JOURNAL OF RESEARCH IN MEDICAL SCIENCES (JRMS)
Year:2014 | Volume:19 | Issue:3|Papers Count:18

The worldwide population is aging, and the number of people above 85 years of age is growing faster than any other age group. As the people continue to age, physicians encounter growing number of older patients with chronic kidney disease and hence, renal failure to be a global challenge as a no communicable epidemic. Chronic kidney disease is either defined as a low estimated glomerular filtration rate of less than 60 mL/min/1.73 m2, or normal estimated glomerular filtration plus evidence of renal da mage (most commonly albuminuria, hematuria and abnormal renal ultrasound for three or more consecutive months), regardless of age.

Background: Systolic blood pressure (SBP) and diastolic blood pressure (DBP) are a multi-factorial traits and significantly heritable. Glutathione S-transferase (GST) enzyme is involved in detoxification of reactive oxygen species. The present study aimed at finding out the association between GSTM1 and GSTT1 polymorphisms and mean arterial pressure (MAP) in Iranian population. MAP, as the important indicator of blood pressure, is calculated by weighted averaging of SBP and DBP.Materials and Methods: we randomly selected 72 healthy individuals from Isfahan Cohort Study (ICS). Polymerase chain reaction (PCR) was done to detect polymorphism of the GSTM1 and GSTT1 genes. The Bayesian Structured Regression model was used, adjusted for sex, age, body mass index (BMI), and smoking status.Results: The results showed that both the GSTT1and GSTM1genotypes deletion had a significant effect on MAP increasing in our samples based on 95% Bayesian credible intervals.Conclusion: This study demonstrated that GSTT1 and GSTM1 gene increase the arterial pressure; hence, it can predict the susceptibility to cardiovascular disease.

Background: Obstructive sleep apnea syndrome (OSAS) is a common sleep disorder characterized by repeated upper airway obstruction during sleep. While respiratory pauses followed by loud snoring and daytime sleepiness are the main symptoms of OSAS, the patients may complain from sleep disruption, headache, mood disturbance, irritability, and memory impairment. However, the association of sleep apnea with anxiety and depression is not completely understood. Adherence to continuous positive airway pressure (CPAP), the treatment of choice for OSAS, may be influenced by psychological conditions, especially claustrophobia. The aim of this study was to evaluate the association of OSAS with anxiety and depression symptoms. This study also investigated the association of anxiety with body mass index (BMI) and the severity of OSAS.Materials and Methods: We conducted a cross-sectional study on 178 adult individuals diagnosed with OSAS at the sleep laboratory between September 2008 and May 2012. The participants were interviewed according to a checklist regarding both their chief complaints and other associated symptoms. The psychological status was assessed according to Beck anxiety inventory (BAI) and Beck depression inventory (BDI) scoring. The severity of breathing disorder was classified as mild, moderate, and severe based on apnea–hypopnea index (AHI) which was ascertained by overnight polysomnography. Daytime sleepiness was assessed by Epworth sleepiness scale (ESS).Results: The mean (SD) age of participants was 50.33 years. In terms of sex, 85.5% of the study population were males and14.4% were females. We found no relation between sex and the symptoms of OSAS. Regarding the frequency of anxiety and depression symptoms, 53.9% of the individuals had some degree of anxiety, while 46.1% demonstrated depressive symptoms. In terms of OSAS severity, this study showed that OSAS severity was associated with the frequency of anxiety, chocking, and sleepiness (P: 0.001). According to polysomnographic results, we found that the majority of patients suffering from anxiety and chocking (66.7% and 71.4%, respectively) had severe OSAS, while only 23.1% of patients with sleepiness had severe OSAS.Conclusion: Our study showed that the frequency of anxiety in OSAS patients is higher than in the general population regardless of the gender. Furthermore, it is more likely that OSAS patients present with anxiety and depression than the typical symptoms.

Background: Coverage of the bronchial stumps (BSs) with adjacent tissues can improve healing and reduce bronchial complications in complex thoracic surgery. There is no evidence for the application of human amnion allograft for prevention of air leak from the BS. The comparison of the amniotic membrane (AM) and pleural patch for BS healing after lobectomy in dogs was our aim in this study.Materials and Methods: A total of eight males and females 12-24-month-old dogs between 17 and 22 kg body-weight were used in this study in 2010, Isfahan University of Medical Sciences. Animals were separated into two groups: group A (n=4; amniotic membrane) and group P (n=4; pleural patch) according to the BS closure technique performed. After lobectomy of the right middle lobe, the BS was closed, while a small bronchopleural fistula (BPF) was created by inserting a catheter via edges of closed stump. Then, it was covered with a piece of AM3×3 cm in group A and with a pedicle graft of pleura in group P. Rethoracotomy was performed after 15 days of observation, and the BS was removed for histological examination. Histological healing was classified as complete or incomplete healing. Neoangiogenesis was measured by Von Willebrand expression using immunohistochemistry (IHC). Data were analyzed by SPSS version 15 using Fisher’s exact test, Mann-Whitney test, and T tests.Results: BPF complications were not seen during observation period. There was no significant difference in histological healing between two groups. Similarly, no significant difference was observed between the groups in terms of neoangiogenesis based on IHC examination (P value=0.69).Conclusion: Human amnion allograft could be as effective as pleural patch for BS wrapping following pulmonary resections.

Background: Diabetes causes the increased concentration of circulatory cytokines as a result of inflammation. Considering that pomegranate juice (PJ) is known to have antioxidant and anti-inflammatory properties, the purpose of this study was to determine the effects of PJ consumption on markers of inflammation in patients with type 2 diabetes (T2D).Materials and Methods: In a randomized, double-blind clinical trial study, 50 patients with T2D (40-65 years old) were randomly assigned to one of two groups. Participants in each group received either 250 mL/day PJ or a control beverage for 12 weeks. Biochemical markers including fasting plasma glucose (FPG), insulin and inflammatory markers were assayed on the baseline and follow-up blood samples.Results: In all, 44 patients in two groups were included in the analysis: PJ (n=22) and placebo (n=22). After 12 weeks of intervention, in the PJ group, there were 32% and 30% significant decreases in plasma C-reactive protein (hs-CRP) and Interlukin-6, respectively (P<0.05). The mean±SD plasma interlukin-6 (7.1±5.6 vs. 11.9±14.4 mg/L) and hs-CRP (1791±1657 and 1953±1561 ng/mL) concentrations in the PJ group were significantly lower than the placebo group after intervention (P<0.05).Conclusion: PJ consumption by patients with T2D does not affect FPG or the insulin resistance index (HOMA-IR), whereas it does reduce Interlukin-6 and hs-CRP concentrations in plasma. Therefore, PJ consumption may have an anti-inflammatory effect in patients with T2D.

Background: Emotion-focused cognitive behavioral therapy (ECBT) is a new form of CBT with emotion regulation components. This form of treatment is suggested to be employed to improve dysregulation of anxiety and other kind of emotions in anxious children. This study observed and compared the effectiveness of CBT and ECBT on anxiety symptoms; sadness and anger management; and cognitive emotion regulation strategies in children with separation anxiety disorder (SAD).Materials and Methods: This study is a randomized clinical trial. Subjects were 30 children from 9 to 13-years-old (15 girls and 15 boys) with diagnosis of SAD, being randomly assigned to CBT, ECBT, and control groups (five girls and five boys in each group). Subject children in CBT group participated in 10-h weekly sessions within Coping Cat manual; whereas, subject children in ECBT group contributed in 12-h weekly sessions within ECBT. The control group received no treatment. The Screen for Child Anxiety Related Emotional Disorders (SCARED; child and parent forms), Children’s Emotion Management Scale (CEMS; anger and sadness forms), and Cognitive Emotion Regulation Questionnaire (CERQ) tests administered to all subjects in pretest, posttest, and the follow-up measurement (3 months later). Analysis of covariance (ANCOVA) repeated measure and Kruskal-Wallis were applied to analyze data by Statistical Package for Social Sciences (SPSS) software package (v. 20).Results: CBT and ECBT; demonstrated no significant difference in reducing separation anxiety and total anxiety symptoms from parent and children’s reports. ECBT effectively increased anger coping and decreased negative cognitive strategies and dysregulation of anger in children, both in posttest and follow-up. Also, ECBT reduced sadness dysregulation and increased sadness coping, though these significant advantages were lost in 3 months later follow-up. CBT reduced negative cognitive strategies in follow-up and increased sadness coping in posttest. None of treatments affected on anger and sadness inhibition and positive cognitive coping in separation anxious children.Conclusion: ECBT, in comparison with CBT; effectively improved emotion regulation strategies in children with separation anxiety.

Background: Sexual dysfunction (SD) is a common reported problem in patients with multiple sclerosis (MS). Aims: to examine frequency and distribution of SD dimensions and to determine whether SD is related to various clinical and demographic variables in female patients.Materials and Methods: A total of 271 MS women (age: 19-50 years) participated in this cross-sectional study. We used a structured demographic and clinical interview and Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19). Disability was rated by Expanded Disability Status Score (EDSS).Results: 63.5% (n=173) of women had SD included 142 (52.4%) women with primary SD, 102 (37.5%) women with secondary SD and 120 (41%) women with tertiary SD. The most common SDrelated complaint was orgasmic problem (41.2%). Women with primary SD were significantly older and had higher EDSS score. No significant relationship was found between primary SD and disease duration. Fatigue (OR=2.69, 95% CI: 1.352-5.385, P=0.005), memory and concentration complaints (OR=1.915, 95% CI: 1.034-3.546, P=0.039) and some of urinary symptoms such as frequency (OR=2.108, 95% CI: 1.015-4.375, P=0.045) were seem to be the significant predictors. Fatigue was also found to be the most powerful predicting factor for tertiary SD (OR=2.793, 95% CI: 1.358-5.744 P=0.005).Conclusion: SD, a common multifactorial problem among MS women, can arise at any time during the disease and with any level of disability. However, we found relationships between SD and some of clinical variables and symptoms. Understanding these relationships would help us to develop practical approach and treatment for SD.

Background: Ratio of second and fourth digit (2D:4D) is known to be germane in analyzing utero concentrations of testosterone and estrogen in human and other vertebrates. 2D:4D had been linked to several traits like athletes’ abilities, reproductive success, risk of cancer and cardiovascular disease (CVD). Metabolic syndrome (MetS) is a clustering of several cardiovascular risk factors. Waist circumference (WC), neck circumference (NC), body mass index (BMI) and waist-to-height ratio (WHtR) are important in measuring MetS. This study investigated sexual dimorphism in 2D:4D and its relationship with MetS indices and CVD factors among adult residing in Ilorin, North central Nigeria.Materials and Methods: This is a cross-sectional, stratified multi-staged sampling study. Participants residing in different neighborhoods were visited at home where finger lengths and anthropometric traits were measured. Participants include 801 healthy adults aged 18-44 years (56% male) who had been living in the area for more than 3 years.Results: Males showed significantly lower 2D:4D than females (unpaired t-test; t [699] =11.49, P=0.001). A significant positive correlation was observed in MetS markers and 2D:4D. WHtR showed the highest correlation with 2D:4D in male (r=0.461, P£0.001) and female (r=0.408, P£0.001) when compared with BMI, NC and WC. All positive correlations recorded in this study were high in male and right hand.Conclusion: Our results showed that 2D:4D is sexual dimorphic and right hand 2D:4D as a predictor of MetS is better. We concluded that 2D:4D is a proxy for MetS and CVD risk factors in Ilorin.

Background: Although evidences emphasize on the importance of aftercare programs to achieve continuity of care, different studies have revealed controversial results about the outcome. The objective of this study was to investigate the effect of aftercare program on outcome measures of patients with severe mental disorders.Materials and Methods: Of a total 123 eligible patients with severe mental disorders, 61 patients were randomly assigned to the intervention group and 62 patients to the control group. The interventions included follow-up phone calls, home visits, and psychoeducation for families. Assessments were performed on hospital admission, discharge and the following 3rd, 6th and 12th month. Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HDRS), Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning (GAF), Clinical Global Impression (CGI), and the World Health Organization Quality of Life Questionnaire (WHO-QOL) were used. Data were analyzed through Chi square, t-test, Mann-Whitney-U, and Repeated Measures Analysis of Co-Variance.Results: Mean of the HDRS scores revealed significant difference between the two groups when HDRS scores on the admission day were controlled (P=0.028). The level of functioning was significantly different between the two groups based on the sequential assessments of GAF (P=0.040). One year after the onset of trial, the number of psychiatric readmissions were significantly different between the two groups (P=0.036).Conclusion: Readmission rates could be reduced by aftercare services, through the first year, after discharge of patients with severe mental disorders. On the other hand, higher levels of functioning would be expected after one year.

Background: Our study aimed to determine if alteration of metabolic parameters is associated with the severity of human immunodeficiency virus (HIV) infection, progress to acquired immunodeficiency syndrome (AIDS), or with the type of antiretroviral treatment (ART).Materials and Methods: In a cross-sectional study among 114 HIV infected patients, we measured hematological and biochemical parameters to assess metabolic alterations according to the disease process and anti-retroviral treatment.Results: Of 114 HIV-positive patients, there were 82 AIDS patients receiving ART and 32 HIV patients without treatment. Alkaline phosphatase and parathyroid hormone (PTH) had lower serum levels in HIV patients with CD4+ cell count£250 (P<0.01). CD4+ cell count was higher in patients receiving Protease Inhibitors (PI) and Nucleoside Reverse Transcriptase Inhibitors (NRTI) regimen compared with those treated with Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI) and NRTI or NRTI alone. Calcium (Ca) serum level was lower in patients with only NRTI regimen while Phosphorus (P) serum level was higher in patients on NNRTI and NRTI (P<0.05).Conclusion: CD4+ cell count£250 cells/ml in HIV-positive patients is associated with decreased level of triglyceride and PTH. Moreover, patients receiving NRTI regimen alone have lower Ca level while this regimen in combination with NNRTI or PI has a positive correlation with P serum level.

Background: Postpartum depression is endangering the health of mothers and has negative impacts on the evolution of social communication and newborns evolution. This study was conducted to determine the effects of Fordyce Happiness program on the postpartum depression.Materials and Methods: This quasi-experimental intervention carried out on postpartum mothers that referred to 4 health centers in Isfahan. A total of 133 mothers were selected by convenient sampling and then randomly allocated in two groups (63 and 70 mothers for intervention and control respectively). Maternal depression 3 times before, immediate and 1 months after intervention in both groups was evaluated with Beck Depression Inventory-II-Persian standardized questionnaires. Educational sessions based on the Fordyce happiness program were conducted for intervention group. Data was analyzed in SPSS17 (SPSS Inc, Chicago, Illinois) descriptive and analytic statistical tests at significance level of 0.05.Results: No significant differences in demographic variables between the two groups (P³0.05). No significant differences in depression scores in the two groups before training. However after 2 months a significant difference in depression score was observed between two groups (control group: 19.38±3.94; intervention group: 16.24±4.8; P<0.001). Furthermore in intervention group showed significant differences in depression scores before and after intervention (19.15±3.41 and 16.24±4.83; P<0.001). However in the control group had not any significant change. Conclusion: Fordyce happiness program was effective in reducing postpartum depression in our study. With attention to the effectiveness and low cost of this program, it is recommended that this program might be considered for all mothers after childbirth in health centers or other community-based settings.

Background: The study was aimed to explore the association between arterial oxygen saturation (SpO2) and spirometer parameters of disease severity in chronic obstructive pulmonary disease (COPD) patients with a view to identify whether the pulse oximetry can be used as an alternative to arterial values in the clinical management of COPD patients in a routine practice.Materials and Methods: Thirty-one patients with COPD were included in this study. After evaluation of each patient through history taking, physical examination and chest X-ray, SpO2 % and data regarding spirometry (FEV1% predicted and FEV1/FVC % predicted) in all patients were measured. Linear correlations among the variables were analyzed using the regression analysis.Results: In total 31 COPD patients according to the criteria established by the Global Initiative for Chronic Obstructive Disease (GOLD) were included in the study. There was not statistically significant correlation between FEV1 % predicted and SpO2 values (P>0.05), but a great correlation existed between FEV1/ FVC % predicted and SpO2 values (r=0.556, P<0.001). Median SpO2 values did not diff er between GOLD stages (Kruskal-Wallis test: P=0.17).Conclusion: The study may demonstrate that oxygen saturation measured by pulse oximetry appears to be independent of the degree of airways obstruction as quantified by the FEV1; although further evidence needs to be assessed these preliminary findings.

Background: Excess serum uric acid (UA) accumulation can lead to various diseases. Increasing evidences reveal that UA may have a key role in the pathogenesis of metabolic syndrome. Little is known about the associations of UA levels with cardiometabolic risk factors in prediabetic individuals. This study was designed to evaluate the association between UA and cardiometabolic risk factors in prediabetic subjects with family history of diabetes compared with those with normal glucose tolerance (NGT).Materials and Methods: In a cross-sectional setting, a sample containing 643 (302 prediabetic subjects and 341 normal) of the first-degree relatives of diabetic patients aged 35-55-years old were investigated. Samples were assessed in prediabetic and normal groups using glucose tolerance categories. Prediabetes was defined based on American Diabetes Association (ADA) criteria. Body weight and height, systolic and diastolic blood pressure (SBP and DBP), UA, creatinine (Cr), albumin (Alb), fasting blood glucose (FBG), hemoglobin A1c (HbA1c), and lipid profiles were measured and compared between two groups.Results: Prediabetic persons were older and obese than normal persons. Also, prediabetic persons (5.2±1.3 mg/dl) had significantly higher UA than normal persons (4.9±1.4 mg/dl) (P<0.05). FBG after 0, 30, 60, and 120 min in prediabetic were higher than normal persons (P<0.001). With respect to metabolic parameters, the patients in the higher UA quartiles exhibited higher levels of body mass index (BMI), SBP, FBG and triglycerides (TG). The higher quartiles of UA tended to be associated with higher BMI and higher total cholesterol (TC) in females prediabetic persons. Based on logistic regression analysis in different models, UA was positively (odds ratio (OR) >1, P<0.05) associated with glucose tolerance categories. This association remained statistically significant after adjusting the effects of age and BMI. Also, the association between glucose tolerance categories and UA were positively significant in both genders.Conclusion: High UA level was associated with some cardio metabolic risk factors in prediabetic individuals compared with normal person. UA level was also a significant predictor for prediabetes condition.

Background: Weight regain after weight loss is a common problem for all those obese or overweight who have had a recent weight loss. Different cures such as diet therapy, behavioral therapy, exercise or a mixture of them have been advised as solutions. The purpose of this review is to find the best diet or eating pattern to maintain a recent weight loss.Materials and Methods: We searched in PubMed and SCOPUS by using the following key words: Overweight, obesity, weight maintenance, weight regain, and diet therapy. Finally, we assessed 26 articles in the present article.Results: Meal replacement, low carbohydrate-low glycemic index (GI) diet, high protein intake, and moderate fat consumption have shown some positive effects on weight maintenance. However, the results are controversial. A Dietary Approach to Stop Hypertension (DASH)-type diet seems helpful for weight maintenance although the need for more study has remained. Some special behaviors were associated with less weight regain, such as, not being awake late at night, drinking lower amount of sugar-sweetened beverages, and following a healthy pattern. Some special foods have been suggested for weight maintenance. However, the roles of specific foods are not confirmed.Conclusion: Healthy diets recommend low carbohydrate, low GI, and moderate fat foods, but it is not clear whether they are useful in preventing weight gain. It seems that consuming fewer calories helps people to keep weight loss. Further research to find strategies in obesity management focusing on successful maintenance of weight loss is needed.

Isolated involvement of the kidney is rare in hydatid disease and is even rarer in children. We present a case of primary right renal hydatidcyst in 6-year-old female child who presented with pain right flank of 4 months duration. The patient was managed by nephrectomy.

Sir,Among the tumors affecting gastrointestinal tract pancreatic head and peri-ampullary cancer may show remarkable morbidity and mortality because of its significant structure and function. Obstructive jaundice is a common symptom of patients suffering from peri-ampullary and pancreatic head tumors. The best procedure for treatment of these patients is pancreaticoduodenectomy (PD). Several complications may occur after this procedure including the anastomosis leakage, especially pancreaticojejunostomy-intestinal complications. The only appropriate option for controlling the pancreatic leakage is surgical intervention but the controversy is how to manage this complication.

Sir,Fahr syndrome, defined by German neurologist Karl Theodor Fahr in 1930, includes neurologic, psychiatric, and cognitive disorders of unknown etiology, and is characterized by symmetric calcifications in the basal ganglia and cerebellar dentate nucleus, in individuals aged 5-65 years.