JOURNAL OF RESEARCH IN MEDICAL SCIENCES (JRMS)
Year:2016 | Volume:21 | Issue:8|Papers Count:15

Background: This study aims to investigate the concentrations of lead, cadmium, and arsenic in the human milk, and to assess the effect of jujube fruit consumption by lactating mothers in reducing the concentration of these heavy metals in their milk. Materials and Methods: This randomized controlled trial was conducted in 2014 among forty postpartum mothers in Isfahan, the second largest and polluted city in Iran. Mothers were randomized into two groups; the intervention group received 15 g/day of fresh jujube fruit, and the controls received routine care for 8 weeks.Results: In the beginning, the concentrations of lead, cadmium, and arsenic were high, without significant difference between groups. The mean (standard deviation) concentrations of lead, cadmium, and arsenic were 29.49 (16.6), 4.65 (3.51), and 1.23 (0.63) mg/L, respectively. The smoothed empirical distribution of environmental pollutants showed that in both groups the mean values and variance of toxic metals decreased after 8 weeks, with a sharper decline in the intervention group. Quantile regression analysis showed that in the intervention group, lead concentration decreased by 2.54 mg/L at the 90th quintile, and cadmium decreased by 0.19 mg/Lat 75th quintile; without significant change in arsenic level. The corresponding figures were not significant in the control group.Conclusion: The concentrations of heavy metals were high in human milk, and the consumption of jujube fruit had some beneficial effects in reducing these harmful elements. Pregnant and lactating mothers should be advised to reduce their exposure to environmental pollutants, and consumption of some natural medicinal foods can be useful in reducing the concentration of pollutants in human milk. Because of numerous benefits of breast milk, in spite of the existence of some toxic trace elements, breastfeeding must be encouraged because such contaminants are also found in water and formula. The impact of the current findings on the primary prevention of chronic disease should be determined in future longitudinal studies.

Background: This study was designed to investigate the effect of clopidogrel-related gene polymorphisms on platelet reactivity and clinical outcome in Chinese Han patients. Materials and Methods: Three hundred and thirty-six percutaneous coronary intervention - treated patients were recruited and followed for 1 year. Blood samples were collected from all patients for DNA genotyping. The platelet reactivity unit was measured by the VerifyNow technique. The CYP2C19*2, CYP2C19*3, CYP2C19*17, ATP-binding cassette subfamily B member 1, ITGB3, CYP2C9*3, CYP2B6*9, and P2Y12 alleles were assessed.Results: The clinical endpoints were related to previous heart disease history (11.90% vs.28.57%, P=0.017), stroke (12.24% vs.16.67%, P=0.039), and diabetes (27.55% vs.52.38%, P=0.047). High on-treatment platelet reactivity (HTPR) was frequent in advanced age (P=0.019), male gender (P=0.016), hypertension (P=0.033), and chronic renal failure (P=0.040). There were more endpoints in the CYP2C19*2 and P2Y12 mutant carriers (76.19% vs.43.20%, P<0.001; 50.00% vs.35.71%, P=0.001, respectively), whereas fewer in the CYP2C19*17 mutant carriers (11.90% vs.56.46%, P=0.001). CYP2C19*2 and P2Y12 polymorphism manifested HTPR (194.25 ± 45.91 vs.151.38 ± 58.14, P<0.001; 180.33 ± 67.25 vs.161.89 ± 56.49, P=0.008, respectively), whereas CYP2C19*17 mutant improved platelet reactivity (97.17 ± 45.38 vs.169.08 ± 57.15, P=0.003). However, there were no further cardiovascular deaths in endpoint patients.Conclusion: In Han Chinese people of mainland China, clopidogrel-related gene polymorphisms are related to variable platelet reactivity after clopidogrel maintenance dosing, which influences major adverse cardiovascular events, without an effect on cardiac death.

Background: The aim of this study was to prevent of increasing end-tidal carbon dioxide (ETCO2) with changing of vital capacity and respiratory rate when using of birthing filter in infants. Materials and Methods: In a randomized clinical trial study, ninety-four infant’ patients were studied in three groups. Basic values, such as peak inspiratory pressure, tidal volume, minute ventilation, respiratory rate, and partial pressure of ET CO2 (PETCO2) level had been evaluated after intubation, 10 min after intubation and 10 min after filter insertion. In the first group, patients only observed for changing in ETCO2 level. In the second and the third groups, respiratory rates and tidal volume had been increased retrospectively, until that ETCO2 ≤35 mmHg was received. We used ANOVA, Chi-square, and descriptive tests for data analysis. P<0.05 was considered statistically significant.Results: Tidal volume 10 min after filter insertion was statistically higher in Group 3 (145.0 ± 26.3 ml) versus 129.3 ± 38.9 ml in Group 1 and 118.7 ± 20.8 ml in Group 2 (P=0.02). Furthermore, respiratory rate at this time was statistically higher in Group 2 (25.82 ± 0.43) versus Groups 1 and 3 (21.05 ± 0.20 ml and 21.02 ± 0.60 ml, respectively) (P=0.001). Minute volume and PETCO2 level were statistically significant between Group 1 and the other two groups after filter insertion (P=0.01 and P=0.00, 1 respectively).Conclusion: With changing the vital capacity and respiratory rate we can control PETCO2 level ≤35 mmHg during using of birthing filters in infants. We recommend this instrument during anesthesia of infants.

Background: Osteoporosis affects quality of life (QoL) and may lead to depression in women. The purpose of this study was to evaluate the effects of zoledronic acid (ZA) treatment on depression and QoL in women with postmenopausal osteoporosis (PO). Materials and Methods: A total of 88 newly diagnosed women with PO were included in this study. All patients were treated with once-yearly ZA (5 mg). A QoL questionnaire from the European Foundation for Osteoporosis and Beck Depression Inventory were given to patients at baseline and at 12 months. The results for baseline and post - 12th month were compared, and bone mineral density (BMD) levels were compared.Results: The consumption of once-yearly ZA (5 mg) treatment increases BMD at levels of lumbers 1-4 (P=0.026), total Hip T scores P value is same as femoral neck (P: 0, 033). ZA 5 mg treatment also improved QoL (P=0.001) and reduced depression (P=0.001).Conclusion: ZA treatment increases BMD levels and QoL while reducing depression. Once-yearly ZA (5 mg) may be considered for postmenopausal women as a first-line treatment.

Background: This study attempted to determine the effects of long-term use of Vitamin C on vascular endothelial function. Materials and Methods: During a pilot clinical trial study conducted at Imam Hussein Hospital (Isfahan) in 2014–2015, a total of forty diabetic patients were selected and then assigned randomly into two twenty-subject groups receiving Vitamin C and placebo tablets. The patients were treated with Vitamin C or placebo for 6 months. All patients were examined through echocardiography in terms of cardiac function before and after treatment. To evaluate the endothelial function (flow-mediated dilatation [FMD], intima-media thickness), they underwent arterial Doppler. Moreover, the chemical indices of vascular function were tested through intercellular adhesion molecule and vascular cell adhesion molecule (VCAM). Finally, the results were compared between the two groups.Results: Based on the results, the mean left ventricular mass significantly reduced after the intervention in the group treated with Vitamin C (from 76.35 ± 25.6–68.62 ± 22.66; P=0.015) while there was no significant difference observed in the control group (from 67.58 ± 25.38–71.63 ± 26.84; P=0.19) but no statistically difference between the two groups-based repeated measures ANOVA test (P=0.6). In addition, the mean of VCAM changes was significantly difference between the two groups (P<0.001).Conclusion: Long-term use of Vitamin C in diabetic patients can improve certain echocardiographic parameters such as ejection fraction, fractional shortening, and FMD, which in turn enhances vascular endothelial function.

Background: Despite a general consensus regarding the impacts of early excision and grafting (EE and G) of burned hand on the reducing of treatment cost and hospital stay, there are some controversial issues about its effect on the outcome of hand function. This study conducted to compare the results of the EE and G and delayed skin grafting in deep hand burns regarding the hand functional outcome. Materials and Methods: This study was conducted from April 2012 to November 2013 in sixty patients with deep thermal burns of the dorsal hand with total body surface area (TBSA)<20% who were admitted to special burn hospital. After standard primary burn care and resuscitation, necessary procedures (EE and G or more conservative treatment) were performed based on the patients’ conditions. The patients were placed into early excision (No.=30) and delayed excision group (No.=30). Total active motion (TAM) of fingers, grip strength of the hand and the assessment of disabilities of the arm, shoulder and hand questionnaire, were measured in all patients 6 months after grafting.Results: The average percentage of TBSA in the EE and G group was more than the delayed excision group (17.34% ±5.12% vs.15.64% ±5.83%), this difference was not significant (P=0.23). After 6 months, the average of the TAM and grip strength in the EE and G group was significantly more than that of the delayed group (P<0.0001 and P=0.019).Conclusion: The present study showed that EE and G with proper physical therapy and rehabilitation management provides a higher functional outcome in dorsal deep burned hand.

We discuss here an uncommon condition of neurogenic hypotension in the context of immunoglobulin light chain (amyloid light-chain) amyloidosis. The most serious feature was autonomic nervous system impairment, mainly characterized by severe refractory orthostatic hypotension, which became progressively invalidating, forcing the patient to bed. Moreover, since the systemic involvement of the disease, the patient presented also diarrhea, dysphagia, asthenia, peripheral edema because of gastrointestinal, and kidney dysfunction. Eventually, the massive myocardial depression and infiltration led to a fatal outcome.

Background: Pre-eclampsia as a hypertensive disorder of pregnancy complicates up to 5–10% of pregnancies worldwide. Endothelial dysfunction plays an important role in the pathogenesis of pre-eclampsia. In this study, we aim to evaluate the effect of high-dose folic acid on endothelial dysfunction in pre-eclamptic patients. Materials and Methods: In this triple-blinded randomized clinical trial, the enrolled patients were divided randomly into two groups. Folic acid 5.0 mg or placebo was taken daily by oral administration from the initiation of diagnosis until 2 months after delivery by the participants. Every patient’s flow-mediated dilation (FMD) was evaluated at the beginning of the study and 2 months after delivery with the same experienced operator at the same period of time (3–5 p.m.) by high-resolution B-mode ultrasonography. Potential confounding variables were included in the independent samples t-test. t-test or Mann–Whitney U-test was used in the comparison of means between the intervention and placebo groups. To compare FMD in each group, before and after the intervention, paired t-test was used.Results: Mean value of FMD in intervention (9.64 ± 5.57) and control group (9.30 ± 4.25) has no significant difference before the consumption of drugs (P>0.05). FMD in intervention group (13.72 ± 7.89) significantly increases after daily consumption of 5 mg folic acid in comparison with control group (10.02 ± 4.81) after daily consumption of placebo (P=0.002).Conclusion: Increased mean of FMD in intervention group shows that this supplement can improve endothelial function and can be significantly affected by maternal blood pressure during pregnancy and some endothelium-dependent disease such as pre-eclampsia and its associated adverse outcomes.

Background: Participation of Iranian women with a family history of breast cancer in breast cancer screening programs is low. This study evaluates the compliance of women having a family history of breast cancer with clinical breast exam (CBE) according to the stage of transtheoretical model (TTM) and health belief model (HBM). Materials and Methods: In this cross-sectional study, we used Persian version of champion’s HBM scale to collect factors associated with TTM stages applied to screening from women over 20 years and older. The obtained data were analyzed by SPSS, using descriptive statistics, Chi-square test, independent t-test, and analysis of covariance.Results: Final sample size was 162 women. Thirty-three percent were in action/maintenance stage. Older women, family history of breast cancer in first-degree relatives, personal history of breast disease, insurance coverage, and a history of breast self-examination were associated with action/maintenance stage. Furthermore, women in action/maintenance stages had significantly fewer perceived barriers in terms of CBE in comparison to women in other stages (P<0.05). There was no significant difference in other HBM subscales scores between various stages of CBE screening behavior (P>0.05).Conclusion: The finding indicates that the rate of women in action/maintenance stage of CBE is low. Moreover, results show a strong association between perceived barriers and having a regular CBE. These clarify the necessity of promoting national target programs for breast cancer screening, which should be considered as the first preference for reducing CBE barriers.

Background: The current study was designed to compare the complications and adverse effects of central venous catheter (CVC) insertion under ultrasound guidance in patients with and without coagulopathy. Materials and Methods: In this clinical trial, 59 patients who needed CVC for various reasons were enrolled. Patients were divided into two groups of those with and without coagulopathy based on complete blood count, prothrombin time, partial thromboplastin time, and international normalized ratio test results, and then, CVC was inserted with ultrasound guidance in both groups. The CVC inserting site was examined for hematoma and hemorrhage in four stages at different times.Results: There was no significant difference in the terms of demographic features, catheter lumen size (P=0.43), and number of attempting for CVC placement (odds ratio [OR] =2.35, 95% confidence interval [CI] =0.36–15.3, P=0.39) between two groups. Seven out of 59 patients suffered from complications (11.9%) that the complications in coagulopathic patients were oozing (5.7%) and superficial hematoma (8.6%) while in noncoagulopathic patients were 4.2% for both complications (OR=0.54, 95% CI=0.09–3.07, P=0.767).Conclusion: According to our results, it can be concluded that inserting CVC with ultrasound guidance under emergency conditions causes no serious and life-threatening complications in coagulopathic patients.

Background: The aim of the study was to determine the correlation between clinical and echocardiographic findings and risk factors of patients with suspected acute pulmonary thromboembolism (PTE) who underwent computed tomography pulmonary angiography (CTPA). Materials and Methods: In this cross-sectional study, 310 hospitalized patients aged>18 years with high clinical suspicion of PTE referred to imaging center of our hospital from different wards for CTPA were enrolled. The frequency of different clinical presentations, risk factors, items of Wells’ criteria, and echocardiographic findings was compared in patients with and without PTE, which have been diagnosed according to the CTPA results.Results: PTE was diagnosed in 53 (17.1%) of patients with suspected PTE. From clinical manifestations, tachypnea, pleuritic chest pain, and edema of lower extremities were significantly more frequent among patients with PTE (P<0.05). Major surgery was the risk factor which was significantly more prevalent among patients with PTE (P<0.05). Frequency of all criteria of Wells’ criteria, except hemoptysis, was significantly higher in patients with PTE (P<0.05). The frequency of all studied echocardiographic variables was significantly higher in patients with PTE (P<0.05).Conclusion: It is suggested that we could use the results of this study for utilizing the diagnostic process of PTE in patients with highly clinical suspicion of PTE and providing more validated decision. Using the results of this study, we could identify high-risk patients and made appropriate risk assessment for better management of patients with suspected PTE as well as reduce the rate of unnecessary CTPA and its related adverse consequences.

Background: The objective of this study was an investigation of the association between depression and sleep quality. Materials and Methods: This cross-sectional study was performed on 360 delivered women that referred to thirty health-care centers in Ardabil, Iran. The Standard Pittsburgh Sleep Quality Index questionnaire was used to the investigation of sleep quality. We used the Edinburgh Postnatal Depression Questionnaire to assess postpartum depression. Logistic regression was used to examine the association of sleep quality with postpartum depression.Results: Chance of depression in women with poor sleep quality was 3.34 times higher than those with good sleep quality (odds ratio=3.34; 95% confidence interval: 2.04–5.48; P<0.001). After controlling for some risk factors, an association observed between sleep quality and depression in postpartum women.Conclusion: we found an association between sleep quality in women who had given birth in the last 3 months and symptoms of postpartum depression.

Background: Cardiopulmonary bypass is associated with increased fluid accumulation around the heart which influences pulmonary and cardiac diastolic function. The aim of this study was to compare the effects of modified ultrafiltration (MUF) versus conventional ultrafiltration (CUF) on duration of mechanical ventilation and hemodynamic status in children undergoing congenital heart surgery. Materials and Methods: A randomized clinical trial was conducted on 46 pediatric patients undergoing cardiopulmonary bypass throughout their congenital heart surgery. Arteriovenous MUF plus CUF was performed in 23 patients (intervention group) and sole CUF was performed for other 23 patients (control group). In MUF group, arterial cannula was linked to the filter inlet through the arterial line, and for 10 min, 10 ml/kg/min of blood was filtered and returned via cardioplegia line to the right atrium. Different parameters including hemodynamic variables, length of mechanical ventilation, Intensive Care Unit (ICU) stay, and inotrope requirement were compared between the two groups.Results: At immediate post-MUF phase, there was a statistically significant increase in the mean arterial pressure, systolic blood pressure, and diastolic blood pressure (P<0.05) only in the study group. Furthermore, there was a significant difference in time of mechanical ventilation (P=0.004) and ICU stay (P=0.007) between the two groups. Inotropes including milrinone (P=0.04), epinephrine (P=0.001), and dobutamine (P=0.002) were used significantly less frequently for patients in the intervention than the control group.Conclusion: Administration of MUF following surgery improves hemodynamic status of patients and also significantly decreases the duration of mechanical ventilation and inotrope requirement within 48 h after surgery.

Background: Obesity is a major risk factor for chronic diseases and has a role on high blood pressure, diabetes type II, etc., This review assesses the prevalence of Iranian children obesity and overweight for different age categories and compares the three standard definitions of obesity. Materials and Methods: To retrieve desirable studies concerning childhood anthropometric data from different area of Iran, the MEDLINE, Scopus, and different local databases such as Scientific Information database were used. The studies reported the prevalence of obesity or overweight of children<6, 6–12, and 12–20 years old, despite differences between definitions of childhood obesity, were included in the study. We combined the reported prevalence of the overweight and obesity with regard to age and gender, and also by the different standard references which are the Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO) definition, and the International Obesity Task Force (IOTF) references. The analysis was carried out using STATA software.Results: Our review covered 75 articles reported the prevalence of overweight or obesity among children and adolescents for different age groups in Iran. Our meta-regression analysis showed that the prevalence of obesity and overweight did not vary significantly in gender and age categories, but different definitions provide different prevalence of overweight and obesity.Conclusion: The effective factors on obesity and overweight included administration policy and organizational, interpersonal, intrapersonal, and social factors. CDC and WHO references intended in monitoring children’s growth and the IOTF cutoffs would rather provide a common set of definitions that researchers and policymakers could use for descriptive and comparative purposes.

Background: Most of the cardiovascular diseases can be prevented by doing regular physical exercises and using herbal supplements. The present study is aimed at assessing ginger supplement and high-intensity interval training (HIIT) on inflammatory indices contributing to atherosclerosis in overweight women. Materials and Methods: The present study is a randomized, experimental, and controlled one in which thirty healthy overweight women aged 20-30 years were randomly divided into three equal groups, namely, ginger, ginger+HIIT, and placebo+HIIT. The training groups performed high-intensity interval exercises (i.e.40-m maximal shuttle run) for ten consecutive weeks. The supplement groups daily took 3 g of ginger pills and the third group took placebo.Results: Paired t-test revealed a significant decrease in the density of type 1 monocytes chemo tactic protein (MCP-1) in HIIT+ginger (P=0.026) and HIIT+placebo (P=0.001) groups. Besides, maximum aerobic capacity in the two training groups significantly increased P=0.002 and P=0.000, respectively. In spite of this, analysis of variance showed no significant differences in three groups regarding the three indices such as intercellular adhesion molecule-1 (ICAM-1) (P=0.093), MCP-1 (P=0.075), and serum interleukin-10 (IL-10) (P=0.164).Conclusion: A 10-week intensive interval exercise, by itself or together with ginger supplement, improved MCP-1 and maximum oxygen consumption in overweight women, without any significant effect on soluble ICAM-1 and IL-10. These findings indicate the relative and efficient role of HIIT in overweight women without the necessity to combine with ginger as an antioxidant/anti-inflammatory supplement.