Breast cancer is the most common cause of cancer related deaths among women worldwide. The disease in women occurs at a younger age in Iran than in western communities.
To determine the practice of breast self examination (BSE) among 25–54-year-old women in Shiraz, southern Iran.
Using a stratified convenient sampling method, a total of 300 women aged 25–54 years who attended our health care centre between September 2006 and May 2007 were invited for an interview on BSE. All invited women accepted and were interviewed. The questions included demographic information, level of education, whether the participant performed BSE and, if yes, how and when. They were also asked about their source of information.
The median (interquartile range (IQR)) age of participants was 38.5 (14) years. Of the 300 studied women, 283 (94.3%) were married; 160 (53.3%) performed BSE—9 (5.6%) of whom did BSE using a correct method and at an appropriate time. Of 140 non-performers, 74 (52.9%) did not know how to do BSE; the remaining women did not do BSE for fear of being found positive for cancer or did not care about it. Those who performed BSE learned it from medical personnel (n = 72, 49.4%), their relatives, and TV, radio, books, journals and pamphlets. Of those who performed BSE, 9 (5.6%) found an abnormal examination; 6 (3.8%) were found positive after further evaluation. The likelihood of performing BSE was not associated with educational level, marital status, age of participant, or how the participant learned about BSE.
Considering that 46.7% of participants did not perform BSE, and that almost all of those who did perform BSE did it incorrectly—and taking into account that a lack of knowledge on how to perform BSE was the main reason why most non-performers did not examine themselves—establishing educational programmes to teach women at risk may help in the early diagnosis of breast cancer.
Peripheral neuropathy is a major contributor to diabetic foot complications including ulceration, sepsis and limb loss. The aim of this study was to document the frequency of this previously undocumented clinical marker of peripheral neuropathy, the "slipping slipper sign" (SSS), characterised by unrecognised loss of slippers from one’s feet while walking, and to compare it with traditional clinical tests for peripheral neuropathy.
To evaluate the relationship between a positive SSS and diabetic peripheral neuropathy.
The study included 105 diabetic outpatients without active foot problems, 40 diabetic inpatients with active foot sepsis, and 69 other patients with neither diabetes nor active foot sepsis as negative controls. Demographic data, clinical neuropathy scores and the presence or absence of the SSS were obtained.
No control subjects had a positive SSS. In contrast, 64 of 145 diabetic patients had severe neuropathy of whom 53 had a positive SSS (83% sensitivity) and 74 of 81 without severe neuropathy had a negative SSS (91% specificity). Diabetic patients with concurrent foot sepsis had a higher frequency of severe neuropathy (70%) and positive SSS (65%) compared with those without (36% and 35%, respectively, p<0.001). Multivariate analysis showed that a positive SSS was strongly related to severity of neuropathy independent of duration of diabetes.
The SSS reflects severe peripheral neuropathy and is particularly prevalent among those with active foot disease. Patients who have experienced the SSS should be encouraged to seek attention and preventive action taken.
Recent guidelines by the National Institute for Health and Clinical Excellence (NICE) and the American College of Cardiology/American Heart Association/European Society of Cardiology (ACC/AHA/ESC) on rate control management for chronic atrial fibrillation have relegated digoxin to second line treatment, recommending instead the use of β-blockers or rate limiting calcium antagonists as first line treatment. The objective of this review is to assess the efficacy of these drugs in controlling heart rate, and in improving symptoms and exercise tolerance.
We electronically searched the Medline, Embase and Cochrane databases, hand searched journals and relevant bibliographies for articles.
We included all study designs evaluating or comparing oral digoxin, β-blockers and calcium antagonists, alone or in combination, for rate control in chronic atrial fibrillation. 46 studies satisfied our inclusion and quality criteria.
Published studies are small and too heterogeneous to be quantitatively combined. Descriptive synthesis of the data shows little evidence that monotherapy with β-blockers or calcium antagonists improves symptoms or exercise capacity in patients with chronic atrial fibrillation. Instead it is associated with dose related side effects.
Based on the limited data available, we conclude that the combination of digoxin with either a β-blocker or calcium antagonist should be first line management in patients with chronic atrial fibrillation.