JOURNAL OF RESEARCH IN MEDICAL SCIENCES (JRMS)
Year:2014 | Volume:19 | Issue:5|Papers Count:20

During the past two decades, Iran has witnessed a positive trend in output of medical research. The impact of such productivity has been reflected on the rate of citations of researchers from other countries.

Background: In this study, we aim to compare insulin and leptin levels in adolescents with or without overweight and in those with or without abdominal obesity.Materials and Methods: This case-control study was conducted among 486 samples. We randomly selected 243 overweight and an equal number of normal-weight adolescents from among participants of the third survey of a national surveillance program entitled “Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable diseases study”. Serum insulin and leptin were compared between two groups and their correlation was determined with other variables.Results: The mean age and body mass index (BMI) of participants were 14.10±2.82 years and 22.12±6.49 kg/m2, respectively. Leptin and insulin levels were higher in overweight than in normal-weight adolescents (P<0.05). Leptin level was higher in children with abdominal obesity than in their other counterparts (P<0.001). Leptin level was correlated with age, fasting blood glucose, BMI, and insulin level.Conclusion: Insulin and leptin levels were higher among overweight and obese children, which may reflect insulin and leptin-resistance. Given the complications of excess weight from early life, prevention and controlling childhood obesity should be considered as a health priority.

Background: Test anxiety aggravates psychological distress and reduces the motivation among graduate students. This study aimed to identify psychological intervention for test anxiety, which reduces the level of psychological distress, amotivation and increases the intrinsic and extrinsic motivation among medical students.Materials and Methods: Westside test anxiety scale, Kessler Perceived Stress Scale and Academic Motivation Scale were used to measure test anxiety, psychological distress and motivation on 436 1st year medical students. Out of 436 students, 74 students who exhibited moderate to high test anxiety were randomly divided into either experimental or waiting list group. In this true randomized experimental study, 32 participants from the intervention group received five sessions of psychological intervention consist of psychoeducation, relaxation therapy and systematic desensitization. Thirty-three students from waiting list received one session of advice and suggestions.Results: After received psychological intervention participants from the intervention group experienced less anxiety, psychological distress, and amotivation (P<0.01) and high intrinsic and extrinsic motivation (P<0.01) in the postassessment compared with their preassessment scores.Conclusion: Overall psychological intervention is effective to reduce anxiety scores and its related variables.

Background: Echocardiography is one of the diagnostic tools that can be applied at the bedside, along with avoiding transporting critically ill patients. This prospective observational study was designed to assess the clinical applicability of the transthoracic echocardiography (TTE) device by noncardiologist intensivists.Materials and Methods: Intensivists performed a limited TTE examination on critically ill patients admitted to the surgical intensive care unit (ICU). After initial cardiac clinical assessment in 85 critically ill adult patients, a limited TTE was performed by an intensivist to assess left ventricular (LV) function and LV volume status as well as valvular function and qualitative factors. Data were analyzed and presented in proportions using descriptive statistics. The setting was in surgical ICU of an academic medical center.Results: Valvular abnormalities (44.8%) as well as qualitative indices (68.3%) were the most frequently detected abnormalities. The ejection fraction was the only alteration, which was affected by the risk factors (P=0.05, mean=55.57).Conclusion: Transthoracic approach can provide useful information on cardiac anatomy and function in most ICU patients along with detecting severe previously unknown conditions in some patients.

Background: Cystatin C (Cys C) has been implicated as a prognostic marker in cardiovascular disease. The aim of this study was to evaluate the value of Cys C as a marker of acute kidney injury (AKI) in acute heart failure (AHF), the impact of Cys C and N-terminal probrain natriuretic peptides (NT-proBNP) on in-hospital and 12 months mortality were also investigated.Materials and Methods: A total of 162 patients with AHF were enrolled. NT-proBNP, Cys C, serum creatinine (Scr), blood urea nitrogen (BUN) and parameters of echocardiography were measured for analyze. The in-hospital and 12 months mortality was analyzed.Results: There was 28 (17%) of all AHF patients with AKI. Compared with no-AKI patients, the levels of Cys C (1.51±0.34vs. 1.32±0.29, P=0.003) and NT-proBNP (8163.87±898.06 vs. 5922.45±576.73, P=0.001) were higher in AKI patients. Higher levels of NT-proBNP (odds ratio (OR)=1.92, 95% confidence interval (CI): 2.19-10.98, P=0.018, OR=4.31, 95% CI: 2.35-9.82,P=0.002, respectively) and Cys C (OR=1.48, 95% CI: 1.75-4.16, P=0.027, OR=2.72, 95% CI: 1.92-4.28, P=0.017, respectively)were independent association with the in-hospital and 12 months mortality. Cys C was positively correlated with NT-proBNP (r=0.87, P<0.001). Combining tertiles of Cys C and NT-proBNP improved risk stratification further. Compared with patients without AKI CysC, patients with AKI cysC was associated with higher in-hospital (7.28 vs. 10.134, P=0.002) and 12-month mortality (13.28 vs. 32.134, P=0.001).Conclusion: Cys C was not only a promising risk marker in patients hospitalized for AHF, but also an independent predictor of 12-month mortality. Combining tertiles of Cys C and NT-proBNP could be used to distinguish the mortality risk identification of patients with AHF. AKI was an independent predictor of in-hospital and 12-month mortality.

Background: Colorectal tumor is one of the main causes of death in our country. The aim of the present study was to determine the clinicopathological aspects of tumor and the presence of hepatic micrometastasis in patients with colorectal cancer (CRC).Materials and Methods: Forty two patients with CRC were evaluated in the study surgical treatment was performed and liver biopsy was taken for the evaluation of micrometastasis by immunohistochemistry and polymerase chain reaction. The variables that have been evaluated were: Patient’s gender, patients age at the time of diagnosis, size and location of tumor, tumor-node-metastasis stage and grade of the primary tumor, lymph node involvement, lymphovascular and neural invasion, presence of macrometastasis and carcinoembryonic antigen level prior to surgery. After 1 year patients were called and asked to come back to the clinic for elective colonoscopy to evaluate the surgical site for recurrence of tumor and survival. All variables were compared between patients in whom liver micrometastasis were present in comparison with patients without liver micrometastasis.Results: Of the studied patients (6 with positive micrometatsis and 36 without micrometstasis), 38 were alive after 1 year (6 with positive micrometatsis and 32 without micrometstasis) and the difference was not significant between groups with or without micro metastasis (P=0.52).In four of survived patients colonoscopy was abnormal, however this difference was not also significant between groups (P=0.59).Conclusion: Clinic pathologic aspect of tumor was not different in CRC patients with and without hepatic micro metastasis.

Background: Few investigations has focused on the patients with lupus nephritis (LN) and neuropsychiatric systemic lupus erythematosus (NPSLE). This study was aimed to investigate the clinical features, mortality, and the predictors for mortality of this group of patients.Materials and Methods: Medical records were retrospectively reviewed in Sun Yat-sen Memorial Hospital from 1996 to 2012. Data of demographic information, clinical manifestations, laboratory tests, SLE disease activity index 2000 (SLEDAI-2K) score, diagnosis, complications, treatment, and mortality was collected.Results: A total of 124 patients were included in our study. Thirty-five (29.1%) patients had glomerular filtration rate <60 ml/min/1.73 m2, while 24 (19.4%) experienced acute kidney injury (AKI). Thirteen of the 19 American College of Rheumatology defined NPSLE syndromes were identifi ed. Th e most frequent manifestation was seizure disorder (56/124, 45.2%), followed by psychosis (37.124, 29.8%) and cerebrovascular disease (35.124, 28.2%). One hundred and five (84.7%) patients had SLEDAI-2K scores ³15, the mean of which was 21.5±6.2. The mortality during hospitalization was 12.9% (16.124) with NP involvement itself being the leading cause of death (7.16, 43.8%). Multivariate logistic regression confirmed that age<14 years at onset of NPSLE (odds ratios [OR]: 9.95, 95% confidence intervals [CI]: 1.43-69.36, P=0.020), AKI (OR: 10.40, 95% CI: 2.33-46.48, P=0.002) and pneumonia (OR: 4.52, 95% CI: 1.14-17.96, P = 0.032) were risk factors for mortality, while cyclophosphamide (CYC) treatment (OR: 0.09, 95% CI: 0.02-0.54, P=0.008) was a protective factor.Conclusion: Most of SLE patients with LN and new-onset NPSLE are in an active disease state. NP manifestation itself was the leading cause of death during hospitalization. Childhood-onset NPSLE, AKI and pneumonia might be predictors of mortality, whereas CYC treatment might improve the prognosis.

Background: Parenteral nutrition (PN) is a valuable lifesaving intervention, which can improve the nutritional status of hospitalized malnourished patients. PN is associated with complications including hyperglycemia. This study was conducted to compare two methods of blood glucose control in traumatic brain injury patients on PN.Materials and Methods: A randomized, open-label, controlled trial with blinded end point assessment was designed. Traumatic brain injury patients (GCS=4-9) on PN, without diabetes, pancreatitis, liver disease, kidney complication, were participated. Patients were randomly assigned to receive continuous insulin infusion to maintain glucose levels between 4.4 mmol/l (80 mg/dl) and 6.6 mmol/l (120 mg/dl) (n=13) or conventional treatment (n=13). Patients in the conventional group were not received insulin unless glucose levels were greater than 10 mmol/l (>180 mg/dl). These methods were done to maintain normoglycemia in ICU. The primary outcome was hypo/hyperglycemic episodes. Other factors such as C-reactive protein, blood electrolytes, liver function tests, lipid profile and mid-arm circumference were compared.Results: Mean glucose concentration were significantly lower in IIT group (118±28 mg/dl) vs conventional group (210±31 mg/dl)(P<0.01). No hypoglycemic episode occurred in two groups. Triglyceride (P=0.02) and C-reactive protein (P=0.001) was decreased in the IIT group, significantly. There were also significant differences in the electrolytes, with magnesium and phosphorus being lower in the IIT group (P=0.05).Conclusion: In this pilot study, blood glucose level, CRP and TG were lower in IIT group. Further data collection is warranted to reach definitive conclusions.

Background: High-grade astrocytoma (Grade 4) or glioblastoma multiforme (GBM) are deadly brain tumors. New therapies attempt to increase lifetime and quality of life in patients with malignant astrocytoma. O6-methylguanine-DNA methyltransferase (MGMT) enzyme expression may be effective in prognosis and response to treatment of these patients. The aim of this study was assessment of MGMT enzyme expression in patients with astrocytoma Grade 4.Materials and Methods: In this study, 48 patients with GBM that were treated with surgery, chemotherapy and radiotherapy were investigated and followed-up for 47 months for the survival rate. Pathology blocks of patients were examined for MGMT enzyme expression using immunohistochemistry method.Results: The patients were 34 males and 14 females. The ages ranged from 24 to 77 years, with a mean age of 53.52±13.39 years. There was no significant difference between two groups (positive and negative MGMT enzyme expression) in overall survival (median [range] 11.5 [4-30] vs. 13 [5-22], P=0.9). The results of our study showed that patients although who were undergone near total surgery had higher overall survival than the group of patients who had biopsy only however, it was not significant. Patients who were treated with temozolomide (TMZ) (Temodal, Merck Canada) had significant overall median survival (14.5) more than the patients who were treated with Procarbazine (Roche, Swiss)-Lomustine (Lilly, USA)-Vincristine (Lilly, USA) regimen (8.75) (P<0.05).Conclusion: O6-methylguanine-DNA methyltransferase enzyme expression had no effect on survival of patients with Grade 4 brain astrocytoma TMZ may increase survival rate.

Background: Leptin plays a key role in the regulation of energy expenditure and is known to circulate in both free and bound forms. Soluble leptin receptor (sOB-R) is a unique circulating form of leptin receptor that can bind to leptin. Leptin and leptin receptor have been implicated in processes leading to breast cancer initiation and progression. Our study was aimed to investigate the relationship between serum levels of sOB-R and leptin with breast cancer.Materials and Methods: Serum leptin and sOB-R levels were measured by enzyme-linked immunosorbent assay in 100 women with breast cancer cases compared with 100 age and body mass index (BMI)-matched controls without cancer. Lipid profiles were measured by enzymatic method.Results: The median serum levels of sOB-R in controls were significantly higher than that in breast cancer cases (odds ratio [OR], 1.98; 95% confidence interval [CI] =0.77-188.2) versus (OR, 0.140; 95% CI=0.09-98.1). Conversely, the median serum level of leptin in breast cancer cases was significantly higher than that in controls (OR, 67.90; 95% CI=2.77-129.9) vs. (OR, 28.30; 95% CI=0.60-113.1). Breast cancer was significantly associated with higher serum level of leptin (OR=1.027, 95% CI=1.017-1.038). Conversely, breast cancer was correlated with lower serum level of sOB-R (OR=0.983, 95% CI=0.969-0.997). Moreover, free leptin index (FLI) (leptin/sOB-R ratio) was associated with breast cancer (OR=1.028, 95% CI=1.015-1.042). The serum sOB-R level was negatively associated with leptin, BMI, and high density lipoprotein (r=-0.238, -0.186, and -0.168, respectively).Conclusion: Our results suggested that FLI and serum leptin level rather than serum level of sOB-R was associated with the breast cancer.

Background: This double-blinded, randomized clinical trial was designed to evaluate the comparison of intravenous versus intraarticular (IA) administration of midazolam on postoperative pain after knee arthroscopy.Materials and Methods: In this study, 75 patients randomized in three groups to receive 75 mc/kg IA injection of midazolam and 10 ml intravenous injection of isotonic saline (Group I), 75 mc/kg intravenous injection of midazolam and 10 cc IA injection of isotonic saline (Group II) or IA and intravenous injection of isotonic saline (Group III) at the end of knee arthroscopy. Pain scores, time until the first request for analgesics, cumulative analgesic consumption, satisfaction, sedation, and complications as studied outcomes were assessed. Patients were observed for 24-h.Results: IA administration of midazolam significantly reduced pain scores in the early postoperative period compared with intravenous injection. Mean of time to first analgesic requirement in Group III (33.6 min) was significantly lower than Group II (288.8 min) and Group I (427.5 min). Cumulative analgesic consumption was increased in Groups II (35.5 mg), and III (70 mg) compared with Group I (16 mg), (P<0.0001). Complications significantly occurred in 3 of 25 patients in Group I in contrast to 20 of 25 patients in Group III (P<0.0001). At 2-, 4- and 8-h after arthroscopy pain score significantly decreased in Group I than other groups (P<0.0001). Patients in Group I were significantly satisfy than other groups (P<0.0001).Conclusion: Results show the greater analgesic effect after IA administration of midazolam than after intravenous injection and hence, IA administration may be is the method of choice for pain relief after knee arthroscopy.

Background: Radiation-induced discomfort is frequently observed during pelvic radiotherapy. This study was performed to determine the effect of a green tea tablet to reduce the incidence of radiation-induced diarrhea and vomiting in patients with abdomen and pelvic malignancy.Materials and Methods: This randomized controlled clinical trial recruited 42 patients with abdomen and pelvic malignancy considered for treatment with 50 Gy radiotherapy, randomly assigned to the green tea tablet 450 mg (n=21) or placebo group (n=21) for 5 weeks. Acute gastrointestinal complications (Diarrhea and vomiting) were weekly assessed using Common Toxicity Criteria of the National Cancer Institute version 3.0 and functional living index emesis, respectively. Two sample t-tests, Pearson’s Chi-square, Mann-Whitney U-test, and Friedman were used for analysis.Result: There was a significant difference in frequency of reported diarrhea between two groups of study at the end of study (P<0.002). About 81% of patients in green tea group reported no history of diarrhea at week 5. The treatment groups have reported no history of severe diarrhea during radiotherapy. There was no significant difference between two groups of study in frequency of vomiting throughout the study, but 9.5% of cases in placebo group showed severe vomiting.Conclusion: Green tea contains a high concentration of catechins could be effective in decreasing the frequency and severity of radiotherapy induced diarrhea. Green tea (450 mg/day) could be considered to be a safe for prevention diarrhea and vomiting in patients undergoing pelvic or abdomen radiotherapy.

Background: There is no published data on the association between serum biochemical and ultrasonographic markers and adverse pregnancy outcomes. Therefore, the aim of this study was to determine the factors associated with perinatal outcomes in singleton pregnancies using ultrasound and maternal serum markers during the first trimester in Panamanians.Materials and Methods: This was a prospective observational study of 468 first trimester singleton pregnancies conducted over a 7-year period. All women attending a prenatal screening clinic during the study period were informed of the study and the option to participate. Two maternal serum markers, free b-human chorionic gonadotropin (b-hCG) and pregnancy associated plasma protein-A (PAPP-A), and four fetal ultrasound markers, nuchal translucency thickness, nasal bone, flow across the tricuspid valve, and flow in the ductus venosus (DV),were measured by certified maternal fetal medicine specialists. Adverse outcomes included miscarriage, major structural defects, genetic disorders, and major fetal cardiac defects.Results: A total of 454 (97%) pregnancies were unaffected. Median maternal age was 31.5 years (range: 18-50). Maternal age was significantly greater in cases of adverse outcome (P=0.007). The number of adverse outcomes associated with an absent or hypoplastic nasal bone, tricuspid valve regurgitation, and abnormal flow in the DV were significantly greater relative to unaffected pregnancies (Ps<0.001). No differences were found in fetal crown-rump length or maternal serum levels of b-hCG or PAPP-A.Conclusion: Abnormal ultrasound markers are associated with adverse outcomes. Women with normal ultrasound and serum markers should be reassured of low risk of adverse pregnancy outcomes.

Background: Due to the wholesome benefits of nuts increased consumption of them has been recommended. However, because of nut’s high energy density, the role of them in the treatment of overweight and obesity is vague. This current clinical trial study aims to investigate the effects of a balanced hypocaloric almond-enriched diet (AED) (almond group) in comparison to a balanced hypocaloric nut-free diet (NFD) (nut-free group) on body weight and cardiovascular disease risk factors in women with body mass index (BMI)>25 for 3-month.Materials and Methods: A total of 108 overweight and obese women were assigned in our 3-month randomized controlled trial. The subjects were randomly divided into two groups regarding a balanced hypocaloric diet with or without almond. The planned reduced calorie diets for both groups were identical except for the almond group who consumed 50 g of almonds daily. Anthropometric and laboratory measurements of the participants who completed the study were made prior to and at the end of the study.Results: A total of 100 subjects completed the study. Weight, BMI, waist circumference, waist to hip circumference ratio, total cholesterol, and triglyceride, total: High density lipoprotein-cholesterol (HDL-C), fasting blood sugar and diastolic blood pressure decreased significantly in the almond group compared to the nut-free group (P>0.001). Greater reduction in low density lipoprotein-cholesterol (P>0.002) and systolic blood pressure (P>0.001) and greater increase in HDL-C (P=0.001) were found in the nut-free group.Conclusion: The balanced hypocaloric AED in comparison to the balanced hypocaloric NFD led to a greater weight-loss and overall better improvements in studied cardiovascular disease risk factors.

Nowadays, scientific c findings in the field of regeneration of nervous system have revealed the possibility of stem cell based therapies for damaged brain tissue related disorders like stroke. Furthermore, to achieve desirable outcomes from cellular therapies, one needs to monitor the migration, engraftment, viability, and also functional fate of transplanted stem cells. Magnetic resonance imaging is an extremely versatile technique for this purpose, which has been broadly used to study stroke and assessment of therapeutic role of stem cells. In this review we searched in PubMed search engine by using following keywords; “Stem Cells”, “Cell Tracking”, “Stroke”, ”Stem Cell Transplantation”, “Nanoparticles”, and “Magnetic Resonance Imaging” as entry terms and based on the mentioned key words, the search period was set from 1976 to 2012. The main purpose of this article is describing various advantages of molecular and magnetic resonance imaging of stem cells, with focus on translation of stem cell research to clinical research.

Most of the ingested foreign bodies pass uneventfully through the gastrointestinal tract. However, long and rigid foreign bodies are associated with an increased risk of gastrointestinal impaction, perforation, and bleeding. Spontaneous passage of a toothbrush has not been reported till date and the technique of its removal is a curiosity for surgeons. Endoscopy is a recommended technique for the removal of such complex foreign bodies. However, if it fails, the foreign body can be removed successfully with a laparoscopic gastrotomy. We devised an innovative technique by using pneumatic gastric insufflation and extracted the toothbrush by a tiny gastrotomy under local anesthesia.

Congenital varicella syndrome encompasses a broad spectrum of malformations present in children of mothers who developed chickenpox during the first 20 weeks of gestation. We report a case of a monochorionic diamniotic twin pregnancy, with maternal exposure to chickenpox during the thirteenth week of gestation, which produced one symptomatic and one healthy child.

Sir,Psoriasis aff ects 2-3% of world’s population.Tuberculosis is the 7th cause of death all over the world, one-third of population is affected by the disease. Romania, in 2010, occupied the 6th position, after Kazakhstan, Moldavia, Georgia, Kirgizstan, and Tajikistan.[3] In 2011, a large retrospective study was carried out on the incidence of present and past tuberculosis within 1236 psoriasis patients, not previously treated with biologics, over 2004-2011.

Sir,Teucrium polium (Lamiaceae family) is a wild-growing fl owering herb, abundantly found in various regions such as Europe, North Africa and South-Western Asia. T. polium has been used for different diseases such as diabetes, rheumatologic diseases, inflammation, and gastrointestinal disorders. Indeed, herbal drugs are being increasingly used throughout the world. However, herbal medicines are not risk-free and many cases of nephrotoxicities, liver toxicities or other complications have been reported.

Sir,Acinetobacter spp. have emerged as an important cause of Health care Associated Infection in recent years. There are complications in the infection control and treatment of patients who were infected with Acinetobacter spp. Because of the extraordinary ability of this bacterium to survive in environment for long periods and its propensity to acquire multiple antibiotic resistance mechanisms. This cross-sectional study was performed for determination prevalence of clinical isolates of Acinetobacter spp., antibiotic resistance pattern and risk factors associated with acquisition of colonization/infection with extensively drug resistant (XDR) Acinetobacter spp. in the specialty teaching hospital, in Isfahan, Iran.