The 11th edition of Harrison's Principles of Internal Medicine welcomes Anthony Fauci to its editorial staff, in addition to more than 85 new contributors. While the organization of the book is similar to previous editions, major emphasis has been placed on disorders that affect multiple organ systems. Important advances in genetics, immunology, and oncology are emphasized. Many chapters of the book have been rewritten and describe major advances in internal medicine. Subjects that received only a paragraph or two of attention in previous editions are now covered in entire chapters. Among the chapters that have been extensively revised are the chapters on infections in the compromised host, on skin rashes in infections, on many of the viral infections, including cytomegalovirus and Epstein-Barr virus, on sexually transmitted diseases, on diabetes mellitus, on disorders of bone and mineral metabolism, and on lymphadenopathy and splenomegaly. The major revisions in these chapters and many

Harrison's Principles of Internal Medicine

Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?

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admission. This proportion could already be greater in some parts of the country and may increase if referrals of cases of self-poisoning increase faster than the facilities for their assessment and management. The provision of social work and psychiatric expertise in casualty departments may be one means of preventing unnecessary medical admissions without risk to the patients. Dr Blake's and Dr Bramble's figures do not demonstrate, however, that any advantage would attach to medical teams taking over assessment from psychiatrists except that, by implication, assessments would be completed sooner by staff working on the ward full time. What the figures actually suggest is that if assessment of overdoses were left to house doctors there would be an increase in admissions to psychiatric units (by 19°U), outpatients (by 5O°'), and referrals to social services (by 140o). So for house doctors to assess overdoses would provide no economy for the psychiatric or social services. The study does not tell us what the consequences would have been for the six patients who the psychiatrists would have admitted but to whom the house doctors would have offered outpatient appointments. E J SALTER

Vitamin D deficiency.

Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis.

Gout is a crystal-deposition disease that results from chronic elevation of uric acid levels above the saturation point for monosodium urate (MSU) crystal formation. Initial presentation is mainly severely painful episodes of peripheral joint synovitis (acute self-limiting 'attacks') but joint damage and deformity, chronic usage-related pain and subcutaneous tophus deposition can eventually develop. The global burden of gout is substantial and seems to be increasing in many parts of the world over the past 50 years. However, methodological differences impair the comparison of gout epidemiology between countries. In this comprehensive Review, data from epidemiological studies from diverse regions of the world are synthesized to depict the geographic variation in gout prevalence and incidence. Key advances in the understanding of factors associated with increased risk of gout are also summarized. The collected data indicate that the distribution of gout is uneven across the globe, with prevalence being highest in Pacific countries. Developed countries tend to have a higher burden of gout than developing countries, and seem to have increasing prevalence and incidence of the disease. Some ethnic groups are particularly susceptible to gout, supporting the importance of genetic predisposition. Socioeconomic and dietary factors, as well as comorbidities and medications that can influence uric acid levels and/or facilitate MSU crystal formation, are also important in determining the risk of developing clinically evident gout.

Global epidemiology of gout: prevalence, incidence and risk factors

Objective: The purpose of this study was to determine the prevalence of musculoskeletal complaints and rheu-matic diseases in southeast of Iran.Methods: Subjects were selected based on a cluster sampling from 20 districts of urban areas in Zahedan, Iran.Subjects 15 years old and over were randomly selected and interviewed by trained interviewers in their houses.The Community Oriented Program for the Control of Rheumatic Disease (COPCORD) and Core Questionnaire(CCQ) were used in this study. The people with musculoskeletal complaints (pain, stiffness and swelling) wereexamined by the rheumatologist. Laboratory tests and radiographic exams were carried out when necessary tofurther categorize diagnoses.Results: Data were collected from October 10, 2008 to September 15, 2009. Two thousand and one hundredsubjects including 921 (43.9%) males and 1179 (56.1%) females were interviewed. The average age of the popu-lation was 33.1 14.7 years. The prevalence of complaints within the past 7 days prior to the interview was54.13%. The most common sites of complaint were as follows: knee (30.59%), dorsolumbar (28.83%), shoulder(22.26%) and neck (17.07%). The most common rheumatic diseases were osteoarthritis and low back pain withthe prevalence of 18.66% and 17.71%, respectively. Finally, the prevalence of rheumatoid arthritis was 0.98%.Conclusion: Musculoskeletal complaints are highly common in southeast Iran. Knee and low back pain werethe most common sites of complaints. The most frequent diagnosed diseases were osteoarthritis of knee followedby low back pain and soft tissue rheumatism. Rheumatoid arthritis was the most prevalent inﬂammatory disease.Key words: Community Oriented Program for the Control of Rheumatic Disease, epidemiology,musculoskeletal disorders, prevalence.

Prevalence of musculoskeletal disorders in southeastern Iran: a WHO-ILAR COPCORD study (stage 1, urban study).

Prevalence and patterns of tobacco, alcohol, and drug use among Iranian adolescents: A meta-analysis of 58 studies

Many efforts are being made around the world to discover the vaccine against COVID-19. After discovering the vaccine, its acceptance by individuals is a fundamental issue for disease control. This study aimed to examine COVID-19 vaccination intention determinants based on the protection motivation theory (PMT). We conducted a cross-sectional study in the Iranian adult population and surveyed 256 study participants from the first to the 30th of June 2020 with a web-based self-administered questionnaire. We used Structural Equation Modeling (SEM) to investigate the interrelationship between COVID-19 vaccination intention and perceived susceptibility, perceived severity, perceived self-efficacy, and perceived response efficacy. SEM showed that perceived severity to COVID-19 (β = .17, p < .001), perceived self-efficacy about receiving the COVID-19 vaccine (β = .26, p < .001), and the perceived response efficacy of the COVID-19 vaccine (β = .70, p < .001) were significant predictors of vaccination intention. PMT accounted for 61.5% of the variance in intention to COVID-19 vaccination, and perceived response efficacy was the strongest predictor of COVID-19 vaccination intention. This study found the PMT constructs are useful in predicting COVID-19 vaccination intention. Programs designed to increase the vaccination rate after discovering the COVID-19 vaccine can include interventions on the severity of the COVID-19, the self-efficacy of individuals receiving the vaccine, and the effectiveness of the vaccine in preventing infection.

/pdf/the-protection-motivation-theory-for-predict-intention-of-4bflxhqdk4.pdf

The protection motivation theory for predict intention of COVID-19 vaccination in Iran: a structural equation modeling approach.

Background: Work-related musculoskeletal disorders commonly experienced by dental professionals are one of 
the main occupational health problem affecting their health and well-being.This study was conducted to evaluate 
ergonomic factors and profession-related postures and also investigate relationship between demographic factors 
and work condition with pain in dental students.
Material and Methods: 60 freshman and sophomore dentistry students were randomly chosen as the subjects of 
control group, and 60 of 5th and 6th-year students were selected as the members of exposure group. Data related 
to the subjects such as sex, doing exercise, severity of musculoskeletal pain were obtained through questionnaire. 
Students’ postures were directly observed while treating patients and they were scored by REBA method. Data 
were analyzed by SPSS software using Man-Whitney, Kruskal-Wallis, Spearman and Kendall correlation tests.
Results: 80.8% of the subjects were not aware of the correct ergonomic postures for dental procedures. Severity of 
musculoskeletal pain in the exposure group (15.9± 4.2) was significantly higher than the control group (10.5 ±3.2), 
(
p
 <0.001). Risk of the most subjects (84%) was at the medium level. Students who were more involved in clinical 
activities experienced more muscular pains.
Conclusions: The musculoskeletal disorders are probable prolonged in working hours in static positions, incorrect 
work postures, implying more force and even tools and instruments. Therefore, students who are aware of ergonomic principals of their own profession would be able to maintain their health through activities and lifelong

/pdf/evaluation-of-ergonomic-factors-and-postures-that-cause-484p6fc8mf.pdf

Evaluation of ergonomic factors and postures that cause muscle pains in dentistry students’ bodies

Background
Nonspecific low back pain is known as one of the most common reasons for chronic low back pain (CLBP) that burdens healthcare systems with high costs. According to a hypothesis, CLBP has been associated with vitamin D3 deficiency, the goal of this study is to evaluate the effect of vitamin D3 administration on improvements in CLBP.

Materials and Methods
This double blind randomized clinical trial included 53 patients aged between 18–40 years with nonspecific CLBP. Pain was measured using the pain visual analogue scale score (VAS), and serum 25-OH-vitamin D level was measured using an enzyme-linked immunosorbent assay kit. The patients were randomly divided into two groups based on sex and weight. Pearl of vitamin D3 (50 000 IU) or placebo was administered orally every week for 8 weeks. Data were analyzed via SPSS 17th edition software using two-tailed paired t-test and chi-square test.

Results
There were 26 and 27 patients in drug and placebo groups respectively. Out of 53 subjects, 75.47% were female. There was no statistically significant difference in the mean age, sex, and mean weight between the two groups. The mean serum 25-OH-vitamin D level was 18.86 ± 9.24 nmol/L on the first visit. After 8 weeks of intervention, the mean serum 25-OH-vitamin D level changed from 17.88 ± 9.04 to 27.52 ± 9.04 (P = 0.043) and from 19.81 ± 9.60 to 18.91 ± 7.84 (P = 0.248) in drug and placebo groups, respectively. The mean VAS score for pain decreased from 5.42 ± 1.65 to 3.03 ± 3.14 (P = 0.001) and from 6.42 ± 1.62 to 3.11 ± 3.08 (P = 0.001) among drug and placebo groups, respectively. The mean changes in chronic pain were 2.38 ± 2.62, 95% confidence interval (CI) = 1.32–3.44 in the drug group and 3.33 ± 3.67, 95%CI = 0.61–2.55 in the placebo group. No significant statistical difference between the two groups was observed.

Conclusion
According to our results, both vitamin D3 and placebo treatments improved CLBP and there was no significant difference between vitamin D3 and placebo groups.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/1756-185X.12172

Mahdi Mohammadi

Papers

Prevalence of musculoskeletal disorders in southeastern Iran: a WHO-ILAR COPCORD study (stage 1, urban study).

Prevalence and patterns of tobacco, alcohol, and drug use among Iranian adolescents: A meta-analysis of 58 studies

The protection motivation theory for predict intention of COVID-19 vaccination in Iran: a structural equation modeling approach.

Evaluation of ergonomic factors and postures that cause muscle pains in dentistry students’ bodies

The effect of vitamin D on nonspecific low back pain