Kowsar Corp Research Articles

Insulin resistance provides the connection between hepatitis C virus and diabetes.

Copyright © 2015, Kowsar Corp. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited. 1. Insulin Resistance as a Bridge Between Hepatitis C Virus and Diabetes

Echocardiographic Assessment of Left Atrial Mechanics: Are We Ready for Daily Clinical Use?

Copyright © 2014, Iranian Society of Echocardiography; Published by Kowsar Corp. This is an open-access article distributed under the terms of the Creative Com-mons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Dalbavancin, Oritavancin and Tedizolid are Safe and Effective for Skin Infection Treatment

Copyright © 2014, Infectious Diseases and Tropical Medicine Research Center; Published by Kowsar Corp. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Acute bacterial skin and skin structure infections are among the most common reasons for hospitalization of adults (1). These infections are most often caused by Staphylococcus aureus and streptococci (2). Methicillin-resistant S. aureus (MRSA) account for many of these infections and present a particular treatment challenge because current therapies are limited by toxicity, resistance, or the lack of an oral formulation (3). Patients with skin or skin structure infections have three new antibiotic options, which have similar efficacy and safety profiles as vancomycin. Glycopeptides, such as vancomycin are the most available agents with in vitro and in vivo activity against gram-positive infection. Dalbavancin (Durata Therapeutics) is a lipoglycopeptide antibiotic agent with in vitro and in vivo activity against gram-positive pathogens and a minimal inhibitory concentration (MIC) of this agent is required to inhibit the growth of 90% of the isolates (MIC90) (4). Oritavancin, a synthetic analog of vancomycin that also has activity against gram-positive bacteria. In a double-blind, placebo-controlled study, oritavancin and IV vancomycin were compared for the treatment of patients with acute bacterial skin and skin structure infection (SOLO I); patients were randomly assigned to receive either a single-dose intravenous oritavancin or intravenous vancomycin twice daily and treatment was successful for 82.3% of the oritavancin group and 78.9% of the vancomycin group (5). Tedizolid is a novel oxazolidinone antibacterial drug designed to provide enhanced activity against gram-positive pathogens. The efficacy and safety of intravenous and oral tedizolid for treatment of patients with acute bacterial skin and skinstructure infections has been established by some studies. Intravenous to oral once-daily tedizolid 200 mg for 6 days is non-inferior to twice-daily linezolid 600 mg for 10 days for treatment of patients with acute bacterial skin and skin-structure infections. Tedizolid could become a useful option for the treatment of acute bacterial skin and skin-structure infections in the hospital and outpatient settings (6). Studies have shown that the efficacy of dalbavancin administered once weekly, Oritavancin single dose and tedizolid 200 mg daily for 6 days are not inferior to that of a conventional twice daily antibiotic regimen with vancomycin or other glycopeptides and the early primary end point of cessation of the spread of infection and the absence of fever showed a consistent treatment effect regarding a reduction in the area of infection (4-6). Patients treated with dalbavancin had fewer adverse events than those treated with vancomycin and linezolid. However, further evaluation and monitoring is necessary as more patients are exposed to these agents; according to preliminary data, the adverse-effect profile of oritavancin and dalbavancin of these lipoglycopeptides is generally similar to that of drugs currently used to treat severe gram-positive infections (7). In the recent years, despite of suitable treatments in terms of cost befit and availability for gram-positive infections in Iran, it seems that the old treatment of gram-positive infection such as vancomycin is still prescribed by Iranian physicians. Studies comparing new and old treatments can lead Iranian physicians to optimal choice for treatment of gram-positive infections.

The Importance of Occult Hepatitis B Infection Screening in Pre-Transplant Evaluation

Implication for health policy/practice/research/medical education: This paper argues the importance of occult hepatitis B infection screening in pre-transplant evaluation. It is applicable for those in the field of organ transplantation. Copyright © 2014, NewPub; Published by Kowsar Corp. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Occult hepatitis B virus infection (OHB) is defined based on the existence of hepatitis B virus (HBV) DNA in liver tissue or serum of the patients, in spite of negative antibody test result for hepatitis B surface antigen (1). Most of these patients have positive hepatitis B core antibody (HBc Ab) test result as the evidence of past HBV infection. Ramezani et al. recommended the evaluation of HBc Ab in hemodialysis patients for detection of OHB (2). There might be low titer of HBc Ab in minority of OHB patients due to immunosuppression. In the other word, all serological Ab panels for HBV might be negative in OHB setting. Searching for HBV DNA in serum is promising for determination of OHB in the immune deficiency state. However, this method could not be recommended in the routine screening due to its high expense. Therefore, defining the best diagnostic strategy for detection of OHB seems to be challenging in particular subgroups of patients. Although the precise clinical manifestations and pathogenesis of OHB are not clear, it is considered as a probable source of HBV infection via blood transfusion, hemodialysis, and organ transplantation. Reactivation of OHB in the post-transplantation phase could be fatal. It is wise to improve the yield of diagnostic tool for OHB screening in the pre-transplant phase to lower the liver-related morbidity and mortality in the transplant candidates. The important issues on OHB are the aggravation of chronic liver damage and concomitant fibrosis (3). Some studies showed that this condition causes progression of cirrhosis and development of hepatocellular carcinoma in chronic liver disease (4) OHB lowers the virologic response in hepatitis C infection (5) Song et al. declared that HBV transmission could occur via transfusion, hemodialysis, and organ transplantation (1). Considering the possibility of HBV reactivation, they suggested the screening of OBI in the post-transplantation phase. Furthermore, they mentioned the need for antiviral therapy in HBsAg-negative transplanted patients who are anti-HBc positive, to prevent the reactivation of HBV infection. HBV recurrence has occurred even two years after discontinuation of the immunosuppression (6). Fontenele et al. issued the role of OHB screening in hemodialysis patients to prevent the transmission of HBV and the consequent liver cell damage (7). Based on the current evidence, it seems reasonable to screen for OHB in the pre-transplantation phase and follow the patient carefully for early detection of OHB relapse. HBc Ab test is a practical screening method for OHB and is a surrogate marker of previous HBV infection in the immune competent patients. HBV DNA assay is an accepted alternative for OHB screening in the immunosuppressed individuals whose HBc Ab is in a low detectable titer.

Curcumin From Traditional Iranian Medicine to Molecular Medicine

Curcumin might be a good natural therapeutic agent; it could inhibit intercellular inflammation pathways and reduce a lot of unfavorable molecular events in chronic inflammatory diseases.Copyright © 2014, Razavi Hospital; Published by Kowsar Corp. This is an open-access article distributed under the terms of the Creative Commons Attribution Li-cense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Phosphate Metabolism Modulation in Chronic Kidney Disease: When, How and to What Extent?

The use of calcium containing vs. calcium free phosphate binder is one of the hot topic in Nephrology due to the survival benefit and cost burden associ-ated with the use of the latter.Copyright © 2014, Nephrology and Urology Research Center; Published by Kowsar Corp. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Hepatitis B vaccination: needs a revision.

Implication for health policy/practice/research/medical education: This study focuses on the many questions needing to be answered around HBV vaccination despite all the advances in the field. Copyright © 2014, Kowsar Corp.; Published by Kowsar Corp. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 1. Hepatitis B virus Infection, Epidemiology and Complications

The Main Public Health Problem of Population in the Future: Aging Conditions or Adolescent and Youth Conditions

Implication for health policy/practice/research/medical education: Due to lack of enough financial support for research and delivering services to both groups, what will be the decision of national decision makers about making a balance in giving services to these two important age groups? Tomorrow would be too late to think about the methods of improving healthy lifestyle among current young people and future elderly population. Today is the time for action. Copyright © 2014, Razavi Hospital; Published by Kowsar Corp. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Nowadays, most policy makers state that the main public health problem of many populations is aging and related consequences and therefore chronic diseases among elder people will be the most important problems of future (1-5), although it has been confirmed that the origin of many elderly diseases returns to the early life conditions (6, 7). Furthermore, many developing countries are experiencing a huge adolescents and youth population which their problems have often been neglected due to aging of their populations. In fact, health professionals are involved in the health of aging population as well as health of adolescents and youth because of their substantial effects on most of the morbidities in aged community. Fortunately, many morbidities and mortalities of adolescents and youth could be prevented; however, it is unknown that how, when, and in whom, these conditions would develop in early adolescence and youth. There are many different problems among adolescents and youths including mental health issues and their potential relations with risky behaviors (with prevalence of 15%), risky sexual behavior, sexually transmitted diseases (STD), early sexual experience as well as sexual abuse and the increased use of alcohol and marijuana at younger ages (8). Unhealthy lifestyle could indeed be considered as the most important issue among adolescents and youths. In fact, unsafe lifestyles in young generation will have a costly consequence for the health services in the future. For instance, Hooshmand and colleagues studied on 4412 adolescents (49% female) who were followed up from grade nine to 12 on their depressive symptoms and six healthrisk behaviors (alcohol use, amount of alcohol consumed per drinking episode, cigarette smoking, marijuana use, hard drug use, and delinquency) (9). In another study, Garrusi and colleagues performed a study to explore the way that Iranian University students live (10). They found that some students, particularly those who were studying medicine, were not enjoying a healthy lifestyle, with better situation of female students than males. It remains a big question to be answered: What should we do now? In one hand, the world population is going old with their own conditions; on the other hand, many (developing) countries have huge adolescent and young population with special needs and attention. Due to the lack of enough financial support for research and delivering services to both groups, what will be the decision of national decision makers about making a balance in giving services to these two important age groups? Do we know about the health services inequality among these two groups? Tomorrow would be too late to think about the ways of improving healthy lifestyle among current young people and future elderly population. Today is the time for action.

Spiritual intelligence and high risk behaviors.

It is necessary to design some treatments and evaluate them based on the components of spiritual intelligence, in accordance with social – cultural situ-ations and the type of disorder. Since this item is useful both for prevention and improvement of the health level, it’s deserving that the researchers and therapists explore this area more than ever.Copyright © 2014, Zahedan University of Medical Sciences; Published by Kowsar Corp. This is an open-access article distributed under the terms of the Creative Com -mons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Efficacy and Safety of Sedation in Cardiac Imaging

Implication for health policy/practice/research/medical education: It is vital that non-anesthesiologist sedation practitioners responsible for intravenous sedation management have appropriate training and skills. A suitable monitoring system must be available during the procedure, and necessary support must be provided by an assistant for the observation of vital signs and management of the airway. Copyright © 2014, Iran University of Medical Sciences; Published by Kowsar Corp. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Nowadays, cardiac imaging is provided via numerous modalities such as echocardiography [transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE)], magnetic resonance imaging of the heart (cardiac MRI), cardiac nuclear study, cardiovascular computed tomography (CT) scan-angiography, carotid artery imaging, and general radiography. Also, an increasing number of adult or pediatric patients currently undergo minimally invasive cardiovascular diagnostic or interventional procedures in catheterization and electrophysiology laboratories. These diagnostic imaging modalities are time-consuming and cooperation-dependent, and the creation of the best examination environment along with adherence to the best “patient safety” standards necessitates the application of most recent sedation guidelines and patient monitoring protocols (1). TEE is a valuable diagnostic method performed for an increasing number of patients in echocardiography laboratories, operating rooms, and intensive care units. Although generally a safe procedure, TEE is regarded as a semi-invasive modality due to its potential for some minor and rarely major complications (1). It is, therefore, essential that TEE be conducted by a highly skilled operator. This imaging technique often requires light degrees of sedation and analgesia. The European Society of Cardiology (ESC) provides clear-cut guidelines for the appropriate premedication and establishment of a standard monitoring system prior to a TEE examination (2). These guidelines are, however, proposed only for TEE in adults and there are other protocols for pediatric patients. The majority of patients need only conscious sedation, which has the benefit of speedy post-procedural recovery and early discharge from the echocardiography laboratory. A large number of patients who receive conscious sedation, must be informed that they will not get a complete anesthetic (3). The personnel in charge of TEE must know that every drug, which depresses the central nervous system, could impair ventilation, circulation system, or both. Therefore, it is necessary that non-anesthesiologist sedation practitioners managing intravenous sedation regularly pass relevant training courses (4). Electrocardiography (ECG) and oxygenation monitoring must be available throughout the procedure, and support must be provided by an assistant for the observation of vital signs and management of the airway (3, 5). This assistant can be an anesthesiologist, a well-trained anesthesia nurse, or any physician familiar with the pharmacology and clinical use of sedative/analgesic drugs and able to manage the patient’s airway and lung ventilation as necessary (3). TEE should not be a painful procedure, and it is essential to remember that tranquilizers do not alleviate pain. Pain in a TEE examination can be a sign of a possible complication (i.e. esophageal erosion) (1, 2, 6).

Razavi International Journal of Medicine, Pioneering the Path to Knowledge

Implication for health policy/practice/research/medical education: Razavi Hospital intends to pave the way for publishing the scientific findings and achievements in medical field through establishing Razavi International Journal of Medicine. All scientists and scientific societies associated in various branches of medicine are invited to collaborate us in providing a friendly environment in order to improve scientific interactions and develop human knowledge regardless of their nationality, race and religion. Copyright © 2013, Razavi Hospital; Published by Kowsar Corp. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Incremental Value of Left Atrium Two-Dimensional Strain in Patients with Heart Failure

Implication for health policy/practice/research/medical education: Left atrium 2D strain is a useful noninvasive method for quantification of regional and global LA deformation. Copyright © 2013, Iran University of Medical Sciences; Published by Kowsar Corp. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Left atrial (LA) size and function is an important determinant of cardiovascular morbidity and mortality. Assessment of LA strain using two-dimensional speckle tracking imaging or velocity vector imaging has been recently introduced for the quantification of regional and global LA deformation. Furthermore, LA strain measurement has been proposed as an alternative method for the estimation of left ventricular (LV) filling pressure (1, 2). Decreased LA strain has been correlated with increased left ventricular end-diastolic pressure (1, 3). Cameli et al. (4) demonstrated that in a group of patients with advanced systolic heart failure, E/Em ratio correlates poorly with invasively obtained LV filling pressures. Nevertheless, LA longitudinal deformation analysis by speckle tracking imaging correlates well with pulmonary capillary wedge pressure, providing a better estimation of LV filling pressure in this particular clinical setting. Recent studies have shown the clinical importance of LA strain in atrial fibrillation, LV systolic and diastolic dysfunction, mitral valve disease, and cardiomyopathies (4, 5). In this issue of the journal, Esmaeilzadeh et al. present interesting data regarding the usefulness of LA 2D strain measurement via velocity vector imaging in LV systolic heart failure patients. They found substantially low 2D LA strain in systolic heart failure patients compared with normal subjects and demonstrated a significant relationship between LA strain and degree of diastolic dysfunction in patients with systolic heart failure. The investigators suggested that a cut-off value of total average LA strain ≥ 23.28% can differentiate between normal and abnormal LA function with sensitivity of 93% and specificity of 100%. The study in question, however, does not mention the effect of other confounding factors such as hypertension and diabetes on LA 2D strain. Mondillo et al. (6) reported reduced peak atrial longitudinal strain in patients with hypertension (29.0 ± 6.5%) and those with diabetes (24.7 ± 6.4%) in comparison with controls (39.6 ± 7.8%). Additionally, they demonstrated that the reduction was more pronounced in patients with both diabetes and hypertension and concluded that LA deformation mechanics are impaired in patients with a normal LA size who have hypertension or diabetes. Dogan et al. (7) confirmed that LA strain has a significant correlation with LV ejection fraction (r = 0.51, P value = 0.001). The authors also reported a significant inverse correlation between LA strain and B-type natriuretic peptide (BNP) level (r = -0.41, P = 0.001) in acute ST-elevation patients. It is, however, worthy of note that different software packages and echocardiography machines are liable to yield different results, rendering the cut-off values incomparable. It seems reasonable to conclude that LA 2D strain is a useful noninvasive tool for the evaluation of LA function in patients with systolic heart failure in as much it correlates well with diastolic dysfunction and LV filling pressure.

Novel 2013 Influenza A (H7N9) Virus: Potential Pandemic Threat

Implication for health policy/practice/research/medical education: Our aims are to answer the elementary questions about: origin, diseases, transmissibility and surveillance of newly emerged avianorigin influenza A (H7N9) virus. Copyright © 2013, Ahvaz Jundishapur University of Medical Sciences; Published by Kowsar Corp. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The Evaluation of the Antibacterial and Antioxidant Activity of Tarragon (Artemisia dracunculus L.) Essential Oil and Its Chemical Composition

Background: Food born pathogenic bacteria are the most important agents of infections in humans, and food spoilage also results in economic losses in food industry. Objectives: The aim of this study was the evaluation of chemical components, total phenolic content, antioxidant and antibacterial activities of Artemisia dracunculus essential oil. Materials and Methods: The essential oil of Tarragon was analyzed by gas chromatography-flame ionization detector (GC-FID) and gas chromatography/mass spectrometry (GC-MS). The antioxidant activity and total phenolic content were evaluated by bleaching of β-carotene and folin ciocalteu methods, respectively. The antibacterial effect of the essential oil was inspected on seven Gram- positive and negative bacteria using the microdilution method. Results: A total of 19 compounds were identified by GC-FID and GC-MS. The main compounds were methyl chavicol (84.83), trans-ocimene (3.86), z-β-ocimene (3.42), limonene (1.79) and α-pinene (0.57). Total phenols were 10.16 ± 0.08 mg/g Gallic acid equivalent. The essential oil showed good antioxidant activity in bleaching of β-carotene method (50 ± 1.63). The minimum inhibitory concentrations (MIC) and minimum bactericidal concentrations (MBC) for essential oil ranged between 3.8 to 250 mg/mL, respectively. Conclusions: The essential oil of Tarragon might be replaced by synthetic antioxidant and preservatives in food industry. © 2013, Ahvaz Jundishapur University of Medical Sciences; Published by Kowsar Corp.

Klotho and Renal Fibrosis

Klotho is a newly discovered protein with pleotropic effects and have affected different fields of renal medicine from translational research to clinical nephrology. Here we want to summarize some new scopes in the field of renal fibrosis and Klotho with this hope that in future it could be implemented as a new therapeutic strategy to combat the renal fibrosis.Copyright © 2013, Nephrology and Urology Research Center; Published by Kowsar Corp. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Extensively Drug-Resistant Tuberculosis Treatment Disappointing Outcomes for Global Public Health

Copyright © 2013, Infectious Diseases and Tropical Medicine Research Center; Published by Kowsar Corp. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Tuberculosis (TB) is an airborne, globally common bacterial infection, easily spread by coughing, and can be fatal. It often lies dormant in the human body for many years; most of the 11 million infected people in the United States are not even aware of its existence. The only available vaccine has limited effectiveness and is not prescribed in most European and American countries. Today, the biggest risk for TB is not HIV/AIDS, which led to a surge in the late 1980s. The most challenging issues in this regard are multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) (1). Researchers followed up the South African patients with XDR-TB, who had been a part of an earlier study looking at early treatment outcomes in 2010. The study said that despite lengthy treatment with a median of eight anti-TB drugs, treatment outcomes were dismal: of 107 patients, only 17 were cured or completed the treatment after 24 months, and 12 had similar favorable outcomes five years after the treatment initiation. Forty nine patients died and in 25, the treatment was failed after 24 months of follow up. After 60 months, 79 patients died and in 11 the treatment was failed. Of the 45 patients released into the community, 19 did not achieve sputum culture conversion (2). Of the 79 patients who died, 32 were infected with HIV. “Twenty four (69%) of 53 patients living with HIV and receiving antiretroviral therapy died by the end of follow-up, compared with 46 (73%) of 63 patients not infected with HIV and all nine patients with HIV not taking antiretroviral therapy” the study said. A CD4 count of less than 200 was also associated with the increased mortality, the study reported. The use of clofazimine in the treatment regimen seemed to reduce the risk of death (2). “Long-term outcomes in patients with XDR-TB are poor, irrespective of HIV status, although antiretroviral therapy has improved survival in patients with HIV” the report stated. “Many patients in our cohort who were discharged from hospital had positive sputum cultures, failed the treatment, and had no further therapeutic options. These patients survived for long periods living in the community and were likely to contribute to the community-based spread of XDR-TB” (2). “Their study should serve as another urgent alarm for global TB control: MDR disease in all its forms is an outof-control problem with potentially vast and devastating repercussions for global public health” they announced. “Clearly, drug regimens that are more effective and better tolerated are needed to improve the adherence, decrease the mortality, and prevent the amplification of TB drug resistance on treatment” (2). As cases of XDR-TB have previously been reported in Iran, both the reports and commentaries call for policymakers and national control programs to urgently develop strategies for applying the existing public health instruments for TB control. They also argue the community-based interventions as well as creation of palliative care facilities to minimize the disease spread by patients with treatment failure (3). Since XDR-TB is resistant to firstand second-line drugs, treatment options are seriously limited. Therefore, it is vital to manage TB control programs properly to prevent further progression of MDR-TB and mitigate the emergence of XDR-TB (4). The mortality rate of patient with XDR-TB infection is about 14%-20%, which may reach to 98% in HIV coinfected patients. In a retrospective study in Iran, a successful outcome was observed in 81.2% of patients with MDR-TB in comparison with 41.6% of patients with XDRTB. These findings indicated that patients with XDR-TB had higher probability of treatment failure and mortality (5).

Frail Elderly Adults: Concerns and Recommendations

Implication for health policy/practice/research/medical education: Multidisciplinary team works are needed to perform research on assessments and intervention programs to prevent or postpone frailty Copyright © 2013, Kowsar corp.; Published by Kowsar corp. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Dear Editor, Frailty is a multi-dimensional syndrome; the most common domains assessed include physical function, gait speed or mobility, and cognition (1, 2). Most assessment methods allow for subcategories that reflect the degree of frailty, including non-frail, pre-frail, and frail (3-5). As reported previously, the overall prevalence of frailty is around 4.1 – 14% in those aged 65 and over in Europe, UK, and USA (2, 6, 7). Frailty is the precursor of functional degeneration in elderly persons, and is the intermediate stage between independent living and death (8). Numerous studies have indicated that frailty decreases the activity and living quality and causes cognitive function impairment (3, 8, 9). In addition, it is associated with daily living function disability, falls, and elevated risks of institutionalization or hospitalization, and may even lead to death (10). Academics have opinions on development factors, clinical definitions, and evaluation methods for frailty and no standardized or consistent concept has been developed. The significance of frailty for the aging in health care is being acknowledged and proponed (2-4). Meanwhile, most assessment methods involve retrospective evaluation that require elderly persons to recall weight variations during the past year or physical activity in the past week (2, 3, 10). These methods are prone to creating biased memories, and are not feasible for screening high-risk patients. Therefore, the assessment of physical fitness is an objective evaluation tool for determining frailty. Objective assessments of elderly persons’ physical abilities and fitness are highly predictive for frailty and level of disability (3, 11). Therefore, objective evaluation of physical fitness status enables early detection for frailty. This enables the further supplementation of relevant guidance and health care interventions to prevent further frailty or mortality. Consequently, multidisciplinary team including physicians, nursing staff, social workers, psychologists, nutritionist, and rehabilitation therapist should focus on this high-risk population and actively perform research on assessments and intervention programs to prevent or postpone frailty (12)

Student-Based Morning Report: An Experience at the Internal Medicine Ward

Implication for health policy/practice/research/medical education: This study is useful for medical students’ training. Copyright © 2013, Kowsar corp.; Published by Kowsar corp. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Morning report was initially performed at non-educational hospitals. The on-service nurse and medical staff reported the problems enfaced for the management of patients of the previous working day to the head of ward (1). The aim of this program was modified in teaching hospitals (2). Thereby, morning report is now considered as one of the key elements in medical students’ training curriculum. A variety of educational groups participate in morning report; however, residents are the main target population (3). Residents carry on the session and discuss the difficulties in the diagnosis and management of patients (4). Routinely, the medical students are not actively involved in the program and they usually get bored. Sometimes the scientific level of discussed issue is so high that they cannot follow the conference. To overcome this shortcoming, medical student-based morning report was designed at internal medicine ward of Sina hospital, affiliated to Tehran University of Medical Sciences. During the student-based morning reports, the on-service senior medical students and residents help the juniors to complete their report before the session. Afterward, the junior medical students present the cases in front of a panel that consists of senior medical students and a resident. Accordingly, senior medical students ask questions about the ambiguous issues in the presentation and clarify the pitfalls of junior students’ presentations. The resident is the leader of the panel and handles the coordination of the team. We implemented a new role for the residents in this especially designed program that is known as ‘resident as a teacher’ (5). The attending professor facilitates the process at each step. A survey on this program showed that it has a progressive character. In fact, the drawbacks in data collection were the major findings in sessions at the beginning of the semester. Comments on how to take a precise report from the patient halted the program at this stage. Medical students were prepared for entering to the next step through resolving the problems with regard to a more accurate history taking. Next step was to make decisions and express the differential diagnosis. Through this step, they were prepared for clinical reasoning and presenting the diagnosis plan later in the semester. The result of this survey also showed that the students were satisfied with the program. The participants’ level of self-esteem in oral case presentation, independent decision-making ability, and clinical reasoning was improved after participating in this program.

Why Colorectal Diseases are Important?

Copyright © 2012, Kowsar Corp.; Published by Kowsar Corp. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The shift of burden of diseases form communicable, highly transmissible diseases to non-communicable diseases is a tangible fact globally. In this shift some of the diseases have received appropriate consideration in prevention, diagnosis and treatment, while many of the others are neglected. Colorectal cancers (CRC) are among those which have received some attention in all of these aspects. CRC is the third most common diagnosis of cancer following lung and breast cancers and the fourth leading cause of cancer death following lung, stomach and liver (1). Although the burden is the highest in high income countries but there are many reports of increasing trend of this cancer in middle income countries (2-4). This cancer is among the cancers with the highest prediction for increase in the next decade in the world (5). CRC has the second largest share of new cancer diagnosis cost in the world (5). That is why it is not a surprise to see this disease among one of those issues with high allocation of resources for research and intervention. Nevertheless there are some ignored issues even in CRC. The issue of appropriate screening has recently gained some concern from economic viewpoint (6). Young patients with CRC are also another important concern. Although CRC is mostly diagnosed in sixth to eighth decades of life, but there are near 50% cases which are diagnosed before age of 50 or after age of 75 (7, 8).These two special groups are not well represented in none of the research studies and policies concerning CRC. Higher percentage of more advanced disease in these special groups with lower possibility of cure makes these groups even more important. The burden of disease in low and middle income countries is increasing and these countries usually do not have enough resources to combat this increasing trend. Constipation and anorectal diseases are among those annoying diseases with high prevalence but with inappropriate consideration in health systems globally. Most of the current consideration on these type of diseases are toward invasive surgical procedures or expensive and potentially harmful drugs, neglecting appropriate preventive measures and cost effective care (9, 10). The burden of these apparently benign but annoying diseases can not be overemphasized. At the same time, the increasing trend of sexually transmitted diseases along with change in sexual behavior has increased the burden of anorectal diseases substantially. All of these makes colorectal research an important agenda in health research. We need more focused research with the ability to change the health policies on these issues. At the same time we need better understanding of the pathophysiology of these diseases with more attentive basic science research to have a more scientific approach in prevention, diagnosis, treatment

Cystic Fibrosis Needs Attention in Iran

Copyright © 2013, Kowsar Corp.; Published by Kowsar Corp. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The purpose of this editorial is to raise awareness of the care of cystic fibrosis (CF) patients in Iran. The outlook for patients diagnosed with cystic fibrosis internationally has improved substantially in the past 30 years, but the same does not hold true for a child born with cystic fibrosis in Iran. Numerous therapies such as antibiotics (1, 2), anti-inflammatory agents (3), mucolytics (4, 5), airway (6) and mucous (7) clearance, nutritional support (8), and cystic fibrosis transmembrane conductance regulator (CFTR) potentiators (9) have proven effective in select CF patients, and allowed the United States, Australia and Europe to make great strides in the treatment of CF. Other therapeutic approaches such as gene therapy have dealt with more difficulty than originally anticipated (10). The barriers to accessing quality health care for CF patients in Iran are multifaceted including access to medication, implementation of recognized CF standard adopted guidelines by providers, and lack of early diagnosis (11), management and treatments of such patients across the country. These difficulties were compounded by lack of pediatric Pulmonology subspecialty until 2010 that would have been an advocate for this disease. Throughout the world there are intensive efforts to find cure for patients with CF in the near future. CF patients in Iran can leap forward past decades of stagnation in their disease management and make the dream of cure into reality. This can be achieved through a systematic team approach with the goal of improving the life of CF patients and their families. This team effort can be initiated by education about the disease and training of team members to manage CF until a cure is found for all. Cystic fibrosis is a systemic autosomal recessive heritable disorder. A defective gene on chromosome 7 produces a defective protein (CFTR) that results in decreased chloride secretion and hyperabsorption of sodium. This produces dehydrated mucous within the airway and thick secretions in the pancreatic ducts leading to pathogenic colonization and chronic infection in the respiratory tract and destruction of pancreatic ducts. Thereby, producing the clinical symptoms of cough, chronic respiratory symptoms and infection, recurrent exacerbations, malnutrition and failure to thrive. Infection control measures (12) should be one of the early educational and quality improvement measures in the clinics and hospitals. Iran has improved substantially