JOURNAL OF RESEARCH IN MEDICAL SCIENCES (JRMS)
Year:2015 | Volume:20 | Issue:8|Papers Count:17

Background: Obesity induces endothelial dysfunction even in the pediatric age group. The possible protective effects of fruits and herbal products on the endothelial dysfunction of obese children remain to be determined. This study aims to investigate the effects of lemon and sour orange peels on endothelial function of adolescents with excess weight.Materials and Methods: This triple-masked, randomized placebo-controlled trial was conducted for 1-month among 90 overweight and obese participants, aged 6-18 years. They were randomly assigned into three groups of equal number receiving daily oral capsules containing lemon or sour orange powder or placebo. Flow-mediated dilatation (FMD) was compared between three groups by using analysis of covariance.Results: Overall, 30 participants in the lemon group, 27 in the sour orange group and 29 in the control group completed the trial. After the trial, mean FMD was significantly (P<0.001) higher in the lemon group (11.99 ± 4.05) and in the sour orange group (12.79 ± 5.47) than in the placebo group (6.45 ± 2.79). FMD percent change was 145.02 ± 24.34 in the lemon group, 142.04 ± 16.11 in the sour orange group, and 46.73 ± 5.16 in controls (P<0.001).Conclusion: This trial showed that consumption of extracts of lemon and sour orange peels, which contain plenty amounts of antioxidants, flavonoids, pectin, and vitamin C, might have significant benefits on endothelial function in children and adolescents with excess weight. Trial registry code: IRCT201311201434N10.

Background: The coexistence primary cancers of the endometrium and ovary are relatively uncommon. The purpose of this study was to characterize patients diagnosed primary synchronous endometrial and ovarian cancer (SEOC), endometrial cancer (EC) with ovarian metastasis, and ovarian cancer (OC) with endometrial metastasis and compare clinicopathologic variables and prognosis.Materials and Methods: All the patients with diagnosis of both endometrium and OC, who hospitalized between 2002 and 2012 in an academic center affiliated to Tehran University of Medical Sciences, were evaluated with respect to different clinicopathologic variables, follow-up times, and outcomes.Results: Fifty-five patients had been diagnosed with both endometrium and OC.17, 26, and 12 patients were diagnosed as SEOC, EC, and OC, respectively. The frequency of abnormal uterine bleeding was significantly lower in OC (16.7%) compared to others (58.8% in SEOC and 53.8% in EC). However, the abdominal/pelvic pain was significantly higher in OC (50%) compared to others (35.3% in SEOC and 34.6% in EC) (P<0.05). Complex atypical hyperplasia (87.5%), endometriosis (88.8%), and endometrioid carcinoma (54.5%) was observed most in SEOC group. The duration of follow-up time was between 3 and 171 months with a mean of 16 months. There was no death in SEOC who followed. Survivals of patients between three group were statistically significant (P=0.032).Conclusion: Our results showed that overall survival (OS) and progression-free survival (PFS) of SEOC patients is better than those with EC and OC (P=0.032).

Background: Creatine monohydrate (CrM) has been shown to be beneficial to health due to its antioxidant potential. Strenuous exercise is associated with oxidative stress, which could lead to apoptosis. We investigated the ability of CrM in amelioration of apoptosis induced by incremental aerobic exercise (AE) to exhaustion in young athletes.Materials and Methods: In a placebo-controlled, double-blind, randomized, parallel study, 31 young athletes (age 19.52 ± 2.75 years, body mass 79.24 ± 16.13 kg, height 1.73 ± 6.49 m, body fat 16.37% ± 5.92%) were randomly assigned to CrM (4 × 5 g/day, n=15) or placebo (PL: 4 × 5 g/day of maltodextrine powder; n=16) to investigate the effect of 7 days CrM on serum p53 and insulin-like growth factor-1 (IGF-1) concentration after acute incremental AE test to exhaustion. Subjects performed AE before (test 1) and after 7 days of supplementation (test 2).Results: Before supplementation, AE to exhaustion induced a significant increase in serum p53 and IGF-1 concentrations at both CrM and PL groups (P<0.05). After supplementation, serum p53 concentrations were significantly lower in CrM than PL at post-AE (P<0.05). There were no differences in IGF-1 concentrations between CrM and PL groups at post-AE (P>0.05).Conclusion: Our results suggest that supplementation with CrM prevents apoptosis, as measured by decreases in p53 concentration, induced by AE to exhaustion in young athletes. However, CrM had no effect on IGF-1 concentration after AE to exhaustion in young athletes.

Background: We aimed to investigate the effects of general, spinal and epidural anesthesia on fetal total antioxidant status (TAS) and total oxidant status (TOS), and oxidative stress index (OSI) during elective cesarean section in this study.Materials and Methods: Forty-seven parturients scheduled for elective cesarean section were randomly allocated into three groups: Group spinal (n=15), group epidural (n=17), and group general (n=15), This prospective randomized study was performed in Faculty of Medicine, TurgutOzal University, Turkey. After the baby was delivered; TAS, TOS levels, and arterial blood gases parameters were analyzed in an umbilical arterial blood sample. OSI values are calculated by a ratio of TOS to the TAS.Results: The levels of TAS and TOS in umbilical arterial blood sample were not statistically different among three. However, OSI values were significantly diff erent among the three groups (P=0.042). Median OSI values is 24 (interquartile range [IQR], 2-37) in group spinal, 19 (IQR, 4-44) in group epidural, and 8 (IQR, 4-36) in group general. There was no significant difference in OSI values in the comparison of group spinal with group general and group epidural, but it was significantly lower in group general when compared with group epidural with Bonferroni correction (P= 0.017). Umbilical cord arterial blood gas values (pH, PaCO2, PaO2, SaO2, HCO3, and CtO2), glucose, lactate, and hemoglobin levels were similar in three groups.Conclusion: General anesthesia may be more favorable than epidural in those undergoing cesarean section when fetal oxidative status gains importance.

Background: Chronic kidney disease is a progressive and irreversible loss of renal function. Anemia is one of the main complications of end-stage renal disease (ESRD) which is linked closely with other complications of the disease. The primary therapy for anemia in these patients is erythropoietin (EPO). The goal of this study was to find the effect of Vitamin D administration in addition to the appropriate dose of EPO in ESRD patients with Vitamin D deficiency.Materials and Methods: This was a double-blind clinical trial on 64 ESRD patients undergoing hemodialysis in Amin and Noor Hospitals of Isfahan, Iran. The patients were divided into two groups of control and intervention. The intervention group was given Vitamin D supplements and the control group received placebo. The required dose of EPO to reach the target hemoglobin (Hb) was measured and statistically analyzed.Results: A total number of 32 females and 32 males were included in this study. All the patients in the treatment group were aged between 18 and 76 and the patients in the control group were aged between 21 and 76 years old. There was a significant statistical relationship between Vitamin D administration and the required dose of EPO in both groups (P=0.013). However, there was no correlation between the concentration of Hb and serum Vitamin D levels.Conclusion: Based on the main finding of this study, the relationship between Vitamin D administration and required dose of EPO seems that the predicted dose of Vitamin D prescribing strategy in Kidney Disease Outcomes Quality Initiative guidelines is not adequate to achieve normal serum Vitamin D in ESRD patients.

Background: Esophageal carcinoma is a common malignancy in the North East of Iran. Combined modality treatments have been adopted to improve survival in patients with esophageal carcinoma. In this trial, we evaluated the efficacy and toxicity of a preoperative concurrent chemoradiotherapy protocol in the patients with locally advanced esophageal carcinoma.Materials and Methods: Between 2006 and 2011, eligible patients with locally advanced esophageal carcinoma underwent concurrent radiotherapy and chemotherapy and 3-4 weeks later, esophagectomy. Pathologic response, overall survival rate, toxicity, and feasibility were evaluated.Results: One hundred ninety-seven patients with a median age of 59 (range: 27-70) entered the protocol. One hundred ninety-four cases (98.5%) had esophageal squamous cell carcinoma. Grades 3-4 of toxicity in patients undergoing neoadjuvant chemoradotherapy were as follows: Neutropenia in 21% and esophagitis in 2.5% of cases. There were 11 (5.6%) early death probably due to the treatment-related toxicities. One hundred twenty-seven patients underwent surgery with postsurgical mortality of 11%.In these cases, the complete pathological response was shown in 38 cases (29.9%) with a 5-year overall survival rates of 48.2% and median overall survival of 44 months (95% confidence interval, 24.46-63.54).Conclusion: The pathological response rate and the overall survival rate are promising in patients who completed the protocol as receiving at least one cycle of chemotherapy. However, the treatment toxicities were relatively high.

Background: This study aimed to determine the relationship between the environmental factor, clinical risk factors, and individual variables with mortality due to acute myocardial infarction (MI) in Isfahan.Materials and Methods: This cross-sectional study was performed between April 2012 and March 2013. The data on the patients’ mortality due to MI in Isfahan were obtained from the MI National Registry. The international classification system (ICD10: I21-I22) was used to diagnose MI. The air quality indicators and environmental variables were used to measure the air pollution. Multilevel logistic regression in the Stata software was used to determine the factors associated with mortality in patients and odds ratios (ORs) were calculated.Results: Six hundred eleven patients with MI were studied during 1-year.444 (72.2%) patients were male and the rest were female.4.7% of the patients died due to MI. The mean age at MI incidence was 62.2 ± 13 years. Of the air pollution parameters, PM10 had the maximum mean concentration (49.113 ppm), followed by NOX, NO, NO2, CO, SO2, and O3. The adjusted OR of mortality was derived 2.07 (95% CI: 1.5-2.85) for right bundle branch block, 1.5 (95% CI: 1.3-1.7) for ST-segment elevation MI, 1.84 (95% CI: 1.13-3) for age, 1.06 (95% CI: 1.01-1.20) for CO, 1.1 (95% CI: 1.03-1.30) for O3, and 1.04 (95% CI: 1.01-1.4) for SO2, all of which were considered as the risk factors of mortality.However, OR of mortality was 0.79 for precipitation (95% CI: 0.74-0.84) and 0.52 for angioplasty (95% CI: 0.4-0.68) were considered as protective factors of mortality. The individual characteristics including age, history of MI in the immediate family, hypertension, and diabetes were significantly associated with mortality from MI. The indices of air pollution including SO2, CO, O3, and environmental factors such as the precipitation and temperature were the determinants of mortality in patients with MI.Conclusion: With regards to the factors associated with mortality from MI reported in this study, air pollution and environmental factors, in addition to the risk factors and predictive factors, should be particularly addressed to control the mortality from MI.

Background: Multiple factors are involved in the development and progression of type 2 diabetes mellitus (DMII) to DMII with metabolic syndrome (MetS) and cardiovascular complications. To identify some of these factors, we aim to investigate the changes in erythrocyte membrane Na+/K+-ATPase activity, serum glucose, insulin, lipid profile, hemoglobin A1C (HbA1c), high-sensitivity C-reactive protein (hs-CRP), anthropometric measurements, and blood pressure in DMII with and without MetS.Materials and Methods: This cross-sectional study comprised 155 male subjects distributed into three groups as healthy controls (50 non-DMII volunteers), Group I (50 DMII without MetS), and Group II (55 DMII with MetS). Fasting blood samples were taken for the measurement of glucose, insulin, HbA1c, hs-CRP and lipid profile. Na+/K+-ATPase activity was determined in erythrocyte ghost.Results: Na+/K+-ATPase activity was significantly decreased in DMII groups compared with controls. No significant difference was shown in Na+/K+-ATPase activity between DMII groups. Total ATPase activity, total cholesterol and low-density lipoproteincholesterol levels were similar in the three groups. Levels of insulin, hs-CRP, triacylglycerols, systolic blood pressure, weight, waist and hip circumference, waist/hip ratio, and body mass index were significantly elevated and high-density lipoprotein-cholesterol significantly decreased only in Group II. Significant differences in serum glucose and hip circumference were seen between the groups.No significant differences in HbA1c levels were observed between DMII groups.Conclusion: Changes in many of the measured risk factors that occurred only in Group II compared with controls and Group I may provide an explanation of how DMII progresses to DMII with MetS and future cardiovascular complications.

Background: Recent evidences have supported migraine headache and neurally mediated syncope as the especial types of endotheliopathies. To determine endothelial function in patients with migraine headache or those with neurally mediated syncope, the present study was conducted.Materials and Methods: This cross-sectional study was performed on 93 consecutive patients aged 5-20 years in four groups; neurally mediated syncope, migraine, both neurally mediated syncope and migraine, and control groups. All subjects were tested for basic biophysical and biochemical features including age, gender, body mass index, systolic, and diastolic blood pressures, intima-media thickness (IMT) and flow-mediated dilation (FMD), blood hemoglobin, fasting blood glucose, lipid profile, intercellular adhesion molecule (ICAM), vascular cell adhesion molecule (VCAM), and E-selectin.Results: The mean levels of VCAM and ICAM were significantly higher in all groups when compared to control group (P<0.05). FMD was significantly higher in syncope, migraine, and syncope and migraine groups than in the control group (P<0.05). Furthermore, mean IMT was significantly lower in migraine and also in syncope and migraine groups than in syncope group and control group (P< 0.05). Examining the association between IMT and other baseline parameters showed positive association of IMT with systolic and diastolic blood pressures.Conclusion: Endothelial dysfunction is seen in both migraine headache and neurally mediated syncope.Changes in endothelial functional indices are also dependent on the blood pressure.

Background: Hyponatremia has poor outcomes in other cardiopulmonary disorders, but its predictive value in predicting mortality of patients with acute pulmonary embolism is unknown. So, we evaluate the mortality of inpatients diagnosed with pulmonary embolism (PE) who had hyponatremia at the time of admission.Materials and Methods: By conducting a cohort study in patients with acute pulmonary embolism admitted in Al-Zahra Hospital during the 24 months of the date of March 2012 to March 2014. We evaluated 224 patients admitted with a primary diagnosis of PE. We used logistic regression analysis to evaluate the independent relation among serum sodium levels at the time of presentation and 30 days mortality, with severity of illness and other patient risk factors were adjusted.Results: 109 patients (48.7%) had normal sodium level (serum level>137 mmol/L).115 patients had sodium level bellow 137 mmol/L. Of these, 56 (25%) had a sodium level 135-137 mmol/L and 59 (26.3%) had a sodium level<135 mmol/L.Patients with a serum sodium of>137, 135-137, and<135 mmol/L had a cumulative 30-day mortality of 14%, 21%, and 42% (P<0.0001), respectively. The mortality of patients with lower serum sodium was significantly increased. When the pulmonary embolism severity index and also its simplified form were replaced in the model and while some confounding variables such patients with a history of cancer, chronic pulmonary disease, heart failure, and chronic renal failure were excluded from statistics, the findings still remained similar.Conclusion: Among patients presenting with PE, hyponatremia is common and is an independent risk factor that increasing short-term mortality. This result could be encountered as a variable in determining of PE severity and mortality.

Background: This systematic review paper aims to study the experimental and human studies on the relationship between metabolic syndrome (MetS), its component and selenium (Se) concentration.Materials and Methods: The literature was searched in PubMed, Scopus, and Google Scholar databases with no time limitation using MetS X and Se key words in medical subject heading. The related papers were selected in three phases. After quality assessment, two reviewers extracted the data, whereas the third reviewer checked their extracted data. All evidence comes from experimental and laboratory studies.Results: Finally, 18 articles were included. While, some studies documented that as an antioxidant agent, Se might be correlated with endothelial function, large controversy exists about the type of correlation including positive, negative, and no correlation between MetS and Se levels in body. Some of the reviewed studies were focused on antioxidant supplementation effects on MetS, results also varied in this regard.Conclusion: This inconsistency could be because of diversity in study design, population, lack of special focus on Se and MetS, and finally the complex nature of MetS.

Background: We are aware of no systematic review or meta-analysis of published findings about the association between Vitamin D status and risk of gastric cancer (GC). We systematically reviewed the current evidence on the association between Vitamin D intake as well as serum 25-hydroxy Vitamin D (25 (OH) D) levels and risk of GC.Materials and Methods: Published evidence in this area was searched to August 2014 through the use of ISI Web of Science, Scopus, PubMed/Medline, Ovid Database, EMBASE, and Google Scholar for relevant articles by cross-referencing. Seven articles had reported odds ratios (ORs) or relative risks (RR) as their effect size; four papers had reported the ORs between Vitamin D intake and GC; and three papers had reported the association between serum 25 (OH) D and risk of GC.Results: Pooled effect size for comparison of highest versus lowest intakes of Vitamin D was 1.09 (95% confidence interval [CI]: 0.94, 1.25; P=0.26) indicating no significant association between Vitamin D intake and risk of GC. We failed to find a significant association between serum Vitamin D levels and risk of GC (OR: 0.92; 95% CI: 0.74-1.14; P=0.429). Among men, the pooled effect size or highest versus lowest category of serum Vitamin D levels was 0.92 (95% CI: 0.71, 1.18, P=0.49). The corresponding figures in women were 1.04 and 95% CI: 0.74-1.47 (P=0.80).Conclusion: We found no evidence for the significant association between Vitamin D status and risk of GC. However, due to limited data in this field, further studies are required to reach a definite conclusion.

Background: Recent studies demonstrated that resveratrol has many therapeutic effects on liver disorders. Resveratrol significantly increased survival after liver transplantation, decreased fat deposition, necrosis, and apoptosis which induced by ischemia in Wistar rats. It provided liver protection against chemical, cholestatic, and alcohol injury. Resveratrol can improve glucose metabolism and lipid profile and decrease liver fibrosis and steatosis. Furthermore, it was able to alter hepatic cell fatty acid composition. According to extension of liver disease around the world and necessity of finding new threat, this review critically examines the current preclinical in vitroand in vivo studies on the preventive and therapeutic effects of resveratrol in liver disorders.Materials and Methods: A search in PubMed, Google Scholar, and Scopus was undertaken to identify relevant literature using search terms, including “liver, ” “hepatic, ” and “Resveratrol.” Bothin vivo and in vitro studies were included. No time limiting considered for this search.Results: A total of 76 articles were eligible for this review. In these articles, resveratrol shows antioxidative properties in different models of hepatitis resulting in reducing of hepatic fibrosis.Conclusion: Resveratrol could reduce hepatic steatosis through modulating the insulin resistance and lipid profile in animals. These high quality preclinical studies propose the potential therapeutic implication of resveratrol in liver disorders especially those with hepatic steatosis. Resveratrol can play a pivotal role in prevention and treatment of liver disorders by reducing hepatic fibrosis.

Background: The effects of the vascular endothelial growth factor (VEGF) gene -2578C/A polymorphism on colorectal cancer (CRC) risk have been investigated in some studies; however, the results of these studies were conflicting and ambiguous. Therefore, we aimed to do a meta-analysis to investigate the association of VEGF −2578C/A polymorphisms with CRC risk from all eligible case-control studies published to date.Materials and Methods: An electronic search of the PubMed, Embase and Medline was performed. Retrieve terms were utilized as following: (“VEGF a” [MeSH Terms]) and (“polymorphism, genetic” [MeSH Terms]) and (“colorectal neoplasms” [MeSH Terms]). The association between VEGF-2578C/A polymorphisms with CRC risk was calculated with odds ratios (ORs) and their corresponding 95% of confi dence intervals (CIs), and stratified analysis was also conducted with respect to ethnicity.Results: A comprehensive meta-analysis of eight studies, including 2312 cases and 2308 controls was performed in this work. Combined analysis revealed that a significant association between the VEGF −2578C/A polymorphism with CRC risk was identified in three comparison models including C allele versus A allele (OR=0.85, 95% CI 0.75-0.97, P=0.02), AA versus CA+CC (OR=1.28, 95% CI 1.09-1.51, P=0.003), and AA versus CC (OR=0.77, 95% CI 0.64-0.93, P=0.006). Moreover, a similar result was obtained in the subgroup analysis that comparison models of C allele versus. A allele (OR=0.85, 95% CI 0.76-0.95, P=0.004), AA versus CA+CC (OR=1.31, 95% CI 1.09-1.57, P=0.004), and AA versus CC (OR=0.73, 95% CI 0.59-0.90, P=0.004) was confirmed to be associated with CRC risk in Caucasian.Conclusion: It has been proved that the C allele versus A allele, AA versus CA+CC, and AA versus CC comparison models of VEGF −2578C/A polymorphism might be risk factors for CRC, but further studies with larger sample sizes are required to make a better assessment of above association.

Calcium oxalate (CaOx) crystal deposition is a common finding immediately after kidney transplantation. However, small depositions of CaOx could be benign while extensive depositions lead to poor graft outcome. Here we report three cases with end-stage renal disease (ESRD), bilateral nephrolithiasis, and unknown diagnosis of primary hyperoxaluria (PH) who underwent a renal transplant and experienced an early-onset graft failure. Although an acute rejection was suspected, renal allograft biopsies and subsequent allograft nephrectomies showed extensive CaOx deposition, which raised a suspicion of PH. Even though increased urinary excretion of CaOx was found in all patients, this diagnosis could be confirmed with further tests including genetic study and metabolic assay.In conclusion, massive CaOx deposition in kidney allograft is an important cause of poor allograft survival and needs special management. Furthermore, our cases suggest patients with ESRD and a history of nephrolithiasis should be screened for elevated urinary oxalate excretion and rule out of PH.

Sir, Rubella is an infectious viral disease which often affects children and young adults without any major complications.However, acquisition of the infection in pregnant females can lead to serious consequences like fetal death or congenital defects known as congenital rubella syndrome (CRS).In fact, every year in excess of 0.1 million babies are born with CRS, of which majority of cases is being reported in South-East Asia and Africa.This is a major global and serious public health concern, as an extremely cost-eff ective option in the form of vaccine is available for more than four decades and still health sector is failing to avoid a preventable cause of disability.

Sir, Hallervorden-Spatz disease (HSD) is a rare neurological condition, caused by iron accumulation, which causes degeneration of the central nervous system.Blood and cerebrospinal fluid iron levels are normal.Accompanying Down syndrome (DS) is very rare.We present our anesthetic approach with midazolam, metoclopramide, and ranitidine combination for tooth extractions of a mentally retarded, DS patient with HSD.We did not come across the use of this combination for HSD patients during the literature search.