JOURNAL OF RESEARCH IN MEDICAL SCIENCES (JRMS)
Year:2016 | Volume:21 | Issue:11|Papers Count:13

Background: Astigmatism is the leading complication in visual recovery after penetrating keratoplasty (PKP) and deep anterior lamellar keratoplasty (DALK); in this study, we evaluated the outcome of femtosecond laser arcuate keratotomy (FLAK) after DALK and PKP in Iranian keratoconic patients. Materials and Methods: In this prospective interventional case series, refractive and keratometric predictability, efficacy, and complications of FLAK for postkeratoplasty astigmatism in keratoconus were evaluated; 23 eyes of 23 consecutive patients (mean age of 32.43 ± 9.11 years) with high astigmatism were enrolled. The femtosecond laser performed paired 90o-angled arcuate incisions.Results: Mean logarithm of the minimum angle of resolution of corrected and uncorrected visual acuity improved from preoperative values of 0.30 ± 0.18 and 0.85 ± 0.32 to 6-month values of 0.19 ± 0.17 and 0.65 ± 0.33, respectively (P<0.05). Mean subjective astigmatism was 7.79 ± 2.64 diopter (D) preoperatively and 3.69 ± 2.25D at 6-month after surgery (P<0.05). Surgically induced astigmatism was 9.27 ± 5.00D. Mean refractive spherical equivalent showed no significant (P=0.69) hyperopic shift from − 4.21 ± 4.84D preoperatively to − 2.16 ± 6.09D postoperatively. Two (8.7%) microperforations were observed.Conclusion: FLAK is a relatively safe and effective method for the treatment of postkeratoplasty astigmatism.

Background: One of the main causes of adverse complications following kidney transplantation is urinary tract infection (UTI). This study was done to define the incidence rate, clinical profiles, causative microorganisms, and UTI risk factors among kidney transplant recipients in Mashhad city. Materials and Methods: In this retrospective study, we perused medical files of 247 kidney recipients who underwent transplant surgery at Mashhad University Montaserie Hospital, during 2012–2014. All patients were followed for UTI during the 1st year after surgery.Results: 75 episodes of UTI developed by 152 pathogens in 56 (22.7%) of patients during 1-year follow-up.26.6% of total UTIs were diagnosed within the 1st month after transplantation. The most frequently isolated uropathogens were Escherichia coli (55.3%, n=84). The high rate of candiduria (8.5%) was observed, too.Conclusion: UTI is known as one of the hospitalization reasons in kidney transplantation recipients. Defining appropriate antibiotic prophylaxis against bacterial and fungal agents and early removal of urethral catheter are suggested to decrease posttransplantation complications.

Sir, Niemann–Pick disease is an autosomal recessive lipid storage disease, characterized with differentiating levels of hepatosplenomegaly and progressive psychomotor retardation (this disease exhibiting heterogenic symptoms has four subtypes; Type A and B, in which sphingomyelinase values are normal, and Type C and D, in which sphingomyelinase values are close to normal values).

Background: Vitamin D deficiency may play a key role in the development of impaired glucose tolerance, type 2 diabetes mellitus (T2DM), and metabolic syndrome. Several studies have shown that Vitamin D has an antioxidant property. We aimed to investigate 25-hydroxy Vitamin D (25 [OH] D) levels in patients with T2DM and in nondiabetic healthy controls and to ascertain the impact of 25 (OH) D levels on glycemic control and oxidative stress in T2DM patients. Materials and Methods: Thirty male patients with T2DM and twenty age- and socioeconomic status-matched male healthy controls were included in the study. Fasting and postprandial blood sugar and glycated hemoglobin (HbA1c) were measured. Enzyme activity of superoxide dismutase (SOD) and glutathione peroxidase (GPx) was determined by spectrophotometric assay, and serum levels of 25 (OH) D were measured using radioimmunoassay.Results: Serum Vitamin D levels were significantly lower in patients with T2DM than healthy controls (P=0.015). There was a significantly lower GPx activity in patients with T2DM than controls (P=0.048), but the difference in SOD activity did not reach statistical significance. There was a significant negative correlation between serum Vitamin D levels and HbA1c (P=0.016), but no statistical correlation was shown between serum Vitamin D levels and GPx and SOD.Conclusion: We conclude that low level of Vitamin D might play a significant role in T2DM pathogenesis. Hence, Vitamin D supplementation may improve glycemic control and oxidative stress in T2DM.

Emergency departments (EDs) are the most challenging ward with respect to patient delay. The goal of this study is to present strategies that have proven to reduce delay and overcrowding in EDs. In this review article, initial electronic database search resulted in a total of 1006 articles. Thirty articles were included after reviewing full texts. Inclusion criteria were assessments of real patient flows and implementing strategies inside the hospitals. In this study, we discussed strategies of team triage, point-of-care testing, ideal ED patient journey models, streaming, and fast track. Patients might be directed to different streaming channels depending on clinical status and required practitioners. The most comprehensive strategy is ideal ED patient journey models, in which ten interrelated substrategies are provided. ED leaders should apply strategies that provide a continuous care process without deeply depending on external services.

Autism is a developmental disability with age of onset in childhood (under 3 years old), which is characterized by definite impairments in social interactions, abnormalities in speech, and stereotyped pattern of behaviors. Due to the progress of autism in recent decades, a wide range of studies have been done to identify the etiological factors of autism. It has been found that genetic and environmental factors are both involved in autism pathogenesis. Hence, in this review article, a set of environmental factors involved in the occurrence of autism has been collected, and finally, some practical recommendations for reduction of the risk of this devastating disease in children are represented.

Background: According to previous publications, in patients with acute ischemic cerebral infarction, thrombolytic therapy using intravenous tissue plasminogen activator (IV‑tPA) necessitates precise documentation of symptoms’ onset. The aim of this study was to identify major barriers related to the IV‑tPA injection in such patients. Materials and Methods: Between the year 2014-2015, patients with definitive diagnosis of acute cerebral infarction (n=180) who attended the neurology ward located at the Isfahan Alzahra Hospital were studied. To investigate barriers related to door to IV‑tPA needle time, personal reasons, and criteria for inclusion or exclusion of patients, three questionnaire forms were designed based on the Food and Drug Administration‑approved indications or contraindications.Results: The mean age of males versus females was 60 versus 77.5 years (ranged 23–93 vs.29–70 years), respectively.Out of total population, only 10.7% transferred to hospital in<4.5 h after the onset of symptoms. Regarding to eligibility for IV‑tPA, 68.9% of total population have had criteria for such treatment. Concerning to both items such as transferring to hospital in<4.5 h after the onset of symptoms and eligibility for IV‑tPA, only 6.6% of total population met the criteria for such management. There was ignorance or inattention to symptoms in 75% of population studied. There was a mean of 195.92 ± 6.65 min (182.8–209.04 min) for door to IV‑tPA needle time.Conclusion: Despite the international guidelines for IV‑tPA injection within 3–4.5 h of ischemic stroke symptoms’ onset, the results of this study revealed that falling time due to ignorance of symptoms, literacy, and living alone might need further attention. As a result, to decrease death and disability, educational programs related to the symptoms’ onset by consultant neurologist in Isfahan/Iran seem to be advantageous.

Background: This study intended to determine the effects of Vitamin D and calcium-Vitamin D in treating leg cramps in pregnant women. Materials and Methods: This study was conducted as a double-blind randomized controlled clinical trial on 126 participants, 18–35-year-old pregnant women with a minimum of two leg cramps per week who were referred to health-care centers in Tabriz-Iran in 2013. The participants were allocated to three 42 member groups using a randomized block design. For 42 days, the intervention groups took a 1000 unit Vitamin D pill or 300 mg calcium carbonate plus a 1000 unit Vitamin D pill, and the control group received a placebo pill every day. The participants were evaluated with regard to the frequency, length, and pain intensity of leg cramps during the week before and during the 3rd and 6th week of the intervention. The ANCOVA and repeated measurement test were used to analyze the data.Results: Results showed that controlling for the effects before the intervention, calcium-Vitamin D, and Vitamin D supplements had no effect on the frequency, length, and pain intensity of leg cramps.Conclusion: The results of this study showed that the calcium-Vitamin D and the Vitamin D supplements have no effect on the frequency, length, and pain intensity of leg cramps during the 6 weeks of the study.

Background: To compare the efficacy of subconjunctival administration of bevacizumab and different doses of sunitinib malate in reducing corneal neovascularization (CNV). Materials and Methods: In this experimental study, central corneal cauterization was created in the right eye of fifty male Sprague–Dawley rats. On day 1 (1 week after cauterization), rats were randomly assigned into five treatment groups. Group control (n=10) received subconjunctival injection of 0.02 ml of base saline solution. Group 1 (n=10) received 0.02 ml of bevacizumab (25 mg/ml). Group 2, 3, and 4 (n=10 for each group) were treated with 0.02 ml of sunitinib malate (10, 20, and 50 μg/ml, respectively). On days 1, 7, and 14, digital photographs of the cornea were taken, and the area of CNV was measured.Results: During the 2-week follow-up, CNV area in treatment groups was less than in control group (P<0.05). On day 7, corneal avascular area was highest in Group 3 at 63%. On day 14, the area of CNV in Groups 2 and 3 was less than in Group 1 (P=0.031 and 0.011, respectively), but the difference between Groups 2 and 3 was not statistically significant (P=0.552). The decreased CNV area on day 14 in Group 4 was significant in comparison to bevacizumab, but it was not significant on day 7 (P=0.25 on day 7 and 0.002 on day 14).Conclusion: Subconjunctival sunitinib malate is more effective than bevacizumab in regressing CNV. This effect is more prominent on day 14.

Background: The incidence rate of breast cancer has been dramatically increasing since the last decade in Iran, and it is now one of the most common female malignant tumors. B‑cell lymphoma 2 (BCL2) family is the most important regulator of apoptosis, and −938C>A single nucleotide polymorphism (SNP) of BCL2 gene promoter has been demonstrated to influence breast cancer susceptibility. In this research, we study the effect of −938C>A allelic variants on breast cancer risk in Mazandaran province at the North of Iran. Materials and Methods: This analysis performed on 120 breast cancer patients who underwent surgery in some referenced hospitals at Mazandaran province along with 130 healthy individuals as a control. DNA extracted from peripheral blood samples was applied in polymerase chain reaction‑single‑strand conformation polymorphism analysis to determine −938C>A genotype. The association of the −938C>A genotype and breast cancer risk as well as clinicopathological characters were analyzed by logistic regression method.Results: Results showed that genotype frequency of AA, AC, and CC genotypes was 10%, 62%, and 28% for case and 28%, 50%, and 22% in control group, respectively. In the logistic regression model, BCL2 − 938C/A variant genotype AA was associated with a decreased risk of breast cancer (P=0.041) by 0.31‑fold (odds ratio=0.31, confidence interval=0.091–0.909) compared to CC genotype. However, no significant association found between −938C>A genotype and clinicopathological characters.Conclusion: The study showed that AA genotype of BCL2 gene (−938C>A) is associated with decreased susceptibility to breast cancer. Hence, investigating the −938C>A SNP of BCL2 gene promoter could be an appropriate molecular marker to determine individual sensitivity to breast cancer.

Neuromyelitis optica (NMO) is an autoimmune inflammatory disease of the central nervous system with preferential involvement in the optic nerve and spinal cord with a widespread spectrum of clinical features; multiple therapeutic agents have been used with different results. Recent evidence points to B‑cell‑mediated humoral immunity in the pathogenesis of NMO. Rituximab targets the CD20 antigen on B‑cells. Treatment leads to profound B‑cell depletion, principally over an antibody‑dependent cell cytotoxicity mechanism. The aim of our study was to review clinical trials to elucidate the impact of rituximab on the relapse rate, Expanded Disability Status Scale (EDSS), and progression of disability in NMO. We performed a comprehensive review of all studies that evaluated clinical and paraclinical effects of rituximab on NMO. MEDLINE‑PubMed, Web of Sciences, EMBASE, and Cochrane databases up to June 2016 included in our searches. In addition, reference lists from articles identified by search as well as a key review article to identify additional articles included in the study. Rituximab targets the CD20 antigen on B‑cells and decreases attack frequency and severity in patients with NMO; however, it does not remove attacks, even when modifying treatment to achieve B‑cell depletion. Most of the investigations revealed that EDSS significantly in all patients with rituximab treatment will be decreased after treatment with rituximab. No new or enlarged lesions or pathological gadolinium enhancement was observed in serial brain and spinal cord magnetic resonance imaging, except for those observed concomitantly with clinical relapses and the median length of spinal cord lesions was significantly reduced after therapy. Rituximab targets the CD20 antigen and decreases attack frequency and severity in patients with NMO.

Sir, Preconception care is defined as the care comprising healthy behavior practices applied before conception and thereby modifying biomedical, behavioral, and social risks for better pregnancy outcome.

Background: Retinol-binding protein 4 (RBP4) is known to regulate lipid and glucose metabolism and insulin resistance. The influences of RBP4 on metabolic syndrome (MS) are still unclear. The purpose of this study is to evaluate the association between serum levels of RBP4 and MS components in first-degree relations of type 2 diabetic patients. Materials and Methods: This cross-sectional study was performed within the framework of the diabetes prevention project in Isfahan. This study has been conducted during 2012–2013. Seventy-eight subjects participate, with an average age of 43.20 ± 5.29 years. Weight, height, waist and hip circumferences, blood pressure (BP) of participants, fasting plasma glucose, hemoglobin A1c, total cholesterol, high-density lipoprotein cholesterol, triglyceride (TG), and serum RBP4 were measured from fasting blood sample taken from each participant after an overnight fast (12–14 h).Results: Systolic and diastolic BP were significantly higher in people in top median of RBP4 (11.8 ± 1.5 vs.11.0 ± 1.2, P=0.01 and 7.8 ± 1.0 vs.7.3 ± 0.9, P=0.03). Moreover, TG in people with high levels of RBP4 was higher compared with those with low levels of RBP4 (177.7 ± 97.6 vs.138.7 ± 56.9, P=0.02). People with low levels of RBP4 had significant greater hip circumferences (107.9 ± 7.5 vs.104.3 ± 8.0, P=0.04). There was no correlation between RBP4 and MS in crude model (odds ratio [OR]: 1.00, 0.95–1.05, P=0.97). This null correlation remained after adjustment for body mass index, age, and physical activity (OR: 0.93, 0.91–1.07, P=0.31).Conclusion: Although RBP4 levels were positively association with some risk factors of MS including hip circumference, TG, and systolic and diastolic BP, it does not seem to be a valuable marker for identification of the MS in the first relative degree of diabetic patients.