JOURNAL OF RESEARCH IN MEDICAL SCIENCES (JRMS)
Year:2017 | Volume:22 | Issue:8|Papers Count:10

Sir, HIV immune reconstitution inflammatory syndrome (IRIS) is one of the most significant challenges of highly active antiretroviral treatment (ART) faced by physicians across the world. Through this letter, I wish to draw the attention of readers to a simple aware, alert, avert strategy that can be used to deal with IRIS, especially in areas with a high load of HIV/AIDS patients.

Background: We aimed to determine the contribution of four DFNB loci and mutation analysis of gap junction beta‑2 (GJB2) andGJB4 genes in autosomal recessive nonsyndromic hearing loss (ARNSHL) in South of Iran. Materials and Methods: A total of 36 large ARNSHL pedigrees with at least two affected subjects were enrolled in the current study. TheGJB2 and GJB4 genes mutations were screened using direct sequencing method. TheGJB2 and GJB4 negative families were analyzed for the linkage to DFNB21, DFNB24, DFNB29, and DFNB42 loci by genotyping the corresponding STR markers using polymerase chain reaction‑PAGE method.Results: We found a homozygous nonsense mutation W77X and a homozygous missense mutation C169W in 5.55% of studied families inGJB2 and GJB4 genes, respectively. Five heterozygous mutations including V63G, A78T, and R127H in GJB2 gene, and R103C and R227W inGJB4 gene were detected. We identified two novel variations V63G in GJB2 and R227W in GJB4. In silico analysis predicted that both novel variations are deleterious mutations. We did not unveil any linkage between DFNB21, DFNB24, DFNB29, and DFNB42 loci and ARNSHL among studied families.Conclusion: This is the first report of GJB2 and GJB4 mutations from Hormozgan population. According to the previous publications regardingGJB2 and GJB4 mutations, the distribution of the mutations is different from other parts of Iran that should be considered in primary health‑care programs. Further investigations are needed to evaluate the contribution of other loci in ARNSHL subjects in South of Iran.

Background: Diagnosis of infection in diabetic foot ulcer (DFU) is not always simple. The analytic precision of procalcitonin (PCT) was evaluated to clarify the use of PCT for distinguish the presence of infection in DFU in comparison to other inflammatory markers.Materials and Methods: This study comprised 88 subjects distributed into four groups: 16 nondiabetic healthy subjects (group control), 17 patients with type 2 diabetes mellitus without foot Complication (group DM), 25 patients with noninfected diabetic foot (group NIDF), and 30 patients with infected diabetic foot (group IDF). Fasting blood samples were taken for measurement of glucose, hemoglobin A1C, lipid profile, renal function, erythrocyte sedimentation rate (ESR), and white blood cell (WBC) and its derivatives.Plasma PCT was determined using an enzyme‑linked immunosorbent assay.Results: PCT, WBC, ESR, and neutrophils (NEU) were found significantly higher in IDF group than other groups. The receiver operating characteristic analysis showed that sensitivity, specificity, the best cutoff value, and the area under the curve were for ESR (100%, 93%, 31.5 mm/h, 1; P<0.001), for PCT (87.5%, 86.7%, 66.55 pg/dl, 0.977; P<0.001), for NEU (93.8%, 93.3%, 5.35, 0.957; P<0.001) and for WBC (93.8%, 90%, 9.29 × 109/L, 0.942; P<0.001), respectively.Conclusion: The outcomes of this study recommend that PCT can be an asymptomatic marker in the diagnosis of infection in DFU with higher Wagner grades in combination with different inflammatory markers.

Hydatid cyst is the larval stage of dog tape wormEchinococcus granulosus. Protoscolices are parasite larvae that develop into adult worms in the final host intestine. During surgical treatment of human hydatidsosis spillage of live protoscolices is the major cause of hydatidosis recurrence. To prevent this problem scolicidal agent such as hypertonic salt are used to kill the protoscolices that may disseminate into the patient’s tissues during surgery. However, they may have some unacceptable side effects. To find scolicidal agents with high efficacy, the effect of different compounds on protoscolices of hydatid cystin vitro has been reviewed. Using PubMed, Scopus, Google Scholar, and SID databases articles about scolicidal effects of different agents on protoscolices of hydatid cystin vitro were collected.Foeniculum vulgare after 5 min, metalonic extracts of Allium sativum and hypertonic saline after 10 min, and warm water after 2 min kill all alive protoscolices. The above agents that in minimum time and minimum concentration have 100% scolicidal activity, could be good candidates for further investigations.

Sir, Transcatheter aortic valve replacement (TAVR) has emerged as an option for patients with severe aortic stenosis. Placement of Aortic Transcatheter Valves trial showed similar 2‑year outcomes in the context of mortality, symptoms reduction, and improved valve hemodynamics.

Sir, Aluminum phosphide (ALP) protects grains from pests, but toxicity to humans is still a major dilemma for society and health professionals, particularly in developing countries such as Iran and India. There is no antidote, and high mortality rate continues even with ongoing developments in treatment. Many papers which are published in the literature, review this important topic, providing extensive facts on metabolic manifestations as well as focusing on novel initiatives to scale‑up the standard of care of patients. However, a vast majority of them have ignored recently published evidence that elaborates the causes of detrimental events associated with the metabolic disturbances.Thus, the story still continues why even with such advances in management protocols and lethal outcomes remain high.

Background: Stroke as a devastating condition is a major cause of death worldwide. It is accountable for long‑term disability with high personal and social cost in adults. Alpha‑lipoic acid (ALA) is an eight‑carbon, sulfur‑containing compound with antioxidant properties which reduces body weight, changes other anthropometric indices, and regulates food intake by suppressing appetite and increasing metabolism This study was designed to evaluate the possible effects of ALA supplementation on anthropometric indices and dietary intake in patients with stroke.Materials and Methods: In this randomized, double‑blind, placebo‑controlled clinical trial, 67 patients with stroke were randomly allocated to two groups (taking a 600 mg ALA supplement or placebo daily for 12 weeks).Weight, waist circumference, energy, carbohydrate, protein, and fat intake were measured, and body mass index (BMI) was calculated before and after intervention. Dietary intake and statistical analyses were carried out using Nutritionist IV and SPSS (version 16; SPSS Inc., Chicago, IL, USA) software, respectively.Results: Primary features were similar in the intervention and placebo groups (P>0.05).Waist circumference (P<0.001), energy, carbohydrate, protein, and fat intake (P<0.001) decreased significantly, after the intervention period, in ALA group compared with placebo. While no significant change was observed in weight (P=0.26) and BMI (P=0.56) in ALA supplementation group compared with placebo.Conclusion: Results of this trial indicated that 12‑week supplementation with 600 mg ALA can decrease waist circumference and food intake (energy, carbohydrate, protein, and fat) in patients with stroke.

Background: Mutations in the acid alpha‑glucosidase (GAA) gene usually lead to reduced GAA activity. In this study, we analyzed the mutations ofGAA and GAA enzyme activity from one sibling suspected Pompe disease and their first‑degree relatives.Materials and Methods: In this cross‑sectional study, GAA enzyme activity assay was assessed using tandem mass spectrometry.Polymerase chain reaction and Sanger sequencing were performed forGAA analysis.Results: GAA enzyme activity was significantly decreased in patients compared to the normal range (P=0.02). Two individuals showed ten alterations in the GAA sequence, in which one of them (c.1650del G) has not been previously described in the literature. A single Guanine deletion (del‑G) was detected at codon 551 in exon 12.Conclusion: According to the literature, the detected change is a novel mutation. We hypothesized that the discovered deletion in theGAA might lead to a reduced activity of the gene product.

Background: Conveying information to patients on how to use medications at the dispensing sessions and retention of this information by the patients is essential to the good pharmaceutical care. The aim of our study was to examine the comprehensibility of the selected three potentially usable pictograms by five groups of subjects who had different levels of literacy in both before and after mini educational sessions.Materials and Methods: Nine experienced pharmacists selected three potentially usable pictograms in Isfahan pharmacies: Pictograms D through F representing respectively: “do not take medication during pregnancy, ” “keep medication in the refrigerator, ” and “take medication with plenty of water.” Then, graduate students of two major universities (Groups 1 and 2), low‑literate and illiterate individuals (Groups 3 and 4), and walk – in patients in the pharmacies affiliated to the Isfahan School of Pharmacy (Group 5) were asked about the comprehensibility of these pictograms before and after mini‑education sessions. The American National Standard Institute and International Organization for Standardization standards were used for comparisons.Results: In the pre‑follow‑up period, D and E pictograms were most understandable (87.4%, 87.2%). In the post‑follow‑up, E and D pictograms were understood most (98.0%, 95.3%), followed by F (92.9%). Among the improvements measured in post‑follow‑up, pictogram F showed the biggest improvement (P=0.0).Conclusion: Pictograms depicting the use of medications during pregnancy (D) and storing medication in the refrigerator (E) was easier to understand by our study population. The groups with the high level of literacy interpreted the pictograms better than those with lower levels of literacy.