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?

Medscape

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

Background: Health literacy can influence physical activity, mortality, self-care behaviors and health outcome for some conditions and diseases especially among the aged population. Objectives: This study aimed to assess health literacy in older adults and its related factors to encourage and inform interventions and the future research outline concerning this group of population in Iran. Methods: This cross-sectional study was conducted on 200 older adults in southeast Iran, during year 2015. The twenty health centers were selected randomly and 10 subjects were selected using multistage random sampling from a population from each health center. The Test of Functional Health Literacy in Adults Questionnaire was used for collecting the data. The data was analyzed using the Stata.12 software using Independent T test, Chi-square test and multiple linear regression. Results: The mean age of the subjects was 62.1 ± 3.9 years (ranging from 55 to 75 years old). The total mean score of health literacy was 64.4 ± 18.4 (range: 12 to 97). The mean score of health literacy amongst males and females was 61.5 ± 19.9 (range: 12 - 96) and 67.1 ± 16.6 (range: 22 - 97), respectively (P = 0.032). About 38.5% (n = 77), 29% (n = 58) and 32.5% (n = 65) of the subjects had inadequate, borderline and adequate HL level, respectively. Bivariate analysis and the results of linear regression analysis demonstrated that monthly income (β = 6.25, 95% CI: 5.03 - 17.27), educational level (β=6.61, 95% CI: 1.78-10.3) and husband’s educational level (β = 5.11, 95% CI: 3.2 - 11.21) were significantly associated with health literacy scores level of older adults. Conclusions: The results of this study showed that generally health literacy level is low among older adults in southeast Iran and needs special attention. The level of education was the most important determinant of health literacy. It seems that the best way to increase health literacy among older adults is health literacy training programs that should be implemented with respect to educational level, gender and income of the individuals.

Health Literacy in Older Adults and Its Related Factors: A Cross-Sectional Study in Southeast Iran

The protein tyrosine phosphatase non-receptor type 22 (PTPN22) gene, which encodes an intracellular lymphoid-specific phosphatase, is considered an important regulator of T-cell activation. We investigated a possible association between the PTPN22 C1858T (R620W) polymorphism and pulmonary tuberculosis in an Iranian population. Single nucleotide polymorphisms of PTPN22 C1858T (rs2476601) were genotyped in 172 pulmonary tuberculosis cases and 204 normal subjects from Zaheden, Iran. Frequencies of genotypes CC, CT and TT of the PTPN22 C1858T polymorphism were 98.3, 1.7 and 0% in the pulmonary tuberculosis patients, and 96.1, 3.9 and 0% in the control group, respectively (P = 0.239). The frequency of the minor (T) allele was 0.8% in pulmonary tuberculosis patients and 2.0% in controls. Significant differences were not observed in genotype or allele frequencies of PTPN22 C1858T in the comparison between pulmonary tuberculosis patients and healthy subjects in our Iranian population sample.

/pdf/r620w-functional-polymorphism-of-protein-tyrosine-3todmqeuj0.pdf

R620W functional polymorphism of protein tyrosine phosphatase non-receptor type 22 is not associated with pulmonary tuberculosis in Zahedan, southeast Iran.

Hepatitis delta virus (HDV) infection results in more severe and even fulminant form of hepatitis B in co-infected cases. This study was designed to estimate the prevalence of anti-HDV positivity and the associated risk factors in patients with chronic hepatitis B virus infection in Zahedan (Iran). In this cross-sectional study a total of 440 consecutive patients with chronic hepatitis B virus (HBV) infection attending the Zahedan Gastroenterology and Hepatology clinics from 2008 to 2011 were included. We performed test for HDV serum marker, using commercially available enzyme-linked immunosorbent assay kit. Patients were split into two groups according to their HDV antibody status as HDV positive or negative. The collected data were coded, and the statistical analyses were conducted. Four hundred and forty patients with various forms of chronic HBV-related liver diseases enrolled in the study. 200 (45.5%) patients were carrier for HBV. 196 (44.5%) patients had chronic active hepatitis and 44 (10%) patients suffered from cirrhosis. Anti-HDV was demonstrated in 75 patients (17%). The prevalence of HDV was 7%, 16.3% and 65.9% in carriers, patients with chronic active hepatitis and cirrhosis, respectively. HDV infection is still an important public health problem in Zahedan and appears a major cause of progression of liver disease induced by HBV.

/pdf/seroprevalence-and-risk-factors-of-hepatitis-delta-virus-in-4l2b245jof.pdf

Seroprevalence and risk factors of hepatitis delta virus in chronic hepatitis B virus infection in Zahedan.

BACKGROUND: In the present study, the epidemiologic aspects of road traffic crashes in South East of Iran are described.METHODS: This cross-sectional study included the profile of 2398 motor vehicle crashes recorded in the police office in one Year in South East of Iran. Data collected included: demographics, the type of crash, type of involved vehicle, location of crash and factors contributing to the crash. Descriptive statistics were used for data analysis.RESULTS: Collisions with other vehicles or objects contributed the highest proportion (62.4%) of motor vehicle crashes. Human factors including careless driving, violating traffic laws, speeding, and sleep deprivation/fatigue were the most important causal factors accounting for 90% of road crashes. Data shows that 41% of drivers were not using a seat belt at the time of crash. One- third of the crashes resulted in injury (25%) or death (5%).CONCLUSIONS: Reckless driving such as speeding and violation of traffic laws are major risk factors for crashes in the South East of Iran. This highlights the need for education along with traffic law enforcement to reduce motor vehicle crashes in future. Language: en

/pdf/the-pattern-of-road-traffic-crashes-in-south-east-iran-sn8mvv94mz.pdf

The Pattern of Road Traffic Crashes in South East Iran.

Objective: The Pediatric Risk of Mortality (PRISM) score is one of the scores used by many pediatricians for prediction of the mortality risk in the pediatric intensive care unit (PICU). Herein, we intend to evaluate the efficacy of PRISM score in prediction of mortality rate in PICU. Methods: In this cohort study, 221 children admitted during an 18-month period to PICU, were enrolled. PRISM score and mortality risk were calculated. Follow up was noted as death or discharge. Results were analyzed by Kaplan-Meier curve, ROC curve, Log Rank (Mantel-Cox), Logistic regression model using SPSS 15. Findings: Totally, 57% of the patients were males. Forty seven patients died during the study period. The PRISM score was 0-10 in 71%, 11-20 in 20.4% and 21-30 in 8.6%. PRISM score showed an increase of mortality from 10.2% in 0-10 score patients to 73.8% in 21-30 score ones. The survival time significantly decreased as PRISM score increased (P≤0.001). A 7.2 fold mortality risk was present in patients with score 21-30 compared with score 0-10. ROC curve analysis for mortality according to PRISM score showed an under curve area of 80.3%. Conclusion: PRISM score is a good predictor for evaluation of mortality risk in PICU.

Mahdi Mohammadi

Papers

Health Literacy in Older Adults and Its Related Factors: A Cross-Sectional Study in Southeast Iran

R620W functional polymorphism of protein tyrosine phosphatase non-receptor type 22 is not associated with pulmonary tuberculosis in Zahedan, southeast Iran.

Seroprevalence and risk factors of hepatitis delta virus in chronic hepatitis B virus infection in Zahedan.

The Pattern of Road Traffic Crashes in South East Iran.

Mortality Risk Prediction by Application of Pediatric Risk of Mortality Scoring System in Pediatric Intensive Care Unit