JOURNAL OF RESEARCH IN MEDICAL SCIENCES (JRMS)
Year:2011 | Volume:16 | Issue:11|Papers Count:20

BACKGROUND: Cisplatin (CP) as a potential drug for solid tumors produces nephrotoxicity and disturbs endothelial function. CP induced nephrotoxicity may be gender related. Nitric oxide plays a pivotal role in endothelial function and L-arginine as endogenous NO donor promotes endothelial function. The role of L-arginine in CP induced nephrotoxicity model and its gender related was investigated in this study.METHODS: Thirty three Wistar rats were randomly assigned to four groups. The groups 1 (male, n=6) and 2 (female, n=11) received a single dose of L-arginine (300 mg/kg, ip), and the day after, they received a single dose of CP (7 mg/kg). The group 3 (male, n=9) and 4 (female, n=7) were assigned to the same regimen except for saline instead of L-arginine. All animals were sacrificed one week after CP administration. The levels of blood urea nitrogen (BUN), creatinine and nitrite were measured. The kidneys were also removed for pathological investigations.RESULTS: Five animals died. All CP treated animals lost weight. The normalized weigh loss was significantly different between male and female in CP+L-arginine treated animals (p<0.05). BUN and creatinine were increased significantly in male treated with CP and in female treated with CP+L-arginine (p<0.05). L-arginine reduced BUN in male (not in female) when compared with control groups (p<0.05). The level of nitrite was increased significantly in L-arginine treated animals. Kidney tissue damage score and normalized kidney weight were greater in females treated with CP+ L-arginine than female received CP alone (p<0.05).CONCLUSIONS: L-arginine may protect against CP induced nephrotoxicity in male, but it promotes the induced damage in female. The exact mechanism need to be defined.

BACKGROUND: Cardiac dysfunction is seen in many patients and could be evaluated with echocardiography and serum biomarkers. The aim of this study was evaluation of the relationship between echocardiographic findings and laboratory serum biomarkers in children with and without low cardiac output.METHODS: Thirty patients older than 1 month with and without low cardiac output were enrolled in this study. It composed of 13 patients with dilated cardiomyopathy (DCM), 7 with end stage renal disease (ESRD) and 10 who had a Fontan operation. Echocardiography was performed with emphasis on shortening fraction (SF) and ejection fraction (EF). Blood samples were collected for measurement of atrial natriuretic peptide (ANP), high sensitivity C-reactive protein (hs-CRP) and alkaline phosphatase (Alk-P). Both echocardiographic findings and laboratory data were compared with control levels in twenty-seven normal children. Pearson correlation and regression analysis were conducted to evaluate the aforementioned associations.RESULTS: The mean of ANP and hs-CRP in the case group was statistically higher than control group (p<0.001). The mean of ANP and hs-CRP were different in all groups (p<0.001). There was a reverse linear regression between the SF and ANP in the case group (r=-0.594, p<0.001).CONCLUSIONS: Determination of the plasma ANP and hs-CRP level may be helpful for decisions related to early diagnosis of patient with low cardiac output.

BACKGROUND: Differentiation between exudative and transudative pleural effusions is the initial step in assessment of pleural effusion. The aim of this study was to determine whether high sensitivity C-reactive protein (hsCRP) and tumor necrosis factor a (TNFa) are diagnostic utilities for exudative pleural effusion.METHODS: This experimental study assessed 79 patients with pleural effusion who underwent diagnostic evaluations at Imam Reza hospital, Mashhad, Iran in 2009-2010. The complete biochemical analysis of pleural fluid, pleural fluid culture, and pathological examination of pleural fluid and tissue were performed. Moreover, hsCRP and TNFa concentrations were measured in pleural fluid samples. The data was analyzed by student's t-test and Mann-Whitney test.RESULTS: According to Light's criteria, 50 patients (63.30%) had exudative effusions while 29 subjects (36.70%) had transudative effusion. The pleural fluid concentrations of hsCRP and TNFa were significantly higher in the exudative group than the transudative group (p<0.05). At a cutoff value of 5 mg/L for hsCRP, the results showed 94% sensitivity and 96.6% specificity. Regarding TNFa, a cutoff value of 12.9 ng/dl represented 96% sensitivity and 93% specificity.CONCLUSIONS: HsCRP and TNFa levels may be considered as beneficial diagnostic factors for detecting exudative effusion in patients with pleural effusion.

BACKGROUND: Despite the new developments in sepsis treatment, mortality rate is still high. In this study, we aimed to investigate endocrinologic changes and the effects of moderate dosage steroid treatment in patients with sepsis.METHODS: Fifty-five patients were included in the study. Basal hormonal evaluation and adrenocorticotropin hormone (ACTH) stimulation test were performed within 24 h in all patients. Both groups received standard treatment for sepsis. However, one group (steroid group) was also given intravenous prednisolone (20 mg/day). All-cause mortality was assessed during the first 28 days.RESULTS: Analysis of the findings revealed a 59.3% mortality rate in steroid group compared with a 53.6% mortality rate in placebo group (p=0.787). Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores, and peak cortisol and ACTH levels were significant factors related to mortality. The incidence of adrenal insufficiency (AI) was 10.9% and relative adrenal insufficiency (RAI) 36.4%. It was also found that steroid treatment did not have any effects on the mortality of patients with AI and RAI (p=0.075 and p=0.999, respectively).CONCLUSIONS: Moderate-dose steroid therapy has no effect on mortality. Higher basal cortisol and peak cortisol levels were found more reliable mortality indicators compared to RAI. In addition, the study revealed that ACTH level was a significant indicator of mortality.

BACKGROUND: Dislocated lens fragments in the vitreous cavity can cause potentially serious complications. This retrospective study aimed to evaluate the visual outcome of patients who underwent pars plana vitrectomy (PPV) for posteriorly dislocated lens fragments after cataract phacoemulsification.METHODS: A retrospective study was conducted on all consecutive cases (60 patients) with pars plana vitrectomy performed for retained lens fragment. In 30 eyes (50%), PPV was performed within 1 week of cataract extraction and in 30 eyes (50 %), PPV was performed more than 1 week post cataract extraction from July 2005 through August 2008.RESULTS: In the late vitrectomy group, 66.6% of eyes developed persistent uveitis, 53.3% of eyes showed elevated intra-ocular pressure (IOP) and 5 eyes retinal detachment. In early PPV group 16.6% developed uveitis and 20% showed elevated IOP and one eye retinal detachment. The final visual acuity was 20±50 in early PPV and 20±200 in late PPV group (mean ±SD, p<0.001).CONCLUSIONS: The early use of PPV to remove posterior dislocated lens fragments within the first week was shown to be advantageous. The inflammatory response was less pronounced, IOP rose less significant, the incidence of retinal detachment was lower and visual recovery was faster.

BACKGROUND: Intercondylar (IC) and intermalleolar (IM) distance measurements are appropriate modalities for screening angular deformities but the values are not the same in all ethnics. This study was conducted to assess the mean values and normal limits of IC and IM distances in Iranian children.METHODS: A total of 2268 children aged eight to eleven years were recruited in this research project. The IC and IM distances were measured and recorded according to a special procedure in standing and supine positions.RESULTS: The mean values of IC distance were 2.4±6.05 and 3.83±8.1 mm in supine and standing positions, respectively, while the corresponding IM distances were 5.63±10.74 and 7.51±11.22 mm. There was no significant difference among the age groups. Moreover, the mean values of these parameters did not differ significantly between two genders.CONCLUSIONS: With respect to reported values, IC and IM measurements, especially when selected according to age, can be used for screening angular deformities of lower limbs.

BACKGROUND: Differentiation between Entamoeba histolytica and Entamoeba dispar is very important for both clinical therapy and epidemiological studies. Although these two species are morphologically identical, they have differences in genetic, chemical specifications and pathogenicity. This study was carried out to differentiate E. histolytica from E. disparand also to find out frequency of the two species.METHODS: Fecal samples were collected three times from 655 patients with gastrointestinal complaints (47.3% male and 52.7% female), who were referred to the primary health care centers of Chelgerd, Chaharmahal and Bakhtiary province. Samples were examined microscopically with direct smear, formalin-ethyl-acetate concentration and trichrom staining methods to distinguish E. histolytica from E. dispar complex and differentiate them from non-pathogenic intestinal amoeba. Genomic DNA was extracted from microscopy positive isolates and polymerase chain reaction (PCR) was carried out to different the two morphologically identical Entamoeba isolates.RESULTS: Among the 655 recruited patients, eleven subjects with E. histolytica / E. dispar isolates (1.7%) were identified by microscopy methods. Ten of the positive isolates (90.9%) were identified as E. histolytica by PCR and one isolate (9.09 %) was positive for E. dispar.CONCLUSIONS: This study revealed that E. histolytica was more prevalent than E. dispar in the studied area. This result was different from the previously reported data in other parts of Iran.

BACKGROUND: Although patients with chronic diseases are at high-risk for symptoms of anxiety and depression, few studies have compared patients with different chronic conditions in this regard. This study aimed to compare patients with different chronic medical conditions in terms of anxiety and depression symptoms after controlling for the effects of socio-demographic and clinical data.METHODS: This cross-sectional study enrolled 2234 adults, either healthy (n=362) or patients with chronic medical conditions (n=1872). Participants were recruited from the outpatient clinic of Baqiyatallah Hospital, Tehran, Iran. Patients had one of the following five medical conditions: coronary artery disease (n=675), renal transplantation (n=383), chronic hemodialysis (n=68), rheumatoid conditions (rheumatoid arthritis, osteoarthritis, systemic lupus erythematosus and ankylosing spondylitis) (n=666) and viral hepatitis (n=80). Independent factors included socio-demographic data, pain disability, and somatic comorbidities (Ifudu index). Outcomes included symptoms of anxiety and depression through Hospital Anxiety and Depression Scale (HADS). Two multinomial regression models were used to determine the predictors of anxiety and depression symptoms.RESULTS: After controlling the effect of age, sex, educational level, comorbidities, disability and pain, rheumatoid arthritis and hepatitis were predictors of higher anxiety symptoms, while coronary artery disease and chronic hemodialysis were predictors of depression symptoms.CONCLUSIONS: Although all chronic conditions may require psychological consideration; be that as it may, different chronic diseases are dissimilar in terms of their mental health need. Anxiety for rheumatoid arthritis and hepatitis as well as depression for coronary artery disease and chronic hemodialysis is more important.

BACKGROUND: Thermotherapy has been indicated by some researchers as a treatment for lymphedema. A study comparing temperatures demonstrated that a temperature of 40oC significantly increased the transportation of lymph compared to other temperatures assessed. The aim of this study was to evaluate the possible benefits of mechanical lymph drainage accompanied with heat in the treatment of lymphedema of the lower limbs.METHODS: In a cross-over randomized study, the effect of heat on lymph drainage was evaluated in the treatment of leg lymphedema. The study, performed in the Godoy Clinic in Sao Jose do Rio Preto, Brazil, involved seven patients (two males and five females) with leg lymphedema. The patients' ages ranged from 18 to 79 years old with a mean of 48.5 years. The subjects underwent a total of 38 assessments including 19 evaluations of mechanical lymph drainage alone and 19 combined with thermotherapy. Heat was applied using an electric blanket which was wrapped around the legs of the patients. The volume of legs was evaluated by water plethysmography before and after treatment sessions. The paired t-test was used for statistical analysis with an alpha error of p=0.05 being considered as acceptable.RESULTS: No statistically significant differences were evidenced between mechanical lymph drainage alone and lymph drainage combined with thermotherapy.CONCLUSIONS: There was no obvious synergic effect in the immediate post-treatment period when heat was combined with mechanical lymph drainage in the treatment of lymphedema.

BACKGROUND: The female at-risk population represents a subgroup that is both a crucial determining factor in acquired immune deficiency syndrome (AIDS) transmission and a gap in the existing literature in Iran. The objective of this study was to evaluate the level of sex workers’ knowledge towards to safe procedures of sexually transmitted infection and AIDS prevention as well as attitudes towards AIDS.METHODS: A sample of 256 female sex workers working in Tehran was obtained by a variety of methods. Appropriate questions for the assessment of knowledge and attitude were developed based on previous studies.RESULTS: The mean age of the subjects was 26.8±6.1 years (ranging from 16 to 45). Methods of transmission were widely recognized, despite the exception that few realized oral (23.4%) and anal (44.9%) intercourse as methods of human immunodeficiency virus (HIV) transmission. Most subjects knew that AIDS currently has no cure (81.2%) and no vaccine (73.4%). Most also acknowledged that HIV is transmissible from people who do not know they are HIV positive (59.4%), proper condom use can reduce the possibility of infection (78.1%), and so can having a single sexual partner (68.8%). Of the participants, 43.4% knew that an HIV-positive person can seem perfectly healthy.CONCLUSIONS: Knowledge towards sexually transmitted infections (STIs) and condom use is still inadequate, especially regarding risky behaviors such as anal sex, and attitudes are mainly negative. Identifying at-risk populations, HIV positive sex workers, education and campaigns to change the attitudes towards AIDS should be regarded a high priority in Iran.

BACKGROUND: Increased proteinuria would lead to a larger risk for renal failure in the long term. Therefore, proteinuria requires immediate and thorough evaluation. This study was designed to evaluate the effects of pioglitazone on proteinuria in patients with non-diabetic renal disease.METHODS: In this self-controlled clinical trial study, forty four non-diabetic patients aged 18 and more, who had renal disease and a stable proteinuria of over 0.5 g in 24 hour, were studied. All patients received 15 mg of daily pioglitazone for 4 months. Urine protein excretion was measured as a main end point prior to the study, at the end of the 2nd and 4th months of treatment, and 2 and 4 months after the cessation of the active drug. Other evaluated variables included systolic blood pressure, serum creatinine, urea, alanine aminotransferase (ALT), aspartate aminotransferase (AST), fasting blood sugar (FBS), blood urea nitrogen (BUN) and glomerular filtration rate (GFR) levels.RESULTS: Proteinuria (mean ± SEM) prior to the study, at the 2nd and 4th months of the treatment, and 2 and 4 months after the cessation of pioglitazone were 1088.6±131.1, 699.9±118.3, 433.9±68.7, 416.1±54.9 and 646.9±89.1, respectively (p<0.001). In addition, the reduction of 24-hour urine protein was statistically significant for both male and female patients (p<0.001 for both).CONCLUSIONS: A reduction of proteinuria in patients with non-diabetic renal disease was observed during the 4-month treatment with pioglitazone which continued for 2 months after the cessation of the treatment. However, 4 months after the cessation of the treatment, a little increase was detected in the level of proteinuria.

BACKGROUND: Cognitive impairment associated with temporal lobe epilepsy (TLE) has been recognized in multiple studies. We designed this study to find a specific cognitive profile in patients with TLE who were candidates for epilepsy surgery. We also sought to find if neuropsychological assessment could differentiate left TLE, right TLE and normal subjects.METHODS: The sample of this study consisted of 29 patients with right TLE, 31 with left TLE, and 32 subjects without history of seizure as the control group. For all recruited patients and controls, demographic questionnaire, Wechsler Memory Scale-III (WMS-III) and Wechsler Adult Intelligence Scale-R (WAIS-R) were administered. Multivariate analysis of variance was carried out to reveal differences in memory and intelligence performance between the three groups.RESULTS: All of the mean scores of the WMS-III indexes were significantly higher in the control group in comparison with the right or the left TLE groups (p<0.001). There were not any significant differences between mean scores of WMS-III indexes of the right and the left. The WAIS-R also showed significantly better mean scores of full scale intelligence quotient (FSIQ) and performance intelligence quotient (PIQ) in the control groups than both of the right and left TLE patients (p<0.001). Although the verbal intelligence quotient (VIQ) mean scores were significantly different between the left TLE and the control group (p=0.037), there were not any significant differences between the right TLE patients and the control group.CONCLUSIONS: These findings indicated that WMS-III and WAIS-R can differentiate patients with refractory temporal lobe epilepsy from normal subjects. However, the obtained cognitive profile could not differentiate between the right and the left TLE.

BACKGROUND: Ischemic heart disease is one of the common fatal diseases in advanced countries. Because signal perturbation in healthy people is less than signal perturbation in patients, entropy measure can be used as an appropriate feature for ischemia detection.METHODS: Four entropy-based methods comprising of using electrocardiogram (ECG) signal directly, wavelet subbands of ECG signals, extracted ST segments and reconstructed signal from time-frequency feature of ST segments in wavelet domain were investigated to distinguish between ECG signal of healthy individuals and patients. We used exercise treadmill test as a gold standard, with a sample of 40 patients who had ischemic signs based on initial diagnosis of medical practitioner.RESULTS: The suggested technique in wavelet domain resulted in the highest discrepancy between healthy individuals and patients in comparison to other methods. Specificity and sensitivity of this method were 95% and 94% respectively.CONCLUSIONS: The method based on wavelet sub-bands outperformed the others.

BACKGROUND: The aim of this study was to investigate the role of carbohydrate-rich drink (CHO) on perioperative discomfort, hemodynamic changes, and insulin response in patients undergoing surgery with spinal anesthesia.METHODS: Forty-four adult patients were assigned to one of the two groups of 22, namely preparation with CHO (CHO group) or fasting from midnight (control group). Ten different discomfort variables, blood glucose and insulin concentrations, and hemodynamic changes were recorded during the perioperative period.RESULTS: Preparation with CHO was effective in reducing hunger, thirst, malaise, unfitness, and, to some extent, anxiety (p<0.05). Plasma glucose and insulin concentrations were increased in the CHO group (p<0.05). Plasma glucose increased and insulin decreased in the control group (p<0.05). In the control group, mean arterial pressure was lower compared to the CHO group (p<0.05).CONCLUSIONS: Preparation with CHO before spinal anesthesia is advantageous due to reducing perioperative discomfort, improving insulin response and stabilizing mean arterial pressure.

BACKGROUND: Etomidate frequently leads to myoclonic jerks during anesthetic induction. This study aimed to detect if pretreatment with magnesium decreases myoclonus incidence.METHODS: A hundred ASA (the American Society of Anesthesiologists) I-II patients were included and randomized into 2 groups. Three minutes before etomidate induction of anesthesia (by 0.3 mg/kg intravenous etomidate), Group M received 2.48 mmol (60 mg) intravenous magnesium sulphate and Group P received equal volume of intravenous saline. Myoclonus was evaluated as "present/absent".RESULTS: The rate of myoclonus was significantly lower in Group M than in Group P (p<0.01). Hemodynamic parameters revealed no significant difference between the two groups.CONCLUSIONS: Low dose magnesium pretreatment before etomidate induction of anesthesia significantly reduces unwanted myoclonic jerks and also protects the hemodynamic stability.

BACKGROUND: This study aimed to find effect of shift work on patient-doctor relationship in Emergency Department.METHODS: In a prospective cross-sectional study, 352 patients (mean age of 44±17 years, 131 females and 221 males) referred to the emergency department of Rasoul-Akram hospital were enrolled in the study. The patient-doctor relationship questionnaire (PDRQ) was asked to be filled by patients. The questionnaires contained 9 items and the appropriateness of the statements was simplified to a scale of 1 (not at all) through 5 (totally).RESULTS: Comparing three shift works, the highest PDRQ score was for morning (27.1±5.5) and the lowest value was for afternoon shift (23.8±5.3). PDRQ score for night shift was 25.1±6.9 (p=0.002).CONCLUSIONS: The results of this study encouraged that patients’ satisfaction of relationship with doctors was the lowest in the afternoon and it may be better to implement some strategies to reduce residents’ workloads and increase quality of works in the afternoon shifts.

Thrombophilia is a rare but potentially catastrophic phenomenon occurring in patients having tendency of thrombosis. It may lead to serious complications. The etiology of thrombophilia is thought to be multifactorial and related to both acquired and inherited factors. Inflammatory bowel disease is an acquired cause of thrombophilia. Thromboembolic events are seen during inflammatory bowel disease, especially during the active period of the disease. In inflammatory bowel disease, thrombus formation in portal, splenic and mesenteric veins are not common. Besides, the association of genetic disorders related to metabolism of homocysteine with inflammatory bowel disease has been evidenced, especially in Crohn disease and rarely in ulcerative colitis. We present a rare case of ulcerative colitis in association with combined portal, splenic and mesenteric vein thrombosis. The patient was recently diagnosed with the disease which was in the inactive period. Interestingly, our patient was also heterozygous for the mutation in methylenetetrahydrofolate reductase (MTHFR) gene.

We report a case of visceral leishmaniasis (VL) in a patient from Shush in Iran with cutaneous lesions, negative for Leishman-Donovan bodies, enlarged spleen filled by leishmania protozoa and negative immunological test. The patient was a 26-year-old male, who attended hospital with fever and two deep purulent lesions on the distal part of his left leg. On physical examination, the patient had splenomegaly. Laboratory results were as follows: pancytopenia, positive C-reactive protein (CRP), elevated erythrocyte sedimentation rate (ESR) and lactate dehydrogenase (LDH) levels. The necessary treatment was administrated to the patient. Biopsy of lesion for Leishman-Donovan body was negative. In addition, indirect fluorescent antibody (IFA) screening for leishmaniasis was negative. Diagnostic splenectomy was performed which pathological exploration showed a bulk of leishmania protozoa in patient's spleen. Twenty days later, this patient expired.

Colonic lipomas are benign adipose tumors that do not usually cause symptoms. Giant colonic lipoma (GCL) is an uncommon finding at endoscopy which may lead to iron deficiency anemia (IDA) with or without macroscopic ulceration. The choice of therapeutic procedure to treat symptomatic GCLs has been controversial. A case of GCL presented with occult bleeding and IDA is reported in this article. IDA resolved following the successful removal of the GCL by a combination of endoloop ligation and snare cautery technique.

Iread with interest the article of Dr Asilian and coauthors entitled “Comparison between the efficacy of Q-Switched 1064-nm Nd: YAG laser and Fraxel CO2 laser on improvement of atrophic facial acne scars” in this journal. In this article the authors concluded a better efficacy for fractional CO2 laser in comparison with 1064-nm Q-switched NdYag laser.