JOURNAL OF RESEARCH IN MEDICAL SCIENCES (JRMS)
Year:2018 | Volume:23 | Issue:12|Papers Count:9

Patient safety is a priority in all health‑ care centers across the world. This study aimed to determine the frequency of events that threaten patient safety and the grade threating of events from the perspective of the health‑ care professionals in the intensive care units (ICUs). Materials and Methods: This cross‑ sectional study was conducted in 2016. The participants were 306 members of health‑ care professionals (physicians and nurses) with at least 1 year of work experience in ICUs of educational hospitals affiliated to Isfahan University of Medical Sciences. Data were collected using a three‑ section self‑ made questionnaire. Data analysis was done using descriptive statistics (frequency distribution and percentage) and version 16 of SPSS software. Results: A total of 306 questionnaires were completed out of 320 questionnaires handed out among participants. During the last month, 91. 2% of the participants had reported at least a case of medication error, 75. 6% had reported at least a case of ventilator‑ associated pneumonia, and 74. 2% had reported at least a case of catheter‑ induced urinary infection in ICUs. Conclusion: The occurrence of events threatening the patient safety in ICUs warrants proper planning by administrators of health‑ care centers. Medication error was the most frequent and important event of threat to patient safety and falling was the least frequent event of threat to patient safety in ICUs. Considering the frequency and magnitude of medication error in ICUs, a well‑ adjusted preventive plan should be designed and implemented to improve the patient safety.

Rheumatoid arthritis (RA) is a common chronic autoimmune disorder that leads to damage of human joints. There are various treatment approaches in which different drugs are prescribed which have several alterations in serum lipids. This research aimed to study the effect of RA treatments on the serum lipids. Materials and Methods: Two hundred randomly selected patients with RA were randomly assigned to three different groups. The first group of patients was treated with a combination of prednisolone (PRD) and hydroxychloroquine (HCQ). The second group was treated with three drugs including PRD, HCQ, and methotrexate (MTX). The third group was treated with four medications including PRD, HCQ, MTX, and sulfasalazine. Within each group, the lipid factors such as triglyceride (TG), total cholesterol (TC), low‑ density lipoprotein (LDL), and high‑ density lipoprotein (HDL), erythrocyte sedimentation rate, and visual analog scale were measured at the beginning of the experiment and 6 months after exposing the treatments. For each group, we also calculated the Disease Activity Score‑ 28 (DAS‑ 28). The analysis of variance revealed that the overall DAS‑ 28 was significantly different among the three groups. Results: In the first group, the level of TG and TC significantly decreased (P = 0. 015 and P ≤ 0. 001, respectively). In the second group, the level of TG and LDL significantly decreased (P = 0. 009). In the third group, the LDL level increased considerably (P < 0. 001). The HDL level significantly increased in all three groups (P = 0. 012, P = 0. 014, and P = 0. 028, respectively). Conclusion: The treatment PRD + HCQ + MTX was more effective in reducing the LDL level and increasing the HDL level. To reduce the risk of cardiovascular diseases in patients with RA, it is important to prescribe the combination of drugs which leads and normalizes the lipid profile levels.

Diabetes mellitus is a chronic metabolic disorder of hyperglycemia. Chronic hyperglycemia produces advanced glycation end products such as the methylglyoxal (MGO) which interferes with cell functions, insulin signaling, and β ‑ cell functions. The present study was conducted to determine the effects of berberine (BBR) therapy on serum MGO and insulin resistance in newly diagnosed type 2 diabetic patients. Materials and Methods: The present case– control study was conducted at the Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro/Hyderabad, from March 2016 to January 2017. A sample of 200 newly diagnosed type 2 diabetic patients was divided into two groups. Group 1 received metformin 500 mg (×3 daily) and Group 2 received BBR 500 mg (×3 daily) for 3 months. Blood samples were collected at baseline and after 3 months to analyze biochemical parameters on Roche biochemical analyzer. MGO was assayed by ELISA kit and homeostasis model assessment of insulin resistance (HOMA‑ IR) model. SPSS version 23. 0 (IBM, Incorporation, USA) analyzed the data at 95% confidence interval (P ≤ 0. 05). Results: Baseline HOMA‑ IR (% IR) and MGO were found elevated in metformin and BBR groups. After 3 months of metformin and BBR therapy, the HOMA‑ IR (% IR) and MGO were decreased to 3. 69 ± 1. 13 and 2. 64 ± 0. 76 and 35. 84 ± 12. 56 and 26. 64 ± 10. 73 ng/ dl, respectively (P = 0. 0001). HOMA‑ IR (% IR) was improved by 40% and 73% (P = 0. 0001) and MGO by 43% and 56% in metformin and BBR groups, respectively (P = 0. 0001). Conclusion: BBR is more effective in decreasing the serum MGO levels and insulin resistance through improved glycemic control in newly diagnosed type 2 diabetic patients.

In celiac patient exposure to even only a small amount of gluten can lead to malabsorption of some important nutrients including calcium, iron, folic acid, and fat‑ soluble vitamins because of small‑ intestine inflammation. A strictly followed gluten‑ free (GF) diet throughout the patient’ s lifetime is the only effective treatment for celiac disease; however, elimination of gluten from cereal‑ based product leads to many technological and nutritional problems. This report discusses different substitutes to replace gluten functionality and examines the economic and social impacts of adherence to a GF diet. Better knowledge about the molecular basis of this disorder has encouraged the search for new methods of patient treatment. The new and common GF sources and different challenges encountered in production and consumption of these products and different solutions for improving their properties are discussed in this review.

Sir, New Delhi metallo‑ β ‑ lactamase (MBL)‑ 1 (NDM‑ 1) gene was first detected in extensively drug‑ resistant (XDR) Klebsiella pneumoniae from a Swedish patient of Indian origin. [1] Thereafter, NDM‑ 1 emerged as a leading threat to the treatment of infections caused by Enterobacteriaceae. In this study, we aimed to study the positivity of blaNDM‑ 1 among Gram‑ negative bacteria (GNB) isolated from human immunodeficiency virus (HIV) patients attending YR Gaitonde Centre, Chennai, India. Antibiotic susceptibility of bacterial isolates was tested using Kirby– Bauer disc diffusion method...

The present study is aimed to evaluate the magnetic resonance imaging (MRI) and electroencephalography (EEG) findings based on characteristics variables in patients with epilepsy. Materials and Methods: In this cross‑ sectional study, all patients with epilepsy who referred between March 2016 and March 2017 to Al‑ Zahra and Kashani Hospitals in Isfahan, Iran, were enrolled. The completed files of 199 patients were assessed to collect information about characteristic data and MRI and EEG findings. MRI and EEG findings were recorded as normal or abnormal. The characteristic data and risk factors in patients with normal MRI and EEG were compared with those patients with abnormal MRI and EEG. Results: History of seizures and trauma are reported in 84 (42. 2%) and 47 (23. 6%) of patients, respectively. The most frequent type of seizures was generalized. MRI finding in 51 patients (25. 6%) was abnormal, and EEG finding in 124 patients (62. 3%) was abnormal. Patients with abnormal MRI were significantly older than those with normal MRI (37. 3 vs. 31. 4, respectively, P = 0. 024). Abnormal MRI in men patients was significantly more frequent than women (31. 2% vs. 18. 9%, respectively, P = 0. 048). In patients with abnormal EEG, seizure was more frequent than patients with normal EEG (50. 8% vs. 28%, respectively, P = 0. 002). Other characteristics and risk factors were not significant differences between patients with normal or abnormal MRI or EEG findings. Conclusion: In patients with epilepsy, older age and being a male were the risk factors of having abnormal MRI, and seizure was the risk factor of having abnormal EEG.

The aim of this study was to determine the effect of Livergol on the improvement of fatty liver in patients with cancer undergoing irinotecan‑ and oxaliplatin‑ based chemotherapy regimen. Materials and Methods: This was an add‑ on nonrandomized clinical trial study on thirty selected eligible cancer patients undergoing irinotecan (8 patients) and oxaliplatin (22 patients) with diagnosed fatty liver disease‑ based liver ultrasonography, as well as alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Patients in each group received Livergol at a dose of 140 mg daily for 1 month. ALT and AST levels as well as grade of fatty liver were evaluated before and after intervention. Results: In the oxaliplatin/Livergol group, 40% and 44. 4% of patients who were in Grade 2 and 3 before intervention were altered to Grades 1 and 2, respectively (P = 0. 005), and in irinotecan/Livergol group, the mentioned percentages were 80% and 66. 7% (P = 0. 014). The mean levels of ALT and AST enzymes were decreased in both groups after tacking Livergol; however, the observed decreases were not significantly different between groups. Conclusion: It was concluded that the adding of Livergol to oxaliplatin and irinotecan regimens significantly improved the fatty liver of patients and none of them was superior.

There is evidence that regular activity can prevent of cardiovascular diseases. There are many reports that exercise and the consumption of olive leaf extract (OLE) have a positive effect on cardiovascular parameters. This study was conducted to compare the effects of exercise and OLE alone and together on electrocardiographic parameters in rats. Materials and Methods: Male Sprague– Dawley rats were randomly divided into six groups (n = 8 rats in each): Control, exercise, OLE (100, 200, and 400 mg/kg, orally for 14 days), and exercise + OLE (200 mg/kg of extract, orally for 14 days). Exercise training in rats was performed using treadmill for 28 days (1 h/day). Electrophysiological parameters including heart rate, PR interval, QT interval, QT corrected (QTc), RR interval, QRS voltage, and duration were obtained from lead II electrocardiogram (ECG) recorded by a PowerLab system. Statistical evaluation was done by one‑ way analysis of variance followed by Fisher’ s least significant difference test and P < 0. 05 was considered statistically significant. Results: The amounts of QT (P = 0. 0009) and QTc interval (P = 0. 0004), RR interval (P < 0. 0001), QRS duration (P = 0. 004), and QRS voltage (P = 0. 003) in the exercise group were significantly higher than those of the control group. However, there were no significant differences in PR interval in comparison with the control group. Exercise (P < 0. 0001) and OLE (400 mg/kg, P = 0. 043) alone and both in combination (P = 0. 007) reduced heart rate and increased the amount of QRS voltage (P = 0. 003, P = 0. 047, and P = 0. 046, respectively) and RR interval (P < 0. 0001, P = 0. 046, and P = 0. 0009, respectively). Conclusion: Results of this study indicated that administration of OLE alone and in combination with exercise has negative chronotropic and positive inotropic effects and also it can prevent of prolongation of QT and QTc interval induced by severe exercise.

The aim of this study was to determine whether insulin resistance, beta‑ cell function, and their associations with alanine aminotransferase (ALT) are affected by the functional variants of paraoxonase‑ 2 (PON2) as an intracellular antioxidant in patients with type 2 diabetes (T2D). Materials and Methods: Quantitative insulin sensitivity check index (QUICKI) and homeostasis model assessment for beta‑ cell function (HOMA‑ BCF) were assessed in T2D patients. Insulin levels were determined using ELISA. The variants PON2‑ A148G and PON2‑ S311C were genotyped using polymerase chain reaction‑ based restriction fragment length polymorphism. Results: According to the PON2‑ G148A variant, ALT was found to be significantly correlated with QUICKI (r = − 0. 616, P = 0. 005) and HOMA‑ BCF (r = 0. 573, P = 0. 01) in the GA + GG group; however, the correlations were not statistically significant in the AA genotypes. Based on the genotypes of PON2‑ S311C, there was a significant correlation between ALT with QUICKI (r = − 0. 540, P = 0. 031) and HOMA‑ BCF (r = 0. 567, P = 0. 022) in the SC + CC group. In the multiple adjusted logistic regression analyses, considering the variants PON2‑ G148A and PON2‑ C311S as independent variables and QUICKI and HOMA‑ BCF as the dependent variables, both variants were significantly associated with the QUICKI (P = 0. 019 for PON2‑ G148A and P = 0. 041 for PON2‑ C311S). Furthermore, PON2‑ C311S remained significantly associated with HOMA‑ BCF (P = 0. 03). Conclusion: These data implicate a role for the functional variants of PON2 in insulin resistance and beta‑ cell function as well as underscore the effective role of these variants in the associations between them and ALT. Our data contribute to our understanding of the important physiologic functions of PON2 in glucose metabolism and its related metabolic diseases.