JOURNAL OF RESEARCH IN MEDICAL SCIENCES (JRMS)
Year:2016 | Volume:21 | Issue:1|Papers Count:18

Background: To investigate the relation between serum leptin levels and cerebral infarction (CI) by meta-analysis.Materials and Methods: Scientific literature databases were searched for studies published in Chinese and English. After retrievingrelevant articles through database searches and screening using predefined selection criteria, high-quality studies related to our researchtopic were selected for inclusion in this meta-analysis. All statistical analyses were conducted using Comprehensive Meta-Analysis 2.0(CMA 2.0, Biostat Inc., Englewood, New Jersey, USA).Results: The study results revealed that serum leptin levels were significantlyhigher in CI patients as compared to normal controls. The outcomes of subgroup analysis by ethnicity suggested that the serum leptinlevels in CI patients were significantly higher than normal controls in both Asian and Caucasian populations. Further, subgroupanalysis based on the detection method indicated that the serum leptin levels in CI patients were significantly higher compared withnormal controls when measured by radioimmunoassay (RIA) but enzyme-linked immunosorbent assay (ELISA) -based measurementsdid not show such statistically significant differences.Conclusion: Our meta-analysis results suggest that serum leptin levels in CIpatients may be closely correlated with CI risks.

Background: Although the effect of cardiac rehabilitation (CR) on cardiovascular disease (CVD) prognosis has been well-documented byseveral systematic reviews, none have focused on the effect of CR on metabolic syndrome (MetS) and its related components. Therefore, the present systematic review and meta-analysis was conducted to assess the effect of CR on MetS and its components. Materialsand Methods: PubMed, SCOPUS, Cochrane library, and Google Scholar database were searched up to February 2014 with no dateand language restrictions. The random effects model was used to assess the overall effect of CR on MetS prevalence and the change inmetabolic or anthropometric measures.Results: Fifteen studies with 19, 324 subjects were included in the present systematic reviewand meta-analysis. Our analysis showed that the CR could significantly reduce MetS prevalence [reduction rate: 0.25, 95% confidenceinterval (CI): 0.21, 0.3, P value<0.001; P value for heterogeneity<0.001, I-squared: 86.2%]. Additionally, results showed the protectiverole of CR on all MetS components including high density lipoprotein cholesterol [mean difference (MD): 2.13 mg/dL, 95% CI: 1.17, 3.1], triglyceride (MD: -27.45 mg/dL, 95% CI: −36.92, −17.98), systolic blood pressure (SBP) (MD: −6.20 mmHg, 95% CI: -8.41, −3.99), diastolic blood pressure (DBP) (MD: −2.53 mmHg, 95% CI: −3.64, −1.41), fasting blood sugar (FBS) (MD: −6.42 mg/dL, 95% CI: −6.85, −5.99), and waist circumference (WC) (MD: −2.25 cm, 95% CI: −3.15, −1.35).Conclusion: CR has resulted in improvement in MetSand its entire components, and could be considered as a useful tool for MetS patients, especially among those with CVD.

Background: Cerebral vascular thrombosis (CVT) is the thrombosis of intracranial and sinuses. The aim of this is to estimate of riskof low folic acid, low vitamin B12, and hyperhomocysteinemia (hyper-Hcys) for CVT. Materials and Methods: A total of 24 patientswith CVT and 36 healthy controls participated in a cross-sectional case-control study. The deficient levels of folic acid and vitaminB12 defined as<10th percentile of folic acid and vitamin B12 level and hyper-Hcys was defined as>90th percentile of homocysteineof control group.Results: Patients had higher levels of total homocysteine (tHcys) than controls (14.7 ± 6.5 vs.6.4 ± 2.7 μmol/L, P=0.001). Also, vitamin B12 level in case group was lower compared to control subjects (185.4 ± 58 vs.299 ± 75 ng/mL, P=0.001).Hyper-Hcys and low vitamin B12 were significantly more prevalent in CVT patients than controls. Although, significant independentassociation with risk of CVT was found for hyper-Hcys [adjusted odds ratio (OR) 14.3, 95% confidence interval (CI): 2.6-77.1, P=0.002] and low vitamin B12 (adjusted OR 24.6, 95% CI: 2.3-262.9, P=0.008). Association between low folic acid and risk of CVTwas not significant. A significant negative correlation was found between the levels of tHcys and vitamin B12 (r=−0.32, P=0.01).Conclusion: Hyper-Hcys and low vitamin B12 were related with the high risk for CVT.

Background: To investigate the effects of moderate aerobic exercise on the hemoglobin, hematocrit, and red blood cell (RBC)mass of women with rheumatoid arthritis (RA). Materials and Methods: This randomized clinical trial was conducted at theSpecialized Clinic of Physical Medicine and Rehabilitation, Al-Zahra Hospital of Isfahan, during a 4-month period in 2014.We included patients with RA who did not have any malignancy and hematologic disorder. Two groups — one group receivingaerobic therapy along with medical therapy (N=16) and the other group receiving medical therapy alone (N=17) both for aperiod of 8 weeks. The levels of RBC mass, Hb, and HCT were measured before and after the intervention. The changes in theseparameters were compared between the two study groups.Results: There was no significant difference between the two studygroups regarding the baseline characteristics. The aerobic exercise resulted in increased RBC mass (P<0.001), Hb (P<0.001), and HCT (P<0.001). However, those who received medical therapy alone did not experience any significant changes in theseparameters. We found that the RBC mass (P=0.581), Hb (P=0.882), and HCT (P=0.471) were comparable between the twostudy groups after 8 weeks of intervention.Conclusion: Although the aerobic exercise results in increased Hb, HCT, and RBCmass in patients with RA, the increase was not significant when compared to that in controls. Thus, the increase in the HB, HCT, and RBC could not be attributable to aerobic exercise.

Objective: To investigate the effect of using intrauterine devices (IUDs) during the fertile window on women’s reproductive systemhealth. Materials and Methods: 2, 744 postmenopausal women in the Minhang District, Shanghai, China were enrolled. In the IUDsgroup there were 2, 253 women; in the tubal ligation group there were 202 women and there were 289 women in the control group.We selected subjects according to the cases number in different hospital by using step sampling, and, in addition, collected thesociological data and information of the previously used contraceptives by the subjects, which included whether the contraceptiveswere used appropriately and the effect they had. Kolmogorov-Smirnov test, Levene’s test, and logistic regression analysis wereused to analyze the data.Results: The prevalence rate of benign reproductive system conditions was significantly different amongthem (P<0.05). Further comparison revealed, the rate in Group 1 was significantly lower than that in Group 2 and Group 3 (P<0.05, respectively). Results of logistic regression analysis show that the risk factors for development of such conditions lie in thewomen’s pregnancy history [odds ratio (OR) =3.85], reproductive history (OR=0.5), the use of IUD in fertile window (OR=0.4), tubal ligation (OR=1.74), birth control time (OR=0.9), contraceptive failure history (OR=1.7), and history of family planningprocedures (OR=1.73).Conclusion: IUDs, maybe, can effectively reduce the risk of getting benign reproductive conditions inpostmenopausal females.

Sir, Dementia refers to a syndrome, which is progressivein nature and leads to deterioration in cognitivefunction which eventually affects the memory, thinking, orientation, comprehension, learning capacity, judgment, behavior, ability to perform routine work, etc....

Background: A dramatic improvement in the survival of acute lymphoblastic leukemia (ALL) patients in the last three decades hasbeen observed. MCP 841 protocol is an old but effective tool with tolerable toxicities. The objective of this study was to estimate therelapse-free survival of ALL patients treated uniformly with MCP 841 protocol on the basis of various prognostic factors. Materialsand Methods: The study design was retrospective and it was conducted in a regional cancer center of Northwest India. Three hundredand ten ALL patients who underwent treatment with MCP 841 protocol and regular follow-up for up to 5 years were selected for thisstudy. Relapse-free survival was calculated by Kaplan–Meier analysis and Cox regression analysis was used to calculate the hazardsratio (HR) using Statistical Package for the Social Sciences (SPSS) software for windows version 20.0.Results: Fifty-four percentpatients were<15 years of age and 69% were males.53.2% patients were in remission at the end of 5 years of starting the treatment.Relapse-free survival at 5 years by Kaplan–Meir analysis for B-cell ALL was 62% [HR 0.67 {95% confidence interval (CI) 0.47-0.95} ]with patients with unknown lineage taken as reference] while for T cell it was 28% [HR 1.41 (95% CI 1.19-1.63), P 0.001]. Patientswith total leukocyte count (TLC)<1 lakh/cmm at presentation, relapse-free survival was 68% and those with TLC>1 lakh/cmmhad 41% survival [HR 2.14 (1.76-2.48) with, P<0.001].Conclusion: MCP 841 protocol is a useful tool for the treatment of ALL inchildren when more aggressive protocols can not be used.

Background: Vitamin D deficiency is common in pregnancy, leading to increase in the frequency of preeclampsia, cesarean delivery, neonatal bacterial vaginosis, and gestational diabetes. The current study was designed and implemented to investigate the effect ofvitamin D during the first and second trimesters of pregnancy in reducing the risk of gestational diabetes mellitus (GDM) in womenwho are at high risk [history of GDM, birth macrosomia, family history, and high body mass index (BMI)]. Materials and Methods: In a randomized, double-blind, and placebo-controlled trial, 90 pregnant women who had at least one risk factor for GDM wererandomized into intervention (46 participants) and control (44 participants) groups. Participants in the intervention group took5000 units of vitamin D daily and the control group took placebo until the 26th week of pregnancy. Then the glucose challenge test(GCT) and the glucose tolerance test (GTT) were performed to evaluate GDM.Results: Mean ± standard deviation (SD) age was31.28 ± 6.38 years and 29 ± 6.24 years for the intervention group and the placebo group, respectively, (P>0.05). In addition, therewere no significant differences between two groups in terms of vitamin D levels and GCT (P>0.05), and the difference was notsignificant. The incidence of diabetes in the intervention groups was statistically lower than in control group (11.4% vs 34.8; P<0.01). The results showed that abnormal GCT in the placebo group was statistically higher than in intervention group (35.9% vs 10.9P<0.005).Conclusion: The results of the current study showed that the prescription of vitamin D supplementation in the first andsecond trimesters of pregnancy was effective in reducing GDM and controlling GTT and GTC.

According to the World Heart Federation website, World Heart Day 2015 focused on creating healthyheart environments by ensuring that everyone has thechance to make healthy heart choices. One of thesechoices is cardiac rehabilitation (CR) and secondaryprevention.

Background: The prevalence of vitamin D deficiency is higher in end-stage renal disease (ESRD) patients compared to healthypopulations. This deficiency could lead to several complications with different mechanisms and might result in reduced survival inpatients. Leptin and adiponectin are messenger proteins with endocrine secretion from adipocytes and various effects in cellularmechanisms. The goal of this study was to find the effect of vitamin D administration on serum levels of leptin and adiponectin inESRD patients. Materials and Methods: This double-blind randomized placebo-controlled clinical trial was carried out on 64 ESRDpatients on hemodialysis in the Amin and Noor hospitals of Isfahan, Iran. Patients were categorized into two groups, on controland intervention; serum levels of vitamin D, leptin, and adiponectin were measured in both groups before and after the study. Theintervention group was treated with vitamin D pearls, while the control group received placebo in the same manner.Results: Themean [standard deviation (SD)] ages of the patients were 62 (21) years and 60 (19) years in the control and treated groups, respectively.Conclusion: The change in serum level of vitamin D was statistically significant in the treatment group but not in the control group.The serum level of leptin was reduced in the treatment group, while the serum level of adiponectin increased significantly, but noneof these changes were statistically significant in the control group. This study showed that vitamin D administration is associatedwith an increase in adiponectin and a decrease in leptin level in ESRD patients.

Background: The food frequency questionnaire (FFQ), as a way to assess the dietary intake in comparison with other methods, is easierto analyze and takes less time and is less costly. Our aim in this study was to develop and validate an FFQ for estimating the intakesof selected antioxidants in elderly Iranian people. Materials and Methods: A total of 185 elderly people were randomly selected.Three-day food records were completed by the subjects and collected every 2 months and dietary intake levels of zinc, selenium, carotenes and vitamins C and E were estimated. Based on the food records data, geographic location, and age, an FFQ was designedto estimate antioxidant intakes during 1 year. In addition, for controlling energy intake, 2-day food records were also collected withthe food frequency questionnaire. To assess the reliability, 40 individuals were asked to complete the FFQ twice with an interval of 3months in between.Results: Intraclass correlation coefficient (ICC) between the two FFQs for antioxidant C, antioxidant E, carotene, selenium, and zinc were 0.62, 0.47, 0.51, 0.54, and 0.58, respectively (P<0.05). In addition, Pearson correlation coefficients betweenthe FFQ and the food records, after controlling energy for vitamin C, vitamin E, carotene, selenium, and zinc, were 0.46, 0.48, 0.38, 0.55, and 0.47 respectively (P<0.001).Conclusion: According to the results of this study, considering the fact that the FFQ wasdesigned for the elderly and the special conditions (patience, memory, etc.) and vulnerability of this age group, the questionnaire isrelatively valid and reliable to use.

Background: Despite the great emphasis on teaching professionalism in universities, creating changes in one’s professional behavioris a serious challenge in medical education. In this regard, one cannot ignore the role of faculty members. The present study wasset to investigate the opinions of medical education experts about the expected results of faculty development programs regardingteaching and learning professionalism. Materials and Methods: The study was carried out in two phases including content analysisstudy and Delphi. In the first phase, 10 medical education experts participated in the study. Data gathering was carried out usingsemi-structured interviews. Codes were analyzed using classic content analysis method. In the second phase, a six-member focusgroup and Delphi with 23 experts from across the country participated, and themes from the previous phase were confirmed andfinalized.Results: Analysis of the content of the interviews in the first phase and discussing in the focus group and Delphi showedtwo main themes: 1) direct results and 2) indirect results with six subthemes. Direct results included three subthemes of creatingrole model faculty members, scientific improvement, improving professionalism, and inspiring the students; indirect results includedthree subthemes of change in educational environment of the university, change in the university system, and effects on the society’sculture.Conclusion: Faculty development in professionalism can contribute to university faculty members to become better rolemodels and inspire their students, peers, and even the society. Therefore, improving professional behavior in university facultymembers can have direct and indirect effects on improving the society due to their crucial role.

Background: We performed this meta-analysis in order to collect all the relevant studies to clarify the correlations of matrixmetalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) with chronic obstructive pulmonary disease(COPD). Materials and Methods: After a literature search in electronic databases, pertinent case-control studies investigating thecorrelations of MMP-9 and TIMP-1 protein expressions within a COPD setting were enrolled based on our strict inclusion andexclusion criteria. We used key words such as “chronic obstructive pulmonary disease, ” “COPD” or “COAD” or “chronic obstructiveairway disease” and “matrix metalloproteinases” or “MMPs” to make a searching strategy in this study. STATA software (version12.0, Stata Corporation, College Station, TX, USA) was utilized for statistical analysis.Results: A total of 20 studies were enrolledinto this meta-analysis including 923 COPD patients and 641 healthy controls. The findings of this meta-analysis revealed that serumexpression levels of MMP-9 and TIMP-1 protein in COPD patients were higher than those of healthy controls (MMP-9: SMD=1.44, 95%CI=0.85 ~ 2.04, P<0.001; TIMP-1: SMD=3.53, 95% CI=2.31  ~ 4.75, P<0.001). Subgroup analysis based on ethnicity revealedthat both Caucasians and Asian COPD patients exhibited higher MMP-9 and TIMP-1 serum protein levels than healthy controls(MMP-9: SMD=0.81, 95%CI=0.15~1.48, P=0.016; TIMP-1: SMD=4.43, 95%CI=1.98 ~ 6.87, P=0.016) and in Caucasians (MMP-9: SMD=2.30, 95%CI=1.21 ~ 3.38, P<0.001; TIMP-1: SMD=2.86, 95%CI=1.47 ~ 4.24, P<0.001).Conclusion: The result of thismeta-analysis indicates that elevated levels of MMP-9 and TIMP-1 proteins may be correlated with the pathogenesis of COPD, andthe two proteins may represent important biological markers for the early diagnosis of COPD.

Background: Studies show that polyunsaturated fatty acids (PUFAs) may have an inhibitory role in carcinogenesis. It was previouslyshown that PLA2 group 2A (PLA2G2A) messenger RNA (mRNA) expression is associated with less frequent metastasis and longersurvival in gastric adenocarcinoma. This study intends to investigate the effect of PUFAs on the expression of PLA2G2A in patientswith gastric cancer. Materials and Methods: Thirty-four patients with gastric cancer (GC) were randomly divided into two groups.The first group received cisplatin medication. The second group received cisplatin medication and supplements of ω-fatty acids forthree courses. The total RNA was extracted from the tissues and cDNA was synthesized. The gene expression of PLA2G2A wasevaluated by the real-time polymerase chain reaction (PCR) method. To confirm the changes in gene expression, frozen sectionwas utilized. The frozen tissue samples were sectioned and stained using the immunohistochemistry technique.Results: Afterchemotherapy and chemotherapy plus supplement, the relative mean of PLA2G2A gene expression increased 1.5 ± 0.5-fold and7.4 ± 2.6-fold, respectively (P=0.006). The relative mean of gene expression in patients who received cisplatin and ω-fatty acidssupplement increased more significantly (7.5 ± 3.3-fold) than in patients who received only cisplatin (P=0.016).Conclusion: It wasfound that PUFAs increased the gene and protein expression of PLA2G2A in gastric cancer. Concerning the fact that studies revealprotective function of PLA2G2A in gastric cancer, it is suggested that increased expression of PLA2G2A is helpful. Furthermore, PUFAs can be considered as a useful therapeutic supplement for patients with gastric cancer.

Background: Type II diabetes mellitus (T2DM) is the prevalent type of diabetes in the world. Prediabetic patients are the mostprobable group to get diabetes. Several studies have mentioned the role of inflammation in the incidence of diabetes. The originof inflammation can be infection such as Helicobacter pylori (HP) infection. This study was designed to explore the effect of HPeradication on insulin resistance. Materials and Methods: This single-blind randomized controlled clinical trial was conducted in2014-2015. The sample size consisted of 49 individuals who were in prediabetes stage with HP infection. Patients with positive stoolantigen were allocated randomly into two groups. The treatment group took medication to eradicate HP infection by the routinemethod of four-drug eradication. However, placebo capsules and tablets were given to the patients in the placebo group. Then fastingplasma glucose (FPG), fasting plasma insulin (FPI), and quantitative C-reactive protein (CRP) levels were measured and homeostaticmodel assessment of insulin resistance (HOMA-IR), homeostatic model assessment of beta-cell function (HOMA-B), Matsuda index, insulinogenic index, and disposition index were calculated.Results: Results of this study showed that FPI and HOMA-IR increasedsignificantly (P value of FPI=0.023 and P value of HOMA-IR=0.019) after HP eradication in the treatment group. On the otherhand, comparison of differences at the baseline and after 6 weeks in FPG (P value=0.045), FPI (P value=0.013), and HOMA-B (Pvalue=0.038) revealed significant differences between the placebo group and treatment group.Conclusion: Results showed thatHP eradication by a 2-week antibiotic medication did not decrease insulin resistance and even increased FPI and insulin resistanceindices. So HP eradication among prediabetic patients is not recommended for the decrease of insulin resistance and postponementof the development of diabetes mellitus.

Background: Polycystic ovary syndrome (PCOS) is one of the common endocrine disorders in women of reproductive ages. It isassociated with a range of disorders, such as dyslipidemia, hypertension, insulin resistance (IR), compensatory hyperinsulinemia, gestational, and type 2 diabetes, and increased risk of cardiovascular morbidity. There are different treatments available for PCOS. Thepurpose of this study was to determine and compare the effects of metformin, flutamide plus oral contraceptives (OCs), and simvastatinon the metabolic consequences of PCOS. Materials and Methods: This study was a single-blind clinical trial. The subjects were selectedfrom a group of patient with PCOS and metabolic syndrome, who were referred to the midwifery clinic of Al-Zahra Hospital andBeheshti Hospital, Isfahan, Iran. A total of 111 subjects were randomly assigned to three groups: metformin, flutamide plus OCs, andsimvastatin groups. The measurements were performed at baseline and after 6 months of therapy. Paired t-test, analysis of variance(ANOVA), and chi-square test were applied in this study.Results: A total of 102 subjects were analyzed in this study, 34 subjects wereallotted in each group. The prevalence of IR was statistically different between three groups (P-value=0.001). After a 6-month course, metformin showed larger reduction in fasting blood sugar (FBS) level (P-value<0.001). However, except for metformin, two othertreatments reduced C-reactive protein (CRP) level significantly (both P-values<0.001). The level of triglycerides (TGs) decreasedconsiderably in all groups (all P-values<0.001). Both metformin and simvastatin decreased BMI significantly (both P-values<0.001).None of the treatments changed high-density lipoprotein (HDL) level (all P-values>0.05).Conclusion: Metformin performed betterin FBS reduction. Simvastatin had better performance in terms of reducing TG level and waist circumference.

Sir, Owing to the prioritization of health and improvementin the various determinants of health, a major proportionof people living in different regions of the world canexpect to live beyond the age of 60 years.....

Background: Nigella sativa (N. sativa) has been used in traditional medicine and several studies have been performed in the last decadesto reveal the effects of it on different medical disorders such as diabetes, dyslipidemia, hypertension, and obesity. We evaluated theeffects of N. sativa supplementation on lipid profiles, glycemic control, blood pressure (BP), and some anthropometric indices in humans.Materials and Methods: A search on published studies was done by using databases including PubMed, Google Scholar, Thomas ReutersWeb of Science, and Cochrane. Medical subject headings (MeSH) terms searched included “N. sativa, ” “Black seed, ” “Black cumin, ”“kalonji, ” and “Triglycerides, ” “Cholesterol, ” “Lipoproteins, ” “LDL, ” “Lipoproteins, ” “HDL, ” “Blood glucose, ” “Hemoglobin A, ” “Glycosylated, ”“Blood pressure”, “Body mass index, ” “Waist circumference”. Initially 515 articles were extracted. Four hundred ninety-two papers thatwere unrelated, reviews, animal studies, and combined and duplicated studies were excluded, 23 articles were eligible for this review.Results: After analyzing 23 articles including 1531 participants, these results were achieved: In 4 trials, N. sativa reduced BP, but in 5trials it could not. Fasting blood sugar (FBS) was reduced significantly in 13 studies. In addition, N. sativa reduced levels of glycosylatedhemoglobin (HbA1c). Although weight and waist circumference (WC) in 2 articles were reduced significantly, in 6 articles they werenot. Fluctuation in lipid profile in the articles was very controversial, being significant in many of them but not in others.Conclusion: Our systematic review revealed that N. sativa supplementation might be effective in glycemic control in humans.