Background: Microcirculation is affected in diabetes mellitus and Microvascular abnormalities cause persistent diabetic complications. The aim of this study was nailfold capillaroscopic assessment to describe the pathological changes (morphological and structural) in capillary of a large series of patients with type 1 and 2 diabetes. Methods: A cross-sectional study was carried out in a Nailfold Capillaroscopy Center (Tehran-Iran) between 2011 and 2014. The study included 235 types 1, 2 diabetic patients. All patients underwent 10 nailfolds capillaroscopy examinations. Microvascular architecture, disturbances capillary distribution, capillary morphology, capillary density, efferent/afferent limb ratio, sub-papillary venular plexus, and morphological abnormalities were evaluated. Conclusions were stated as normalor scleroderma pattern. Results of patients' capillaroscopic images were recorded and analyzed quantitatively and qualitatively. P value < 0.05 was considered as statistical significance. Results: of all participants with mean age 59.91 ± 12.39, 183 cases (77.9%) were female and 52 (22.1%) were male. Tortuosity of capillaries was more often observed in our subjects (235 cases) followed by angiogenesis (171 cases). Normal and early scleroderma patterns were observed in 195 (83.0%) and 40 cases (17.0%). Based on P values, altered micro vascular architecture, capillary distribution and capillary morphology were more frequent in patients with scleroderma pattern in comparison to patients with normal pattern (P value < 0.05). Morphological abnormalities except from neo formation capillary and mega capillary were also significantly more common in patients with scleroderma pattern than patients in counterpart group (P value < 0.05). Conclusion: Nailfold capillaroscopy as a non-invasive, diagnostic and prognostic method may potentially affect on diabetes outcome and control.

The congenital talipes equinovarus (clubfoot) is one of the most common congenital conditions requiring orthopedic intervention. This study was carried out to evaluate the effect of unintentional partial Achilles tendon cut during percutaneous tenotomy on the success rate of Ponseti management. Percentage of Achilles tendon cut following percutaneous tenotomy was measured by ultrasound in 16 clubfeet (11 patients). After a mean of 21 months of follow-up, the final results (Dimeglio score) were compared between two groups of patients: those with complete tendon cut and those with partial cut. Complications and parameters such as feeling of pop during tenotomy and ankle dorsiflexion during tenotomy were also compared. There was no significant correlation between the percentage of Achilles tendon cut and increase in ankle joint dorsiflexion, age at diagnosis, or pop sensation. There was no statistically significant difference between the two groups in their ankle joint dorsiflexion, feeling of pop, and final follow-up Dimeglio score. No complications were encountered following tenotomy. One patient needed tibialis anterior transfer at his last follow-up visit. Partial cut of Achilles tendon following tenotomy does not necessarily compromise the final results of Ponseti management. Achieving more than 10°-20° ankle dorsiflexion even with a partial tendon cut can ensure good final results.

Background The process of atherosclerosis begins early in childhood and usually remains asymptomatic until later in life. Carotid intima-media thickness (cIMT) as a marker of subclinical atherosclerosis could identify early vascular alterations. Unhealthy snacks consumption is associated with obesity and other CVD risk factors in children and adolescents. The aim of this study is to investigate the association of different snack substitution and cIMT among overweight and obesity children and adolescents. Methods A total of 339 participants aged 6 to 13 years with the body mass index Z score ≥ 1 based on WHO criteria enrolled in this study. We measured food intakes of participants by validate and reliable food frequency questionnaire (FFQ). Carotid intima media thickness was measured in the common carotid artery with high-resolution ultrasonography. Results After controlling for confounders, intake of nuts had a negative relationship with cIMT (β = 0.135 mm P value = 0.009). Moreover, participants in the last tertile of nuts intake had 59% lower risk of high cIMT in comparison with those who consumed less than 0.64 serving/wk./1000Kcal of nuts (P for trend = 0.010). Substituted of nuts intake with sweet unhealthy snacks had a negative relationship with cIMT (β = 0.15 mm). There was no other significant association between energy-dense nutrient-poor solid snacks and cIMT. Conclusions Our findings emphasize the impact of nuts consumption as a healthy snack on subclinical stages atherosclerosis. Clinical trial studies could examine the effect of different kinds of nuts consumption on cIMT and complications of CVD risk factors. Electronic supplementary material The online version of this article (10.1186/s12986-019-0350-y) contains supplementary material, which is available to authorized users.

BackgroundTo investigate the association between markers of insulin metabolism and carotid intima-media thickness(cIMT) among overweight and obese children and adolescents.MethodsA total of 378 children and adolescents aged from 6 to 13 years, with WHO body mass index Z-Scores ≥2 were enrolled in this study. We measured fasting serum insulin and glucose, conducted a homeostatic model assessment of insulin resistance(HOMA-IR), and calculated the quantitative insulin sensitivity check index(QUICKI). Carotid intima-media thickness was measured in the common carotid artery with high-resolution ultrasonography.ResultsThe study participants consisted of 198 boys and 180 girls with a mean(±SD) age of 9.3 ± 1.7 years, 18.3% being pre-pubertal. In boys, after controlling for confounders, a one-SD increase in fasting insulin and HOMA-IR were associated with 0.351 mm(P < 0.001) and 0.350 mm(P < 0.001) increases in cIMT, respectively. However, a one-SD increase in QUICKI was associated with a − 0.305 mm(P = 0.001) decrease in cIMT. When categorizing into tertiles, a one-SD increase in fasting insulin and HOMA-IR were associated with 87 and 81% increases in the odds of higher categories of cIMT(both P < 0.05). However, a one-SD increase in QUICKI was associated with 37% lower odds of higher categories of cIMT(P = 0.022). No significant associations were found among girls.ConclusionThis study demonstrated that insulin resistance and sensitivity markers were independent predictors of cIMT in overweight and obese boys, but not in girls, highlighting the importance of chronically elevated insulin levels for predisposing these boys to alterations in their vascular structure.

Background: Chest computed tomography (CT) scan has been used widely to diagnose COVID-19 in Iran. Objectives: To trace the footsteps of COVID-19 in Iran by exploring the trend in using chest CT scans and its economic impact on radiology departments. Methods: In this cross-sectional study, the number of imaging examinations from 33 tertiary radiology departments in 9 large cities of Iran was collected from September 23, 2019 to March 20, 2020 (Months 1 to 6) and the corresponding months in 2018–2019. Results: A 50.2% increase was noted in the chest CT scan utilization in 2019–2020 compared to 2018–2019. This increase was +15%, +15%, +27%, +2%, +1% in Months 1–5 of 2019–2020, respectively. In Month 6 of 2019–2020, a 251% increase in the acquisition of chest CT scans was observed compared to the Month 6 of 2018–2019. Following negative balance of revenue from Month 1 to 5 with respect to the inflation rate, the total income in Month 6 was further 1.5% less than the same Month in 2018–19. Conclusion: The observed peak in chest CT utilization in Month 3 prior to the surge in Month 6 could be explained by the seasonal influenza. However, unawareness about an emerging viral disease, i.e. COVID-19, might have underutilized chest CT in Months 4 and 5 before the official announcement in Month 6. The unbalanced increase in the workload of radiology departments in the shortage of cardiothoracic radiologists with the simultaneous decrease in income initiated a vicious cycle that worsened the economic repercussions of the pandemic.