scores in children with adenotonsillar problems, regardless of obstructive or infectious surgical indications.

Ankle-Brachial Index as a Prognostic Factor and Screening Tool in Coronary Artery Disease: Does it Work?

BACKGROUND: Given the lack of consistency in the literature regarding the reliability of the ankle-brachial index (ABI) as a valid screening tool and an independent risk indicator of cardiovascular events and mortality, we compared it with angiography as a reference standard test. METHODS: This case-control study, conducted between 2010 and 2011 in Tehran Heart Center, recruited 362 angiographically confirmed cases of coronary artery disease (CAD) and 337 controls. A standard protocol was used to measure the ABI and different CAD risk factors. RESULTS: A low ABI had specificity of 99.7%, positive predictive value of 95.8%, negative predictive value of 49.8%, sensitivity of 64%, likelihood ratio of 24.07, and odds ratio (OR) of 22.79 (95%CI: 3.06-69.76). The role of the associated risk factors was evaluated with OR (95%CI), with the variables including gender 3.15 (2.30-4.30), cigarette smoking 2.72 (1.86-3.99), family history 1.72 (1.17-2.51), diabetes 1.66 (1.15-2.4), and dyslipidemia 1.38 (1.02-1.88). In a multivariate model, the following variables remained statistically significantly correlated with CAD [OR (95%CI)]: ABI 13.86 (1.78-17.62); gender 3.69 (2.43-5.58); family history of CAD 2.18 (1.41-3.37); smoking 1.69 (1.08-2.64); age 1.04 (1.02-1.06). CONCLUSIONS: A low ABI had specificity of 99.7%; however, because of its low sensitivity (64%), we should consider CAD risk factors associated with a low ABI in order to use it as a first-line screening test.

Attitudes, concerns, perceived impact and coping strategies for avian influenza among the first year medical students and interns in Tehran University of Medical Sciences.

To study and compare the attitudes, concerns, perceived impact and coping strategies for avian influenza (AI) among the first year medical students (FYMS) and interns in Tehran University of Medical Sciences. This was a cross sectional study carried out on FYMS (n=158) and interns (n=158) in 2008. The data collection tool was a questionnaire containing 37 questions in five parts. The three choices including "agree, disagree and unsure" were considered for all questions. We used Chi-square and Fisher's exact tests for analysis. Most of FYMS and interns (78.2%) believed their health would be depended on the care of their selves. Most of them (95.3%) believed that if they knew avian flu better, they could be more prepared for it. The majority were concerned about risk to their health from their work (62.7%). Most (67.7%) accepted the risk and only 5 (1.6%) would consider stopping work. For non-work concerns, 70.9% were concerned about their spouses/sexual partners and 65.8% about their children. For perceived impact, most (66.5%) believed that they would feel stressed at work and the majority (74.4%) expected an increased workload. FYMS and interns have positive attitudes but major concerns about contracting AI and its relation to medical practice.

Health-related quality of life in Iranian women with different levels of physical activity.

PURPOSE: One of the most significant current discussions is the effect of different levels of physical activity on health-related quality of life (HRQOL), but there have been no studies in Iran which investigate this issue. The aim of this study was to investigate the relationship between the level of physical activity and HRQOL in Iranian women. METHODS: This was an analytical cross-sectional study conducted from October 2010 to January 2011 in Karaj's gymnasiums. We selected gymnasiums using simple randomized sampling. The validated Persian short form 36-item HRQOL questionnaire version 2.0 (SF-36 v2) and the short form of the International Physical Activity Questionnaire were used for data collection. Based on IPAQ, participants were classified into two groups: one with a high level of physical activity (N=240) and another with a moderate level (N = 120). RESULTS: The group with a high level of physical activity had significantly higher vitality scores (P=0.01) and lower role limitation-physical scores (P=0.02) than the group with a moderate level. The high level of physical activity was associated with considerably higher scores in general health (73.94 ± 0.99 vs.70.82 ± 1.33) (P=0.06) and mental well-being (73.94 ± 1.18 vs.70.88 ± 1.82) (P=0.1) domains than moderate level. CONCLUSIONS: It seems that the high level of physical activity, compared with the moderate level, tends to have positive association with more domains of SF-36 v2.

Teaching evidence-based medicine more effectively.

UNLABELLED: Evidence-based Medicine (EBM) is becoming an integral component of graduate medical education competency and a requirement for grad medical education practice-based learning core competency. This study tries to compare the efficacy of conferences utilizing small-group discussions with the traditional conference method in enhancing EBM competency. The participants in this randomized controlled trial (RCT) were 170 members of the medical faculty who were divided into two groups of 86 (intervention) and 84 (control). Following the intervention, EBM competency was assessed by a written examination. statistical analysis made use of chi-square test, independent sample t-test and relative risks for univariate analysis. Mantel-Hanszel was used for bivariate analysis. Cox proportional hazard models were used to evaluate multivariate-adjusted associations between EBM educational intervention and EBM knowledge, attitude and skills. A new indicator of number needed to intervention (NNI) was defined and computed. RESULTS: The results proved conference along with small-group discussion to be a more effective teaching method with P=0.001 on knowledge, P<0.001 for attitude and skills P<0.001 in an EBM exam when compared with medical faculty members who did not participate in EBM educational intervention (n=84). Moreover, they had also increased confidence with critical appraisal skills, and searching EBM resources. CONCLUSIONS: Conferences followed by small-group discussions significantly enhance EBM knowledge, attitude, critical appraisal skills and literature review skills.

Station-based deconstructed training model for teaching procedural skills to medical students: a quasi-experimental study.

BACKGROUND: Every procedural skill consists of some microskills. One of the effective techniques for teaching a main procedural skill is to deconstruct the skill into a series of microskills and train students on each microskill separately. When we learn microskills, we will learn the main skill also. This model can be beneficial for tuition on procedural skills. OBJECTIVE: In this study, we propose a stationed-based deconstructed training model for tuition of each microskill, and then we assessed the medical students' self-perceived abilities. METHODS: This quasi-experimental study was conducted in 268 medical students (536 matched pre- and post-questionnaires) at the surgical clerkship stage during five consecutive years in three teaching and learning groups. In this study, we taught each skill in 10 steps (proposed model) to the students. We then evaluated the students' self-perceived abilities using a pre- and post-self-assessment technique. SPSS v13 software with one-way analysis of variance and paired t-tests were used for data collection and analysis. RESULTS: Assessment of medical students' perceived abilities before and after training showed a significant improvement (P < 0.001) in both cognitive and practical domains. There were also significant differences between the three teaching and learning groups (P < 0.001). There were no significant differences for the different years of training regarding the observed improvement. CONCLUSION: This study suggests that deconstructing the practical skills into microskills and tuition of those microskills via the separated structured educational stations is effective according to the students' self-ratings.

Iranian school teachers: knowledge and attitude toward ecstasy.

UNLABELLED: The drug ecstasy has been increasingly used for recreational purposes, especially among students. Teachers play an important role in altering student attitudes toward ecstasy. OBJECTIVE: The aim of this study was to access teacher knowledge and attitude toward ecstasy and its side effects. METHODS: In a cross-sectional study, 460 teachers from 20 public and 10 private schools were randomly invited to participate in the study between April 2005 and April 2006 and their knowledge and attitudes toward ecstasy were collected on the basis of a designed questionnaire. RESULTS: No significant correlation was found between knowledge about ecstasy and gender, whereas, there was a positive relation between knowledge and education level of the teachers (P = .033). Attitude was higher in female participants (P = .012), but was not related to the age of the teachers. We found no relation between attitude toward ecstasy and the teachers' education levels. CONCLUSION: Knowledge about ecstasy and its side effects was dependant on the teachers' education level, whereas their attitude toward ecstasy was dependent on the teachers' gender.

Quality of life and its relation to sociodemographic factors among elderly people living in Tehran.

AIM: The objective of this study was to assess the quality of life (QOL) and its relation to sociodemographic factors among elderly living in Tehran. METHODS: A descriptive/correlational study was conducted. The sample consisted of 5600 people aged 60 years or older from 11 districts of Tehran. QOL was measured with the 36-item short form questionnaire. RESULTS: QOL was positively associated with education levels, having previous state jobs and being employees, and negatively associated with smoking and having disease. Compared to men, women had lower scores for overall QOL and its dimensions. CONCLUSION: Sociodemographic inequalities, smoking and having diseases should be the main targets for improving the QOL in the elderly population.