پژوهش در علوم پزشکی
سال:1397 | دوره: | شماره: |تعداد مقالات:10

Background: Lower gastrointestinal (GI) bleeding is a common clinical problem in young patients. The management of this disease in patients is challenging. The aim of this study is to compare sigmoidoscopy with full colonoscopy in these patients. Materials and Methods: In this cross‑ sectional study, 120 eligible patients under 50 years old with acute rectal bleeding were enrolled. After cleaning the colon, initially the patients underwent sigmoidoscopy. Pain, the comfort of the test by physician and patient, duration of the procedure, and pathologic findings were recorded. The procedure continued until the splenic flexure passed in the ileocecal valve, and this stage was considered as proximal colonoscopy. Pain, easy performance by physician and the patient, duration of procedure, and pathologic findings were recorded in this stage too. The variables in the two stages were compared with each other. Results: There were 66 women (55%) and 54 men (45%) and the mean of age was 41 ± 7. 9 years. Proximal colonoscopy from splenic flexure to reach cecum was relatively easier for the physician and the patient than sigmoidoscopy (P < 0. 001). Furthermore, the time spent to carry out proximal colonoscopy was less than the time taken for sigmoidoscopy (P < 0. 001). Pathologic findings recorded in full colonoscopy were more than sigmoidoscopy (P < 0. 001). Therefore, full colonoscopy that includes sigmoidoscopy and proximal colonoscopy is relatively easier than sigmoidoscopy for patients, and it also proves more advantageous than sigmoidoscopy for physicians to perform in Iranian patients because of more tortuous and elongated sigmoid colon in these patients. Conclusion: It is advised to perform full colonoscopy than sigmoidoscopy in young patients with lower GI bleeding.

Background: Since the increase in some tubular damage biomarkers can be observed at the early stage of diabetic nephropathy, even in the absence of albuminuria, we aimed to investigate if urinary albumin is superior than tubular damage marker, such as serum retinol‑ binding protein 4 (RBP4), in predicting renal function decline (defined as estimated glomerular filtration rate [eGFR] <60 mL/min/1. 73 m2) in the cohort of patients with type 2 diabetes mellitus (T2D). Materials and Methods: A total of 106 sedentary T2D patients (mean [± standard deviation] age 64. 9 [± 6. 6] years) were included in this cross‑ sectional study. Anthropometric and biochemical parameters (fasting glucose, glycated hemoglobin [HbA1c], lipid parameters, creatinine, RBP4, high sensitivity C‑ reactive protein [hsCRP], urinary albumin excretion [UAE]), as well as blood pressure were obtained. Results: HsCRP (odds ratio [OR] =0. 754, 95% confidence interval [CI] (0. 603– 0. 942), P = 0. 013) and RBP4 (OR = 0. 873, 95% CI [0. 824– 0. 926], P < 0. 001) were independent predictors of eGFR decline. Moreover, although RBP4 and UAE as single diagnostic parameters of renal impairment showed excellent clinical accuracy (area under the curve [AUC] = 0. 900 and AUC = 0. 940, respectively), the Model which included body mass index, HbA1c, triglycerides, hsCRP, and RBP4 showed statistically same accuracy as UAE, when UAE was used as a single parameter (AUC = 0. 932 vs. AUC = 0. 940, respectively; P for AUC difference = 0. 759). As well, the Model had higher sensitivity and specificity (92% and 90%, respectively) than single predictors, RBP4, and UAE. Conclusion: Although serum RBP4 showed excellent clinical accuracy, just like UAE, a combination of markers of tubular damage, inflammation, and traditional markers has the higher sensitivity and specificity than UAE alone for prediction renal impairment in patients with T2D.

Background: Elevated blood pressure is still one of the major risk factors for diseases and disabilities and also a public health challenge worldwide. In the present longitudinal study, we aimed to evaluate the association between risk of hypertension and dietary advanced glycation end products (AGEs) as a recently discussed potential risk factor. Materials and Methods: Dietary assessment of 1775 participants in the third phase of Tehran lipid and glucose study to obtain dietary intake of AGEs was performed using a validated semi‑ quantitative food frequency questionnaire, and they were followed up for a mean duration of approximately 6 years. To determine the incidence of hypertension across quartiles of AGEs intake, logistic regression models with adjustment for potential confounding variables were used. All statistical analyses were conducted using SPSS, and P < 0. 05 was considered statistically significant. Results: Higher hypertension occurrence risk was generally attributed to higher AGEs intake quartiles after adjusting for age in men (odds ratio [OR] = 1. 48, 95% confidence interval [CI] = 1. 11– 1. 52, P = 0. 038) and additional adjustment for smoking, drugs, and physical activity in women (OR = 1. 38%– 95% CI = 1. 09– 1. 42, P = 0. 042). Moreover, across the increasing trend of dietary AGEs intake, the percentage of fat intake increased and that of carbohydrate significantly decreased (P < 0. 0001). Conclusion: In conclusion, it is highly recommended to limit dietary AGEs consumption to prevent and manage hypertension and its complications.

Background: The objective of the study was to determine whether serum levels of procollagen type 1 N propeptide (P1NP), a bone formation turnover marker, differs between diabetic foot ulcer with osteomyelitis (DFO) and diabetic foot ulcers without osteomyelitis serving as controls. It was also aimed to assess the usefulness of P1NP in diagnosing DFO compared to other common inflammatory markers. Materials and Methods: A case– control study was designed comparing the aforementioned groups. Patients were classified as osteomyelitis and controls based on the International Working Group diagnostic criteria. Serum P1NP and three other inflammatory markers, namely, C‑ reactive protein (CRP), white blood cells (WBC), and platelets were analyzed on patients with DFO and controls. Results: The mean serum P1NP levels were significantly higher in the DFO group (n: 16), 10. 5 ± 5. 2 (ng/ml), than the control group (n: 11) 3. 1 ± 2. 8 (ng/ml), P = 0. 001. P1NP showed the highest sensitivity/specificity 86. 7%/80% compared to 70. 6%/80%, 56. 2%/45. 4%, and 50%/37% for CRP, WBC and platelets, respectively. Receiver operator characteristic curves showed the best value of area under the curve of 0. 9 for P1NP compared to 0. 85, 0. 54, and 0. 46 for CRP, WBC, and platelets. Conclusion: We found marked elevation of serum P1NP in diabetic foot ulcer with bone infection with potential value in using it to diagnose DFO.

Background: People of all ages can suffer from Henoch‑ Schö nlein purpura (HSP), but it is the most common vasculitis in childhood. The most important involving gene is located on chromosome 6p21. 3, a region coding for human leukocyte antigens (HLAs). Among HLA genes, because of the high rate of polymorphisms, HLA‑ DRB1 is estimated to have a strong association with HSP. In this study, we aimed to assess the association of HLA‑ DRB1 alleles with HSP in Iranian children. Materials and Methods: This study consisted of thirty Iranian children with HSP and 35 healthy controls. Genomic DNA was extracted, and HLA typing was performed by polymerase chain reaction with sequence‑ specific primers technique. Results: The results have shown that HLA‑ DRB1*01 and HLA‑ DRB1*11 (P = 0. 002, odds ratio [OR] = 7. 579, confidence interval [CI] = 1. 934– 29. 697 and P = 0. 039, OR = 3. 333, CI = 1. 030– 10. 788), respectively, are the most frequent alleles associated with HSP in Iranian children population. The frequency of other alleles was not significantly different in both groups. The results also show no correlation between HLA types and disease manifestations. Conclusion: According to these results, there is an association between HLA‑ DRB1*01 and HLA‑ DRB1*11 gene polymorphisms and susceptibility to HSP in our study group.

Background: Significance of platelet distribution width (PDW) and mean platelet volume (MPV) in assessing disease activity of systemic lupus erythematosus (SLE) remains unclear. This study was aimed to evaluate PDW and MPV as potential disease activity markers in adult SLE patients. Materials and Methods: A total of 204 study participants, including 91 SLE patients and 113 age‑ and gender‑ matched healthy controls, were selected in this cross‑ sectional study. They were classified into three groups: control group (n = 113), active SLE group (n = 54), and inactive SLE group (n = 37). Demographic, clinical, and laboratory data were analyzed. Results: In patient group, PDW was statistically higher than that in control group (13. 54 ± 2. 67 vs. 12. 65 ± 2. 34, P = 0. 012), and in active group, PDW was significantly increased compared to inactive group (14. 31 ± 2. 90 vs. 12. 25 ± 1. 55, P < 0. 001). However, MPV was significantly lower in SLE group than in control group (10. 74 ± 0. 94 vs. 11. 09 ± 1. 14, P = 0. 016). PDW was positively correlated with SLE disease activity index (P < 0. 001, r = 0. 529) and erythrocyte sedimentation rate (P = 0. 002, r = 0. 321) and negatively correlated with C3 (P < 0. 001, r = − 0. 419). However, there was no significant association between MPV and these study variables. A PDW level of 11. 85% was determined as a predictive cutoff value of SLE diagnosis (sensitivity 76. 9%, specificity 42. 5%) and 13. 65% as cutoff of active stage (sensitivity 52. 6%, specificity 85. 3%). Conclusion: This study first associates a higher PDW level with an increased SLE activity, suggesting PDW as a novel indicator to monitor the activity of SLE.

Background: In this study, we investigated the associations of erythrocytes fatty acid composition, activities of delta‑ 5 desaturase (D5D) and delta‑ 6 desaturase (D6D), and other metabolic risk factors, with type 2 diabetes (T2D) risk to determine if rs174583 polymorphism of FADS2 gene had any effect on these associations. Materials and Methods: Fatty acid profile of erythrocytes was determined using gas chromatography‑ mass spectrometry in 95 T2D patients and 95 apparently healthy participants. The genotypes of single‑ nucleotide polymorphism (SNP) of FADS2 gene were determined using the polymerase chain reaction‑ restriction fragment length polymorphism technique. Other biochemical parameters were measured in the serum using standard analytical procedures. Results: D6D activity was increased (P < 0. 001) and D5D activity was decreased in T2D patients (P < 0. 001) compared to controls. Homeostatic model assessment insulin resistance (HOMA-IR) index was positively correlated with D6D (r = 0. 34, P < 0. 001) and negatively correlated with D5D (r = − 0. 19, P = 0. 02). Palmitic acid (P < 0. 001) and dihomo‑ gamma‑ linolenic acid (P = 0. 03) were higher and linoleic acid (P < 0. 001) and arachidonic acid (AA) (P < 0. 001) were lower in T2D patients. The distribution of rs174583 genotypes which includes C/T, C/C, and T/T was not different in the two groups (P = 0. 63). Conclusion: In the population studied, there was a strong association in the erythrocytes fatty acid composition, D5D and D6D activities and other metabolic risk factors between non‑ T2D and T2D patients. In addition, there was a strong association in erythrocytes DGLA and AA contents and D5D activities between rs174583 genotypes in all participants. However, the distribution of rs174583 genotypes did not differ significantly between T2D patient and controls, and it did not appear to be an association between rs174583 SNP and incident of T2D.

Background: Doppler ultrasonography (Doppler US) plays an important role in evaluating patients with liver cirrhosis. This study aims to investigate the hemodynamic alterations of hepatic artery and portal vein among children with liver cirrhosis and portal hypertension (esophageal varices). Materials and Methods: We conducted an analytical cross‑ sectional study in Imam Hossein Children’ s Hospital, Isfahan, Iran, in 2016. A number of 33 cirrhotic children with or without esophageal varices were selected through convenience sampling method to be compared with 19 healthy children as controls using color and spectral Doppler US. Results: Portal vein mean velocities were 15. 03 ± 7. 3 cm/s in cirrhotics, 16. 47 ± 6. 4 cm/s in controls (P = 0. 51), 11. 6 ± 4. 7 cm/s in patients with varices, and 17. 9 ± 7. 3 cm/s in patients without varices (P = 0. 015). Mean diameters of caudate lobe, portal vein, and splenic vein, as well as the mean values of liver and spleen span, were significantly higher in cirrhotic children. The frequency of flow reversal (hepatofugal flow) was not detected significantly different in cirrhotics. Peak systolic velocity, end diastolic velocity, pulsatility index, and resistive index for hepatic artery as well as liver vascular index were not significantly different in cirrhotics in comparison with controls. Conclusion: Alterations in Doppler parameters of portal vein including diameter and velocity may be the helpful indicators of liver cirrhosis and esophageal varices in children, respectively. Parameters of hepatic artery may not differentiate children with liver cirrhosis.