Defective formation of IgA memory B cells, Th1 and Th17 cells in symptomatic patients with selective IgA deficiency

Objective

Selective IgA deficiency (sIgAD) is the most common primary immunodeficiency in Western countries. Patients can suffer from recurrent infections and autoimmune diseases because of a largely unknown aetiology. To increase insights into the pathophysiology of the disease, we studied memory B and T cells and cytokine concentrations in peripheral blood.

Methods

We analysed 30 sIgAD patients (12 children, 18 adults) through detailed phenotyping of peripheral B‐cell, CD8⁺ T‐cell and CD4⁺ T‐cell subsets, sequence analysis of IGA and IGG transcripts, in vitro B‐cell activation and blood cytokine measurements.

Results

All patients had significantly decreased numbers of T‐cell‐dependent (TD; CD27⁺) and T‐cell‐independent (TI; CD27⁻) IgA memory B cells and increased CD21^low B‐cell numbers. IgM⁺IgD⁻ memory B cells were decreased in children and normal in adult patients. IGA and IGG transcripts contained normal SHM levels. In sIgAD children, IGA transcripts more frequently used IGA2 than controls (58.5% vs. 25.1%), but not in adult patients. B‐cell activation after in vitro stimulation was normal. However, adult sIgAD patients exhibited increased blood levels of TGF‐β1, BAFF and APRIL, whereas they had decreased Th1 and Th17 cell numbers.

Conclusion

Impaired IgA memory formation in sIgAD patients is not due to a B‐cell activation defect. Instead, decreased Th1 and Th17 cell numbers and high blood levels of BAFF, APRIL and TGF‐β1 might reflect disturbed regulation of IgA responses in vivo.

These insights into B‐cell extrinsic immune defects suggest the need for a broader immunological focus on genomics and functional analyses to unravel the pathogenesis of sIgAD.

The challenges of male nurses in the care of female patients in Iran

BACKGROUND

Nurses professional duty mean that nurses must care for patients without gender discrimination. Meanwhile, the intrinsic differences between men and women and the need for personal contact with the patients during care procedures can create challenges for male nurses in the process of caring for a female patient.

AIMS

The present study aims to understand the challenges of male nurses in the care of female patients in Iran.

METHODS

A descriptive qualitative study was conducted with 20 male nurses selected by purposive sampling. Data were collected through unstructured and semi-structured interviews as well as observations and were analysed using conventional content analysis, based on the Graneheim and Lundman model.

FINDINGS

The findings revealed two main themes, including 'religious-cultural restrictions' and 'inappropriate organizational context'.

DISCUSSION/CONCLUSION

Male nurses are faced with a combination of religious-cultural and organizational challenges in providing patient care without discrimination in clinical settings. In addition to negatively affecting the quality of nursing care and satisfaction for female patients, these problems also create a stressful work environment for male nurses.

IMPLICATIONS FOR HEALTH PRACTICE AND POLICY

These problems can be alleviated in clinical settings by trying to ensure same-gender nurses and patients, especially when performing personal care. In addition to the efforts made by nurses to present a positive and real image of themselves in caring for female patients, health policy-makers should also attempt to improve society's attitude towards male nurses caring for female patients through the media.

A Review of the Strategies and Studies on the Prevention and Control of the New Coronavirus in Workplaces

Workplaces are susceptible places for exposure to the new coronavirus (Covid-19) infection due to gathering of many people. Hence, different instructions have been promoted by international organizations regarding high-risk employees and the necessity of implementing health policies to prevent exposure and infection in the workplace. Here we reviewed the required strategies to prevent and control COVID-19 in the workplace. In conclusion, considering the fast spreading and growing prevalence of the new corona virus disease in the world over, all managers, employers, and business owners should receive the necessary information and training on prevention and control strategies based on scientific guidelines and standards.

Performance and feeding behavior of dairy cows fed high-concentrate diets containing steam-flaked or ground corn varying in particle size

Steam-flaked corn (SFC) and ground corn (GC) of different particle sizes were evaluated for their effects on dry matter intake (DMI), milk yield and components, chewing activity, ration sorting, ruminal fermentation, and digestibility in lactating dairy cows. Eight multiparous Holstein cows in mid-lactation (46.6 ± 3.5 kg/d milk production and 101 ± 10 d in milk) were used in a double 4 × 4 Latin square design with 21-d periods. Cows were fed diets (dry matter basis) containing 36.2% forage (alfalfa hay and corn silage), 37.4% corn grain, and 26.4% other ingredients. The corn grain was ground (coarse: 1.08 mm; medium: 0.84 mm; and fine: 0.73 mm) or steam-flaked (SFC; density = 0.40 kg/L). The dry matter proportion retained on an 8-mm sieve was greater for the SFC diet than for the GC diets. There were no treatment effects on DMI, milk yield, fat-corrected milk, energy-corrected milk, fat or lactose yield, protein or lactose content, or milk urea nitrogen concentration. However, digestibility of dry matter and organic matter were greater for fine GC and SFC than the other diets. In addition, cows fed SFC had lower total-tract starch digestibility than cows fed GC diets. Cows fed SFC tended to have lower propionate proportion (22.8 vs. 27.1 mM) and total volatile fatty acid concentration (88.6 vs. 99.8 mM) in ruminal fluid than those fed GC diets. Acetate and butyrate concentration, acetate to propionate ratio, and ruminal concentration of ammonia-nitrogen were not affected by treatments. Ruminal pH (6.46 vs. 6.01) as well as milk fat content (2.75 vs. 2.59%) and efficiencies (fat-corrected milk/DMI and energy-corrected milk/DMI) were greater for SFC than GC, regardless of its particle size. Milk fat content tended to increase linearly with increasing particle size of GC. Eating activity (min/d) tended to be less for SFC compared with GC, but rumination activity (min/d) and total chewing activity (min/d) were not affected by processing or particle size. The results of study indicate that, compared with GC, steam flaking of corn with 400 g/L density increased milk fat content and efficiency of high-producing dairy cows without any negative effect on milk yield. For GC, milk fat content tended to linearly increase and starch digestibility decreased linearly with increasing particle size.

The effectiveness of a traditional Persian medicine preparation in the treatment of chronic cough: A randomized, double-blinded, placebo-controlled clinical trial

OBJECTIVES

The roots and rhizomes of licorice (Glycyrrhiza glabra L.) are used in traditional Persian medicine for the treatment of numerous diseases. A chronic cough is a non-specific reaction to irritation anywhere in the respiratory system. It usually lasts for more than eight weeks. The current study aimed to evaluate the effect of a modified traditional Persian medicine preparation, licorice pastille, in healing a chronic cough.

METHODS

Through a randomized, double-blinded, placebo-controlled clinical trial was performed in a respiratory disease clinic in Shiraz, Iran; between October 2016 and December 2017. Seventy participants with a chronic cough took part in the trial. The outcome measures were as the daily cough scores (the score being logged via patient symptoms, diary, and the visual analogue scale) and the quality of life measure of chronic cough according to the Leicester Cough Questionnaire.

RESULTS

At baseline, there were no significant differences in the demographic or clinical (cough score) characteristics between the two groups. There was complete adherence to protocol in both groups but, the drop-out rate was 4 patients in the placebo and 6 ones in the intervention groups. The results at the end of the trial (Week 2) and follow-up (Week 4) demonstrated the efficacy of the licorice pastille in terms of the cough severity score against the placebo group. This item showed a significant decrease in the intervention group (1.2 ± 0.93) comparing to the placebo one (1.8 ± 1.03) at follow-up time. No major side effects were reported during the study and follow-up time.

CONCLUSIONS

Licorice pastille could be a promising choice in the treatment of a chronic cough of unknown origin.

Serogroups, and drug resistance of nontyphoidal Salmonella in symptomatic patients with community-acquired diarrhea and chicken meat samples in Tehran

BACKGROUND

Salmonella is considered as a main cause of community-acquired diarrhea in humans, however, sources of the multi-drug resistant (MDR) strains and their link with the disease are not well known.

AIMS

This study aimed to investigate the frequency, serogroup diversity, and antimicrobial susceptibility patterns of Salmonella strains in poultry meat and stool samples of patients with community acquired diarrhea in Tehran.

METHODS

We compared the frequency of non-typhoidal Salmonella serogroups, the similarities of their resistance patterns to 10 antimicrobial compounds, the prevalence of extended spectrum β-lactamase (ESBL) and ampicillinase C (AmpC) genetic determinants, and class 1 and 2 integrons in 100 chicken meat and 400 stool samples of symptomatic patients in Tehran during June 2018 to March 2019.

RESULTS

Salmonella was isolated from 75% and 5.5% of the chicken meats and human stool samples, respectively. The chicken meat isolates mainly belonged to serogroup C (88%, 66/75), while the human stool isolates were mainly related to serogroup D (59.1%, 13/22). The MDR phenotype and the most common rates of resistance to antibiotics, including tetracycline, trimethoprim/sulfamethoxazole (TS) and azithromycin, were detected in 4.5% and 45.3%, 59% and 13.6%, 43% and 9.1%, 42% and 9.1% of the human stool and chicken meat samples, respectively. Carriage of bla _CTX, bla _SHV, and bla _PER genes in the meat isolate with ESBL resistance phenotype and bla _ACC, bla _FOX, and bla _CMY-2 among the 7 meat strains with AmpC resistance phenotype was not confirmed using polymerase chain reaction (PCR). High prevalence of class 1 and 2 integrons was characterized and showed a correlation with resistance to TS and chloramphenicol.

CONCLUSION

These findings showed a lack of association between chicken meats and human isolates due to discrepancy between the characterized serogroups and resistance phenotypes.

A case of gastrointestinal tuberculosis with unusual manifestations of carcinomatosis

Unusual manifestations of TB may include gastrointestinal symptoms such as abdominal pain, constipation, and IVC thrombosis. These symptoms may be misdiagnosed for carcinomatosis. According to our study even with medical advances, the diagnosis of GI TB is still enormously difficult.

Conceptualizing and determining core clinical competencies in nursing students: a qualitative study

AIM

This study aimed to conceptualize and explain the core clinical competencies of nursing students in Iran.

BACKGROUND/INTRODUCTION

Despite the national and international efforts to modify nursing curricula such that the students' clinical competencies are improved, there is still a widespread concern about this issue, perhaps due to the impact of factors other than the curriculum itself, such as the lack of a clear definition for the concept of clinical competency and its main components in nursing students.

METHODS

This qualitative study was conducted using conventional content analysis. The participants were selected through purposive sampling and included 14 senior students of bachelor of nursing, four nurses working in teaching hospitals and six clinical instructors. Individual semi-structured interviews were used for data collection. After recording and transcribing the interviews, content analysis was used to extract the concepts.

FINDINGS

The main theme of the study was 'multidimensionality of the concept of clinical competency,' which had six main categories, namely 'adoption of and adaptation with the nursing practice,' 'nursing knowledge,' 'self-direction in clinical learning,' 'patient care skills,' 'professional ethics' and 'the development of professional behaviours.'

DISCUSSION/CONCLUSION

Clinical competency and its dimensions among students comprise a multidimensional concept. Having a clear and comprehensive understanding of this concept and focusing on its core axes may be the most important step in improving students' clinical competency.

IMPLICATIONS FOR NURSING, HEALTH AND EDUCATION POLICY

Policymakers and nursing education authorities can identify the problems existing in the students' clinical competency and provide them with practical solutions for a standard professional education through a clear understanding of the concept of clinical competency and its dimensions.

Effects of Nitroglycerine on Renal Ischemia-Reperfusion Injury in Adult Male Rats

BACKGROUND

Ischemia-reperfusion (I-R) leads to acute kidney injury (AKI). The present study investigated the effects of nitroglycerine (NG) on improving renal dysfunctions caused by I-R in rats.

METHODOLOGY

Twenty-four rats were equally divided into four groups: (1) the control group, (2) the sham group, (3) the I-R group, and (4) NG-treated groups.NG (50 μg/kg) was injected intraperitoneally after induction of IR. I-R was induced through clamping of the bilateral renal artery and vein of both kidneys for 20 min followed by 24 h of reperfusion.

RESULTS

NG significantly increased the creatinine clearance levels and renal blood flow rate (which was reduced by I-R). NG also significantly improved serum electrolytes (sodium and potassium) that were disordered by I-R. In addition, NG significantly offset impaired antioxidant defense mechanism and inhibited lipid peroxidation.

CONCLUSIONS

The results show NG has a protective effect on renal tissue against AKI caused by I-R. These protective effects mediated through antioxidant activity and decrease of lipid peroxidation.

Determining frequency and pattern of infections associated with diabetes based educational hospitals in Ahvaz city; Iran

BACKGROUND

Diabetes mellitus is a metabolic disease known as one of the most common illness in the world. It is believed that diabetic patients are at high risk of varied infections than non-diabetics. The aim of this study was to determine the frequency and pattern of infections in diabetic patients admitted to the internal wards of educational hospitals of Ahvaz Jundishapur University of Medical Sciences.

METHODS

This descriptive cross-sectional study was performed on 700 diabetic patients from January 2014 to December 2015 in internal wards (general, endocrine, gastroenterology, lung, nephrology, cardiology, neurology and infectious diseases) of educational hospitals affiliated to Ahvaz JundishapurUniversity of Medical Sciences. Data includeddemographic information, type of diabetes treatment, duration of diabetes mellitus, final diagnosis, and blood sugar on admission that were analyzed statistically.

RESULTS

Out of 700 patients, 374 (53.4%) women and 326 (46.6%) men were entered into this study. The number of non-infectious and infectious patients were 506 (72.3%) and 194 (27.7%). The mean of age,duration of diabetes, and glucose were 62.34 ± 14.38 years, 11.11 ± 7.18 years, and 271.98 ± 90 (mg/dl) in patients with infectious diseases respectively. The most common infectious illnesses were diabetic foot infections (32.5%), pneumonia (18%), soft tissue abscess(13.9%), and urinary tract infections (11.3%).

CONCLUSION

Infectious diseases are one of the most common factorsto hospitalize diabetic patients (27.7%), most of whom had diabetic foot infections, pneumonia, and soft tissue abscess.

Relationship between the use of electronic devices and susceptibility to multiple sclerosis

Multiple sclerosis (MS) is an autoimmune condition influenced by both genetic and environmental factors. Dirty electricity generated by electronic equipment is one of the environmental factors that may directly or indirectly impact MS susceptibility. The current Study aimed to evaluate the relationship between the usage time of electronic equipment and susceptibility to MS in North-West Iranian people. This approach was carried out upon 471 MS-diagnosed patients and 453 healthy participants as control group in East Province of Azerbaijan. By utilizing structured questionnaires, the information of all participants about usage status of some electronic devices was obtained. Data were analyzed by IBM SPSS Statistics version 18.0 and the quantitative variables were analyzed by Chi Square and Independent sample t tests. P values below or equal to 0.05 were considered as significant. Among the evaluated items in this approach, the utilization of cell phones and satellite television dishes were significantly higher in MS patients (p < 0.001, p = 0.07). Furthermore, a correlation was observed between sleeping with cell phone and/or laptop under the pillow (p = 0.011) and MS disease; however, there was no significant differences between MS patients and controls in computer using and television watching. Our study reinforces the concept that the utilization of some electronic devices and the continuous exposure to dirty electricity would increase the risk of MS disease thereupon by enhancing the cognizance of adverse effects of dirty electricity and reducing the time spent over electronic devices during adolescence and adulthood the occurrence probability of MS could be declined.

Putative electron-affinic radiosensitizers and markers of hypoxic tissue: Synthesis and preliminary in vitro biological characterization of C3-amino-substituted benzotriazine dioxides (BTDOs)

INTRODUCTION

The redox characteristics of 1,2,4-benzotriazine-1,4-dioxides (BTDOs) make them potential radiosensitizing agents for hypoxic cells in solid human cancers. Tirapazamine (TPZ) is the most clinically tested BTDO radiosensitizer, despite its toxicity at effective doses. To date, no BTDOs have been developed as diagnostic markers of tissue hypoxia.

HYPOTHESIS

TPZ analogues with appropriate reporting groups can act as potential radiosensitizers and hypoxia selective diagnostics.

EXPERIMENTAL AND RESULTS

3-Chloro-1,2,4-benzotriazine 1-oxide was substituted at the C3 position to afford 3-(2-hydroxyethoxyethyl)-amino-1,2,4-benzotriazine-1-oxide, which was oxidized to 3-(2-hydroxyethoxyethyl)-amino-1,2,4-benzotriazine-1,4-dioxide (HO-EOE-TPZ) or converted to 3-(2-tosyloxyethoxyethyl)-amino-1,2,4-benzotriazine-1,4-dioxide (Tos-EOE-TPZ). Tos-EOE-TPZ was intended for use as a synthon for preparing 3-(2-azidoethoxyethyl)-amino-1,2,4-benzotriazine-1,4-dioxide (N₃-EOE-TPZ) and 3-(2-iodoethoxyethyl)-amino-1,2,4-benzotriazine-1,4-dioxide (I-EOE-TPZ). The logP values (-0.69 to 0.61) for these molecules bracketed that of TPZ (-0.34). Cell line dependent cytotoxicities (IC₅₀) in air were in the 10-100 μM range, with Hypoxia Cytotoxicity Ratios (HCR; IC₅₀-air/IC₅₀-hypoxia) of 5-10. LUMO calculations indicated that these molecules are in the optimal redox range for radiosensitization, offering cell-line-specific Relative Radiosensitization Ratios (RRSR; SER/OER) of 0.58-0.88, compared to TPZ (0.67-0.76).

CONCLUSION

The LUMO, IC₅₀, HCR and RRSR values of 3-(2-substituted ethoxyethyl)-amino-1,2,4-benzotriazine-1,4-dioxides are similar to the corresponding values for TPZ, supporting the conclusion that these TPZ analogues are potentially useful as hypoxia-activated radiosensitizers. Further studies into their biodistributions in animal models are being pursued to determine the in vivo potential in hypoxia management.

An integrated droplet-digital microfluidic system for on-demand droplet creation, mixing, incubation, and sorting

Droplet microfluidics is a technique that has the ability to compartmentalize reactions in sub nano- (or pico-) liter volumes that can potentially enable millions of distinct biological assays to be performed on individual cells. In a typical droplet microfluidic system, droplets are manipulated by pressure-based flows. This has limited the fluidic operations that can be performed in these devices. Digital microfluidics is an alternative microfluidic paradigm with precise control and manipulation over individual droplets. Here, we implement an integrated droplet-digital microfluidic (which we call 'ID2M') system in which common fluidic operations (i.e. droplet generation, cell encapsulation, droplet merging and mixing, droplet trapping and incubation, and droplet sorting) can be performed. With the addition of electrodes, we have been able to create droplets on-demand, tune their volumes on-demand, and merge and mix several droplets to produce a dilution series. Moreover, this device can trap and incubate droplets for 24 h that can consequently be sorted and analyzed in multiple n-ary channels (as opposed to typical binary channels). The ID2M platform has been validated as a robust on-demand screening system by sorting fluorescein droplets of different concentration with an efficiency of ∼96%. The utility of the new system is further demonstrated by culturing and sorting tolerant yeast mutants and wild-type yeast cells in ionic liquid based on their growth profiles. This new platform for both droplet and digital microfluidics has the potential to be used for screening different conditions on-chip and for applications like directed evolution.

Micromagnetic study of soft magnetic nanowires

In this paper, micromagnetic analysis of an array of long magnetic nanowires (NWs) embedded in a nonmagnetic matrix is performed. It is found that for NWs with diameters on the order of a hundred nanometers, the anisotropy and exchange energies are negligible, so the total free energy is a sum of the Zeeman and magnetostatic energies. The minimum magnetostatic energy corresponds to the maximum Zeeman energy, whereby half of the NWs are magnetized parallel to the external field, while the rest of the NWs are magnetized antiparallel to the external fields. The study shows a vortex behavior of the magnetic moments in the magnetization reversal process. Additionally, the hysteresis loop area of the nanocomposite is inversely proportional to the NW diameter in the range from 20 to 200 nm. The results pave the way for designing of NW-based devices such as optimized magnetic sensors for biomedical applications with a trade-off between miniaturization and energy loss.

Partial least Squares- least squares- Support Vector Machine Modeling of ATR-IR as a Spectrophotometric Method for Detection and Determination of Iron in Pharmaceutical Formulations

Iron is an essential element used as supplement in different dosage-forms. Different time and expenditure-consuming methods introduced for detection and determination of elemental ions such as Atomic Absorption Spectroscopy. In this research, two different and routine methods containing ATR-IR and atomic absorption were applied to define the amount of iron in 198 samples containing different concentrations of commercial iron drops and syrups and the output data of the methods was transferred to chemometric model to compare the accuracy and robustness of the methods. By applying this mathematical model, in addition to the confirmation of ATR-IR (a time and energy-saving method) as a replacement of Atomic Absorption Spectroscopy to produce the same results, chemometrical model was used to evaluate the output data in a faster and easier method. At first, ATR-IR spectra data converted to normal matrix by SNV preprocessing approach. Then, a relationship between iron concentrations achieved by AAS and ATR-IR data was established using PLS-LS-SVM. Consequently, model was able to predict ~99% of the samples with low error-values (root mean square-error of cross-validation equal to 0.98). Y-permutation test performed to confirm that the model was not assessed accidentally. Although, chemometric methods for detection of some heavy metals have been reported in the literature, combination of PLS-LS-SVM with ATR-IR was not cited. In this study a fast and robust method for iron assay was suggested.As a result, ATR-IR can be a suitable method in detection and qualification of iron-content in pharmaceutical dosage forms with less energy-consumption but similar accuracy.

Comparing Plasmapheresis plus IVIg with Plasmapheresis plus IVIg plus Rituximab on the Management of Suspicious Antibody-Mediated Acute Rejection in Kidney Transplant Recipients

BACKGROUND

There is no treatment of choice for the management of acute antibody-mediated rejection (ABMR) in kidney transplant recipients. Plasmapheresis ± intravenous immunoglobulin (IVIg) ± rituximab has been used in different regimens with contradictory results.

OBJECTIVE

To compare three regimens of acute ABMR management including plasmapheresis + IVIg ± rituximab in two different rituximab regimens.

METHODS

In this prospective, observational study kidney transplant recipients with suspicious ABMR were categorized into three groups. Group 1 patients were treated with plasmapheresis + IVIg. Groups 2 and 3 received weekly rituximab at a dosage of 375 mg/m² for either 4 doses (group 2 or high dose) or 2 doses (group 3 or low dose) in addition to plasmapheresis + IVIg.

RESULTS

8, 15, and 9 patients were categorized in groups 1, 2, and 3, respectively. There was no difference among the groups in terms of demographic and clinical characteristics of recipients and donors. Although, 1-year graft (37.5%, 60.0%, and 66.7% for groups 1, 2, and 3, respectively; p=0.308) and patients survival (75.0%, 86.7%, and 77.8% for groups 1, 2, and 3, respectively; p=0.730) were not significantly different among studied groups, graft survival was 22%-30% higher in rituximab-treated groups. Estimated glomerular filtration rate at 12^th month of follow-up did not differ among groups (56.3±19.6, 57.3±20.6, 48.7±16.1 mL/min/1.73 m² for groups 1, 2, and 3, respectively; p=0.683). However, kidney function steadily improved over time in rituximab-treated patients.

CONCLUSION

Adding high or low doses of rituximab to plasmapheresis + IVIg comparably increased graft survival in suspicious acute ABMR kidney recipients and steadily improved kidney function among survived allografts over time.

Carnosine and Histidine Supplementation Blunt Lead-Induced Reproductive Toxicity through Antioxidative and Mitochondria-Dependent Mechanisms

Lead (Pb)-induced reproductive toxicity is a well-characterized adverse effect associated with this heavy metal. It has been found that Pb exposure is associated with altered spermatogenesis, increased testicular degeneration, and pathological sperm alterations. On the other hand, it has been reported that Pb-induced reproductive toxicity is associated with increased reactive oxygen species (ROS) formation and diminished antioxidant capacity in the reproductive system. Hence, administration of antioxidants as protective agents might be of value against Pb-induced reproductive toxicity. This study was designed to investigate whether carnosine (CAR) and histidine (HIS) supplementation would mitigate the Pb-induced reproductive toxicity in male rats. Animals received Pb (20 mg/kg/day, oral, 14 consecutive days) alone or in combination with CAR (250 and 500 mg/kg/day, oral, 14 consecutive days) or HIS (250 and 500 mg/kg/day, oral, 14 consecutive days). Pb toxicity was evident in the reproductive system by a significant increase in tissue markers of oxidative stress along with severe histopathological changes, seminal tubule damage, tubular desquamation, low spermatogenesis index, poor sperm parameters, and impaired sperm mitochondrial function. It was found that CAR and HIS supplementation blunted the Pb-induced oxidative stress and mitochondrial dysfunction in the rat reproductive system. Thereby, antioxidative and mitochondria-protective properties serve as primary mechanisms for CAR and HIS against Pb-induced reproductive toxicity.

Risk factors associated with diabetic foot ulcer-free survival in patients with diabetes

AIMS

This study was done to assess the risk factors associated with diabetic foot ulcer-free survival in patients with diabetes.

MATERIALS AND METHODS

Based on a prospective cohort study, ADFC (Ahvaz Diabetic Foot Cohort) study, carried out in a university hospital, all of the patients with diabetes were followed up for new diabetic foot ulcer (DFU). The time of ulcer development was final outcome during two years in the present study. To analyze the data, the variables were first evaluated by univariate analysis. Subsequently variables with P value <0.2 were tested in multivariate analysis, using backward elimination multiple Cox regression.

RESULTS

From among 605 eligible patients of ADFC study, 566 patients without foot ulcer were included for a 2- years follow-up. Thirty subjects (5.3%) developed DFU during the study course none of whom underwent amputation. The DFU-free survival rate was 0.945 over two years of follow-up. In final multivariate Cox regression analysis, the variables which remained in the model and had a statistically significant relationship with time to develop foot ulcer were: dyslipidemia, history of DFU or amputation, nephropathy callus formation in the feet and diabetes duration. Foot deformity and patients' training about self-care of their feet were statistically borderline significant.

CONCLUSIONS

The DFU-free survival rate was 0.945 over two years of follow-up. In this study, independent risk factors associated with ulcer-free survival in diabetic foot patients were dyslipidemia, prior history of DFU or amputation, diabetic nephropathy, callus formation in the feet and diabetes duration.