JOURNAL OF RESEARCH IN MEDICAL SCIENCES (JRMS)
Year:2015 | Volume:20 | Issue:11|Papers Count:17

Background: We investigated the efficacy of a mobile-based bolus advisor app in comparison with the usual multiple daily injections(MDIs) in diabetic patients. Materials and Methods: In a nonrandomized, controlled clinical trial, 62 diabetic patients wereselected to receive a 12-week intensive glycemic control by either a mobile-based bolus advisor (app) or MDI in the usual manner.We compared mean blood glucose (BG) and HbA1c before and just after the treatment program. The data were analyzed usingpaired sample t-test and analysis of variance (ANOVA).Results: Fifty-six patients (30 cases and 26 controls) completed the study.The mean [standard deviation (SD)] of BG was 220.57 (43.7) and 231.5 (55) in the app group and control group, respectively. MeanBG decreased 38 mg/dL in the app and 16 mg/dL in the control group (P=0.001 and 0.049 respectively). Changes of mean BG weredifferent between the two groups significantly (P=0.039). HbA1c decreased from 8.4% to 7.6% in the case and from 8.4% to 8% inthe control group (P=0.001 and 0.06, respectively). Changes of HbA1c were not different between the two groups (P=0.141). Themean episodes of hypoglycemia were not different between the groups significantly (P=0.108).Conclusion: In conclusion, this studyrevealed that mobile-based bolus advisors can reduce mean BG better in patients who are planned to have a tight glycemic controlas a feasible and available method and may improve HbA1c in the long term.

Background: The pathogenesis of atopic dermatitis (AD) remains to be determined; recently a possible change in the immune systemwith production of immunoglobulins is proposed. As vitamin E is a potent antioxidant, with the ability to decrease the serum levels ofimmunoglobulin E (IgE) in atopic patients, we aimed to evaluate the effect of oral vitamin E on treatment of AD. Materials and Methods: Thisrandomized, double-blind, placebo-controlled trial comprised seventy participants with mild-to-moderate AD, based on the Hanifin andRajka diagnostic criteria. The patients were randomly selected from teaching skin clinics in Isfahan, Iran. They were randomly assigned totwo groups of equal number, receiving vitamin E (400 IU/day) and placebo for four 4 months. Each month, the extent, severity, and subjectivesymptoms including itch and sleeplessness were measured by SCORAD index. Three months after the end of intervention, the recurrencerate was assessed.Results: The improvement in all symptoms, except sleeplessness, was significantly higher in the group receiving vitaminE than in controls (–1.5 vs.0.218 in itching, –10.85 vs. –3.54 in extent of lesion, and –11.12 vs. –3.89 in SCORAD index, respectively, P<0.05). Three months after the end of intervention, the recurrence rate of AD was evaluated. Recurrence rate between all 42 individuals, whoremained in the study, was 18.6%. Recurrence ratio of the group receiving vitamin E compared to the placebo group was 1.17, without significantdifferences between the two groups (P>0.05).Conclusion: This study suggests that vitamin E can improve the symptoms and the qualityof life in patients with AD. As vitamin E has no side effects with a dosage of 400 IU/day, it can be recommended for the treatment of AD.

Addiction is a phenomenon that causes structural changes in different systems of society. Studies show for planning of addictionprevention and treatment, it is necessary to create an information management system. Substance dependence information systemsrefer to systems which collect, analyse and report data related to substance dependence information. The aim of this study was toidentify advantages and barriers to implement Substance Dependence Treatment Information System (SDTIS). This study was anarrative review. Our review divided into three phases: literature collection, assessing, and selection. We employed the followingkeywords and their combinations in different areas of articles. In this study, 22 of collected articles and reports were selected basedon their relevancy. We found many advantages for a substance dependence treatment information system such as recording sufficient, complete and accurate information and easy and timely access to them and monitoring and enhancing the quality of care received bypatients. But we may face some concerns for implementing this information system like taking time and funds from client services, being expensive or even problems regarding the quality of data contained in these information systems. There are some importantproblems in the way of implementing. In order to overcome these issues, we need to raise community awareness.

Background: Chlorpyrifos (CP) is one of the most widely used organophosphate (OP) insecticides in agricultural and residential pestcontrol with its attendant adverse health effect. In the present study, it is proposed to investigate the possible modulatory role of magnesiumoxide nanoparticles (MgO NPs) against CP-induced toxicity in human lymphocytes and determine the mechanisms lying behind thisprotection by viability and biochemical assays. Materials and Methods: Isolated lymphocytes were exposed to 12 mg/mL CP either aloneor in combination with different concentrations of MgO NPs (0.1 mg/mL, 1 mg/mL, 10 mg/mL, and 100 mg/mL). After a 3-day incubation, the viability and oxidative stress markers including cellular mitochondrial activity, caspase-3 and -9 activities, total antioxidant power, lipidperoxidation, and myeloperoxidase (MPO) activity were measured. Also, the levels of tumor necrosis factor-a (TNF-a) as inflammatoryindex, along with acetylcholinesterase (AChE) activity were measured. Statistical differences were determined using one-way analysis ofvariance (ANOVA) and Dunnett’s multiple comparison tests.Results: It is indicated that CP-exposed lymphocytes treated with MgONPs resulted in a substantial reduction in the pace of mortality as well as the stages of oxidative stress in a dose-dependent manner. Also, MgO NPs (100 mg/mL) meaningfully restored CP-induced increase of TNF-a (P<0.001) and decrease of AChE activity (P<0.001) andwere capable of preventing CP-treated human lymphocytes from apoptosis (P<0.001).Conclusion: Our results demonstrate that MgONPs in approximate 100 nm diameter not only make cells resistant to the toxic properties of CP but also attenuate toxic effects of CP, which is demonstrating the potential of MgO NPs to be applied in future immune deficiency therapeutic strategies.

Background: In-toeing and out-toeing rotational deformities are among the most common referrals for consultation withorthopedic specialists. Although a few number of patients need surgical interventions, most of them get better spontaneouslywithout major complications in adult life. In this study, we investigated the prevalence of permanent gait deformities due to hiprotational disorders in a group of patients who underwent conservative treatments. Materials and Methods: This retrospectivecohort study was conducted in the orthopedic department on patients with rotational deformities of the lower extremities (hipanteversion and hip retroversion). From 2, 983 patients, 611 were included in this study and followed up for 10 years. Medialrotation of the hip, lateral rotation of the hip, and tibia fibula angle (TFA) of each patient were measured independently.Results: In this study, 611 patients were assessed and 323 (143 male and 180 female) were followed up in our study. Two hundred andseventy patients had in-toeing gait disorders due to hip anteversion, which 178 of them were corrected conservatively (%).Furthermore, among 53 patients with out-toed gait due to hip retroversion, 44 patients (%) were corrected in the same conditions(P=0.001). It was determined that gait disorders were corrected conservatively in 102 of 143 males and 120 of 180 females (P=0.37).Conclusion: Our findings showed that rotational deformities are expected to be corrected by conservative management.It is better to consider surgical procedures as the last therapeutic option.

Background: Women with polycystic ovary syndrome have lower pregnancy rates, possibly due to the decreased uterine receptivity. Successful implantation depends on protein networks that are essential for cross-talk between the embryo and endometrium. Apolipoprotein A1 has been proposed as a putative anti-implantation factor. In this study, we evaluated apolipoprotein A1 expression in human endometrial tissues. Materials and Methods: Endometrial apolipoprotein A1 messenger RNA (mRNA) and protein expression were investigated using quantitative real-time polymerase chain reaction (PCR) and Western blot. The distribution of apolipoprotein A1 was also detected by immunostaining. Samples were obtained from 10 patients with polycystic ovary syndrome and 15 healthy fertile women in the proliferative (on day 2 or day 3 before ovulation, n=7) and secretory (on days 3-5 after ovulation, n=8) phases.Results: Endometrial apolipoprotein A1 expression was upregulated in patients with polycystic ovary syndrome compared to normal subjects. However, apolipoprotein A1 expression in the proliferative phase was significantly higher than in the luteal phase (P value<0.05).Conclusion: It seems that differentially expressed apolipoprotein A1 negatively affects endometrial receptivity in patients with polycystic ovary syndrome. The results showed that apolipoprotein A1 level significantly changes in the human endometrium during the menstrual cycle with minimum expression in the secretory phase, coincident with the receptive phase (window of implantation). Further studies are required to clarify the clinical application of this protein.

Sir/Madam, We would like to report an 8-year-old child with swelling of the right parotid gland after general anesthesia. He weighed 18 kg and underwent adenoidectomy and bilateral tympanostomy tube insertion operation.

Background: Few studies have shown the limitation of the World Health Organization (WHO) / International Council for theControl of Iodine Deficiency (ICCIDD) -adopted thyroid gland volume references as universal normative values for thyroid glandvolume. So we decided to measure thyroid gland volume by sonography in schoolchildren in Rasht, Gilan Province, Iran — Rasht isa metropolitan city on the Caspian Sea coast — and compare them to WHO normative values. Materials and Methods: In a crosssectionalstudy, 2, 522 schoolchildren, aged 6-13 years, in Rasht, Gilan Province, Iran were selected by multistage random sampling.Data were collected on their age, sex, weight, height, body surface area (BSA), and thyroid gland size by palpation and sonography.The terminal phalange of thumb finger volume was calculated with the same formula used in sonography, for the thyroid glandin 1, 085 of these cases.Results: Goiter prevalence was 64% (1613 cases) by palpation, 76.1% (1228 subjects) grade I and 23.9%(385 cases) grade II. The mean thyroid gland volume in girls was more than boys (3.67 ± 1.89 mL vs 3.41 ± 1.58 mL, P<0.0001).According to the 1997 WHO thyroid gland volume reference, none of the children had goiter based on BSA and age even in thosewith grade II goiters (23.9%). In contrast, the median thyroid gland volume in our cases was larger than the 2004 WHO reference.The best single predictor of thyroid gland volume was age (R2=0.391, P<0.0001) followed by BSA (R2=0.151, P<0.0001). Therewas also a significant difference between thyroid gland and finger volume in all grades of goiter and grade II goiters (3 ± 1.4 mL vs9.59 ± 2.4 mL; P<0.0001.4.3 ± 1.4 mL vs 9.3 ± 2.5 mL; P<0.0001).Conclusion: The WHO standards for thyroid gland volume bysonography may underestimate or overestimate the goiter prevalence in many areas and populations. Finger volume was much largerthan thyroid gland volume in even visible goiters.

Background: Programs for improving health status of patients with illness related to pain, such as headache, are often still in theirinfancy. Mindfulness-based stress reduction (MBSR) is a new psychotherapy that appears to be effective in treating chronic pain andstress. This study evaluated efficacy of MBSR in treatment of perceived stress and mental health of client who has tension headache.Materials and Methods: This study is a randomized clinical trial. Sixty patients with tension type headache according to theInternational Headache Classification Subcommittee were randomly assigned to the Treatment As Usual (TAU) group or experimentalgroup (MBSR). The MBSR group received eight weekly classmates with 12-min sessions. The sessions were based on MBSR protocol.The Brief Symptom Inventory (BSI) and Perceived Stress Scale (PSS) were administered in the pre- and posttreatment period andat 3 months follow-up for both the groups.Results: The mean of total score of the BSI (global severity index; GSI) in MBSR groupwas 1.63 ± 0.56 before the intervention that was significantly reduced to 0.73 ± 0.46 and 0.93 ± 0.34 after the intervention and at thefollow-up sessions, respectively (P<0.001). In addition, the MBSR group showed lower scores in perceived stress in comparisonwith the control group at posttest evaluation. The mean of perceived stress before the intervention was 16.96 ± 2.53 and was changedto 12.7 ± 2.69 and 13.5 ± 2.33 after the intervention and at the follow-up sessions, respectively (P<0.001). On the other hand, themean of GSI in the TAU group was 1.77 ± 0.50 at pretest that was significantly reduced to 1.59 ± 0.52 and 1.78 ± 0.47 at posttestand follow-up, respectively (P<0.001). Also, the mean of perceived stress in the TAU group at pretest was 15.9 ± 2.86 and that waschanged to 16.13 ± 2.44 and 15.76 ± 2.22 at posttest and follow-up, respectively (P<0.001).Conclusion: MBSR could reduce stressand improve general mental health in patients with tension headache.

Background: Considering the importance of using more appropriate imaging technique for accurate diagnosis of pulmonarythromboembolism (PTE) with less side effects, we aimed to evaluate the quality of pulmonary 64-multidetector computedtomographic (MDCT) angiography in pregnant and postpartum women with suspected PTE in Isfahan. Materials and Methods: In this descriptive study, radiological findings of pregnant and postpartum women with suspected PTE who underwent pulmonary64-MDCT angiography were evaluated. Prevalence of PTE in pregnant and postpartum women, mean of pulmonary arteries densityfor right and left pulmonary arteries, and their lobar and segmental branches, diagnostic quality of the pulmonary arteries density andtheir scoring, frequency of diagnostic and nondiagnostic images, mean of radiation dose and mean of bolus time, and the correlationbetween the quality of the vascular density with the peak density of the pulmonary artery were determined.Results: In this study, 44 pregnant and postpartum women with suspected PTE were selected. The overall prevalence of PTE was 9.1% (4.44). PTE wasdiagnosed in 1 (3.7%) pregnant and 3 (17.5%) postpartum women (P=0.14). Mean density of pulmonary trunk was 278.81 ± 108.16Hounsfield unit (HU) and 308.41 ± 59.30 HU in pregnant and postpartum women, respectively. Mean of bolus timing, kilovoltagepeak (kVp), tube current, and dose length product (DLP) were 12.53 ± 2.36 s, 105.22 ± 45.71 milliamperage (MA), 382.9 ± 173.5MA, and 317.98 ± 78.92 mGy/cm, respectively. The rate of nondiagnostic images was 4.5%.Conclusion: Our findings indicatedthat pulmonary 64-MDCT angiography is an appropriate imaging method for diagnosing PTE in pregnant and postpartum womenwith suspected PTE. It seems that, using fast CT systems (64-MDCT), in accordance with high flow rate, high contrast mediumconcentration and low kVp could explain the obtained appropriate quality of images more efficiently than computed tomographicpulmonary angiography (CTPA).

Sir, We read with interest the article by Bilir et al. [1] as well as its associated conference abstract [2] reporting a clinical trial of chlorhexidine, octenidine, and povidone-iodine for skin antisepsis with the purpose of preventing vascular catheter-related infections.

Sir, Zoonoses refer to those diseases that are naturally transmitted from vertebrate animals to humans and vice versa. [1] In fact, zoonotic disease accounts for almost two-third of the infectious agents that can affect humans by causing more than 200 diseases.

Benzofuran as an important heterocyclic compound is extensively found in natural products as well as synthetic materials. Sincebenzofuran drivatives display a diverse array of pharmacological activities, an interest in developing new biologically active agentsfrom benzofuran is still under consideration. This review highlights recent findings on biological activities of benzofuran derivativesas antimicrobial and antibreast cancer agents and lays emphasis on the importance of benzofurans as a major source for drug designand development.

Background: Because of the increasing usage of waterpipe globally, we need to know more about the different factors related to waterpipeand cigarette smoking. Therefore, the present study aims at gaining more insight on waterpipe and cigarette smoking based on perceivedparental reaction and appeal and repellent of smoking among adolescents. Materials and Methods: A cross-sectional survey entitled“Isfahan Tobacco Use Prevention Program” (ITUPP) was conducted among 5, 500 adolescents in Isfahan Province, Iran in 2010 using a selfadministeredanonymous questionnaire. Demographic factors, cigarette and waterpipe smoking status, appeal and repellent of smoking, perceived parental reactions, and the main reasons behind the increase in waterpipe smoking were measured. Chi-square, univariatelogistic regression, and multiple logistic regression were used. For all analyses, we defined statistical significance a priori with a two-tailedalpha of 0.05. Statistical analyses were conducted using the Statistical Package for the Social Sciences (SPSS) version 15.Results: 50% of thesample was female and 89% lived in urban areas. The average age of the respondents was 14.37 ± 1.70 years. While a majority of cigarettesmokers (70.9%) were waterpipe smokers, only 35.7% of waterpipe smokers smoked cigarettes. The incidence of smoking was high in thosewho expected less extensive parental reaction with odds ratio (OR) =1.89 [95% confidence interval (CI): 1.35-2.63] (P<0.001) amongcigarette smokers and OR=2.75 (95% CI: 2.16-3.50) (P<0.001) among waterpipe smokers. “Taste” was rated the most attractive featureby waterpipe and cigarette smokers 2.83-fold (95% CI: 2.06, 3.90) (P<0.001). Most waterpipe smokers compared to nonsmokers believedthat the main reason behind waterpipe popularity was habit.Conclusion: The factors related to waterpipe smoking were different fromthose in cigarette smoking; so we need to implement different interventions to overcome the surging usage of tobacco use.

Nowadays, diabetes mellitus (DM) and hypertension are considered as the most common causes of end-stage renal disease (ESRD).In this paper, other than presenting the role of DM in ESRD, glucose metabolism and the management of hyperglycemia in thesepatients are reviewed. Although in several large studies there was no significant relationship found between tight glycemic control andthe survival of ESRD patients, it is recommended that glycemic control be considered as the main therapeutic goal in the treatmentof these patients to prevent damage to other organs. Glycemic control is perfect when fasting blood sugar is less than 140 mg/dL, 1-h postprandial blood glucose is less than 200 mg/dL, and glycosylated hemoglobin (HbA1c) is 6-7 in patients with type 1 diabetesand 7-8 in patients with type 2 diabetes. Administration of metformin should be avoided in chronic renal failure (CRF) because oflactic acidosis, the potentially fatal complication of metformin, but glipizide and repaglinide seem to be good choices.

Background: Kidney transplantation is a preferred treatment for many patients with end-stage renal disease (ESRD) and is farmore profitable than hemodialysis. Analyzing renal transplantation data can help to evaluate the effectiveness of transplantationinterventions. The aim of this study was to determine the organ survival rate after kidney transplantation during a period of 10 years(March 2001-March 2011) among transplanted patients in Arak, Markazi Province, Iran. Materials and Methods: In this historicalcohort study, all recipients of kidney transplantation from Arak, Markazi Province, Iran who had medical records in Valiasr Hospitaland “charity for kidney patients” of Arak, Markazi Province, Iran during a period of 10 years from March 2001 to March 2011 wereincluded. Data collected by using checklists were completed from patients’ hospital records. Kaplan-Meier method was used todetermine the graft cumulative survival rate, log-rank test to compare survival curves in subgroups, and Cox regression model todefine the hazard ratio and for ruling out the intervening factors. Statistical analysis was conducted by Statistical Package for theSocial Sciences (SPSS) 20 and Stata 11.Results: Mean duration of follow-up was 55.43 ± 42.02 months. By using the Kaplan-Meiermethod, the cumulative probability of graft survival at 1, 3, 5, 7, and 10 years was 99.1, 97.7, 94.3, 85.7, and 62.1%, respectively. Thenumber of dialysis by controlling the effect of other variables had a significant association with the risk of graft failure [hazard ratiosand 95% confidence interval (CI): 1.47 (1.02-2.13)].Conclusion: This study showed that the graft survival rate was satisfactory in thiscommunity and was similar to the results of single-center studies in the world. Dialysis time after transplantation was a significantpredictor of survival in the recipients of kidney transplantation that should be considered.

Background: Cardiovascular diseases are viewed worldwide as one of the main causes of death.This study aims to reportthe burden of ischemic heart diseases (IHDs) in Iran by using data of the global burden of disease (GBD) study, 1990-2010.Materials and Methods: The GBD study 2010 was a systematic effort to provide comprehensive data to calculate disability-adjustedlife years (DALYs) for diseases and injuries in the world. Years of life lost (YLLs) due to premature mortality were computed on thebasis of cause-of-death estimates, using Cause of Death Ensemble model (CODEm). Years lived with disability (YLDs) were assessedby the multiplication of prevalence, the disability weight for a sequel, and the duration of symptoms. A systematic review of publishedand unpublished data was performed to evaluate the distribution of diseases, and consequently prevalence estimates were calculatedwith a Bayesian meta-regression method (DisMod-MR). Data from population-based surveys were used for producing disabilityweights. Uncertainty from all inputs into the calculations of DALYs was disseminated by Monte Carlo simulation techniques.Results: The age-standardized IHDs DALY specified rate decreased 31.25% over 20 years from 1990 to 2010 [from 4720 (95%uncertainty interval (UI): 4, 341-5, 099) to 3, 245 (95% UI: 2, 810-3, 529) person-years per 100, 000]. The decrease were 38.14% amongwomen and 26.87% among men. The age-standardized IHDs death specefied rate decreased by 21.17% [from 222) 95% UI: 207-243(to 175 (95% UI: 152-190) person-years per 100, 000] in both the sexes. The age-standardized YLL and YLD rates decreased 32.05%and 4.28%, respectively, in the above period.Conclusion: Despite decreasing age-standardized IHD of mortality, YLL, YLD, andDALY rates from 1990 to 2010, population growth and aging increased the global burden of IHD. YLL has decreased more than IHDdeaths and YLD since 1990 but IHD mortality remains the greatest contributor to disease burden.