JOURNAL OF RESEARCH IN MEDICAL SCIENCES (JRMS)
Year:2015 | Volume:20 | Issue:5|Papers Count:18

Dear Editor, World heart federation has announced a day as “world heart day” since 2000. Hence, all peoples and governments would be informed about such diseases and their significance. September 28, 2014 is the present world heart day with this motto “heart-healthy choices”. This is why it was decided to survey “the day.” Every year “world heart day” has got a new title.Here, we present the significance of cardiovascular disease (CVD) in adults and children in east of Iran.

Background: To investigate the prevalence of antibiotic usage in children aged<5 years with acute respiratory tract illness (ARTI) in Iran.Materials and Methods: Data were collected from a national health survey conducted in 2010 (Iran’s Multiple Indicator Demographic and Health Survey). Participants of this cross-sectional study were selected by multistage stratified cluster-random sampling from 31 provinces of Iran. Parents of children with<5 years of age responded to questions about the occurrence of any cough during the previous 2 weeks, referral to private/governmental/other health care systems, and utilization of any oral/injection form of antibiotics. Data were analyzed using SPSS software18. The chi-square test was used to determine antibiotic consumption in various gender and residency groups and also a place of residence with the referral health care system.Results: Of the 9345 children under 5 years who participated in the study, 1506 cases (16.2%) had ARTI during 2 weeks prior to the interview, in whom 1143 (75.9%) were referred to urban or rural health care centers (43.4 vs.30.4%; P<0.001). Antibiotics were utilized by 715 (62.6%) of affected children.Injection formulations were used for 150 (13.1%) patients. The frequency of receiving antibiotics was higher in urban than in rural inhabitants (66.0% vs.57.7%; P<0.05).Conclusion: The prevalence of total and injection antibiotics usage in children<5 years with ARTI is alarmingly high in Iran. Therefore, interventions to reduce antibiotic use are urgently needed.

Background: Myocardial infarction (MI) is a leading cause of mortality and morbidity in Iran. No spatial analysis of MI has been conducted to date. The present study was conducted to determine the pattern of MI incidence and to identify the associated factors in Iran by province.Materials and Methods: This study has two parts. One part is prospective and hospital-based, and the other part is an ecological study. In this study, the data of 20, 750 new MI cases registered in Iranian Myocardial Infarction Registry in 2012 were used. For spatial analysis in global and local, spatial autocorrelation, Moran’s I, Getis-Ord, and logistic regression models were used.Data were analyzed by Stata software and ArcGIS 9.3.Results: Based on autocorrelation coeffcient, aspecific pattern was observed in the distribution of MI incidence in different provinces (Moran’s I: 0.75, P<0.001). Spatial pattern of incidence was approximately the same in men and women. MI incidence was clustering in six provinces (North Khorasan, Yazd, Kerman, Semnan, Golestan, and Mazandaran). Out of the associated factors with clustered MI in six provinces, temperature, humidity, hypertension, smoking, and body mass index (BMI) could be mentioned. Hypertension, smoking, and BMI contributed to clustering with, respectively, 2.36, 1.31, and 1.31 odds ratio.Conclusion: Addressing the place-based pattern of incidence and clarifying their epidemiologic dimension, including spatial analysis, has not yet been implemented in Iran. Report on MI incidence rate by place and formal borders is useful and is used in the planning and prioritization in different levels of health system.

Background: Excess weight in children and adolescents is a multi-factorial phenomenon and associated with earlier risk of obesityrelated diseases. This study aims to assess the prevalence of weight disorders and the mean values of anthropometric indices according to regional, socioeconomic, and urban-rural variations among Iranian children and adolescents.Materials and Methods: This nationwide study was performed in 2011-2012 among a representative multi-stage cluster sample of 14, 880 Iranian students aged 6-8 years. The World Health Organization (WHO) reference curves were used to define weight disorders. Abdominal obesity was defined as the waist-to-height ratio (WHtR) of more than 0.5. Iran was classified into four regions according to the socioeconomic status (SES).Results: The mean (95% confidence interval) of body mass index (BMI), waist circumference (WC), and hip circumference (HC) was 18.8 (18.7, 18.9) kg/m2, 67.0 (66.7, 67.3) cm, and 80.8 (80.3, 81.2) cm, respectively. The prevalence of underweight was 12.2%. A total of 9.7%, 11.9%, and 19.1% of students overweight, obese, and abdominally obese, respectively. The highest mean of BMI, WC, wrist circumference, HC, and WHtR were related to the second high SES (North-northeast) area (19.2 [18.8, 19.5], 68.3 [67.3, 69.4], 14.8 [14.7, 15.0], 82.6 [81.1, 84.0], and 0.464 [0.460, 0.468]). In contrast, the lowest SES (Southeast) region had the lowest mean of these anthropometric indices (17.6 [17.1, 18.2], 63.2 [61.7, 64.8], 14.5 [14.2, 14.8], 76.9 [74.9, 79.0], and 0.439 [0.434, 0.444]).Conclusion: We found considerable differences in the prevalence of anthropometric measures throughout the country by SES of the region. Health policy making and implementing health strategies should consider SES of regions.

Background: Distraction osteogenesis (DS) is currently an important technique for lengthening shortened bones of the hand and foot.Authors report their experience in applying DS for various conditions of the hand and foot using a distractor that the senior author has designed.Materials and Methods: Records of patients who underwent DS for hand and foot conditions in a private clinic were retrieved between January 2001 and January 2015. Data concerning distraction, outcome, and complications were recorded.Results: There were 17 patients, 7 males, and 10 females with a total 24 distractions. The mean length gained was 21.2 mm (1.69) and the mean total treatment time was 198.58 (15.88) days. Overall, complications occurred in 9 (37.5%) distractions. Major complications occurred in 2 (8.33%) of distractions. Minor complications occurred in 7 (29.2%) distractions.Conclusion: DS is an effective modality for lengthening bones of the hand and feet for both traumatic and congenital conditions. Joint stiff ness/contracture is an important complication following DS of the metatarsals.

Background: Computed tomography (CT) scan is one the most useful devices in chest imaging. CT scan can be used in mediastinal abnormality, lungs, and pleural evaluations. According to the high prevalence and different causes of pulmonary nodules, we designed this study to evaluate the prevalence and the types of pulmonary nodules in noncancerous patients who underwent chest multi-detector CT (MDCT) scan.Materials and Methods: This was a cross-sectional study which was in our hospital to evaluate the prevalence of pulmonary nodules in noncancerous patients who underwent MDCT. A checklist was used for data collection containing number, location, size, and shape of pulmonary nodules if present in CT scan, and we also included patient’s age and history of smoking. We analyzed the data with Statistical Program for Social Sciences software (version 18).Results: In this study, 115 patients (40%) had a pulmonary nodule. The mean number of a total nodule in each patient was 0.8 ±0.07. Mean number of intra-parenchymal, sub pleural, and perivascular nodules were 0.34±0.04, 0.31±0.04, and 0.14±0.02, respectively. The mean number of calcified nodules was 0.13±0.02. There was no significant correlation between age and nodule characteristics (P>0.05).Conclusion: The prevalence of pulmonary nodules was quite frequent in MDCT scan of noncancerous cases. So, it should not be overvalued in noncancerous cases.

Background: There is limited information on the relationship between metabolic syndrome (MetS) and chronic kidney disease (CKD) in the Iranian population, a group that has a high prevalence of CKD and obesity. The aim of present study was to determine the relationship between MetS and CKD in West of Iran.Materials and Methods: A total of 800 subjects aged more than 35 years admitted from 2011 to 2013 were enrolled in the study. MetS was defined based on the Adult Treatment Panel III criteria, and CKD was defined from the Kidney Disease Outcomes Quality Initiative practice guidelines. Waist circumference and body mass index were calculated, as well, blood samples were taken and lipid profile, plasma glucose levels, and serum creatinine were measured. Data were analyzed with SPSS version 17 (SPSS Inc., Chicago, IL, USA).Results: CKD was seen in 14.8% patients with MetS and 8.3% individuals without MetS. MetS was associated with an increased odds ratio (OR) for a glomerular filtration rate<60 ml/min/1.73 m2 (OR: 1.91; 95% confidence interval [CI]: 1.22-2.99; P=0.004).Individuals with 2, 3, 4, and 5 components of the MetS had an increased OR for CKD: 2.19 (95% CI: 0.95-3.62), 2.65 (95% CI: 1.03-4.71), 2.86 (95% CI: 1.08-5.53), and 5.03 (95% CI: 1.80-8.57), respectively, compared with individuals with none of the components.Conclusion: We found a high prevalence of CKD in patients with MetS compared with the subject without MetS. Our observations raised major clinical and public health concerns in Iran, where both the MetS and kidney diseases are becoming common.

Background: Despite the fact that new criteria of antisocial personality disorder (ASPD) in diagnostic and statistical manual of mental disorders-fifth edition (DSM-5) were resulted from five-factor model (FFM), there is a small amount of studies that investigate the relations between proposed personality traits and FFM. Also, cross-cultural study in this field continuously would be needed. The aim of the present study was to evaluate the relation between the FFM and DSM-5 ASPD pathological traits.Materials and Methods: This study was a crosssectional study design. The participants consisted of 122 individuals with ASPD that selected from prisoners (73.0%), outpatients (18.0%), and inpatients (9.0%). They were recruited from Tehran Prisoners, and Clinical Psychology and Psychiatry Clinics of Razi and Taleghani Hospitals, Tehran, Iran, since 2013-2014. The Sample was selected based on judgmental sampling. The structured clinical interview for DSM-IV axis II disorders-Personality Questionnaire, NEO-Personality Inventory-Revised, and DSM-5 personality trait rating form were used to diagnosis and assessment of personality disorder. Pearson correlation has been used for data analysis. All statistical analyses were performed using the SPSS 16 software.Results: The results indicate that neuroticism (N) has positive significant relationship with hostility (r=0.33, P<0.01), manipulativeness (r=0.25, P<0.01), deceitfulness (r=.23, P<0.01), impulsivity (r=0.20, P<0.05), and negative relation with risk taking (r=-0.23, P<0.01). Also, there was significant relationship between extraversion (E) with manipulativeness (r=0.28, P< 0.01) and deceitfulness (r=0.32, P<0.01). Agreeableness and conscientiousness have negative significant relation with DSM-5 traits.In addition, results showed that there is positive significant relationship between FFM and DSM-5 personality traits with DSM-fourth edition-text revision (DSM-IV-TR) ASPD symptoms (P<0.01).Conclusion: Except manipulativeness, deceitfulness, and callousness, there is positively significant relationship between DSM-5 ASPD traits and DSM-IV-TR ASPD symptoms. The present study helps to understand the adequacy of dimensional approach to evaluation of ASPD pathology, specifically on Iranian sample.

Background: Migarine is the most common headache around the world including Iran. In recent years, Vitamin D deficiency has been shown to a global health problem. A few studies have been determined inverse association between serum levels of Vitamin D with a headache. So, in this study, we investigated the effect of Vitamin D supplementation on symptoms and C-reactive protein (CRP) among patients with migraine.Materials and Methods: This study was randomized, double-blind, and controlled-placebo clinical trial. Sixty-five migraine patients aged 10-61 years were included for analysis. Vitamin D was administrated for 10 weeks with 50, 000 IU dosage of Vitamin D per week. Multivariate analysis of covariate and univariate analysis of covariate were done to determine the effects of Vitamin D supplementation on symptoms, including severity, duration, frequency of headache, and the headache diary result (HDR).Results: Mean headache frequency and HDR had significant difference among two groups (5.9±7.0 vs.7.0±6.0, P=0.06 and 85.0±134.2 vs.132.1±147.1, P=0.04). But, a mean difference of headache frequency was marginally significant (P=0.06). These values were lower among the intervention group compared to placebo group. The association was not observed between CRP with migraine disease.Conclusion: In this study, we shown Vitamin D supplementation may be useful in decreasing frequency of headache attacks and HDR among patients with migraine.

Background: Formoterol and salmeterol are two long-acting b2-agonists given by inhalation, with bronchodilating effects lasting for at least 12 h after a single administration. Formoterol has a faster onset of action compared with salmeterol. The aim of this study was to perform a systematic review and meta-analysis on the data published from previous review in order to calculate pooled estimates of effectiveness and safety assessment of formoterol and salmeterol in treatment of patients with asthma.Materials and Methods: In this study, we conducted an electronic search for medical citation databases including Cochrane, PubMed, Scopus, PsycInfo, and IranMedex. Besides manual search of the databases that record randomized clinical trials, conference proceedings, and journals related to asthma were included. Studies were evaluated by two independent people based on inclusion and exclusion criteria, and the common outcomes of studies were entered into the RevMan 5.0.1 software, after evaluation of studies and extraction of data from them; and in cases where there were homogeneous studies, meta-analysis was performed, and for heterogeneous studies, the results were reported qualitatively.Results: Of the 1539 studies initially found, 13 were included in the study. According to the meta-analysis conducted, no significant difference was found between the inhalation of formoterol 12mg and salmeterol 50 mg in the two outcomes of mean forced expiratory volume 1 s (FEV1), 12 h after inhalation of medication and Borg score (A frequently used scale for quantifying breathlessness) after inhalation of medication. In addition, salmeterol was more effective than formoterol in the two outcomes of percent decrease in FEV1 after inhalation of methacholine and the number of days without an attack. Since the two outcomes of FEV1 30-60 min after inhalation of medication and morning peak expiratory flow after inhalation of medication were heterogeneous, they had no meta-analysis capabilities, and its results were reported qualitatively.Conclusion: The data from included studies shows that, more efficacy has been achieved with Salmeterol, especially in some outcomes such as the percent decrease in FEV1 after inhalation of Methacholine, and the number of days without an attack; and therefore, the administration of Salmeterol seems to be beneficial for patients, compared with Formoterol.

The incidence of diabetes mellitus (DM) is increasing rapidly and it is expected to increase by 2030. Other than currently available therapeutic options, there are a lot of herbal medicines, which have been recommended for its treatment. Herbal medicines have long been used for the treatment of DM because of the advantage usually having no or less side-effects. Most of these plants have antioxidant activities and hence, prevent or treat hard curable diseases, other than having the property of combating the toxicity of toxic or other drugs. In this review other than presenting new findings of DM, the plants, which are used and have been evaluated scientifically for the treatment of DM are introduced.

Background: Dyslipidemia is considered as an important modifiable risk factor for cardiovascular disease (CVD). The link between childhood dyslipidemia and occurrence of atherosclerosis and its sequels in adulthood are well-documented. This study aimed to systematically review the prevalence of dyslipidemia among Iranian children and adolescents.Materials and Methods: An electronic search was conducted on studies published from January 1990 to January 2014. The main international electronic data sources were PubMed and the NLM Gateway (for MEDLINE), Institute of Scientific Information (ISI), and SCOPUS. For Persian databases, we used domestic databases with systematic search capability including IranMedex, Irandoc, and Scientific Information Database (SID). We included all available population-based studies and national surveys conducted in the pediatric age group (aged<21 years).Results: In this review, 1772 articles were identified (PubMed: 1464; Scopus: 11; ISI: 58; SID: 90; IranMedex: 149; Irandoc: 57). During three refine steps and after removing of duplicates, 182 articles related to the study domain were selected. After quality assessment, 46 studies were selected for text appraisal, of which 26 qualified articles were evaluated at the final step. The prevalence range of hypercholesterolemia, hypertriglyceridemia, elevated low-density lipoprotein cholesterol, and low high-density lipoprotein cholesterol (HDL-C) were 3-48%, 3-50%, 5-20% and 5-88%, respectively. Low HDL-C and hypertriglyceridemia were the most prevalent lipid disorders in this group of population.Conclusion: Dyslipidemia is a common health problem among Iranian children and adolescents. Few data were available in preschool children. This finding provides useful information for health policy makers to implement action-oriented interventions for prevention and early control of this important CVD risk factor.

Functional neurological symptom disorder commonly presents with symptoms and defects of sensory and motor functions. Therefore, it is often mistaken for a medical condition. It is well known that functional neurological symptom disorder more often caused by psychological factors. There are three main approaches namely analytical, cognitive and biological to manage conversion disorder. Any of such approaches can be applied through short-term treatment programs. In this case, study a 12-year-old boy with the diagnosed functional neurological symptom disorder (psychogenic myopia) was put under a cognitive-analytical treatment. The outcome of this treatment modality was proved successful.

Sarcoidosis is a granulomatous disorder mostly could involve intrathoracic structures. Th e gastric involvement is rare and the symptoms may be non-specifi c. We herein report a case of a 56-year-old female patient who was admitted due to chest tightness and discomfort. Computed tomography (CT) of the thorax revealed bilaterally nodular lesions in the lower lobes of the lung and pleural eff usion on the left side. Positron emission tomography/CT showed lung nodules and gastric involvement with mesenteric lymphadenomegalies with pathological uptake of 18F-fl uoro-2-deoxy-d-glucose. Pathological examination of the lung biopsy taken by thoracotomy demonstrated non-caseating granulomas. Th e gastric biopsies taken by endoscopy also showed non-caseating granulomas consistent with a diagnosis of sarcoidosis.

Sir, It has been more than a year since the notification of first case of Ebola virus disease in March 2014 in West-Africa, and even now the public health authorities have not been successful to interrupt completely the transmission of the disease.The recent estimates released by the World Health Organization revealed that almost 24907 cases and 10326 associated deaths have been reported worldwide in the affected nations. Although, critical analysis of the affected nations has identified multiple reasons for the rapid progression of the disease, having a weak public health care delivery system with limited human resources/infrastructure support, remains the leading cause, especially in the most severely affected nations, Guinea, Sierra Leone, and Liberia.

Sir, Disability is a part of human life. Almost all people temporarily or permanently will be impaired at some point in their life. Disability is the umbrella term for impairments, activity limitations, and participation restrictions, referring to the negative aspects of the interaction between an individual (with a health condition) and that individual’s contextual factors (environmental and personal factors).According to global population estimates, around a billion people (15% of the world’s population) live with some form of disability.The world health survey results show that 785 million (15.6%) persons, 15 years and older live with a disability. Of these, the report estimates that 110 million people (2.2%) have very signifi cant diffi culties in functioning.

Sir, In multiple sclerosis (MS) a lot of researches, indicate that 45-60% of patients are cognitively impaired.It is seen in the subclinical radiologically isolated syndrome, clinically isolated syndrome, and all phases of clinical MS. In pediatric-onset MS, cognition is frequently impaired and worsens relatively rapidly cognitive impairment o en affects personal life and vocational status.Depression, anxiety and fatigue aggravate symptoms, whereas cognitive reserve partially protects it.Although there are no predictors of which patients will suffer MS-related cognitive deficits. Disease duration and subtype, race, sex, and cognitive reserve may all play a role. Patients with progressive subtypes of MS are more likely to experience cognitive impairment, in general.Adult African-American patients with MS develop cognitive deficits earlier in the disease course compared with adult Caucasian patients. The incidence and severity of cognitive deficits are higher in men. As with Alzheimer disease, MS patients with high levels of cognitive reserve are less likely to experience cognitive impairment.

Background: To investigate the association between the red cell distribution width (RDW) and mortality in patients with acute pancreatitis (AP), and to assess the ability of RDW to predict mortality in AP patients.Materials and Methods: This retrospective cohort study included 120 patients (50 males and 70 females) with AP who were admitted to the First Affiliated Hospital of Zhongshan Medical University from January 2011 to October 2013. Demographic data and laboratory measures including RDW were obtained from medical records of each patient. A receiver operating characteristic (ROC) curve analysis was used to assess RDW values to predict the death of AP patients.Results: The serum concentration levels of total Ca2+ (P=0.007) and albumin (P<0.001), and the white blood cell counts (P=0.005) were significantly lower, and the mortality rate (P<0.001) and body mass index (P<0.001) were significantly higher (P=<0.001, <0.001) in patients with RDW values of>13.4% than in patients with RDW values of ≤13.4%.RDW values were negatively correlated with the serum concentration levels of albumin (r=−0.212, P=0.012) and total Ca2+ (r=-0.206, P=0.033), and were positively correlated with the patient’s age (r=0.201, P=0.035). ROC analysis showed that the AUC for the RDW value was 0.894 (P<0.001, 95% confidence interval=0.823-0.966), and the optimal cut-off value to predict death was 14.35 (sensitivity=88.2%, specificity=91.8%).Conclusion: Red cell distribution width is a potentially new and sensitive predictor of mortality in patients with AP.