JOURNAL OF RESEARCH IN MEDICAL SCIENCES (JRMS)
Year:2015 | Volume:20 | Issue:6|Papers Count:17

Background: To date, few results on well-being in individuals with neurological disease have been published, while several studies in other groups have indicated that well-being may not be the only absence of psychological distress, but also positive psychological function. The aim of the present study was to compare the psychological well-being (PWB) between the people with Multiple sclerosis (MS) and normal individuals and identify correlated demographic factors to PWB in people with MS disorder. Materials and Methods: A case-control study was performed in July 2012 on 55 people with MS who were referred to MS clinic (located at the Kashani Hospital), Isfahan Neurosciences Research Centre and 83 normal individuals with matched mean of age, level of education, and gender. The participants filled up the 18-item Ryff’s PWB and demographic profile. The data were analyzed by SPSS software based on the independent t- test, and ANOVA.Results: There is significant different in all PWB dimensions between people with MS and normal groups. There were no significant differences in PWB in people with MS in relation to gender and marital status, but individuals with higher level of education scored higher in total PWB, positive relationship with others and purpose in life.Conclusion: People with MS are at risk of lower level of PWB. Interventional programs for improving PWB are strongly recommended.

Background: Tocotrienols have been shown to improve glycemic control and redox balance in an animal study, but their effects on patients with diabetes are unknown. The study aimed to investigate whether tocotrienols improves glycemic control, insulin sensitivity, and oxidative stress in individuals with type 2 diabetes mellitus (T2DM).Materials and Methods: This study was a double-blinded, placebo-controlled, randomized trial. A total of 50 patients, aged 35-60 years, with T2DM treated by noninsulin hypoglycemic drugs were randomly assigned to receive either 15 mL/day tocotrienols (200 mg) enriched canola oil (n=25) or pure canola oil (n=25) for 8 weeks. Fasting blood sugar (FBS), fasting insulin, total antioxidant capacity (TAC), malondialdehyde (MDA), and homeostatic model assessment for insulin resistance (HOMA-IR) were determined before and after the intervention. The data were compared between and within groups, before and after the intervention.Results: Baseline characteristics of participants including age, sex, physical activity, disease duration, and type of drug consumption were not significantly different between the two groups. In tocotrienol enriched canola oil, FBS (mean percent change: -15.4% vs.3.9%; P=0.006) and MDA (median percent change: –35.6% vs.16.3%; P=0.003) were significantly reduced while TAC was significantly increased (median percent change: 21.4% vs.2.3%; P=0.001) compared to pure canola oil. At the end of the study, patients who treated with tocotrienols had lower FBS (P=0.023) and MDA (P=0.044) compared to the pure canola oil group. However, tocotrienols had no effect on insulin concentrations and HOMA-IR.Conclusion: Tocotrienols can improve FBS concentrations and modifies redox balance in T2DM patients with poor glycemic control and can be considered in combination with hypoglycemic drugs to better control of T2DM.

Background: One of the most common anomalies in newborn infants is cleft lip and/or cleft palate (CL/P). In spite of several studies about the prevalence of this, no investigation evaluated this prevalence in the West and North-West of Iran. With due attention to different ethnic groups in this area, the aim of this study is to investigate whether the distribution of CL/P live births varies regionally in this area of Iran.Materials and Methods: A cross-sectional study was conducted using hospital registry records to identify all children born with CL/P. The hospitals with a maternity unit were selected in the capital cities of four provinces in the West and North-West of Iran, East Azarbaijan, Kurdestan, Gilan, and Markazi. The population under study included all infants born alive from 2008 to 2012.Results: During the study period, 107, 317 live births were registered in the hospitals with a maternity unit of four cities, and 52 infants (0.485/1000 live births) were born with CL/P. The prevalence in Rasht, Arak, Sanandaj, and Tabriz cities was 0.557, 0.352, 0.503, and 0.559/1000 live births, respectively (P<0.05), and in cleft types (P<0.05). Of the 52 infants who were born with CL/P, 24 (46.15%) were girls and 28 (53.85%) were boys (P>0.05), whereas the prevalence of CL/P based on sex was statistically different among the four provinces (P<0.05).Conclusion: This study shows regional variations in the birth prevalence of clefts and various cleft types. The different effects of gender on the birth prevalence of CL/P from city-to-city may be explained environmentally and/or by genetic factors affecting the development of oral clefts.

Background: Factor V G1691A (FV Leiden), FII GA20210, and methylenetetrahydrofolate reductase (MTHFR) C677T mutations are the most common genetic risk factors for thromboembolism in the Western countries. However, there is rare data in Iran about cerebral venous and sinus thrombosis (CVST) patients. The aim of this study was to evaluate the frequency of common genetic thrombophilic factors in CVST patients.Materials and Methods: Forty consequently CVST patients from two University Hospital in Isfahan University of Medical Sciences aged more than 15 years from January 2009 to January 2011 were recruited. In parallel, 51 healthy subjects with the same age and race from similar population selected as controls. FV Leiden, FII GA20210, MTHFR C677T, and FV Cambridge gene mutations by polymerase chain reaction technique were evaluated in case and control groups.Results: FV Leiden, FII GA20210, and FV Cambridge gene mutations had very low prevalence in both case (5%, 2%, 0%) and control (2.5%, 0%, 0%) and were not found any significant difference between groups. MTHFR C677T mutations was in 22 (55%) of patients in case group and 18 (35.5%) of control group (P=0.09).Conclusion: This study showed that the prevalence of FV Leiden, FII GA20210, and FV Cambridge were low. Laboratory investigations of these mutations as a routine test for all patients with CVST may not be cost benefit.

Background: There is a global interest for deploying faculty members’ activities evaluation systems, however implementing a fair and reliable system is a challenging issue. In this study, the authors devised a model for evaluation of faculty members’ activities with regard to their viewpoints and meta-evaluation standards.Materials and Methods: The reliability of the current faculty members’ activities metrics system was investigated in Medical School of Tehran University of Medical Sciences in 2014. Then authors conducted semi-structured interviews regarding meta-evaluation standards and designed a questionnaire based on interviews’ results which were delivered to faculty members. Finally, they extracted the components of the model regarding interviews’ content analysis and questionnaire’s factor analysis and finalized them in a focus group session with experts.Results: Reliability of the current system was 0.99 (P<0.05). The final model had six dimensions (mission alignment, accuracy, explicit, satisfaction, appropriateness, and constructiveness) derived from factor analysis of the questionnaire and nine factors (consensus, self-reporting, web-based system, evaluation period, minimum expectancies, analysis intervals, verifiers, flexibility, and decision making) obtained via qualitative content analysis of the interviews.Conclusion: In this study, the authors presented a model for faculty members’ activities evaluation based on meta-evaluation of the existing system. The model covered conceptual and executive aspects. Faculty members’ viewpoints were the core component of this model, so it would be acceptable in a medical school to use the model for evaluating their activities.

Background: Diabetic nephropathy (DN) is one of the most important complications of diabetes mellitus. Now-a-days, cystatin C (CysC) is introduced as a new marker for diagnosis of renal damages; however, use of this marker in clinical laboratories is still controversial. The present study was aimed to evaluate the diagnostic value of serum CysC for early detection or monitoring treatment of kidney damages in the Kurdish people with type 2 diabetes mellitus.Materials and Methods: Glomerular filtration rate (GFR) was estimated by Modification of Diet in Renal Disease formula. Serum CysC and urine microalbumin were also measured in 126 diabetic and healthy subjects. Blood glycated hemoglobin (Hb) also measured in all healthy and diabetic patients. Two independent samples t -test, Mann-Whitney U-test, one-way ANOVA, and Kruskal-Wallis test, as well as Pearson/Spearman correlation coefficient statistical tests were used as appropriate.Results: Serum CysC was higher (1312.41 ng/ml) in diabetic patients with GFR<60 ml/min than other subjects (993.25 ng/ml) (patients with normal kidney function and healthy subjects). A borderline significant correlation between CysC and estimating GFR (r s=-0.16, P=0.05) but highly significant with microalbumin (r s=0.22, P=0.014) was observed. Serum CysC sensitivity, negative and positive predictive values were 100 and 4%.Conclusion: CysC cover variation of GFR and urine microalbumin, but it cannot be used as a surrogating marker of glycated Hb. According to our results, it seems that serum CysC is a useful marker for screening of DN; but it cannot be used for monitoring of treatment in diabetic patients.

Background: Psychological profile of inflammatory bowel disease patients is not well studied in Iran. We investigated the psychological status of Iranian patients with ulcerative colitis (UC) and its relationship with disease activity and quality of life (QOL). Materials and Methods: A cross-sectional study was conducted on adult UC patients. The Lichtiger Colitis Activity Index, Hospital Anxiety and Depression Scale, General Health Questionnaire-12, and WHOQOL-BREF, were completed by the patients.Results: From 120 studied patients, 35 (29.2%), 48 (40.0%), and 46 (38.3%) had significant anxiety, depression, and psychological distress, respectively. Anxiety, depression, and psychological distress were strongly correlated with disease activity (r=0.357 to 0.439, P<0.01). Disease activity was negatively correlated with all QOL dimensions (r=-0.245 to -0.550, P<0.01). Anxiety, depression, and psychological distress were also negatively correlated with all QOL domains (r=-0.356 to -0.789, P<0.01). In the regression models, anxiety was independently associated with active disease (b=4.150, P=0.049). Furthermore, disease activity was associated with the physical health (b =-0.371, P<0.001). For almost all of the QOL domains, depression and psychological distress were independent predictors (b =-0.296 to -0.453, P<0.001).Conclusion: Anxiety, depression, and psychological distress are highly frequent in UC patients of our society and are strongly associated with disease activity. Depression and psychological distress are important predictors of poor QOL in these patients. Further prospective studies, as well as clinical trials, are warranted in this regard.

Background: In developing countries it is important to the exploration of available and safe regimens for medical abortion. The present study was designed to assess the effect of letrozole compared to placebo pretreatment followed by sublingual misoprostol for therapeutic abortion in eligible women with gestational age less than 17 weeks. Materials and Methods: In this randomized control trail, 130 women eligible for legal abortions were randomly divided into two groups of case and controls. Cases received daily oral dose of 10 mg letrozole 10 mg letrozole for three days followed by sublingual misoprostol. Controls received daily oral dose of placebo followed by sublingual misoprostol. The dose of misoprostol was administrated according to ACOG guidelines based on patients’ gestational age. The rate of complete abortion, induction-of-abortion time, and side-effects were assessed as main outcomes.Results: Complete abortion was observed in 46 (76.7%) letrozole group and 26 (42.6%) controls (P<0.0001). Also, in 14 subjects of letrozole group and 35 subjects in placebo group, the placenta was not delivered during follow-up and curettage was performed. The mean interval induction-to-abortion was 5.1 h in letrozole group and 8.9 h in control (P<0.0001). The cumulative rates of the induction-of-abortion time were a significant difference between the two groups (P<0.0001). The incidence and severity of side-effects was comparable for the two groups (P=0.9).Conclusion: Letrozole could be a quite beneficial adjuvant to misoprostol for induction of complete abortion in those who are candidates for legal medical abortion.

Background: Positive attitude leads to a more successfully implementation of a change. We investigated the effect of attitudes of stakeholders toward a program on their prioritization of the program components for selecting the key question of a theory-driven evaluation with concept mapping method. Materials and Methods: During a brainstorming session, stated statements defined the program components. Then they were sorted and rated regarding the importance and feasibility of them. In addition, the attitudes of participants were assessed by a 30 items questionnaire extracted from a pool named as “50 reasons not to change.” We determined and compared the consensus points of participants both with and without of considering their attitudes toward the program.Results: The participants were divided into two groups of high (45% - above the mean) and low (55% - below the mean) attitude. Brainstorming discussions generated a pool of almost 120 statements which were subsequently refined to 44 statements. Matching the rating scores between two attitude groups yielded a consensus at a higher priority than the other method.Conclusion: In the concept mapping procedure, it is crucial to reach the consensus with respect to the participants’ attitude, rather than the similarity of mean scores of feasibility and importance.

Background: Treating inflammatory bowel disease (IBD) with antidepressants might be of utility to improve patient’s condition. The aim of this study was to assess the efficacy of Duloxetine on depression, anxiety, severity of symptoms, and quality of life (QOL) in IBD patients. Materials and Methods: In a randomized, double-blind, controlled clinical trial on 2013-2014, in Alzahra Hospital (Isfahan, Iran), 44 IBD patients were chosen to receive either duloxetine (60 mg/day) or placebo. They were treated in a 12 weeks program, and all of the participants also received mesalazine, 2-4 g daily. We assessed anxiety and depression with Hospital Anxiety and Depression Scale, the severity of symptoms with Lichtiger Colitis Activity Index and QOL with World Health Organization Quality of Life Instruments, before and just after the treatment. The data were analyzed using Paired sample t -test and ANCOVA.Results: In 35 subjects who completed the study, the mean (standard error [SE]) scores of depression and anxiety were reduced in duloxetine more than placebo group, significantly (P=0.041 and P=0.049, respectively). The mean (SE) scores of severity of symptom were also reduced in duloxetine more than the placebo group, significantly (P=0.02). The mean (SE) scores of physical, psychological, and social dimensions of QOL were increased after treatment with duloxetine more than placebo group, significantly (P=0.001, P=0.038, and P=0.015, respectively). The environmental QOL was not increased significantly (P=0.260).Conclusion: Duloxetine is probably effective and safe for reducing depression, anxiety and severity of physical symptoms. It also could increase physical, psychological, and social QOL in patients.

Background: These findings from several observational studies, investigated the association between red meat consumption and gliomas, were inconsistent. We conducted a systematic review and meta-analysis of observational studies to summarize available date on the relation between meat intake and risk of glioma. Materials and Methods: A systematic literature search of relevant reports published until May 2014 of the PubMed/Medline, ISI Web of Knowledge, Excerpta Medica database, Ovid database, Google Scholar, and Scopus databases was conducted. From 723 articles yielded in the preliminary literature search, data from eighteen publications (14 case-control, three cohort, and one nested case-control study) on unprocessed red meat, processed meat, and/or total red meat consumption in relation to glioma in adults were included in the analysis. Quality assessment of studies was performed. Random effects model was used to conduct the meta-analysis.Results: We found a positive significant association between unprocessed red meat intake and risk of glioma (relative risk [RR] =1.30; 95% confidence interval [CI]: 1.08-1.58) after excluding three studies with uncertain type of brain cancer. This analysis included only one cohort study which revealed no relation between unprocessed red meat intake and glioma (RR=1.75; 95% CI: 0.35-8.77). Consumption of processed meats was not related to increased risk of glioma in population-based case-control studies (RR=1.26; 95% CI: 1.05-1.51) and reduced risk in hospital-based case-controls (RR=0.79; 95% CI: 0.65-0.97). No significant association was seen between processed red meat intake and risk of glioma in cohort studies (RR: 1.08; 95% CI: 0.84-1.37). Total red meat consumption was not associated with risk of adult glioma in case-control or cohort studies.Conclusion: In this meta-analysis of 18 observational studies, we found a modest positive association between unprocessed red meat intake and risk of gliomas based almost entirely on case-control studies. Processed red meat was overall not associated with risk of gliomas in case-control or cohort studies.

Background: Early puberty is a common worldwide problem. Different parameters as genetics, metabolic diseases, obesity, as well as environmental factors may affect the age of puberty. This systematic review aims to survey the related literature on the effects of environmental pollutants and especially organohalogens and phthalates on early puberty. Materials and Methods: A systematic review of papers published in the English language was completed in January 2014. Studies on the associations of organohalogens and phthalates with the puberty time were included. A literature search was conducted in EMBASE, PubMed, Scopus, ISI Web of Science, and Cochrane Library from 1995 to January 2014; moreover manual search through references of relevant manuscripts was considered. The literature search identified 212 papers, of which 13 papers fulfilled the inclusion criteria of the current study. Two reviewers independently identified relevant papers for potential inclusion and assessed the methodological quality.Results: This review included 6572 participants in nine countries from three continents (Europe, North America, and Asia). Different studies determined the effects of pollutants on maturation signs and pubertal stages and confirmed the association of organohalogens and phthalates with early puberty.Conclusion: Based on the studied literature, environmental pollutants surround and accumulate in human societies and their adverse health effects are well documented. It can be concluded that organohalogens and phthalates are disturbing the normal process of puberty timing; especially their influence on early maturation in girls should be underscored.

Background: Numerous studies have evaluated the association between the angiotensinogen (AGT) T174M polymorphism and ischemic stroke (IS) risk. However, the specific association is still controversial.Materials and Methods: In order to explore this association more deeply, we performed a meta-analysis. All of the relevant studies were identified from PubMed, Embase, and Chinese National Knowledge Infrastructure database up to October 2014. Statistical analyses were conducted with STATA 12.0 software. Odds ratio (OR) with 95% confidence interval (CI) values were applied to evaluate the strength of the association.Results: Six studies with 1290 cases and 1125 controls were included. No significant variation in IS risk was detected in any of the genetic models in the overall (MM vs. TT: OR=1.64, 95% CI=0.51-5.28; MT vs. TT: OR=0.93, 95% CI=0.66-1.31; dominant model: OR=1.08, 95% CI=0.69-1.72; recessive model: OR=0.61, 95% CI=0.20-1.91). Taking into account the effect of ethnicity, further stratified analyses were performed. The results showed that AGT gene T174M polymorphism might be associated with IS risk in Asians (MM vs. TT: OR=3.28, 95% CI=1.79-6.02; recessive model: OR=0.31, 95% CI=0.17-0.57).Conclusion: In conclusion, the AGT T174M polymorphism may be a susceptible predictor of the risk of IS in Asians. Further, large and well-designed studies are needed to confirm this conclusion.

Sir, Diabetic kidney disease is one of the most devastating complications affecting diabetic patients’ survival. When suffering from both type 1 diabetes mellitus (DM) and end-stage renal disease (ESRD), simultaneous pancreas-kidney transplantation (SPKT) is the best therapeutic option and life-saving procedure.Hypertension is known to be a common comorbidity associated with DM. The incidence of hypertension is above 60%, in some regions even exceeding 75%, among patients with DM. Both hypertension and DM related closely to an increased risk of morbidity and mortality due to long-term macro- and microvascular pathological conditions, notably chronic kidney disease. Furthermore, 80-90% of patients at stages IV and V chronic kidney disease suffer from resistant hypertension. Therefore, hypertension may have a great impact on the long-term outcome after SPKT. Here, we present a case of SPKT patient who survived over 10 years without cardiovascular complications under effectively immunosuppressive and anti-hypertensive medication.

Sir, A previously healthy 54-year-old woman presented to our hospital with a 3-month history of pelvic pain. There was no history of constitutional symptoms such as unintentional weight loss, fever, and loss of appetite. Clinical examination revealed pain on deep palpation of the right iliac region. There was no evidence of soft tissue swelling or redness in the site of patient’s pain. The rest of physical exam was unremarkable. Laboratory investigations were within normal limits (erythrocytes sedimentation rate of 20 mm in the 1st h, negative C-reactive protein and white blood count of 4800 per ml).

Sir, Decubitus ulcer is a common and serious problem for inpatients in hospital. When someone is in sleep mode, pressure of his body weight enters at certain points and in the long-term, this will result in bruises and ultimately incurable wounds; therefore, hospital staff has to rotate these patients on their beds regularly to prevent it from happening. Due to the fact that prevention is more cost-effective than treatment and with the great cooperation of healthcare staff in the prevention of decubitus ulcer, decubitus ulcer is still as a significant problem for certain patients in hospital and society.

Sir, Our study was designed to sequence the entire exonic regions and intronic junctions of theBRCA1, BRCA2, and PTEN genes with regard to identifying the influence of PTEN mutations in two Iranian families with familial breast cancer and BRCA1/2 wild-type genes.