JOURNAL OF RESEARCH IN MEDICAL SCIENCES (JRMS)
Year:2020 | Volume:25 | Issue:5|Papers Count:10

Background: The reasonable use of amino acids (AAs) in parenteral nutrition (PN) is very critical to the growth and development of premature infants. However, the appropriate dose of AAs has not been determined. Our study was designed to investigate the clinical effect of two different doses of AAs in PN for low birth weight premature infants. Materials and Methods: This randomized controlled study included 191 preterm infants who admitted to the neonatal intensive care unit of the First Affiliated Hospital of Nanjing Medical University from June 2015 to December 2016 and they were randomly divided into Group 1 (n = 81) and Group 2 (n = 110). In Group 1, the starting dose of AAs dose was 1. 0– 1. 5 g/kg/day, which was increased by 0. 5 g/kg with the maximum dose at 3. 5 g/kg/day. In Group 2, the starting dose of AAs was 1. 8– 2. 5 g/kg/day and was increased by 1. 0 g/kg with the maximum dose at 4. 0– 4. 5 g/kg/day. We analyzed the clinical characteristics, body weight, body length, total calorie intake, nonprotein calorie intake, total protein intake, liver and kidney function, and complications of the two groups of preterm infants. Results: The start of enteral feeding and the recovery of birth weight in Group 2 were earlier than those in Group 1 (3. 83 ± 3. 15 day vs. 5. 53 ± 5. 63 day, P = 0. 016 and 6. 36 ± 4. 88 day vs. 8. 48 ± 9. 27 day, P = 0. 043, respectively). The duration of PN and the time before total enteral nutrition were shorter in Group 2 than in Group 1 (16. 46 ± 10. 33 day vs. 21. 41 ± 18. 00 day, P = 0. 029 and 15. 47 ± 10. 54 day vs. 19. 47 ± 14. 57 day, P = 0. 038; respectively). The duration of mechanical ventilation (1. 12 ± 2. 62 day vs. 3. 31 ± 8. 13 day, P = 0. 028) in Group 2 was shorter than that in Group 1. Conclusion: High doses of AAs in the early PN for preterm infants facilitate the promotion of early growth and development, advance recovery of birth weight, reduce the duration of PN, and reduce respiratory support without increasing the incidence of complications.

Background: The role of inflammatory states in cardiometabolic risks among patients with type 2 diabetes mellitus (T2DM) with similar degrees of obesity is unknown. The study aimed to compare cardiometabolic risk factors in inflammatory obesity phenotypes with regard to the role of the FTO rs9939609 gene polymorphism. Materials and Methods: This study was performed on 155 patients with T2DM (77 men and 78 women) in Ahvaz, Iran. Participants were grouped into four groups based on the presence of obesity and inflammation (high‑ sensitivity C‑ reactive protein ≥ 3. 9 mg/L): low inflammatory normal weight (LINW), high inflammatory normal weight (HINW), low inflammatory obese (LIO), and high inflammatory obese (HIO). The genotypes of FTO rs9939609, including homozygous carriers of the FTO risk allele (AA), heterozygous carriers (AT), and carrying no risk allele (TT), were studied. The cardiometabolic risk factors, including anthropometric status, hypertension, lipid and glycemic profile, and inflammatory markers, were evaluated. The waist– hip ratio (WHR), mean arterial pressure (MAP), and atherogenic index of plasma (AIP) were calculated. Results: The patients in inflammatory groups (HINW and HIO) have significantly higher levels in AIP when compared to inflammatory healthy groups (LINW and LIO). No significant differences between any of the four group means were detected in WHR, blood pressure, MAP, glycemic status (fasting blood sugar and insulin), homeostatic model assessment, lipid profile (triglyceride, very low‑ density lipoprotein, high‑ density lipoprotein, low‑ density lipoprotein, and cholesterol), interleukin‑ 6, and total antioxidant capacity. The most frequent of high‑ risk genotype (AA) of FTO rs9939609 was in HIO, LIO, HINW, and LINW. Conclusion: T2DM patients with inflammatory condition have similar degree of increased atherogenic risk irrespective of obesity. The obesity‑ risk genotype AA of FTO gene was associated with an increased risk for inflammatory obesity in T2DM patients.

Background: Although increasing salt intake is associated with greater odds of obesity, little is known about its relationship with body fat. We investigated the relation of urinary sodium (UNa) with obesity indices, including Clí nica Universidad de Navarra– Body Adiposity Estimator (CUN‑ BAE), a body shape index (ABSI), body mass index (BMI), waist circumference (WC), and waist‑ to‑ height ratio (WHtR). Materials and Methods: A total of 508 free‑ living adults aged ≥ 19 years were selected through stratified multistage random method as a representative of general population from central parts of Iran and were included in this cross‑ sectional study. Dietary sodium intake was measured using 24‑ h UNa (24‑ UNa) excretion. Weight, height, and WC were measured using standard protocols and calibrated equipment and used to measure obesity indicators, including BMI, WHtR, ABSI, and CUN‑ BAE. Adjusted univariate multiple logistic regression was used to assess the risk of having greater obesity measures across the tertiles of 24‑ UNa. Results: Individuals in the top tertile of 24‑ UNa in comparison with those in the first tertile had greater body weight (72. 02 ± 1. 00 vs. 66. 02 ± 0. 89 kg; P < 0. 0001), BMI (26. 14 ± 0. 33 vs. 24. 82 ± 0. 29 kg/m2; P = 0. 007), and CUN‑ BAE (29. 89 ± 0. 42 vs. 28. 38 ± 0. 78; P = 0. 036). There was a trend toward an increment in WC by increasing sodium intake (P = 0. 073). After controlling for potential confounders, individuals with greater sodium consumption had greater chance for overweight (odds ratio [OR]: 1. 004, 95% confidence interval [CI]: 1. 001– 1. 007; P = 0. 015), abdominal obesity (OR: 1. 004, 95% CI: 1. 00– 1. 008; P = 0. 031), and more body fat (OR: 1. 007, 95% CI: 1. 003– 1. 01; P = 0. 001). No significant association was found for sodium and WHtR and ABSI. Conclusion: Greater 24‑ UNa excretion was associated with greater means of body weight, BMI, WC, and CUN‑ BAE. Although changes in obesity indices per each additional 24‑ UNa excretion were small, our findings are relevant because of the rising obesity epidemic.

Background: Failed extubation and subsequent re‑ intubation in ventilated patients can lead to many adverse consequences, including organizational and personal expenditures. Extubation decisions based on subjective methods are a major contributor to extubation failure. This study compared the effect of cough peak expiratory flow (PEF) measurement and cough strength measurement using the white card test (WCT) on extubation success. Materials and Methods: This randomized clinical trial was conducted in two groups in 2018 on 88 ventilated patients in intensive care units of Imam Reza Hospital in Mashhad, Iran. Ninety patients were divided into two groups of 45, but two were excluded from the white card group. The criteria established for extubation included PEF ≥ 60 L/ min during coughing in the cough PEF group and noticing card humidity in the WCT group. In both groups, extubation success was determined as the sole outcome and was compared with the standard PEF and cough strength. The researcher who assessed the outcome and statistician were blinded about group allocation. Results: Extubation success was measured as 97. 8% in the cough PEF group and 76. 7% in the WCT group (P = 0. 003) during the first 24 h. In the second 24 h, however, successful extubation was reported as 90. 9% in the cough PEF group and 60. 6% in the WCT group (P = 0. 002). Conclusion: Using the cough PEF rate increases the likelihood of extubation success and reduces adverse effects, and is recommended to be used for extubation decision‑ making.

Background: Duane’ s retraction syndrome is a congenital eye movement anomaly with narrowing of the palpebral fissure and globe retraction on attempted adduction. There are several surgical approaches to treat the narrowing of the palpebral fissure. The purpose of the present study was to evaluate the efficacy of unilateral medial rectus recession (MRR) muscle combined lateral rectus (LR) muscle marginal myotomy (MM) with unilateral MRR alone in the management of narrowing of the palpebral fissure of patients with Type 1 Duane’ s retraction syndrome (DRS). Materials and Methods: Twenty‑ eight patients with unilateral DRS Type 1 were randomly divided into two groups (14 eyes of 14 patients in each group). Age ≥ 5 years with DRS Type 1 with <20 prism diopters in primary position who were candidates for surgery were consecutively enrolled in this randomized controlled trial. Patients were divided into treatment groups to receive unilateral MR recession with simultaneous MM group or with unilateral MR recession alone. The amount of deviation in primary position, abnormal head position, palpebral fissure width (PFW), and up/down shoot was evaluated before and 3 months after the surgery. This study was registered at the Iranian Registry of Clinical Trials under the registration code IRCT20131229015975N3. Results: PFW increased within MRR/MM group at the end of the study (8. 86 ± 1. 51) compared with the baseline (7. 79 ± 1. 48) (P < 0. 001). In contrast, in the MRR/MM group, PFW did not increase statistically significantly within the MRR group at the end of the study (8. 14 ± 1. 35) compared with the baseline (8. 07 ± 1. 38) (P = 0. 67). Mean ± standard deviation of PFW (mm) in MRR/MM group after surgery (8. 86 ± 1. 51) was statistically significantly higher than that in the MRR group (8. 14 ± 1. 35), (P = 0. 002). Conclusion: The results of our study demonstrate PFW significantly increased after unilateral MRR muscle combined LR muscle MM.

Dear Editor, Emerging viral infection is considered an important problem for the medical society. There are many new emerging virus infectious diseases. In December 2019, a new coronavirus infection, Wuhan coronavirus infection, was firstly reported from China and became a global public health consideration. [1] The countries that have international relationship with China with many international flights have to implement infectious control programs against the new emerging disease. Thailand, a country in Southeast Asia, is a country with many international flights from China, which had implemented the standard thermo‑ scan screening at all border posts at international airports for the detection of the emerging Wuhan coronavirus infection. Here, the authors summarize the observation on the screening during the 1st month of disease emergence...

Background: Serous adenocarcinoma of the uterine cervix is an extremely rare variant of cervical adenocarcinoma. This study aimed to evaluate the clinicopathological and molecular features and outcomes of serous adenocarcinoma of the uterine cervix (SACC). Materials and Methods: This was a retrospective study conducted based on the clinical and pathological data of seven patients diagnosed with SACC after hysterectomy, who were evaluated at the gynecologic oncologic centers between 2010 and 2019. Results: Five cases were diagnosed at Stage IB and two at Stage IV. All patients underwent radical hysterectomy with bilateral salpingo‑ oophorectomy and subsequently received postoperative radiotherapy or chemotherapy. One patient showed persistent disease, and two patients suffered recurrence. Immunohistochemical study showed that three (43%) of the seven patients were positive for p53, and among these three patients, two with diffuse strong p53 expression experienced an aggressive course with recurrences at pelvic lymph nodes, lung, and brain. Conclusion: High p53 expression and advanced stage may be associated with poorer clinical outcomes in SACC, which suggest that immunohistochemistry may contribute to the prediction of prognosis.

Background: Scoliosis is a three‑ dimensional deformity of the spine with lateral curvature in addition to the rotation of vertebral bodies. The aim of the present study was to determine the prevalence of adolescent idiopathic scoliosis (AIS) in our society and its demographic‑ related factors. Materials and Methods: This was a cross‑ sectional study that took place from November 2014 to March 2015 in Isfahan, Iran. During the period of study, 24 schools were randomly chosen from six zones by a simple random sampling method. In each school, about 120 students were randomly selected and evaluated. Anterior forward bending test and scoliometry were done in all students and suspicious ones referred to Alzahra spine clinic for further evaluation. The diagnosis of AIS was based on radiographic finding and Cobb angle more than 10° . Data about age, sex, height, body mass index, hand dominancy, and type of schoolbag were recorded. Results: A total number of 3018 children were evaluated and 19 were diagnosed with AIS that showed the prevalence of 0. 62%. None of the study variables had a significant relation with the presence of AIS. The cutoff point for the detection of AIS with scoliometry was calculated as 3. 5, with a sensitivity of 73. 7% and specificity of 86. 7%. Conclusion: The prevalence of AIS in our area was 0. 62%, which was lower than previous reports and did not have a relation with demographic factors; however, screening surveys identify a significant number of children with AIS who could benefit from preventive treatment.

Background: Considering the role of Vitamin D in cardiovascular disease (CVD) and the relationship between coronary artery calcification (CAC) and CVD, we aimed to investigate the association between the serum level of Vitamin D and CAC. Materials and Methods: This was a cross‑ sectional study on 67 consecutive patients who were referred for performing computed tomography angiography. We used Spearman correlation to evaluate the relationship between Vitamin D and CAC and then linear regressions to control for demographics and vascular risk factors. Results: There was no association between CAC and Vitamin D levels (Spearman coefficient = − 0. 03, P = 0. 805). After controlling for age, sex, hypertension, hyperlipidemia, diabetes mellitus, and smoking, there was still no association between Vitamin D and CAC score (estimate = 0. 001, S. E. = 0. 020, P = 0. 942). Conclusion: We did not find the association between the serum level of Vitamin D and coronary artery calcification.

COVID19 is an emerging pandemic outbreak that is changing our life causing a big challenge worldwide. [1] A major concern is being the virus highly and rapidly contagious, very protean clinical features along with the poor preparedness of global armamentarium against this “ gate‑ crasher. ” Apart from proper preventive measures, we as clinicians should find a way to cope optimally with the inflicted victims. Given the new face of a wild disease in addition to the absence adequate data on the treatment of COVID19 no standard of care is proposed so far; a great burden on health care systems. Most of the international and local guidelines on treatments are based on empirical and/or anecdotal reports with overall disappointing results and rather high morbidity and mortality...