Background: Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease (6%-35%) and is associated with cardiovascular risk factors and metabolic syndromes (age, diabetes, hyperlipidemia, hypertension and smoking). Hereby, we evaluated the association of increased carotid intima-media thickness (IMT) with NAFLD considering other cardiovascular risk factors to see if NAFLD is independently associated with increased carotid IMT. Patients and Methods: Totally 300 patients [150 NAFLD and 150 normal] who were referred to four academic referral hospitals were enrolled. Patients with a history of alcohol use, hepatitis, HIV, chemotherapy and other organ failures were excluded. A single radiologist performed abdominal sonographies [3-5 MHz probe] and carotid sonography [7.5 MHz probe] (measured the posterior wall of both common carotids and calculated the mean value). NAFLD was diagnosed based on sonographic findings in the absence of acute or chronic liver and kidney diseases and malignancies. Results: The mean age was 51.2 ± 14.8 [20-97] and 184 [61.3%] were male. Mean IMT was greater in patients with diabetes, hypertension, hyperlipidemia and NAFLD [all Ps < 0.001] and these variables with age were statistically significant in univariate models for estimating IMT. Among NAFLD patients, 38 [25.3%] had increased IMT [unilateral or bilateral; considering 0.8 as cutoff point] while this frequency was 8 [%5.3] among normal subjects [P < 0.001, odds ratio = 6, 95% confidence interval (CI) = 2.7-13.4]. In multivariate regression models [IMT as dependent variable], NAFLD, age and hyperlipoproteinemia (HLP) were independent significant variables in linear model [R 2 = 0.41] and NAFLD showed highest odds ratio [16.4] among significant variables [age, body mass index (BMI), NAFLD and HLP] in the logistic model. Conclusion: Increase carotid IMT is highly associated with NAFLD independent of other cardiovascular risk factors and should be considered in these patients.

Background:A sore throat is one of the common causes behind visits to the physician and antibiotic overtreatment in the world, especially in Iran. There are six ways of approaching pharyngitis patients. It is necessary to perform a cost-effectiveness analysis and find the best approach in all situations on group A streptococcus (GAS) pharyngitis management to propose a pharyngitis guideline.Method:The decision tree of managing pharyngitis and its complications was drawn. The probability of every status and the branches of the tree were derived from the literature, and the cost of related diseases and complications were calculated based on the dossiers of the patients in two main pediatric central hospitals in Tehran, Iran. Further, cost-effectiveness, sensitivity, and threshold analyses were conducted to find out the best management strategy. Moreover, for a situation analysis of pharyngitis management in Iran, a questionnaire was designed and given to general practitioners and pediatricians; 130 subjects responded to it. The results were then analyzed.Results:The rapid test antigen (RTA) and culture strategy were proved to have the highest effect on the quality-adjusted life year. In addition, a less expensive strategy was solely observed to be the RTA. The worst effect gained (most quality-adjusted lost days) was, however, from the “treat none” strategy.Conclusion:According to our cost-effectiveness analysis, the best management of pharyngitis occurs in RTA alone, followed slightly by culture strategies; the “RTA then culture if needed” and “RTA and culture” approaches become possible options after them. The “treat all” and “treat none” approaches, however, were not proper strategies in any case.

Background: The prevalence of non-alcoholic fatty liver disease (NAFLD) has increased in recent decades. There are some concerns about the efficacy and side effects of drugs used for the treatment of NAFLD. Objectives: Therefore, new treatment methods and modalities are needed. This study aimed to determine the efficacy of Beta vulgaris extract in the treatment of NAFLD. Methods: This is a double-blind, parallel-group, randomized clinical trial. This clinical trial was conducted from November 2018 to April 2019 in Shahid Beheshti Hospital of Kashan, Iran. Among 143 NAFLD patients who met the inclusion criteria, 120 patients agreed to participate in the study. Subsequently, they were divided into two equal groups via simple randomization. The Beta vulgaris group received Beta vulgaris extract, alongside standard NAFLD treatment, including vitamin E and Silybum marianum extract (Livergol). The placebo group received standard NAFLD treatment, as well as a placebo instead of Beta vulgaris extract. The levels of aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP), fasting blood sugar (FBS), low-density lipoprotein (LDL), and high-density lipoprotein (HDL) were evaluated and compared between the groups. Variables were measured at the beginning of the study and after three and six months. Results: Overall, 52% of the participants were male. The mean (SD) age of Beta vulgaris and placebo groups was 47.5 (10.5) and 46.4 (8.7) years, respectively. The results of between-group analysis revealed that AST significantly reduced in the Beta vulgaris group, compared to the placebo group (P = 0.04). Conversely, ALT reduction was not significant in the groups. The significant interaction between time and groups indicated that the effect of Beta vulgaris on ALT increased over time (P < 0.001). Moreover, the ALP, FBS, LDL, and HDL levels significantly improved in the Beta vulgaris group compared to the placebo group (P < 0.05). Conclusions: Integration of Beta vulgaris extract in the standard treatment of NAFLD could significantly improve AST, ALP, FBS, LDL, and HDL. This study also revealed that the effect of Beta vulgaris on ALT increased over time.

BackgroundTissue damage, pain, and anesthesia cause immunological alterations and metabolic and endocrine reactions in patients both perioperatively and postoperatively. [1][2][3] These responses related to severity can have differing consequences, varying from the patient's susceptibility to infection, wound healing, systemic inflammatory response syndrome, and organ malfunction or failure. [4][5][6][7] In addition to inflammation, increased inflammatory markers, and pain, following surgery, high doses of narcotics and non-opioid analgesics may be required. 8,9 However, controversies remain about the effects of the types and amounts of anesthesia and postoperative analgesia on immunological reactions to major surgical procedures. [10][11][12] Gastrointestinal surgery produces inflammatory reactions and pain for patients. The administration of highly safe analgesia in surgery is essential for reducing pain and improving inflammatory reactions. Inappropriate pain management may result in increased morbidity and, consequently, increased hospitalization and higher medical costs. 8 Epidural analgesia is commonly used as an effective and safe strategy for pain relief in surgeries. 8,9 It can reduce pain and effect earlier intubation times, better hemodynamics, and fewer respiratory complications. 8 ObjectivesThe current study compared inflammatory markers and pain in epidural infusion of bupivacaine-fentanyl and morphine bolus injection in gastrointestinal cancer surgeries.