JOURNAL OF RESEARCH IN MEDICAL SCIENCES (JRMS)
Year:2019 | Volume:24 | Issue:9|Papers Count:8

Background: Although positive airway pressure (PAP) therapy is effective for treating obstructive sleep apnea (OSA), some patients with severe OSA are intolerable to this treatment, which may lead to an increase in the mortality and morbidity of cardiovascular diseases. We investigated the relationship between heart rate variability (HRV) and sleep parameters during natural sleep and treatment of patients with OSA. Materials and Methods: This was the cross‑ sectional observation study. Patients were 17 males with severe OSA who were unable to accept continuous PAP. Standard polysomnography was performed for two consecutive nights, i. e., during natural sleep and following night with bilevel PAP (BiPAP) treatment. Time‑ dependent responses of the amplitudes of low frequency (LF), very low frequency (VLF), and high frequency components of HRV were assessed with the technique of complex demodulation. Results: Apnea– hypopnea index, oxygen desaturation time, and percentage of stage 1 sleep were significantly reduced, whereas the percentages of rapid eye movement and stages 3 + 4 sleep were increased, by BiPAP treatment. Therapy also reduced the amplitudes of VLF and LF components of HRV. Difference in amplitudes of VLF during natural sleep and treatment with BiPAP was significantly correlated with difference in percentages of stage 1 and stages 3 + 4 sleep. Conclusion: Therapy‑ induced amelioration of OSA and sleep quality was accompanied by decrease in the amplitudes of VLF components of HRV. The VLF component may thus reflect physiological changes in both autonomic activity and sleep structure and serve as an objective marker for therapeutic efficacy in patients with severe OSA.

Acromegaly is a rare chronic disease and associated with an increased risk of malignancy. The issue of the risk of thyroid cancer in these patients is a topic of debate, and the number of large case– control studies is very limited. Several studies indicated that a chronic excess insulin‑ like growth factor‑ 1 stimulates the proliferation of various cell types and induces an antiapoptotic effect in thyroid follicular cells. In the literature, the risk of thyroid cancer was reported greater than five‑ fold. In this review, we will briefly summarize the studies available regarding thyroid cancer in patients with acromegaly and present three case reports.

Sir, Human immunodeficiency virus (HIV) patients continue to be at high risk of acquiring bacterial bloodstream infections (BSIs) despite antiretroviral treatment. [1] Clinical utility of high‑ class antibiotics, especially the third‑ generation cephalosporins and carbapenems as treatment options, drives the emergence of multidrug‑ resistant (MDR) bacteria. [2] Studying bacterial etiology of BSI in HIV patients and understanding their resistance rate to antibiotics would help in the proper antibiotic selection for treatment regimens and avoid further emergence of antibiotic resistance...

Background: This study aimed to assess the accuracy of three‑ point compression ultrasonography (3PCUS) performed for the diagnosis of proximal deep‑ vein thrombosis (DVT) in Emergency Department (ED) compared with the results of duplex US (DUS) (whole‑ leg compression ultrasound). Materials and Methods: The current prospective cross‑ sectional study with diagnostic test assessment was conducted on adult patients who were referred to the ED of a general teaching hospital in Shiraz, southern part of Iran (September 2016– May 2017), suspected of lower‑ extremity DVT, using a convenience sampling. The results of 3PCUS performed by ED residents were compared with the results of DUS performed by the radiology residents, which was considered as a criterion standard. Results: A total of 240 patients were enrolled, with a mean (standard deviation) age of 59. 46 (16. 58). 3PCUS has a sensitivity and a specificity of 100% (95% confidence interval [CI], 96. 55%– 100%) and 93. 33% (95% CI, 87. 72%– 96. 91%), respectively, in comparison with DUS (whole‑ leg compression ultrasound). Negative predictive value and positive predictive value were 100% and 92. 11% (95% CI, 86. 12%– 95. 64%), respectively, with an accuracy of 96. 25% (95% CI, 93%– 98. 27%). Conclusion: The results of this study showed that 3PCUS of the lower extremities with a portable US machine, performed by the ED’ s residents, can accurately identify the presence or absence of lower‑ extremity DVT.

Background: Considered the increasing rate of cardiovascular diseases (CVDs) and a positive relationship between prevalence of CVDs and obesity, the goal of the present study was to investigate the effects of green tea supplement and high‑ intensity interval training (HIIT) on lipid panel, fibrinogen, and maximal oxygen consumption (VO2max) in overweight women. Materials and Methods: In this randomized placebo‑ controlled clinical trial, 30 overweight women (age range, 20– 30 years), were chosen purposefully and randomly divided into three equal groups (green tea, HIIT + green tea, and HIIT + placebo), and they trained HIIT workouts for 10 weeks (40‑ m maximal shuttle run) and used 500 mg/daily green tea or placebo tablets. Serum levels of low‑ density lipoprotein (LDL), high‑ density lipoprotein (HDL), triglyceride (TG), and plasma level of fibrinogen were assessed before and after the intervention in fasting state. To test the hypothesis of the research, Paired t‑ test, Wilcoxon signed‑ rank test, analysis of covariance, and Tukey’ s post hoc tests were used at the significance level of P ≤ 0. 05. Results: After 10 weeks, TG, LDL, weight, fibrinogen, and body fat percentage decreased in all groups (P ≤ 0. 05). Further, HDL (P = 0. 012) and VO2max (P = 0. 007) significantly increased in HIIT + green tea and HIIT + placebo groups; while in the green tea group, HDL (P = 0. 06) and VO2max (P = 0. 06) showed no significant difference for within group differences. Average between‑ group variations of all indicators were statistically significant, and they were more meaningfully pronounced in HIIT + green tea group than the other two groups (P ≤ 0. 05). Conclusion: Based on the findings, the combination of HIIT and green tea consumption significantly leads to a reduction in weight, body fat percentage, fibrinogen, TG, and LDL while improves VO2max and HDL levels rather than green tea consumption or performing training alone, in overweight women. However, it seems that exercise training has a vital role in the improvement of mentioned variables according to percentage changes.

Background: For both the clinician and a radiologist, the diagnosis of cerebral venous sinus thrombosis (CVST), because of the variety of signs and symptoms, remains a challenge. In this study, the role of unenhanced brain computed tomography (CT) in the diagnosis of CVST was assessed. Materials and Methods: In this case– control study, unenhanced CT of 35 patients with acute CVST was compared with 70 normal patients. Hematocrit (HCT), creatinine, and blood urea nitrogen were recorded in all patients. CT images were read, and the attenuation was measured by two independent experienced radiologists. The H: H ratio was calculated for all patients in both case and control groups to normalized densities regarding HCT. Results: The mean of attenuation in patients was 66. 95 ± 10. 63 Hounsfield unit (HU) and in the controls was 52. 51 ± 2. 92 HU (P < 0. 0001). The mean of H: H ratio in patients was 1. 78 ± 0. 40 and in controls was 1. 46 ± 0. 28 (P < 0. 0001). Attenuation >60. 4 HU was the best optimal cutoff with area under the curve of 0. 918 (0. 848– 0. 962) and had 71. 4% sensitivity and 100% specificity. H: H ratio >1. 42 as the optimal cutoff had 94. 3% sensitivity and 54. 3% specificity for identifying the CVST. Conclusion: Attenuation value >60. 4 HU and H: H ratio >1. 42 calculated based on unenhanced CT can be used as reliable methods to detect CVST in the absence of magnetic resonance imaging and magnetic resonance venography in the emergency setting.

Background: Invention of peritoneal dialysis (PD) has opened new windows for patients under dialysis due to its fewer time requirement and being ambulatory in comparison to hemodialysis. Open surgery and laparoscopic technique have been utilized for peritoneal catheter embedding; however, data about the superior technique are controversial. This study aimed to assess the outcomes of open surgery versus laparoscopic technique and compare their complications in those with survival of over and less than a year in patients who need PD for the first time. Materials and Methods: This randomized clinical trial study was conducted on 121 cases admitted for PD. Patients were randomly divided into two groups undergoing either open or laparoscopic surgery for embedding PD catheter. Patients’ demographics, as well as PD function and complications, were followed for a 12‑ month duration and compared between the two groups. Results: Catheter survival for over 12 months occurred in 39 patients (65%) underwent laparoscopic surgery, and 45 (73. 8%) patients underwent open surgery (P = 0. 09). Complications, including catheter obstruction, leak, abdominal hernia, and peritonitis, were not statistically different between the two techniques over 12 months of survival (P > 0. 05). Complications among the catheters with less than a year survival, including obstruction, leak, catheter displacement, hernia, and peritonitis, were not significantly different comparing open surgery with laparoscopic technique (P > 0. 05). Conclusion: Considering complications, PD catheter implantation through laparoscopic surgery was not statistically different from open surgery, neither for those with less than 12 months of survival nor for those with over a year.

Sir, Investing in health refers to the investment in human resources, material, equipment, physical space, and intersectional and international interactions. One type of investment in the field of health is smart investment. Smart investment means informed decisions, making for investing in an accurate and accountable opportunity, so that an investor exactly supervised how to invest and the protection of capital. [1] It is significant that the return on investment in health field is almost twice of that in oil and gas fields and with smart investment in a specified time period achieved optimal productivity...