JOURNAL OF RESEARCH IN MEDICAL SCIENCES (JRMS)
Year:2009 | Volume:14 | Issue:1|Papers Count:10

Background: Patients have a major role in the control and treatment of type 2 diabetes. So, knowledge of different aspects of this disease especially diet therapy is very important for these patients. This study was conducted to determine the effectiveness of the Health Belief Model (HBM) on nutrition education in type 2 diabetic patients.Method: Eighty eight type 2 diabetic patients attending Iranian Diabetes Association seminars were randomly selected to participate in the study (44 in intervention group and 44 in control group). The intervention was consisted of two educational sessions each one for 80 minutes. Data were collected by a validated and reliable questionnaire (58 questions) before intervention and one month after intervention.Results: After intervention, knowledge scores increased in the intervention group compared to the control group (Mean differences in the intervention and test group: 22.68±15.90 vs -2.27±17.30, P<0.001). Perceived susceptibility increased significantly in the intervention group compared to the control group (27.5±18.5 vs 3.9±17.2, P<0.001). The result was the same for perceived severity, perceived threatened and perceived benefits (P<0.001). In contrast perceived barriers reduced in the intervention group compared to the control diet (-14.7±13.3 vs 0.9±13.9, P<0.001). In the intervention group, behavior grades increased more than control group (34.61±14.93 vs -0.23±8.52, P<0.001).Conclusion: The efficacy of the health belief model in nutritional education to the diabetic patients was confirmed in the present study.

Background: To assess the risk of neonatal mortality and morbidity in twin, triplet and quadruplet pregnancies.Methods: In a retrospective study, the neonatal outcome of all twin, triplet and quadruplet gestations delivered from October 2001 to September 2006 was reviewed. The neonatal outcome of triples and quadruplets was compared with a matched group of twins for gestational age.Results: During a 5-year period, 511 sets of twin pregnancies, 42 sets of triplet and 5 sets of quadruplet pregnancies were studied. The mean of gestational age for twins, triplets and quadruplets were 33.92±3.5 weeks, 30.92±3.8 weeks and 31.60±2.0 weeks, respectively, (P=0.0001). Triplets and quadruplets weighed less than twins, (P=0.0001). Neonatal mortality was 13.5% for twins, 26.8% for triplets and 30% for quadruplets. In vitro fertilization, use of ovulation induction agents, and cesarean delivery in the women with triplet and quadruplet were significantly higher than in those with twin pregnancies, (P=0.0001). The mean age of mothers with triplets and quadruplets was significantly higher than with twins (P=0.026). There was not a significant difference in respiratory and non-respiratory short outcomes between triplets, quadruplets and twins when matched for gestational age. Apgar score at 1 and 5 minutes was significantly lower in triplets and quadruplets than twins. There was no influence of birth order on neonatal mortality of triplet pregnancy. Neonatal mortality of triplet births was significantly decreased over the 5 years of the study period.Conclusions: Triplets and quadruplets have a similar neonatal outcome as twins when matched for gestational age.There is no influence of birth on the neonatal mortality of triplet pregnancy. It appears that outcome is mainly dependent on gestational age.

Background: Occult hepatitis B is defined as presence of HBV DNA in tissue or serum without hepatitis B surface antigen. The aim of this study is to determine frequency of occult hepatitis B among hepatitis C patients in Tehran and compare the route of transmission and liver enzymes between positive and negative HBV DNA patients.Methods: In a cross sectional study, serum of 103 hepatitis C cases (79.6% men and 20.4% women) were analyzed for s, x and core genes via a nested polymerase chain reaction technique.Results: HBV DNA was detectable in serum of 20 patients (19.4%). No significant difference in age, sex and route of transmission were seen in HBV DNA positive and negative patients. In HBV DNA positive and negative groups, mean of AST was 73, 47 (p<0.05) and mean of ALT was 76 and 36 respectively (p<0.05).Conclusion: Occult hepatitis B was observed in a considerable number of hepatitis C patients in Tehran. It was associated with elevation in liver enzyme but was not related to route of transmission.

Background: To investigate the effects of Baicalin and Octreotide on inflammatory mediators and pancreatic acinar cells apoptosis of rats with severe acute pancreatitis (SAP).Methods: SD rats were randomly divided into sham operated group (I group), model control group (II group), Baicalin treated group (III group) and Octreotide treated group (IV group). Each group was also divided into subgroup of 3, 6 and 12 h (n=15). The mortality rate, ascites / body weight ratio as well as the level of endotoxin, NO and ET-1 in blood was measured. The pathological severity score of pancreas, apoptotic indexes, and expression levels of Bax and Bcl-2 proteins in each group were investigated.Results: The survival rate of III and IV group has a significant difference compared with II group (P12h<0.05). The ascites volume, contents of inflammatory mediators in blood and pathological severity score of pancreas of III and IV group declined at different degrees compared to II group (P<0.05, P<0.01 or P<0.001). Apoptotic index in III group was significantly higher than that in II group at 3 and 6 h (P3, 6h<0.05). Apoptotic index in IV group was significantly higher than that in II group at pancreatic tail at 6 h (P6h<0.05). Expression level of Bax in III group was significantly higher than that in II group (pancreatic head P3h, 6h<0.01, pancreatic tail P3h<0.001).Conclusions: Compared with Octreotide in the treatment of SAP, the protective mechanisms of Baicalin include reducing the excessive inflammatory mediators’ release, inducing the pancreatic acinar cells apoptosis.

Background: A bipolar spectrum definition presented to help the designation of more appropriate diagnostic criteria for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V) is Ghaemi et al. Bipolar Spectrum Disorder (BSD). The present study evaluates the BSD frequency among inpatients with major depressive disorder (MDD) and tries to elucidate the contribution of second degree diagnostic items of BSD in the BSD definition.Methods: One hundred individuals aged 18-65 with current MDD consecutive admitted in three university affiliated psychiatric center were clinically interviewed. The patients with mental retardation or the history of substance dependence / abuse were excluded. The interviews were carried out by a trained general practitioner according to an 11-item checklist comprised of criteria C (2 items) and D (9 items) of Ghaemi et al. BSD.Results: Fifty three males and 47 females entered the study. Patients' mean age was 34.16 ± 9.58. Thirty eight patients (39.2%: 18 males and 20 females) met the complete diagnostic criteria of BSD. Early-onset depression (53.0%), recurrent depression (40.0%) and treatment resistant depression (38.8%) were the most frequent accessory items of BSD, but using logistic regression three items -recurrent major depressive episodes (MDEs), treatment resistant depression, and brief MDE - had the significant weight to predict the BSD. Then, three mentioned items were simultaneously entered the logistic regression model: brief MDE (b=1.5, EXP (b)=4.52, p=0.007), treatment resistant depression (b=1.28, EXP (b)=3.62, p=0.01), and recurrent MDEs (b=1.28, EXP (b)=3.62, p=0.01) had the highest strength in predicting BSD and account for 21-30% of BSD diagnosis variance in sum.Conclusions: Regarding the greater diagnostic strength of some accessory items – especially brief MDE - to predict the BSD, it is suggested that these items were considered as the main ones in the BSD criterion C.

Background: Recently, it is proposed that oxidant-antioxidant imbalance may have a role in the pathophysiology of schizophrenia. The present study was performed to assess differences in plasma levels of nitric oxide (as oxidant), caeruloplasmin (secondary antioxidant), and antioxidant trace metals (Zn, Se, Mn, Cu and Fe) in patients with schizophrenia compared with healthy controls. Our secondary aim was to further evaluate the impact of psychopharmacologic treatment on these parameters.Methods: Plasma levels of nitric oxides (NO), caeruloplasmin, zinc (Zn), selenium (Se), manganese (Mn), copper (Cu) and iron (Fe) in patients with schizophrenia before (n=15) and after antipsychotic drug treatment (n=20) were compared with those of healthy controls (n=20). Convenient sampling method was used for the selection of subjects. NO was estimated by the use of Griess method, caeruloplasmin was estimated by the use of immunodiffusion method and antioxidant trace metals was estimated by the use of atomic absorption spectrophotometer.Results: The levels of Cu and caeruloplasmin were not significantly different while Fe and Se were significantly reduced in both groups of schizophrenic patients compared with the controls. Zn was significantly elevated in medicated schizophrenics compared with drug-free patients or controls. NO was significantly elevated in drug free patients with schizophrenia compared with controls or treated patients.Conclusions: Our findings suggest the application of management strategies that will reduce NO but will increase antioxidant trace metals in patients with schizophrenia.

Pulmonary embolism (PE) and deep vein thrombosis (DVT) are associated with considerable morbidity and mortality, mostly, in case of PE for its lack of sensitivity of its early detection. For as much as twenty-five percent of PE patients the primary clinical appearance is unexpected death. While PE is one of the most avertable causes of hospital-associated deaths, its diagnostics can be extremely difficult. Newly increased interest in an inherited thrombophilic states has been provoked by the discovery of several common inherited abnormalities, i.e. the prothrombin (PT) gene G20210A, Factor V Leiden (FVL) mutation (Arg506Gln), hyperhomocystenemia and homocysteiuria, Wein-Penzing defect, Sticky Platelet Syndrome (SPS), Quebec platelet disorder (QPD) and Sickle Cell Disease (SCD). PE incidence rates increase exponentially with age for both men and women, as they might harbor more than one thrombophilic state. Although the impact of genetic factors on PE is to some extent documented with lacking taxonomy, its genetic testing as its prevention strategy fall short.In this review thrombophilic states are divided into inherited or acquired, and only the inherited and newly documented are more closely followed. Factors are further grouped based on its thrombophilic taxonomy into; inherited defects of coagulation, inherited defects of fibrinolysis, inherited defects of enzymatic pathway in relation to development of VTE and PE and inherited defects of platelets in relation to PE. It was beyond the scope of this review to follow all inherited and newly recognized factors and its association to VTE and PE; however the overall taxonomy makes this review clinically valuable i.e. in relation to genetic testing as PE prevention.

Gorlin syndrome (GS), also known as nevoid basal cell carcinoma syndrome (NBCCS), is a rare inherited multisystem disorder. This paper presents a 22-years-old Iranian woman with this syndrome whose past history was multiple keratocysts of maxillary bone. She was referred to gynecology clinic with the chief complaint of irregular menses and vaginal spotting. On examination, frontal bossing and hypertelorism were detected. Physical examination of genitalia disclosed bilateral adnexal masses. Pelvic ultrasound showed two solid, echogenous and calcified masses measuring 100*50*10 & 60*50*45 mm in the left and right ovaries, respectively. The patient underwent right oophorectomy and ovarian mass resection with preservation of intact ovarian tissue on the left side. On frozen and permanent histological sections, bilateral and calcified ovarian fibromas were diagnosed. Surprisingly, during the last follow-up one year after the surgery, we found that our patient was expecting a baby. It can be concluded that in the presence of bilateral and calcified ovarian fibromas, the possibility of GS should be considered. Accurate diagnosis is only possible with close attention to the familial and past medical history and physical examination. In these patients, careful follow up for detecting malignancies and other complications is highly recommended.

Avulsion or fracture of posterior ring apophysis of lumbar vertebra is an uncommon cause of radicular low back pain in pediatric age group, adolescents and athletes. This lesion is one of differential diagnosis of disc herniation. We reported two teenage boys with sever low back pain and sciatica during soccer play that ultimately treated with diagnosis of slipped vertebral apophysis.

In the latest issue of the Journal of Research in Medical Sciences, Dr. Shaygannejad et al1 described a patient with diagnosis of multiple sclerosis (MS) accompanying by hoarseness. Herein, I shall consider some points on the subject of this exciting case report.