JOURNAL OF RESEARCH IN MEDICAL SCIENCES (JRMS)
Year:2011 | Volume:16 | Issue:4|Papers Count:20

BACKGROUND: Methotrexate, a toxic antimetabolite that limits cellular reproduction by acting as an antagonist to folic acid, has been used to control autoimmune disease with different results. The aim of this study was to evaluate the effectiveness of low dose Methotrexate in the relapsing-remitting multiple sclerosis (RRMS).METHODS: Eighty patients with definite RRMS aged 15 to 55 years were randomly allocated to receive a 12-month treatment course of either oral Methotrexate (7.5 mg/week) or intramuscular Interferon b-1a (30 mg/week). Response to treatment was assessed at 12 months after start of therapy.RESULTS: The results of the study demonstrated significant reduction in relapse rate in both groups (p<0.01). In 40 patients treated by Methotrexate, the mean value (SD) of relapse rate decreased from 1.75 (0.74) to 0.97 (0.83) (p<0.01). Correspondingly, the mean value (SD) of relapse rate in patients treated by Interferon b-1a decreased from 1.52 (0.59) to 0.57 (0.78) (p<0.01). Decrease of relapse rate in Interferon b-1a group was more than that in the other group (p=0.06).CONCLUSIONS: This study suggests that although treatment with Methotrexate may significantly reduce relapse rate and slow progression of disease in patients with RRMS, its efficacy is less than Interferon b-1a and it may be better used as add-on therapy.

BACKGROUND: This study was performed to compare the outcomes of open surgical procedure and percutaneously peritoneal dialysis catheter (PDC) insertion using laparoscopic needle.METHODS: This randomized clinical trial study was conducted in the Nephrology Department in Noor Hospital, Isfahan, Iran between 2009 and 2010.64 uremic patients were randomized into two study groups using random allocation software.Thirty four catheters were inserted percutaneously (P group) and 30 catheters were placed surgically (S group).Collected information included demographic data, body mass index, and cause of renal disease, duration of operation and length of hospitalization. Outcomes were considered as mechanical and infectious complications.RESULTS: There were no significant differences in age, gender, the mean of body mass index, having history of hemodialysis, diabetes mellitus, hypertension, ischemic heart disease, and length of hospitalization. Hemopenitoneom was more frequent in S group than P group (13.3% versus 3.2%; p<0.0001). There was no significant difference between two groups in early peritonitis, early leakage, hernia, hollow viscous perforation, catheter obstruction, and malpositioning and the time of peritoneal dialysis onset. Outflow failure and the exit site infection were more frequent in S group than P group (p<0.0001). Mean of the operative time was longer in S group than P group (27.70±2.79 minutes versus 10.48±1.91 minutes, p<0.001).CONCLUSIONS: Percutaneous catheter insertion has fewer rate of complications and is less time consuming in comparison with surgical method.

BACKGROUND: School feeding programs are important interventions for improving the nutritional status of students.Therefore, this study was conducted to evaluate the effects of milk supplementation on physical, mental and school performance of students.METHODS: This case-control population-based intervention was conducted on 469 students from 4 schools in a medium socio-economic status region in Tehran. The schools were chosen by Iranian ministry of education and training and they were allocated in case and control groups randomly. All the students in the first to third classes in the intervention schools were daily consumed sterilized and homogenized milk for three months (250 ml each). Anthropometric measurements were done according to the standard methods. For evaluating the mental function, the Raven’s Coloured Progressive Matrices (CPM) and Wechsler Intelligence Scale for children (verbal, non-verbal, total Intelligent Quotient) were conducted on students. School performance was assessed by grade-point averages of each student.RESULTS: The weight of children was significantly different between control and intervention group at the end of the study among girls (23.0±3.8 vs.23.8±4.3 kg; p<0.05). Psychological tests' scores were significantly different between the control and the intervention groups (p<0.05) at the end of the trial among boys. The grade-point average was significantly different at the end of the trial between the intervention and the control group among girls (p<0.05).CONCLUSIONS: School feeding programs focus on milk supplementation had beneficial effects on the physical function and school performances specifically among girls in Iran.

BACKGROUND: Postsurgical pain usually results in some complications in the patients. This study has tried to investigate the effects of parasternal single injection of bupivacaine on postoperative pulmonary and pain consequences in patients after open heart surgery.METHODS: In a prospective double blind clinical study, 100 consenting patients undergoing elective open heart surgery were randomized into two groups. In case group, bupivacaine was injected at both sides of sternum, immediately before sternal closure. In the control group, no intervention was performed. Then, the patients were investigated regarding intubation period, length of ICU stay, arterial blood gas (ABG) parameters, morphine requirement, and their severity of postoperative pain using a visual analogue scale (VAS) device.RESULTS: No differences were found between the two groups regarding to age, sex, pump time, operation time, and body mass index and preoperative cardiac ejection fraction. Mean intubation length in case group was much shorter than that in control group. Mean PaO2 in case group was lower in different checking times in postoperative period. The patients in the case group needed less morphine compared to those in the control group during the 24-hour observation period in the ICU. Finally, mean VAS scores of pain in case group were significantly lower than those in control group at 6, 12, and 24 hours postoperatively.CONCLUSIONS: Patients' pain relief by parasternal single injection of bupivacaine in early postoperative period can facilitate earlier ventilator weaning and tracheal extubation after open heart surgery as well as achieving lower pain scores and narcotic requirements.

BACKGROUND: The location of acute myocardial infarction (MI) is an important prognostic factor for risk stratification of patients with first ST-segment elevation MI (STEMI). The main goal of this study was to compare the severity and extension of coronary involvement in inferior and anterior MI.METHODS: This study reviewed angiographic reports of 579 patients with a first anterior wall STEMI and 690 with a first inferior STEMI that were referred to Tehran Heart Center between March 2004 and September 2007. The number of coronary vessels involvement and the presence of left main lesion were determined based on angiography reports.The Gensini score was also calculated for each patient from the coronary arteriogram.RESULTS: Incidence of left main lesion was similar between the two groups. Although coronary arteries involvement according to Gensini score was more severe in anterior wall MI group compared with inferior wall MI group, the number of involved coronary arteries was significantly higher in the inferior MI patients. Recommendation of coronary artery bypass grafting, percutaneous coronary intervention (PCI) or medical treatment were the same for both groups; however, patients with anterior MI were treated more with primary PCI.CONCLUSIONS: According to our angiography database, despite anterior wall MI is associated with more severity of coronary artery disease; inferior wall MI is more extent with regard to the number of involved coronary vessels. Location of MI can predict the severity and extension of infarction.

BACKGROUND: Visfatin is an adipocytokine which is secreted from adipose tissue and can affect on the diabetes inflammatory reaction and also serum lipids level. On the other hand, Omega-3 can also prevent formation of insulin resistance.In the present study, the effect of Omega-3 on the serum visfatin concentration was evaluated.METHODS: 71 women with type II diabetes were randomly assigned to the group that took Omega-3 capsules or control group with placebo capsules. In the first step, study subjects filled a questionnaire collecting their age, height, weight, waist circumference, and hip circumference. Also their blood samples were taken for blood tests. In the second step, the intervention was done for 8 weeks and in the third step the aforementioned were collected again. In the blood samples visfatin and lipid profiles (low density lipoprotein [LDL], high density lipoprotein [HDL], triglyceride [TG], and cholesterol), glucose and HbA1c were measured.RESULTS: There was no significant difference in serum visfatin level between Omega-3 and placebo groups before the intervention (p=0.14), while after the intervention, the mean serum visfatin level in the Omega-3 group was significantly higher (p<0.001). In addition, the mean difference between the serum visfatin level before and after the intervention in both groups was significant (p<0.001).CONCLUSIONS: This study showed an increase in visfatin level following consuming Omega-3 fats but according to controversial issues on insulin-like function of visfatin, the effects of Omega-3 on diabetes should be studied more in further studies.

BACKGROUND: Toxoplasmosis is a worldwide infection. Most studies on toxoplasmosis are in women in child bearing ages. We conducted an epidemiological survey on the population of the Isfahan Province to identify characteristics of the individuals associated with seropositivity.METHODS: In a cross sectional study, 599 serum samples were randomly collected for seroepidemiology of Hepatitis A and E, and were also used for titration of IgG anti-toxoplasma gondii antibody by a commercial enzyme-linked immunosorbent assay (ELISA) kit. Data were analyzed using SPSS software15. Chi square and Fisher exact tests were employed to examine antibody status in different age, gender, education and residency groups.RESULTS: The overall prevalence was 41.4% (248/599). There was a statistical significant association between seroprevalence with age, education, and gender (p<0.05) but not with residency state. The peak age for acquisition of the infection in females was 20-29 and in males 20-39 years old.CONCLUSIONS: Results of current study showed a moderate prevalence of toxoplasma gondii infection. However higher seroconversion rate in active social and reproductive ages, females and low educated individuals necessitate active preventive programs in these high risk groups.

BACKGROUND: There is limited data about the influence of timing of cardiac surgery in relation to diagnostic angiography and/or the impact of the amount of contrast media used during angiography on the occurance of acute renal failure (ARF). Therefore, in the present study the effect of the time interval between diagnostic angiography and cardiac surgery and also the amount of contrast media used during the diagnostic procedure on the incidence of ARF after cardiac surgery was investigated.METHODS: Data of 1177 patients who underwent different types of cardiac surgeries after cardiac catheterization were prospectively examined. The influence of time interval between cardiac catheterization and surgery as well as the amount of contrast agent on postoperative ARF were assessed using multivariable logistic regression.RESULTS: The patients who progressed to ARF were more likely to have received a higher dose of contrast agent compared to the mean dose. However, the time interval between cardiac surgery and last catheterization was not significantly different between the patients with and without ARF (p=0.05). Overall, postoperative peak creatinine was highest on day 0, then decreased and remained significantly unchanged after this period. Overall prevalence of acute renal failure during follow-up period had a changeable trend and had the highest rates in days 1 (53.57%) and 6 (52.17%) after surgery. Combined coronary bypass and valve surgery were the strongest predictor of postoperative ARF (OR: 4.976, CI=1.613-15.355 and p=0.002), followed by intra-aortic balloon pump insertion (OR: 6.890, CI=1.482-32.032 and p=0.009) and usage of higher doses of contrast media agent (OR: 1.446, CI=1.033-2.025 and p=0.031).CONCLUSIONS: Minimizing the amount of contrast agent has a potential role in reducing the incidence of postoperative ARF in patients undergoing cardiac surgery, but delaying cardiac surgery after exposure to these agents might not have this protective effect.

BACKGROUND: Antimicrobials treatment of Otitis media (OM) reduces some complications, but some of chronic complications, and specially otitis media with effusion (OME), seem to increase. Theoretically the usage of nasal corticosteroid sprays may prevent this problem by reducing the local inflammation around the eustachian tube. So, this study aimed to evaluate the role of nasal corticosteroid spray as an adjuvant for the treatment of OME.METHODS: In a randomized, prospective clinical trial, 2 groups of 46 subjects who had OME were recruited. A questionnaire containing patients' characters, history, complaints, otologic examinations, and the report of tympanometries was filled for all before and after treatment. We administered a period of amoxicillin and a decongestant for both group and nasal beclomethasone spray only for case group.RESULTS: Thirty five of cases (76.1%) and 22 (47.8%) of controls had an improvement in their symptoms or the quality of hearing (p=0.005). Partial remission was the most common finding in 52.2% of the patients in the case group but for control group there was no change (p=0.024). The higher improvement in the tympanic retraction in the case group was significant (p<0.05). A significant better tympanometric result has showed in the treatment of left ear in the patients of the case group (p=0.038) but not for right ear (p=0.136).CONCLUSIONS: We concluded that the administration of nasal beclomethasone spray as an adjuvant for the treatment of OME not only improved the results treatment but also increased the resolution of symptoms and the patients' quality of hearing.

BACKGROUND: Nocturia may be due to urological and non-urological diseases and some of the possible underlying non-urological diseases may be life-threatening. We investigated the efficacy and safety of lowest dose of oral desmopressin in treatment of nocturia in elderly men. METHODS: 60 old men referring to urology clinic of Imam Reza hospital in Tehran, Iran from 2008-2009 for treatment of nocturia were included in a double-blind placebo-controlled study. Patients were randomly divided into 2 study groups (30 patients in each group). Care was taken to match the patients of the 2 groups by age and clinical criteria. They complained of about 2 voids per night. We divided the patients into 2 study groups. Patients belonging to group A (n=30) received placebo and patients of group B (n=30) received 0.1 mg desmopressin at bed time for 8 weeks. Patients were assessed after 4 and 8 weeks of treatment. The means were compared using paired sample t-test and chisquare test for time of nocturia before and after treatments and also between the two groups. ANOVA test was used for assessement of statistical differences between outcomes of the two groups. RESULTS: Mean number of nocturia before and after receiving desmopressin were 2.6 and 1.6 respectively which differed significantly (p<0.001). Mean number of nocturia before and after receiving placebo were 2.5 and 2.3 respectively with no significant difference (p=0.344). After 4 weeks of treatment with desmopressin, 17 patients (56.7%) had less than 2 voids, 5 patients (16.7%) had 2 voids and 8 (26.7%) had more than 2 voids per night (p<0.05). After 8 weeks, patients were evaluated and it was noticed that in group B, 4 patients (13.3%) had 2 voids, 24 (80%) had less than 2 voids and 2 patients (6.7%) had more than 2 voids per night (p=0.004). CONCLUSIONS: Oral administration of desmopressin is an effective and well-tolerated treatment for nocturia in elderly men.

BACKGROUND: Either general or regional anesthesia can be used for lumbar disk surgery. The common anesthetic technique is general anesthesia (GA). The aim of this study was to compare the intra and postoperative outcomes of spinal anesthesia (SA) with GA in these patients.METHODS: Seventy-two patients were enrolled in the study. They were randomized into two groups with 37 patients in GA Group and 35 ones in SA Group. The heart rate (HR), mean arterial pressure (MAP), blood loss, surgeons satisfaction with the operating conditions, the severity of postoperative pain based on visual analogue scale (VAS) and analgesic use were recorded.RESULTS: The mean blood loss was significantly less in the SA Group compared to GA Group (p<0.05). Intraoperative maximum blood pressure and heart rate changes were significantly less in SA Group (p<0.05). The surgeons satisfaction was significantly more in the SA Group (p<0.05). The number of patients who used postoperative analgesic as well as postoperative mean VAS was significantly less in SA Group in comparison with GA group (p<0.05 for both).CONCLUSIONS: Our study showed that SA was superior to GA in providing postoperative analgesia and decreasing blood loss while maintained better perioperative hemodynamic stability without increasing adverse side effects.

BACKGROUND: Stability is often described to be static (quiet standing) and dynamic (maintaining a stable position while undertake a prescribed movement). Many researchers have used only static tests to evaluate the stability of normal and handicapped subjects. However, it is important to evaluate the stability of subjects while undertaking various tasks (dynamic stability). It is not currently clear whether static balance can predict dynamic balance or not. Therefore, the aim of this research was to investigate the relationship between parameters of static and dynamic stability tests.METHODS: The current clinical trial study was carried out in the Bioengineering Unit of Strathclyde University during 2008 and 2009. The normal subjects with no history of musculoskeletal disorders from staff and students of the Unit were selected in this study. Twenty-five normal subjects were recruited to participate in this research project. They were asked to stand on a force plate in quiet standing and while undertaking various hand tasks. The functional stability of the subjects was measured while transverse and vertical reaching tasks were undertaken. The correlation between various parameters of stability in quiet standing and functional hand tasks was evaluated using Pearson correlation.RESULTS: There was no significant correlation between static and dynamic stability parameters. The Pearson correlation coefficients for all parameters regarding the static and dynamic tests were less than 0.46.CONCLUSIONS: As there was no correlation between stability parameters in quiet standing and while performing various hand tasks, it is not practical to discuss ability of the subjects to control their balance while undertaking various hand tasks based on static balance ability.

BACKGROUND: Hepatitis B is the most important cause of cirrhosis in developing countries. Hemodialysis patients are susceptible to infection due to repeated contact with dialysis machines and blood products. The aim of this study was to compare the efficacy of intradermal low dose with intramuscular high dose hepatitis B vaccination in hemodialysis patients.METHODS: In a cross-sectional study on 24 hemodialysis patients that not responded to conventional method of vaccination in this center (double dose in 0, 1 and 6 months) and have antibody titer less than 10 mu/ml were enrolled to intramuscular or intradermal group, randomly. In intradermal (ID) group 10 mg (0.5 ml) recombinant vaccine, every 2 weeks to 6 months and in intramuscular (IM) group 40 mg (2 ml) at 0, 1, 2, and 6 months were prescribed and antibody titer were checked after 1 and 3 months of the end of vaccination.RESULTS: Mean HBS antibody titer in patients was 4.4±3.1 mu/ml at the beginning of study (minimum: 1.1 mu/ml and maximum: 9.2 mu/ml) and after 1 month and 3 months, mean HBS antibody were 190.4±59 and 223.3±83.9, respectively (p<0.001). After one month, in intradermal and intramuscular groups, mean HBS antibody was 198.8±75.6 mu/ml and 181.2±61.8 mu/ml, respectively (p=0.5) and after 3 months it was 230±76 mu/ml and 216.2±94.3 mu/ml, respectively (p=0.83).CONCLUSIONS: Antibody titer was high (>50 mu/ml) in two groups after 1 and 3 months of vaccination and no significant difference was found between the 2 groups. Therefore, two methods of vaccination (high dose IM and low dose SC) are equally effective and the selection of vaccination method is based on health policy.

BACKGROUND: Health equity audit, as an alternative solution, is a process by which local partners systematically review inequalities in the patients` health, their access to appropriate services and health system outputs. Then, necessary activities needed in order to have more equitable services are agreed on and these concurrences become the executive scheme and action initiates. Therefore, it is pivotal for health care organizations to pay special attention to this important topic. The objective of the current study was to review the health equity audit model in different countries to gather viewpoints of various involved groups in health sector, particularly health experts, and to offer a practical and appropriate model for health equity audit in Iran.METHODS: This study adopted applied research approach in two phases. In the first step, this study conducted theoretical health equity audit models in the texts; the experiences of other countries were studied and the most appropriate model for Iranian health system was selected. In the second step, this study employed the Delphi technique. According to the Delphi technique the questionnaire applied in order to gather data and then, the final model was extracted.RESULTS: Agreeable topics, performing agencies, 6 equity audit stages, and equity indicators under 3 main parts with 16 sub-sections were elaborated and viewpoints of Iranian experts in the above fields were gathered and presented as the proposed health equity audit model for Iran.CONCLUSIONS: This study reviewed the model of health equity audit for UK and provided a comparative model for health system of Iran with respect to the opinions of academic experts.

The childhood obesity has been a growing concern over the last decade all over the world. Built environmental characteristics such as parks and playgrounds serves as a reference point for physical activity in children. The equality issues related to ethnicity, Social Economic Status (SES), gender and social support have been related with both physical activity and presence and quality of parks and playgrounds. However, only limited studies have addressed these issues in children. The current paper is a general enumerative review that would discusses the above issues with respect to obesity in all age groups, giving particular emphasis to childhood obesity. The importance of this review is to further explore the importance and highlight the findings related to these issues, so that future original studies could be planned keeping these associations in mind.

Physicians all through the world visit patients under time limitations. The most important troubled clinical skill under "time constraint" is the diagnostic approach. In this situation, clinicians need some diagnostic approaches to reduce both diagnostic time and errors. It seems that highly experienced physicians utilize some special tactics in this regard. Evidence- based medicine (EBM) as a relatively new paradigm for clinical practice stresses on using research evidences in diagnostic evaluations. The authors aimed to evaluate experts' strategies and assess what EBM can add to these tactics.They reviewed diagnostic strategies of some veteran internists in their busy outpatient clinics and proposed an evidence- based diagnostic model engaging clinical experience and research evidence. It appears that every clinician utilizes a set of "key pointer" questions for decision-making. In addition to use of evidence-based resources for making differential diagnosis and estimating utility of various diseases, clinicians should use "key pointers" with significant likelihood ratios and from independent systems to reduce time and errors of history taking. Clinical trainees can improve their practice by constructing their own set of pointers from valid research evidences. Using this diagnostic model, EBM can help physicians to struggle against their "time constraint".

Liposarcoma are one of the common soft tissue sarcomas of adulthood which are remarkable because of their frequently large size. We report a case with an extremely large well-differentiated retroperitoneal liposarcoma that weighted 32 kilograms. The patient had relapse about one year later and two recurrent tumors were successfully excised.

Medullary thyroid carcinoma accounts for 4% of thyroid carcinoma and originates from parafollicular cells, secreting calcitonin and carcinoembryonic antigen (CEA). Conventional radiographic modalities such as Computerized Tomography (CT), Magnetic Resonance Imaging (MRI), and Ultrasonography (U/S), are used for detecting recurrences following total thyroidectomy. However, metastatic disease frequently escapes detection by the above modalities, even when its presence is suggested by persistently elevated serum calcitonin levels. In this paper, we report a case of medullary thyroid carcinoma in a 40 year-old woman who had whole body octreotide scintigraphy to evaluate and detect the origin of calcitonin and CEA secretion.

Endometrial polyps are common pathologic findings in gynecologic pathology practice. Although malignant changes in these lesions are uncommon, numerous studies confirmed this association especially with endometrial serous and clear cell carcinoma. Two cases of malignant endometrial polyps in association with presumed precursor lesion in one of them are presented.

dose of our intervention, this could challenge the applicability of the findings.I also have a concern about the implemented statistical approach. The authors have reported between-group, but not within-group comparisons; the efficacy of training is based on non-significant and significant differences in pre- and post-intervention outcomes, respectively; and the P values for within-group changes in outcomes are missing.