Repository of Research and Investigative Information Isfahan University of Medical Sciences
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From inequalities to solutions: an explanatory sequential study on type 2 diabetes health services utilization
No full textBackgroundHealth inequities are a significant issue. This study aimed to measure and decompose socioeconomic inequality in the utilization of type 2 diabetes (T2D) services and propose solutions to mitigate these inequalities. MethodsThis explanatory sequential mixed-method study was conducted in two phases: quantitative and qualitative. A total of 2000 T2D patients from health centers, hospitals, and diabetes clinics in Isfahan and Khuzestan provinces, Iran, were selected. In the quantitative phase, the existence of inequality in the utilization of T2D services was examined using the Concentration Index (CI) approach. To determine the contribution of each explanatory variable to T2D inequality, we used concentration index decomposition analysis. In the qualitative phase, based on the main contributors identified in the quantitative phase, we conducted semi-structured interviews with purposefully selected key experts to identify solutions for reducing inequality in the utilization of T2D services. ResultsThe sample consisted of 65.3 men, with 40 of T2D patients being over 60 years old. The CI values were 0.31 (p 0.05) for inpatient services, and 0.11 (p < 0.05) for pharmaceutical services. This indicates an inequality in the utilization of outpatient and pharmaceutical services among T2D patients, while the inequality in inpatient services was not significant. The main variables contributing to inequality in outpatient services were health status (33.54), basic insurance (27.43), and socioeconomic status (24.08). For pharmaceutical services, the contributing variables were health status (22.20), basic insurance (13.63), and socioeconomic status (34.35). Experts' solutions to reduce socioeconomic inequalities in Iran were classified into three main themes: socioeconomic status, health status, and basic insurance, with 29 sub-themes. ConclusionThe results suggest that targeted health interventions for poor T2D patients are recommended. Efforts towards universal coverage in outpatient care and commonly used pharmaceutical items, such as: Antidiabetic Drugs, Triglyceride Control Drugs, Cardiovascular Drugs, Neuropathy Drugs, and Nephropathy Drugs, should be considered
Investigating therapeutic efficacy of dacarbazine and temozolomide, alone and in combination with BRAF(V600E) siRNA in A375 human melanoma cell line
No full textObjective(s): Melanoma is one of the most aggressive and deadly skin cancers. Despite advances, effective melanoma treatment is challenging, often requiring a shift from individual therapies to combination approaches. This study explores whether combining dacarbazine (DTIC) and temozolomide (TMZ) with the siRNA approach holds promise for melanoma treatment. Materials and Methods: To determine the IC50 values of DTIC and TMZ, the A375 cell line was treated with different drug concentrations for 24-72 hr. The best exposure time of BRAF siRNA transfection was performed. Subsequently, cell viability (using the MTT assay), apoptosis (by flow cytometry), and gene expression levels of B-Raf proto-oncogene, serine/threonine kinase (BRAF), caspase 3 (CASP3), and phosphoinositide-3-kinase regulatory subunit 3 (PIK3R3) genes (by quantitative real-time PCR) were assessed in the treated groups (i.e., control, negative controls, DTIC alone, TMZalone, DTIC+ TMZ, BRAF(V600E)siRNA alone, siRNA+ DTIC, siRNA+ TMZ, and siRNA+ DTIC+TMZ groups). Results: Cell viability significantly decreased in the chemotherapy-only and siRNA+drug groups, although no difference was observed between them. The apoptosis percentage in all treated groups indicated a significant difference compared to the control group. The expression of the BRAF gene notably decreased in the BRAF (V600E) siRNA +drug groups compared to the chemotherapy groups. Despite overexpression of CASP3 in the chemotherapy-treated groups, the most effective enhancement was noted in the siRNA+DTIC+TMZ group (P<0.0001). The mean expression of the PIK3R3 gene in siRNA+chemotherapy groups revealed a notable reduction. Conclusion: These findings suggest that the siRNA-transfected treatment groups have the potential to provide therapeutic effects comparable to those of chemotherapy
Evaluation of common COL2A1 gene variants in Iranian patients suspected with Stickler syndrome type I
No full textBackground: Stickler syndrome, also known as hereditary progressive arthro-ophthalmopathy, is a connective tissue disorder that arises from mutations in multiple genes, each with distinct hereditary patterns. Stickler syndrome type I, which is inherited in an autosomal dominant manner, is specifically linked to mutations in the COL2A1 gene. The objective of this study is to investigate the prevalence of common variants of the COL2A1 gene among individuals suspected of having Stickler syndrome type I. Materials and Methods: Twenty-six Iranian patients suspected of having Stickler syndrome type I referring to Al-Zahra Hospital of Isfahan were employed in this cross-sectional study. The DNA was extracted from the patient's peripheral blood samples, and the selected exons of the COL2A1 gene were amplified by polymerase chain reaction. Subsequently, the purified amplicons were subjected to Sanger sequencing to identify common variants associated with Stickler syndrome type I. Results: All patients exhibit cleft abnormalities (palate, lip, and alveolar), 84.6 of patients exhibit ocular abnormalities, 53.8 of patients exhibit hearing abnormalities, and 34.6 of patients exhibit skeletal abnormalities. As the data displays, the highest phenotype presentation prevalence rate was related to cleft lip and palate, while hemiparesis was the lowest clinical finding among the patients. Molecular analysis which conducted to screen the COL2A1 gene of patients, identified two different variants, including a novel nonsense variant, (c.1030C>T), consistent with dominantly inherited Stickler syndrome type I, also synonymous mutation (c.213C>T) affecting in exon 2, which have been reported in database. Conclusion: Genetic analysis of Twenty-six unrelated families with Stickler syndrome type I disorder discovered one novel pathogenic variant in the COL2A1 gene in a patient with Stickler syndrome type I. Genetic analysis is helpful for the diagnosis of this clinically variable and genetically heterogeneous disorder
Efficacy of two radiographic algorithms for detection of peri-implant bone defects on cone-beam computed tomography scans
No full textBackground Early detection of peri-implant bone defects can improve long-term durability of dental implants. By the advances in cone-beam computed tomography (CBCT) scanners and introduction of new algorithms, it is important to find the most efficient protocol for detection of bone defects. This study aimed to assess the efficacy of metal artifact reduction (MAR) and advanced noise reduction (ANR) algorithms for detection of peri-implant bone defects. Materials and methods In this in vitro study, 40 titanium implants were placed in 7 sheep mandibles. Crestal, apical, and Full defects (n = 10 from each type) were created around the implants, and 10 implants were also placed as controls. CBCT scans were obtained in four modes: with MAR, with ANR, with both MAR and ANR, and without any filter. Totally, 28 scans were obtained and evaluated by a radiologist and a maxillofacial surgeon. The observers recorded their observations in a checklist, and data were analyzed by SPSS version 21 using the kappa coefficient of agreement, sensitivity and specificity values, area under the receiver operating characteristic (ROC) curve (AUC), intraclass correlation coefficient, t-test and paired t-test (P 0.05). The most common diagnostic error was related to misdiagnosis of control group with full defect with ANR filter, such that the existing bone was not detected. Defect depth was averagely over-estimated while defect length was under-estimated. Correct diagnosis of defects had the highest frequency when both filters were on. Conclusion The diagnostic accuracy and sensitivity for detection of different defect types were not significantly different in different scan modes but activation of ANR filter significantly decreased the specificity and positive predictive value compared with no use of filter
Acute kidney sympathectomy alters renal vascular responses to graded angiotensin II infusion in rat: The role of mas receptor and gender
No full textBackground We examined the roles of the Mas receptor (MasR) and acute renal sympathetic nerve ablation on renal hemodynamic and kidney function responses to angiotensin II (Ang II) in male and female rats. Methods Mean arterial pressure (MAP), renal blood flow (RBF), renal vascular resistance (RVR) and kidney function responses to Ang II with or without acute renal denervation (ARDN) were measured in a vehicle or A779 (MasR antagonist) treated male and female anesthetized rats. Results Baseline MAP, RBF, and RVR did not differ significantly between ARDN and intact groups. After Ang II administration, MAP increased with no significant difference between ARDN and intact groups. RBF and RVR responses to Ang II were different significantly between intact and ARDN male rats treated with saline (P < 0.05), but such results were observed in female rats treated with A779 (P < 0.05). ARDN increased urine flow and fractional sodium excretion in both genders significantly (P < 0.05), but after Ang II injection, these two parameters did not show significant differences between intact and ARDN rats. Conclusion MasR antagonist contributes to provide different RBF and RVR responses to Ang II between ARDN and intact female rats
Prognostic Implication of Preprocedural Pulmonary Hypertension in Patients with Severe Aortic Valve Stenosis Undergoing Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-analysis
No full textPulmonary hypertension (PH) is a common comorbidity in patients with aortic stenosis (AS) who are candidates for transcatheter aortic valve implantation (TAVI). Herein, we sought to elucidate the prognostic value of preprocedural PH on the early and late mortality after TAVI. The Cochrane Library, Scopus, PubMed, Web of Science, Embase, and ProQuest were screened using a predefined search query. We considered odds ratios (ORs) as the measure of effect. Meta-regression analysis was applied to investigate the potential impact of baseline characteristics on the outcomes. Egger's and Begg's tests were used to assess the publication bias. Thirty-three studies comprising 34 datasets representing 68,435 patients were included in the analysis. Regardless of the definition and severity of PH, pooled data analysis indicated that preprocedural PH was associated with higher cardiac and overall 30-day OR, 1.45 (1.15-1.82) and OR, 1.75 (1.42-2.17), respectively, and 1-year mortality OR, 1.63 (1.35-1.96) and OR, 1.59 (1.38-1.82), respectively. Meta-regression analysis demonstrated that older age, higher New York Heart Association function class, history of hypertension, diabetes, and lower left ventricular ejection fraction were predictors of higher mortality rate following TAVI. Moreover, we found that preprocedural PH is significantly associated with higher in-hospital mortality and 30-day acute kidney injury. Our results demonstrated that preprocedural PH is associated with higher early and late cardiac and overall mortality following TAVI; however, this finding is limited regarding the considerable inconsistency in the definition of PH and PH severity among studies
Review of the Genetic Spectrum of Hereditary Spastic Paraplegias in the Middle East and North Africa Regions
No full textBackground and ObjectivesHereditary spastic paraplegias (HSPs) are inherited neurodegenerative disorders, and their classification is based on inheritance mode, allelic variants, and clinical presentation. Despite global occurrence, research, especially in the Middle East and North Africa (MENA) regions, is lacking, underscoring the need for further investigation. The objective of this study was to improve the regions' clinical practice and public health, and this study aims to gather data on HSP prevalence, pathogenic variants, and patient characteristics in MENA countries.MethodsA systematic literature review encompassing PubMed, MEDLINE, and Google Scholar was conducted. Quality assessment was performed on the included studies. Data extraction and analysis provided insights into HSP's current status in the region.ResultsIran had the highest number of patients with HSP, followed by Tunisia. SPG11 (19.8), FA2H (8.5), and ZFYVE26 (7.7) were the most frequently found genes in the cases. Autosomal recessive HSP with thin corpus callosum was common among the affected patients, with SPG11 identified as the primary cause.DiscussionOur analysis highlights genetic diversity and regional prevalence variations. Despite limited research in MENA countries, we stress the importance of further investigation to address gaps in understanding and improve patient care and public health initiatives
Incidence and predictors of type 2 diabetes mellitus during 17 years of follow-up in the Golestan Cohort Study
No full textIn this study, we aimed to determine the incidence and predictors of type 2 Diabetes Mellitus (T2DM) in the Golestan Cohort Study (GCS). This study is a prospective population-based cohort study conducted in the Golestan province of Iran with the participation of 50,044 people aged 30 to 87 years between 2004 and 2008. Participants were followed up for 17 years for T2DM. The cumulative incidence of T2DM was 13.32 in the GCS. We observed hypertension (HTN) and dyslipidemia (DLP) increased the risk of T2DM 1.16 and 1.63 times relative to the healthy participants (RR: 1.16, 1.63, 95 CI : 1.102-1.222, 1.393-1.928, p < 0.001). For every one-unit increase in the body mass index (BMI), the risk of T2DM increased 1.09 times (RR: 1.09, 95 CI :1.086-1.106, p < 0.001). High-risk waist circumference (WC) increased the risk of T2DM by 1.89 times more than normal WC (RR: 1.89, 95 CI : 1.756-2.053, p < 0.001). Smokers had an 89 lower risk of T2DM than non-smokers (RR: 0.897, 95 CI : 0.814-0.989, p = 0.029). We conclude that environmental factors induce T2DM by affecting body fat. Also, other metabolic diseases could develop T2DM
Personality traits and alexithymia: A closer look at university students in a cross-sectional study
No full textThis study investigates the association between student personality traits and alexithymia among university students. In this cross-sectional study, 290 students were selected through multistage cluster sampling. Standard questionnaires of 5 personality traits (NEO Five-Factor Inventory) and the Toronto Alexithymia Scale were used to determine alexithymia and personality traits. An independent t test in SPSS 21.0 was performed to compare the scores of several personality traits between students with and without alexithymia. Also, the logistic regression model was used to investigate the adjusted associations. The mean age of participants was 22.6 +/- 3.8 years. Most students were female (77.9) and single (88.5). According to the Toronto Alexithymia Scale, 127 of 290 students (43.8) displayed signs of alexithymia. The neuroticism trait was considerably greater in alexithymic students than the others (27.20 +/- 3.90 vs 25.48 +/- 4.90; P < .01), as well as the conscientiousness trait (20.16 +/- 3.84 vs 21.58 +/- 5.00; P = .01). Logistic regression showed that each unit increase in neuroticism trait increases alexithymia odds by 10, while each unit raises in conscientiousness trait decreases odds by 8. Considering a significant association between personality traits and alexithymia, better screening and interventional programs through personality traits will prevent or alleviate the symptoms of alexithymia among university students