JOURNAL OF RESEARCH IN MEDICAL SCIENCES (JRMS)
Year:2014 | Volume:19 | Issue:6|Papers Count:20

Background: For effectively promoting fruit and vegetable consumption among adolescents, it is necessary to identify the determinants of intake. This qualitative research was conducted to explore the determinants of fruit and vegetable consumption among Tehranian adolescents in 2012.Materials and Methods: The present qualitative study is aimed at identifying the determinants of fruit and vegetable consumption among Tehranian adolescents in 2012. Male and female students in the middle schools of Tehran, in the age range of 11-14 years, were used as the study population, which was selected by the convenience method. Semi-structured interactional interviews were used for data collection. Data was analyzed using the qualitative content analysis method.Results: The availability and accessibility of fruits and vegetables in home, availability of unhealthy options in the environment, socioeconomic status, advertising about unhealthy options, subjective norms, reinforcement, and modeling were explored as environmental factors in this study. Also, individual factors were extracted as the second category that encompassed the subcategories including; preferences, knowledge, skill in preparing fruits and vegetables, outcome expectations, outcome expectancy, perceived susceptibility, and perceived seriousness.Conclusion: It is recommended that interventions have family-based designs as well as environmental policy-based (especially schools) ones. Meanwhile, families should be educated to adapt their children’s sapour with tastes of fruits and vegetables during their childhood.

Background: Lead is a pollutant with numerous adverse effects on health. Since it can affect blood pressure, peripheral blood vessels, and the heart, the present study aimed to evaluate the relation between occupational exposure to lead and blood pressure.Materials and Methods: This cross-sectional study included male individuals working in battery firms in Isfahan. A questionnaire covering demographic characteristics and the history of different diseases and occupational exposure to lead was completed. Each participant’s blood pressure was also measured and recorded. After obtaining blood samples and determining lead levels, mean and frequency analyses were performed. In addition, Pearson’s correlation test and linear regression were used to assess the relation between blood lead levels (BLLs) and systolic and diastolic blood pressure. All analyses were performed in SPSS.19.Results: The mean age of the 182 studied workers was 42.85±13.65 years. They had worked in battery firms for a mean period of 23.67±14.72 years. Moreover, the mean value of BLLs among the participants was 7.92±3.44 mg/dL. Correlation between BLL and systolic and diastolic blood pressure was not significant. The effects of lead on systolic and diastolic blood pressure after stepwise regression were B=-0.327 [confidence interval (CI) 95%: -0.877 to 0.223] and B=-0.094 (CI 95%:-0.495 to 0.307), respectively.Conclusion: This study revealed that BLLs in battery firm workers to be normal. Additionally, BLLs were not significantly related with either systolic or diastolic blood pressure which might have been the result of normal BLLs.

Background: In surgeries of closed calcaneal fractures, the lateral L-shaped incision is usually adopted. Undesirable post-operative healing of the incision is a common complication. In this retrospective study, controllable risk factors of incision complications after closed calcaneal fracture surgery through a lateral L-shaped incision are discussed and the effectiveness of clinical intervention is assessed.Materials and Methods: A review of medical records was conducted of 209 patients (239 calcaneal fractures) surgically treated from June 2005 to October 2012. Univariate analyses were performed of seven controllable factors that might influence complications associated with the surgical incision. Binomial multiple logistic regression analysis was performed to determine factors of statistical significance.Results: Twenty-one fractures (8.79%) involved surgical incision complications, including 8 (3.35%) cases of wound dehiscence, 7 (2.93%) of flap margin necrosis, 5 (2.09%) of hematoma, and 1 (0.42%) of osteomyelitis. Five factors were statistically significant: The time from injury to surgery, operative duration, post-operative drainage, retraction of skin flap, bone grafting, and patients’ smoking habits. The results of multivariate analyses showed that surgeries performed within 7 days after fracture, operative time>1.5 h, no drainage after surgery, static skin distraction, and patient smoking were risk factors for calcaneal incision complications. The post-operative duration of antibiotics and bone grafting made no significant difference.Conclusion: Complications after calcaneal surgeries may be reduced by postponing the surgery at least 7 days after fracture, shortening the time in surgery, implementing post-operative drainage, retracting skin flaps gently and for as short a time as possible, and prohibiting smoking.

Background: We assessed the effects of low-dose IV ketamine-midazolam versus morphine on pain control in patients with closed limb fracture(s); and also compared the incidence of adverse events (cardio-pulmonary) between two groups.Materials and Methods: Th is prospective, single-blind, non-inferiority trial randomized consecutive emergency department (ED) patients aged 18-60 years to two groups: Receiving 300-500 mcg/kg ketamine plus 0.03 mg/kg midazolam, or 0.05-0.1 mg/kg morphine. Visual analogue score (VAS) and adverse events were verified during an interval of 30 minutes.Results: Two hundred and thirty-six patients were selected, among whom 207 were males (87.3%). The average age was 29±2, (range, 18-60 years). The VAS score at T30 (i.e., 30 minutes after initial analgesic dose) was significantly decreased compared with VAS score at T0, in both groups. No statistically significant difference, however, was observed between the two groups (-6.1±1.1 versus -6.2±1.0; P=0.16). With regard to systolic blood pressure and respiratory rate, however, a meaningful difference was noted between the two groups (1.5±6.4 versus -2.1±6.6; P=0.000 for SBP, and -0.2±1.1 versus -1.1±6.1; P=0.048 for RR).Conclusion: “Low-dose” intravenous ketamine plus midazolam has the same analgesic effects as morphine on pain control in trauma patients with closed limb fracture(s), in addition to less respiratory adverse events.

Background: The role of obesity in clinical curse of rheumatoid arthritis (RA) is not clear. We investigated the association of obesity and adiposity with disease activity and clinical response to combination therapy in RA patients.Materials and Methods: Active RA patients with the disease activity score using 28 joint counts (DAS28) > 2.6 were studied. Height, weight, and waist and hip circumferences were measured and body mass index (BMI) and waist to hip ratio were calculated. Patients were treated with methotrexate (7.5 to 10 mg/week) plus hydroxychloroquine (200 to 400 mg/day) and prednisolone (2.5 to 10 mg/day) and were followed by DAS28 for up to 24 weeks.Results: One hundred and six patients were studied; age=48.5±13.8 years, 87.7% female, disease duration=4.4 years [SE=0.48]. DAS28 was decreased from 4.5±1.6 to 2.9±1.4 (P<0.001) after 24 weeks of treatment. Only in patients with disease duration of£2 years, BMI (r=-0.415, P=0.005) and waist circumference (r=-0.296, P=0.05) were correlated with baseline DAS28. Although BMI (r=-0.337, P=0.025) and waist circumference (r=-0.315, P=0.038) were correlated with change in DAS28 after therapy, these correlations were disappeared after controlling for baseline DAS28.Conclusion: Obesity and adiposity are associated with less severe disease activity in early stage of RA, but are not associated with response to combination therapy with methotrexate plus hydroxychloroquine in RA patients.

Background: Increased impedance to flow in the uterine arteries assessed by value of the Doppler is associated with adverse pregnancy outcomes, especially pre-eclampsia. We investigated the predictive value of a uterine artery Doppler in the identification of adverse pregnancy outcomes such as ‘pre-eclampsia’ and ‘small fetus for gestational age’ (SGA).Materials and Methods: Three hundred and seventy-nine women, with singleton pregnancy, between 18 and 40 years of age, without risk factors, randomly underwent Doppler interrogation of the uterine arteries, between 16-22 weeks of gestation. Those who had a mean pulsatility index (PI) of >1.45 were considered to have an abnormal result, and were evaluated and compared with those who had normal results for adverse pregnancy outcomes, including pre-eclampsia and small for gestational age. The relationship between the variables was assessed with the use of the chi-square test.Results: There were 17 cases (4.5%) of abnormal uterine artery Doppler results and 15 of them (88.2%) developed pre-eclampsia and four cases (23.5%) had neonates small for gestational age. For predicting pre-eclampsia, the mean uterine artery PI had to be >1.45, had to have a specificity of 95.5% (95% CI, 70-92%), a sensitivity of 79% (95% CI, 43-82%), a negative predictive value (NPV) of 98.9% (95% CI, 72-96%), and a positive predictive value (PPV) of 88.2% (95% CI, 68-98%). In the case of ‘small for gestational age’ it had to have a specificity of 96.5% (95% CI, 42-68%), a sensitivity of 57% (95% CI, 53-76%), an NPV of 99.2% (95% CI, 70-92%), and a PPV of 23.5% (95% CI, 30-72%).Conclusion: Uterine artery Doppler evaluation at 16-22 weeks of gestation might be an appropriate tool for identifying pregnancies that may be at an increased risk for development of pre-eclampsia and small fetus for gestational age.

Background: Kiwifruit (Actindia Deliciosa) is demonstrated to have antibacterial and pro-angiogenic effects. It also contains proteolytic enzymes (actinidin) and ascorbic acid. In this study, the effects of Kiwifruit on neuropathic diabetic foot ulcer healing in clinical settings were evaluated.Materials and Methods: In this randomized clinical trial of 37 patients (17 in experimental and 20 in control groups) with neuropathic diabetic foot ulcer were studied in Isfahan-Iran. Patients of the control group received just the standard treatments. In the experimental group, in addition to the standard treatments, ulcers were dressed with pure extract of kiwifruit twice daily for 21 days. The ulcers were examined and evaluated based on macroscopic, microscopic and microbiological status. Pre- and post-interventions, biopsies were taken from the ulcers to perform microbiological and histological studies.Results: Mean reduction in surface area of foot ulcer in the experimental group was significantly higher than the control group (168.11±22.31 vs. 88.80±12.04 mm2 respectively, P<0.0001). The amount of collagen and granulation tissues was significantly higher in the experimental groups than the control group (P value<0.0001). Significantly higher levels of angiogenesis and vascularization were found in the kiwifruit treated patients (P value < 0.0001). No significant antibacterial effect was observed for kiwifruit.Conclusion: Natural compounds in the kiwifruit including protein-dissolving enzymes (Actinidin) improved different aspects of the wound healing process. Based on these benefits and safety aspects, we conclude that using kiwifruit is a simple, applicable and effective way for treatment of neuropathic diabetic foot ulcer.

Background: Proper management of depression in elderly population would improve the outcome of the disease and reduce its related disability and mortality. Use of memantine with minimal side effects and drug interaction seems reasonable in the elderly but its antidepressant activity is controversial. The aim of the current research is to investigate the effects of add-on memantine during citalopram therapy in elderly patients with depression, in Isfahan.Materials and Methods: In this double-blind, placebo controlled trial study; elderly patients aged more than 60 years who were recently diagnosed with depression, were enrolled. The selected patients were randomly split into two groups, viz. intervention and placebo groups. The intervention was memantine (20 mg daily) or identical placebo plus citalopram for 8 weeks. The severity of depression and quality of life was evaluated using Geriatric Depression Scale (GDS-15), Hamilton Rating Scale for depression (HRSD) and World Health Organization Quality of Life WHOQOL-BREF respectively. The mentioned scores were evaluated at baseline, 4 weeks and 8 weeks, after initiating the trial in two studied groups and compared with each other.Results: 28 and 29 patients were studied in the intervention and placebo groups, respectively. Score of GDS-15, HRSD and WHO-QOL-BREF scales at baseline, 4 weeks and 8 weeks, after initiating trial did not change significantly after use of memantine (P>0.05). There was no significant difference in mean +/- SD of GDS-15, HRSD and WHO-QOL-BREF scales among intervention and placebo groups (P>0.05).Conclusion: The outcome of this clinical trial did not support the antidepressant effect of add-on memantine in elderly patients with depression receiving citalopram. It is recommended to design further studies considering the limitations of the current study mentioned herein and the eff ect of memantine with other anti-depressant agents.

Background: Alteration in plasma lipid and lipoprotein profile has been documented in diabetic patients. The purpose of this study was to compare the effect of probiotic and conventional yogurt on lipid profile in type 2 diabetes mellitus patients.Materials and Methods: A total of 44 patients with type 2 diabetes aged 30-60 years old who had low density lipoprotein cholesterol (LDL-c) ³100 mg/dl enrolled in this randomized, double – blind controlled trial and were assigned to two intervention and control groups. The subjects in the intervention group consumed 300 g/d probiotic yogurt containing Lactobacillus acidophilus La-5 and Bifi dobacterium lactis Bb-12 and subjects in the control group consumed 300 g/d conventional yogurt for 8 weeks. Anthropometric indices, dietary intake, and serum lipid profile were evaluated at the beginning and end of the intervention. Independent-sample t-test, paired sample t-test, ANCOVA, and repeated measures were used for statistical analysis.Results: The consumption of probiotic yogurt caused significant decrease in LDL-c/high density lipoprotein cholesterol (HDL-c) ratio (3.13±1.00-2.07±0.71, P=0.016). The levels of HDL-c were increased significantly (43.66±6.80-50.42±6.64, P=0.023) in the intervention group post intervention. However, there were no significant differences in triglyceride and total cholesterol levels between two groups post intervention (P < 0.05).Conclusion: It is suggested that probiotic yogurt consumption may be used as an alternative prevention approach and treatment method to improve dyslipidemia in patients with type 2 diabetes.

Background: This study aimed to evaluate the relation between C-reactive protein (CRP), interleukin (IL) 6 and 8 with the response to tocolytic therapy.Materials and Methods: A total of 75 singleton pregnant women between 18 and 35 years old, and with symptoms of preterm labor were hospitalized in “Shahid Beheshti” hospital in Isfahan, Iran. Tocolysis in patients was performed first with infusion of 4 g of magnesium sulfate 20% and then 2 g per hour continued. Next, they were followed till delivery time to assess the response to the treatment. Baseline data and serum levels of IL-6 and IL-8 and CRP were all recorded.Results: A total of 16 patients with symptoms of preterm labor did not respond to the treatment and delivered prematurely and 59 women responded to tocolytic treatment and delivered at term. There was a significant relationship between serum IL-6, IL-8 and CRP levels with response to the treatment in cut-off > 45 for IL-6 [area under the curve [(AUC), 0.894; SE, 0.042; P-value < 0.0001, >171 for IL-8 (AUC, 0.864; SE, 0.059; P-value<0.0001)] and >1.8 for CRP (AUC, 0.738; SE, 0.076; P-value=0.001). Also, pairwise comparison of receiver operating characteristic curves between CRP, IL-6, and IL-8 showed that there were no significant differences between areas for IL-6 with IL-8 (P-value=0.46); IL-6 with CRP (P-value=0.086); and IL-8 with CRP (P-value=0.18).Conclusion: Maternal serum concentrations of IL-6 and IL-8 and CRP can be used as appropriate biomarkers for predicting the response to tocolytic therapy in pregnant women and there were no significant differences between these markers in predicting tocolytic therapy.

Background: Chemical pollutants found in industrial environments can cause chronic genotoxicity in vulnerable individuals during the long-term exposure. The primary purpose of the present study was to assess the deoxyribonucleic acid (DNA) damage caused by occupational exposure to industrial chemicals and secondary purpose is to investigate the effect of possible risk factors of genotoxicity.Materials and Methods: The blood samples of the workers of Isfahan Polyacryl Company were evaluated in terms of genotoxicity using the comet assay method. The percentage of DNA in the tail and tail moment were measured and DNA damage was evaluated. Furthermore, the effect of age, smoking, duration of working in the company and working in two parts of the company on the degree of vulnerability to genotoxicity was assessed.Results: The amount of DNA damage in the target group (the production line workers) was significantly higher than the control group (the staff s), 3.87 versus 1.52 as tail moment, (P<0.0001). DNA damage was significantly higher in smoker groups compared with non-smoker target group and control group, 4.18 versus 3.07 and 1.52 respectively as tail moment, (P<0.0001). Furthermore, it was higher in person working in two different parts of the company compared to those work in one part and control group, 4.63 versus 3.74 and 1.52 respectively as tail moment, (P<0.0001).Conclusion: Occupational exposure to Polyacryl caused DNA damage. Smoking and working in two parts of the company may have a significant role in DNA damage.

Background: Sedation of pediatric patients undergoing cerebral angiography is challenging. Although dexmedetomidine is used for sedation in various procedures, it has not been reported for pediatric patients undergoing cerebral angiography. This study compared the safety and efficacy of dexmedetomidine with that of propofol for cerebral angiography in pediatric patients.Materials and Methods: Sixty-two patients (6-15 years) scheduled for elective cerebral angiography were apportioned randomly and equally to receive either propofol or dexmedetomidine sedation. Patients in the propofol group received an initial bolus of intravenous propofol (1 mg/kg) and a maintenance infusion of 100 mg/kg/min. Patients in the dexmedetomidine group received an initial bolus of intravenous d exmedetomidine (1 mg/kg over 10 min) and a maintenance infusion of 1 mg/kg/h. An additional bolus of propofol 0.5 mg/kg or dexmedetomidine 0.25 mg/kg was repeated if needed. Procedure time, time to recovery and adverse events associated with sedation were recorded.Results: All cerebral angiographies were completed successfully under sedation with dexmedetomidine or propofol. Mean cerebral angiography time was 36±10 min in the propofol group and 31±7 min in the dexmedetomidine group (P=0.047). The percentage of airway events and total adverse events were significantly higher in the propofol group (P<0.05). Heart rate decreased in the dexmedetomidine group and mean arterial pressure decreased in the propofol group (P<0.05, each).Conclusion: Although cerebral angiography can be performed successfully under sedation with either propofol or dexmedetomidine, dexmedetomidine may be a better alternative because of fewer respiratory adverse events.

Background: Autogenous fat injection of the face is a viable and lasting remedy for soft tissue loss and has become a mainstay in facial rejuvenation. Fat transfer as either a stand-alone technique or as an adjunct to other filler technique and lifting depending on patient needs. Although soft tissue augmentation with autologous fat transfer has been increasingly used by esthetic surgeon, but there is no agreement concerning the best way of processing the harvested fat before injection? This study compared the clinical results obtained using simple filtered and washed fat via metal sieve with those achieved by means of pure centrifuged fat.Materials and Methods: A prospective single-blind analysis on 32 healthy patients undergoing nasolabial fold fat transplantation from 2009 to 2011 (simple sampling). Patients assigned in two groups randomly. The face of half (16 subjects) was injected with centrifuged, another half with simple filtered and washed fat to evaluate the effect of preparation methods on fat graft viability. Objective method was used to evaluate the results, involving the evaluation of postoperative photographs (in month 1, 6 and 12) by an esthetic surgeon (according to the nasolabial scale). Subjective method was a self-assessment obtained from patients about general level of satisfaction and improvement of skin texture, statistical analysis were performed by means of the Wilcoxon and Mann–Whitney test. Acquired data were analyzed using SPSS version 15 and a value of P>0.05 was considered as significant.Results: There was no significant difference in the survival of grafted fat between the Group 1 (fat-processing with centrifuge at 3400 rpm for 1-min) and Group 2 (washing the fat in the sieve).Conclusion: Our data suggest that the centrifuge of the fat does not enhance survival of grafted fat (P > 0.05).

Background: In Iran, burns are the second most common cause of death, after traffic accidents in individuals under the age of 15 years. Many burned patients die or suffer injury due to lack of immediate care, so we need to use an alternative resuscitations to cure them immediately. Telemedicine describes the use of medical information exchanged from one site to another via electronic communications to improve patients’ health status and care. The aim of this study was to express the advantages of Telemedicine to resuscitate and care burn patients.Materials and Methods: This study was a narrative review. The literature was searched on fast resuscitation and care of the patients’ burn by telemedicine with the help of libraries, databases, and also searches engines available at Google, Google scholar, books and conference proceedings. In our searches, we employed the following keywords and their combinations: Telemedicine, Telecare, Burn, Burn patient, Air transport, Triage and Health Information Management in the searching areas of titles, keywords, abstracts and full texts. Results: In this study, more than 78 articles and reports were collected and 30 of them were selected based on their relevancy. Conclusion: Acute evaluation of burn patients can be performed by the telemedicine and it plays an important role in improving access to the required expertise, and raises physician confidence in treating burn patients. This can reduce under-triage or over-triage for air transport and finally lead to saving time and cost.

Background: The purpose of this study was to screen of parC gene mutations in clinical isolates of Acinetobacter baumannii from intensive care units (ICUs) of Alzahra Hospital, Isfahan, Iran.Materials and Methods: Seventy isolates of A. baumannii between March 2011 and June 2012 were studied. Susceptibility test was established by E-test method. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and sequencing was performed for detection of parC gene mutation.Results: 77.1% of specimens were highly resistant. Mutation at position 80 in parC was observed in 93% of isolates.Conclusion: High proportion of A. baumannii isolates had a mutation in parC that can play an important role in increased incidence of these isolates.

Thoracic endovascular aortic repair (TEVAR) is still associated with complications which include mortality in 7.3% of cases. In this report, we describe the case of a man with a pseudoaneurysm of the aortic isthmus that was scheduled to undergo endovascular repair. During the procedure, the patient had a sudden cardiac arrest due to a compressive hemopericardium caused by perforation of the ascending aorta. The diagnosis was not clear and was made by transthoracic echocardiography after five minutes of resuscitation. In spite of the evacuation of the hemopericardium and suture of the perforation, the patient died. The diagnosis would have been easier and faster if the patient had been monitored continuously by transesophageal echocardiography during the procedure.

Giant cell tumor (GCT) of bone is a relatively common benign bone lesion and is usually located in long bones, but involvement of the olecranon is extremely rare. Here, we present a case of solitary GCT of bone in the olecranon that was confirmed by preoperative needle biopsy and postoperative histological examination. The treatment included intraregional curettage, allogeneic bone grafting, and plating. At 26 months follow-up, the patient had no local recurrence.

Toxic epidermal necrolysis (TEN) is a rare, but life-threatening medical emergency with significant morbidity and mortality. Current treatment standards for TEN patients include stopping all possible drugs associated with the new onset of symptoms, prompt referral and treatment in a specialized center with fluid resuscitation, adequate analgesia and maintenance of nutritional needs. Extensive debridement of the involved epidermis followed by coverage with a skin substitute reduces the mortality from a skin infection and also improves the fluid and electrolyte balance and pain control. This is increasingly considered an important part of the intensive care of these patients. Admitting physicians should be aware of this rare but life-threatening emergency, to allow prompt diagnosis and avoid delays in treatment.

Sir,I read with interest the paper by Shavakhi A et al., about association between severity of fi brosis in Hepatitis C virus (HCV) patients and ABO blood group.[1] According to the only meta-analysis of the prevalence of HCV, total prevalence in general population of Iran is 0.16%.[2] There are some sources for sampling bias. Authors did not include those who had received anti- HCV treatments. By excluding cases who were treated for HCV, we are excluding more severe cases and may underestimate the association between severity of liver fi brosis in HCV patients and blood group. I was interested to know if is there any change in severity of this association if we consider the situation of these cases before their enrollment in the treatment and include them in analysis? On the other hand, the probability of selecting more severe cases increases when patients are selected from University clinics in comparison with private clinics.

Sir,Diabetic kidney disease is a major risk of end-stage renal disease. Many complex factors are associated with the progression of diabetic nephropathy. Recently, much attention has been directed toward the role of vitamin D in the insulin resistance and treatment of diabetic nephropathy. Heshmat et al., conducted a randomized double-blind clinical trial to find out the effect of vitamin D on insulin resistance and anthropometric parameters in type 2 diabetes mellitus (T2DM). They included 42 diabetic patients with similar baseline characteristics in two groups; intervention group with single intramuscular injection of 300,000 IU of vitamin D3 and placebo group. In their study, 3 months after vitamin D injection, HbA1c, anthropometric factors, and homeostasis model assessment index in the intervention group remained constant while, serum 25-hydroxy vitamin D3 (25 (OH) D3) significantly increased. They assumed that a single injection of vitamin D was not accompanied with improvement of diabetes control and insulin resistance.