JOURNAL OF RESEARCH IN MEDICAL SCIENCES (JRMS)
Year:2018 | Volume:23 | Issue:4|Papers Count:10

We reported the first case of inoperative thymic adenocarcinoma successfully palliative treated by the double‑ stent procedure. In a patient who expressed stridor, computed tomography was done and necrotic mediastinal mass, which protrudes into a trachea, was demonstrated. Fiberoptic bronchoscopy showed tracheal infiltration and 70% stenosis; therefore, surgical resection was inapplicable. Recanalization with repeated argon plasma coagulation and debridement of necrotic mass was performed, followed by placement of the endotracheal stent, radiotherapy, and chemotherapy. After 1 year, the patient developed gastric aspiration and tracheoesophageal fistula; therefore, the esophageal stent was placed. The outcome was lethal, but the placement of endotracheal stent significantly increased a length of survival for the patient with invasive thymic adenocarcinoma.

Background: The aim of this study was to recognize the findings of ultrasonography (US) in remitted rheumatic arthritis (RA) patients for detection subclinical arthritis. Materials and Methods: This descriptive study was conducted during 2016 in a rheumatology center. A total of 70 patients with remitted RA were included in the study. Sonography was performed on all 70 patients who did not show any clinical arthritis in clinical examination to find synovitis and effusion were evaluated with gray scale and hyperemia with power Doppler US. Results: Nearly 44. 3% (n = 31) of our patients had positive sonography results including 20% synovitis, 21. 4% hyperemia, and 18. 6% (n = 13) effusion. A total of 1960 joints of 70 patients were evaluated, in which 3. 2% (n = 63) of joints had positive sonography findings including 1. 2% synovitis, 1. 5% hyperemia, and 1. 1 with effusion. Conclusion: US can diagnosis subclinical arthritis in patients with remitted RA who does not show any joint involvement in clinical examination.

Varicella (chickenpox) is the primary infection of varicella‑ zoster virus (VZV), it is a mild self‑ limiting infection, but it is also highly contagious and can cause severe complications among high‑ risk group of individuals. It is usually a childhood infection providing lifelong immunity, but adults without varicella history are also susceptible to infection. High‑ risk group of individuals is more likely to develop serious complications. Varicella vaccine was introduced to protect this group of individuals and to prevent epidemic spread of VZV infection in a community. Thus, it was added to the recommended vaccination schedules for children in most developed countries. This review aimed to outline varicella status, seroprevalence, complications, and vaccination in the Middle East region. Based on our findings, children were the most affected age group, but there are also adult cases due to high number of expatriates, especially in Gulf Cooperation Council countries. Central nervous system involvements and skin diseases followed by varicella pneumonia were the most varicella‑ associated complications. Varicella vaccine was introduced in most Middle East countries, either mandatory by the Ministries of Health or optional in the private clinics. Few numbers of studies have reported an obvious reduction in varicella prevalence, hospitalizations, and deaths in the Middle East following varicella vaccination. A basic database about varicella infection before the initiation and implementation of a vaccination policy is essential to determine the target group of individuals. As far as our knowledge, this is the first review about varicella infection in the Middle East.

Background: Testosterone is considered as a primary sex hormone, also known as an important anabolic steroid, that may involve in various mental disorders such as bipolar I disorder (BID). The goal of this study was to compare the testosterone salivary levels between different phases of BID and its association with the clinical features of BID. Materials and Methods: In a case– control study, 15 patients in the mania phase, 10 patients in the depression phase, and 16 in the euthymia phase were selected as patient groups. 18 healthy sex‑ and age‑ matched individuals were considered as healthy control group. Salivary samples obtained from all patients and control group and levels of testosterone were determined in saliva using an enzyme‑ linked immunosorbent assay. All statistical calculations were conducted with the software Statistical Package for Social Science version 20 (IBM Inc., Chicago, IL, USA). Results: The mean testosterone level in euthymia phase was 186. 34 ± 182. 62 pg/mL, mania phase was 239. 29 ± 273. 22 pg/mL, depression was 153. 49 ± 222. 50 pg/mL, and healthy participants was 155. 73 ± 126. 0 pg/mL; no significant difference was found between groups (P = 0. 68. ( No statistically significant differences were found between psychotic and nonpsychotic as well as between patients who attempted suicide and nonattempter patients in terms of testosterone levels (P > 0. 1). Conclusion: Our findings do not reveal significant difference between different phases of BID in terms of salivary testosterone levels. However, more comprehensive studies with larger sample size are required to confirm our findings.

Background: According to traditional herbal medicine, chamomile has been considered as one of the herbal remedies for patients with polycystic ovary syndrome (PCOS). The study aimed to investigate the effect of chamomile on lipid and hormonal parameters in women of reproductive age with PCOS. Materials and Methods: This study is a randomized clinical trial which was conducted on 80 women (40 patients in each group) of childbearing age with PCO. The intervention group received 370 mg oral capsules of chamomile three times a day for 3 months. The control group did receive starch capsule (three times a day). Hormonal and lipid parameters were examined before and 3 months after the intervention. Results: The mean age of the patients was 22. 40 ± 5. 10 and 24. 38 ± 6. 14 years in the intervention and control groups, respectively. Decreased level of testosterone was observed in the intervention group (in women with PCOS) who received chamomile capsules (P = 0. 017). A significant difference was not seen in low‑ density lipoprotein cholesterol level (P = 0. 249), high‑ density lipoprotein cholesterol (P = 0. 073), triglycerides (P = 0. 603), the hormone dehydroepiandrosterone sulfate (P = 0. 423), and the ratio of luteinizing hormone/follicle‑ stimulating hormone (LH/FSH) in the experimental and control groups after the intervention (P = 0. 420). Conclusion: According to the findings, oral administration of chamomile capsule caused a significant decrease in total testosterone levels in these patients. However, no significant change was reported with lipid parameters, the ratio of LH/FSH, and dehydroepiandrosterone sulfate level.

Leishmania infantum is the causative agent of infantile visceral leishmaniasis (VL) in the Mediterranean region. Despite developing protective responses, the disease progresses due to many of factors. These include the action of suppressive cytokines, exhaustion of specific T cells, loss of lymphoid tissue, and defective humoral response. Genetic changes that occur inside the genome of alienated or parasite cells, along with immune responses, play an important role in controlling or progressing the disease. Proapoptotic proteins such as Smac/DIABLO, EndoG, AIF (apoptosis‑ inducing factor), and cytochrome C are effective in apoptosis. EndoG is a mitochondrion‑ specific nuclease that translocates to the nucleus during apoptosis. Once released from mitochondria, endoG cleaves chromatin DNA into nucleosomal fragments independently of caspases. Therefore, endoG represents a caspase‑ independent apoptotic pathway initiated from the mitochondria. A comprehensive understanding of the immune and genetic events that occur during VL is very important for designing immunotherapy strategies and developing effective vaccines for disease prevention. In this review which explained the immunological responses and also the important factors that can contribute to parasite apoptosis and are used in subsequent studies as a target for the preparation of drugs or recombinant vaccines against parasites are briefly reviewed.

Background: This study, for the first time, aimed to assess the effects of fermented camel milk (FCM) on glycemic and inflammatory parameters related to metabolic syndrome (MetS), an aggregation of cardiometabolic risk factors, in adolescents. Materials and Methods: In a double‑ blind, randomized crossover trial, overweight/obese adolescents (fulfilling MetS criteria, aged 11– 18 years) were randomly assigned to receive FCM 250 cc per day for an 8‑ week period, a 4‑ week washout, and then diluted cow’ s yogurt (DCY) 250 cc/day for another 8‑ week period, or the reverse sequence. Fasting blood sugar (FBS), fasting insulin, insulin resistance by three equations, incretin hormone glucose‑ dependent insulinotropic peptide (GIP), and glucagon‑ like peptide‑ 1 (GLP1) as well as inflammatory markers such as interleukin 6 (IL6) and tumor necrosis factor‑ alpha (TNF‑ α ) were measured before and after each of the four periods. A 3‑ day food record and physical activity questionnaire were completed before each period. Statistical analyses were done using Minitab and SPSS software considering the significance level of 0. 05. Results: Twenty‑ four participants with a mean (standard deviation) age of 13. 77 (1. 87) years (range: 10. 45– 16. 25 years) (58% girls) completed the study. It resulted in nonsignificant mean reduction in IL6 (− 18. 28 pg/mL [95% confidence interval [CI]: − 47. 48; 10. 90]; P = 0. 20) and nonsignificant increase in glucose metabolizing hormones such as GIP (683. 10 pg/mL [95% CI: − 457. 84; 1824. 0]; P = 0. 22) and GLP1 (6. 98 pg/mL [95% CI: − 66. 61; 80. 57]; P = 0. 84) by FCM consumption in comparison to DCY. Nonsignificant decrease was observed in TNF‑ α in the first periods of the study. The changes of FBS, fasting insulin, and insulin resistance indices were not statistically significant as well. Conclusion: According to preliminary positive influences of FCM on inflammatory markers, and findings related to glucose metabolism, we suggest conducting further studies on its clinical impacts.

Background: In this study, we aimed to evaluate the effectiveness of extracorporeal shockwave treatment (ESWT) on pain and ankle‑ hindfoot scale of the American Orthopedic Foot and Ankle Society (AOFAS) score of patients with chronic Achilles tendinopathy (AT). Materials and Methods: In this double‑ blind clinical trial, 43 patients with chronic AT were selected and randomly allocated in two groups to receive a basic treatment with ESWT or sham SWT (radial and focused shock waves, four sessions once a week for 4 weeks). AOFAS and pain scores for each patient were recorded at baseline (before intervention), immediately after intervention, and 4 and 16 weeks after intervention using AOFAS and visual analog scale (VAS) scaling method. Results: A total of 43 patients (22 ESWT and 21 sham SWT) were participated in this study. Both groups improved during the treatment and follow‑ up period. The mean VAS score decreased from 7. 55 to 3 in the intervention group and from 7. 70 to 4. 30 in the sham SWT group. Mean AOFAS and VAS scores were significantly different between ESWT and no ESWT groups at 16 weeks of follow‑ up (P = 0. 013) (P = 0. 47). There was no significant difference in terms of AOFAS and VAS scores between both the groups in the other follow‑ up times. Conclusion: Overall, ESWT causes decrease in VAS score and increase in AOFAS score. However, due to the small sample size, the results were not statistically significant. It is recommended to plan more interventional studies with larger sample size in the future.

Background: Head‑ and‑ neck squamous cell carcinoma (HNSCC) is the sixth most prevalent type of cancers in the world. Due to its relatively high rate of recurrence, the prognosis of patients is poor and the survival rate is low; therefore, identifying the prognostic factors is considered necessary for better treatment. Materials and Methods: This historical cohort study was conducted on 201 patients diagnosed with aerodigestive SCC who underwent surgery and lymph node dissection. We determined the prognostic value of lymph node ratio (LNR) on overall survival (OS), disease‑ free survival (DFS), and locoregional failure‑ free survival (LFFS). We noticed an association between LNR and survival by Kaplan– Meier analysis. Hazard ratio (HR) of LNR was determined by Cox’ s regression model. Results: Two hundred and one patients entered this study after their medical histories were evaluated. The mean of lymph node count and LNR was 14. 30 (± 9. 50) and 0. 12 (± 0. 23), respectively. Eighty patients (39. 80%) experienced recurrence of SCC. Five‑ year OS, DFS, and LFFS were 32%, 21%, and 64%, respectively. The median of OS was 40. 70 months and 30. 11 months in patients with LNR of ≤ 0. 06 and >0. 06, respectively (P < 0. 01). The LNR >0. 06 was found to be a significant prognostic factor for lower OS of patients with HNSCC (HR = 2. 11 [1. 10, 4. 40]; P = 0. 04). DFS was not significantly different among patients with LNR ≤ 0. 06 and patients with LNR >0. 06 (P = 0. 9). However, LFFS was slightly different among two groups (HR = 2. 04 [0. 90– 4. 80]; P < 0. 1). Conclusion: We recommend more intensive adjuvant therapies such as chemotherapy with radiotherapy and short interval follow‑ up for patients with LNR >0. 06. Further investigations with larger sample sizes are recommended.