JOURNAL OF RESEARCH IN MEDICAL SCIENCES (JRMS)
Year:2015 | Volume:20 | Issue:4|Papers Count:14

Cerebral palsy (CP) is the most common chronic motor disability and neurological complication in children and occurs due to a nonprogressive lesion in the developing brain. Physically handicapped are one of the less frequent but the most different groups among exceptional children. CP is the most common motor disability in children after mental injuries, and the incidence of CP is about 2/1000 live births in Europe.

Background: The goal of the study is to test medialization of the neocord after oncological surgery for glottic cancer, using autologous tragal cartilage and perichondrium by the direct approach.Materials and Methods: Sixteen patients underwent comprehensive assessment including auditory perceptual assessment, videostrobolaryngoscopy, and acoustic voice analysis. The cartilage graft was inserted into a pocket created in the tyroarytenoid- lateral cricoarytenoid muscle complex or the excavated musculomembranous part of the neocord, and fixed by placing the perichondrium by the direct approach. The patients were evaluated preoperatively, and at 14 days, 60 days, and 6 months later.Results: Improvement of voice and breathiness was correlated with the increase of closed quotient and harmonic-to-noise ratio; the acoustic voice parameters studied showed significant differences between preoperative and postoperative voices, and these objective measurements of voice changes provided accurate and documentary evidence of the results of surgical treatment.Conclusion: This method may be considered a safe and efficient phonosurgical procedure for voice restoration.

Background: Depending on the site of irradiation, about 40-80% of patients undergoing radiotherapy (RT) will experience nausea and/or vomiting. The current study aimed to investigate the efficacy of ondansetronas as a single agent and with a combination to aprepitant on preventing RT-induced nausea and vomiting (RINV).Materials and Methods: In a clinical randomized controlled trial (from September 2010 to September 2011), conducted in Radiation Oncology Department of Seyed-al-Shohada Hospital, Isfahan University of Medical Sciences, 40 abdominopelvic malignancies cancer patients were allocated into two aliquots using block randomization of size. Patients in the first group (group I) received ondansetron alone while those patients in the remaining group (group II) received ondansetron and aprepitant. Then, developing of RINV and its severity and benefit of adding aprepitant to ondansetron, in comparison with ondansetron as a single drug therapy were evaluated.Results: The average age of the patients in group I was 61.15 ± 12.27 years while in group II it was 50.1 ± 13.27 years. No statistically significant gender differences were found between the two groups. In patients treated with ondansetron single drug therapy (group I), frequency and grade of RINV were significantly more than the group treated simultaneously by aprepitant and ondansetron (group II) (odds ratio [OR] =21.2; P<0.01). Compared with RT alone, the patients whom underwent RT along with chemotherapy showed lower probability of experiencing RINV (OR=0.13; P<0.05).Conclusion: The present study indicated a significant superiority of combination of ondansetron and aprepitant in management of RINV, in patients undergoing RT, compared to ondansetron as a single agent therapy. More accurate follow-up studies are needed for the evaluateon of the efficacy of ondansetron with combination to aprepitant on preventing the RINV.

Background: The preschool years are a crucial time to study the determinants of childhood obesity, as it is when eating and physical activity habits are becoming established. The purpose of this study was to compare the prevalence of overweight and obesity among preschoolers living in the capital of Iran and to determine relationships between overweight and obesity and selected motor- and health-related fitness parameters.Materials and Methods: This exploratory cross-sectional study was conducted with 190 boys and 191 girls aged 5-6 years. Study children were selected from the kindergartens in Tehran, the capital of Iran. All children underwent anthropometric, motor- and health-related fitness tests. Height, body mass, body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and percentage of body fat (PBF) were measured for anthropometric assessments. Sit-and-reach, modified sit-ups, modified pull-ups, the 4×9 m shuttle run, the 20 m sprint test and the 20 m multistage shuttle run test were measured for motor- and health-related fitness tests. Overweight and obesity prevalence was determined by the International Obesity Task Force, Centers for Disease Control and Prevention and World Health Organization standard criteria.Results: International Obesity Task Force criteria indicate almost 12% (23.190) of boys and 22.5% (43.191) of girls were overweight or obese with 4.73% (9.190) of boys and 10.99% (21.191) of girls in the obese category. Significant correlations were found between modified pull-ups test and body mass, BMI, WC, WHR, WHtR, PBF in boys and modified pull-ups and modified sit-ups tests were significantly correlated with body mass, BMI, WC, WHR, WHtR, and PBF in girls. Compared to their counterparts, overweight and obese boys demonstrated inferior performance in modified pull-ups and predicted VO2max and overweight and obese girls demonstrated inferior performance in modified pull-ups, modified sit-ups, 4×9 m agility shuttle run and predicted VO2maxConclusion: This study highlighted the relatively high prevalence of overweight and obesity in both genders of preschoolers and found that overweight and obesity were associated with poor fitness performances. The findings provided evidence to support the establishment of tailored physical fitness intervention programs to manage and prevent obesity in preschoolers.

Background: Based on several reports including genome-wide association studies, genetic variability has been linked with higher (nearly half) susceptibility toward coronary artery disease (CAD). We aimed to evaluate the association of chromosome 9p21 single nucleotide polymorphisms (SNPs): rs2383207, rs10757278, and rs10757274 with the risk and severity of CAD among Arab population.Materials and Methods: A prospective observational case-control study was conducted between 2011 and 2012, in which 236 patients with CAD were recruited from the Heart Hospital in Qatar. Patients were categorized according to their coronary angiographic findings. Also, 152 healthy volunteers were studied to determine if SNPs are associated with risk of CAD. All subjects were genotyped for SNPs (rs2383207, rs2383206, rs10757274 and rs10757278) using allele-specific real-time polymerase chain reaction.Results: Patients with CAD had a mean age of 57±10; of them 77% were males, 54% diabetics, and 25% had family history of CAD. All SNPs were in Hardy-Weinberg equilibrium except rs2383206, with call rate>97%. After adjusting for age, sex and body mass index, the carriers of GG genotype for rs2383207 have increased the risk of having CAD with odds ratio (OR) of 1.52 (95% confidence interval [CI] =1.01-2.961, P=0.046). Also, rs2383207 contributed to CAD severity with adjusted OR 1.80 (95% CI=1.04-3.12, P=0.035) based on the dominant genetic model. The other SNPs (rs10757274 and rs10757278) showed no significant association with the risk of CAD or its severity.Conclusion: Among Arab population in Qatar, only G allele of rs2483207 SNP is significantly associated with risk of CAD and its severity.

Background: Incomplete efficiency of oral medications restricts their therapeutic success in pain control of the painful form of the diabetic peripheral neuropathy (DPN). Use of topical medications because of less systemic side effects is more acceptable. This study aimed to compare the effect of clonidine gel and capsaicin cream in relieving pain associated with DPN.Materials and Methods: This 12-week, randomized, double-blind and parallel-group trial was conducted to compare the efficacy and safety of topical clonidine and capsaicin. Totally, 139 patients with type 2 diabetes with a pain score of at least 4 as assessed by visual analog scale (VAS), were treated for up to 3 months. The endpoint of the study was the reduction in the median pain score from baseline, as assessed by the VAS at the 4 weekly follow-up visits.Results: The intention-to-treat population for the efficacy analysis consists of 69 patients receiving clonidine and 70 patients receiving capsaicin. Both drugs significantly relieved pain at 12 weeks (P<0.001 for both) but no significant difference in the efficacy between the two treatments was observed (P=0.931). Dermatologic complications were more common in capsaicin group (P=0.001).Conclusion: The results of this study showed the comparable efficacy of clonidine gel in comparison with capsaicin cream in the treatment of pain due to DPN with less adverse events. More studies are required to better evaluate the efficacy and safety of this topical compound for relieving pain in DPN.

Background: There is accumulating evidence for a possible protective role of vitamin D in the development and disease course of multiple sclerosis. Whether vitamin D is also effective in treating patients with optic neuritis (ON) is not known. The aim of this study was to evaluate the effect of oral vitamin D on the thickness of retinal nerve fiber layer (RNFL) in vitamin D deficient patients with ON by optical coherence tomography.Materials and Methods: A Phase II placebo-controlled randomized clinical trial conducted between July 2011 and November 2012 included 52 patients with confirmed unilateral ON aged 15-38 years and low serum 25-hydroxyvitamin D levels. The main outcome measures were changes in thickness of RNFL and macula 6 months after treatment. Patients were randomly allocated to receive 6 months of treatment with adding either 50, 000 IU/ week vitamin D or placebo.Results: In the 27 patients treated with vitamin D, the mean (standard deviation [SD]) thickness of RNFL decreased from 111.3 (18.9) mm at baseline to 91.4 (13.3) at the end of study period (P<0.001). Correspondingly, in the 25 patients treated with placebo, the mean (SD) thickness of RNFL decreased from 113.7 (21.5) mm at baseline to 96.1 (12.3) at the end of study period (P<0.01). In both groups, the mean thickness of the macula did not changed (P>0.05). Average thickness of RNFL at the end of trial did not differ between groups.Conclusion: Adding vitamin D to routine disease therapy had no significant effect on the thickness of RNFL or macula in patients with ON. This trial is registered on www.clinicaltrials. gov (ID NCT01465893).

Background: Transient neurological symptoms (TNS), was described in patients recovering from spinal anesthesia with lidocaine but its etiology remains unknown this study was evaluated the influence of ambulation time on the occurrence of TNSs after spinal anesthesia with lidocaine 5%.Materials and Methods: This randomized clinical trial was conducted on 60 patients with American Society of Anesthesiologists Grades I and II, who were candidates for lower abdominal surgery in supine or lithotomy positions. Patients were randomly divided into early ambulation group (Group A) who were asked to start walking as soon as the anesthesia was diminished or to the late ambulation group (Group B) who walked after at least 12 h bedridden. Participants were contacted 2 days after spinal anesthesia to assess any type of pain at surgical or anesthesia injection site, muscle weakness, fatigue, vertigo, nausea, vomiting, headache, and difficult urination or defecation.Results: Four subjects (13.3%) in Group A and two patients (6.7%) in Group B had pain at anesthesia injection site (P=0.019). Fourteen patients in Group A (46.7%) and six patients in Group B (20%) had post-dural puncture headache (P=0.014). Participants in Group B reported difficult urination more than Group A (P=0.002). there were not statistically significant differences between two groups regarding frequency of fatigue, muscle weakness, vertigo, nausea, vomiting, difficult defecation, paresthesia, and the mean of visual analogue scale at the surgical site.Conclusion: Early ambulation after spinal anesthesia with lidocaine did not increase the risk of neurologic complication.

Background: Identifying the strengths and weakness points is one of the effective methods to analyze current status, and prioritizing actions based on the gap between current and optimal status is necessary for short-term and long-term planning in departments and colleges. The aim of this study was to determine the gap between current and optimal status of curriculum leadership in the postgraduate courses in two Iranian universities.Materials and Methods: In this cross-sectional study, a sample of 212 faculty members from the two Iranian universities (one medical and one nonmedical) was randomly selected through stratified random sampling method. Data were collected by using a researcher-made questionnaire, with 55 items categorized in four areas of main dimensions in curriculum leadership. The validity of the questionnaire was determined by curriculum studies scholars, and the reliability was confirmed as the Cronbach’s alpha calculated 0.969. Data were analyzed using descriptive and inferential statistics according to the variables.Results: There was a gap in all dimensions and roles. The maximum gap (-1.70) with the highest frequency (98%) were related to “improving the educational atmosphere” dimension. As for items, the maximum gap (-2.41) was related to “society needs and expectations and the labor market” in “curriculum development and revision” dimension.Conclusion: The negative gap between all dimensions of curriculum leadership implies faculty members’ dissatisfaction. Curriculum leadership at universities, colleges and departments of the study in all aspects need to be improved. Hence, it is necessary for managers to make use of the viewpoints of the faculty members to decrease the gap.

Background: This study was carried out in order to evaluate the relationship between retinopathy and carotid intima-media thickness (CIMT).Materials and Methods: In a cross-sectional study, 154 diabetic patients who had a history of diabetic disease were evaluated in two equal groups of 77 patients with and without retinopathy, respectively. CIMT was evaluated in all of the patients.Results: Mean age of the patients was 59.65 ± 9.37 years. Mean CIMT of all patients was 0.84 ± 0.18. CIMT of patients with retinopathy was significantly greater than patients without retinopathy (P<0.001). CIMT also correlated with age, duration of diabetes, systolic blood pressure, blood urea nitrogen, and serum creatinine.Conclusion: CIMT may be used as a simple, available and noninvasive method for screening of macro and microvascular complication of diabetic patients.

New formulations and technologies have been developed through oral drug delivery systems’ researches. Such researches display significance of oral route amongst patients. We’ve reviewed all the features associated with medicated chewing gum as a modern drug delivery by introducing the history, advantages and disadvantages, methods of manufacturing, composition differences, evaluation tests and examples of varieties of medicated chewing gums. Acceptance of medicated chewing gum has been augmented through years. The advantages and therapeutic benefits of chewing gum support its development as we can see new formulations with new drugs contained have been produced from past and are going to find a place in market by formulation of new medicated chewing gums. Potential applications of medicated chewing gums are highly widespread as they will be recognized in future. Nowadays standards for qualifying chewing gums are the same as tablets. Patient-centered studies include medicated chewing gums as a delivery system too which creates compliance for patients.

Graves’ disease with accompanying functioning nodules is known as Marine-Lenhart syndrome. Autonomously functioning thyroid nodules (AFTNs) also within Graves’ thyroid tissue are almost always bening in nature. A 45-year-old man developed hyperthyroidism due to the coexistence of Graves’ disease and AFTN. Total thyroidectomy was performed. The hyperfunctioning nodule with centrally hypoactive foci detected by technetium-99m thyroid scanning was histologically diagnosed as papillary thyroid carcinoma that was 2.5 cm in diameter. We report the presence of papillary thyroid carcinoma within AFTN in patients with Marine-Lenhart syndrome, which has not been reported so far.

Fanconi syndrome results from a generalized abnormality of the proximal tubules of the kidney and owing to phosphate depletion can cause hypophosphatemic osteomalacia. Adefovir dipivoxyl (ADV) effectively suppresses hepatitis B virus replication but exhibits nephrotoxicity when administered at a low dosage. We report two cases of Fanconi syndrome induced by ADV at 10 mg/day to call for regular screening for evidence of proximal tubular dysfunction and detailed bone metabolic investigations for prompt detection of ADV nephrotoxicity is critically important to ensure timely drug withdrawal before the development of irreversible tubulointerstitial injury.

Sir, A 32-year-old woman was referred to our clinc in Al-Zahra University Hospital, Isfahan, Iran for positive serum nontreponemal; Venereal Disease Research Laboratory (VDRL) and rapid plasma reagin (RPR) tests recently. She was in a healthy condition. She works in a bank as cashier. Her previous husband was an intravenous drug user. She lived with him for about 2 years and divorced. She had no pregnancy in the past. She is going to be married to another person. She underwent lumbar puncture. Cerebrospinal fluid (CSF) analysis was in normal range. VDRL of CSF was negative. All rheumatologic tests including rheumatoid factor, P-ANCA, C-ANCA, antinuclear antibody, Cardiolipin LE cell was negative. Hepatitis markers, hepatitis B surface antigen, hepatitis C antibody and human immunodeficiency virus antibody all were negative. Other sexually transmitted diseases were ruled out. Serology for brucellosis was negative. History of Chronic TB, Recent vaccination and IVDU were negative. Blood smear stain for Malaria showed no parasite. She had received doxycicline for 4 weeks period.