Jundishapur Journal of Chronic Disease Care
Year:2021 | Volume:10 | Issue:3|Papers Count:10

Background: The association of celiac disease (CD) with refractory hypothyroidism is a known but less common condition. Objectives: This study aimed to evaluate the prevalence of CD among patients with refractory hypothyroidism and compare the accuracy of diff erent diagnostic procedures of CD in these patients. Methods: During a six-month period, 25 patients with refractory hypothyroidism were included from the endocrinology outpatient clinics of Ahvaz Jundishapur University of Medical Sciences, Khuzestan, Iran. For all the participants, the serological profi le of CD, including anti-tissue transglutaminase (anti-tTG), anti-endomysial antibody (anti-EMA), and total immunoglobulin A, was determined, and then they were referred to undergo upper endoscopy and random biopsies from the fi rst and second parts of the duodenum. Results: The average duration of hypothyroidism among the participants was 7 months. In addition, 75% of the patients (n = 19) were female. The mean age values of male and female subjects were 31. 3  17 and 34. 3  8. 5 years, respectively (age range: 17-53 years). The average daily dosage of levothyroxine was 285. 1  89. 9 mg. The most common comorbidities were anemia (72%) and diarrhea (24%). The most frequent serologic fi ndings in these patients were positive anti-tTG (28%) and anti-EMA (16%). The most common results of upper endoscopy were normal mucosa (48%), gastritis (28%), duodenal fi ssuring (8%), duodenal atrophy (8%), and duodenal erythema (8%). Based on the results of the pathology report, 20% of the patients (n = 5) were diagnosed with CD (mostly marsh 1 and 0 stages). The sensitivity and specifi city of tTG were 33 and 87. 5%, respectively. The sensitivity and specifi city of EMA were 11. 1 and 87. 5%, respectively. Conclusions: Based on the results of this pilot study, the prevalence of CD among cases with refractory hypothyroidism is higher than that of global reports. Furthermore, routine screening of CD in these patients is highly recommended even with negative serology. The endoscopic view is not adequate for the diagnosis of CD among patients with refractory hypothyroidism. In addition, it is necessary to focus on pathology reports and antibody titer.

Background: Renal colic is one of the most common complaints among patients referring to the emergency department (ED). Non-steroidal anti-infl ammatory drugs (NSAIDs) and opioids are gold standards to refereeing patients. Objectives: The aim of this study was to evaluate the eff ects of intranasal Ketamine on pain control versus Ketorolac. Methods: In this randomized clinical trial (RCT), the patients were randomly assigned into two groups. Ketorolac 30 mg was given intravenously to all patients in the control group, the patients in intervention group received 1 mg/kg drops of Ketamine intranasally. Pain severity, vital signs, and adverse events (AEs) were recorded after 60 minutes post-dose. Results: A total of 100 patients were enrolled in this study. The mean visual analog scale (VAS) score after the fi rst 5 minutes was lower in the intranasal Ketamine group compared to control (5  2. 26 vs. 8. 62  0. 49, respectively; P < 0. 001), which remained signifi cant at the end of 60th minutes (P < 0. 001). Moreover, additional analgesics administration was higher in intravenous Ketorolac than intranasal Ketamine (22 vs 0%), which was signifi cantly diff erent (P = 0. 001). Patients’ satisfaction was higher in the intranasal Ketamine group compared to control (3. 56  0. 35 vs. 1. 82  0. 98, respectively; P < 0. 001). Conclusions: Intranasal Ketamine was benefi cial in controlling renal colic-induced pain, which could be prescribed as a treatment instead of normal treatment. It can rapidly improve pain relief in the short term, has lower AEs, and increases the patients’ satisfaction.

Background: Despite the role of hot weather and activity at high temperatures in physical and environmental stress influencing the occurrence or recurrence of heart disease, the role of seasonal variations in temperature in this disease has not been well studied. Objectives: This study aimed to investigate the relation of seasonal variations in temperature to the number of patients with ischemic heart disease and heart failure (HF). Methods: We extracted data, including file number, diagnosis, age, gender, hospitalization date, and discharge date, from the medical files of patients admitted to a referral center of heart diseases in a tropical region from 2013 to 2015. Results: Diagnosed and studied patients (n = 4, 041) were as follows: 625 (patients with HF), 2410 (patients with unstable angina), and 1006 (patients with myocardial infarction). A total of 57% of patients were male, and 43% were female. The average number of patients per day (P/d) in the cold season was higher than in other seasons (5. 89 versus 5. 53 in the moderate season and 5. 18 during the warm season). The mean length of hospitalization for patients with myocardial infarction (MI) and HF in the cold season was longer than in other seasons, and this difference was statistically significant (P = 0. 035 and 0. 021, respectively). Conclusions: All hospitalizations occurring with these diagnoses in cold seasons are longer, increasing the burden on the health care system. There are considerable seasonal variations in HF hospitalization and mortality. Immunization against pneumococcus and influenza and also more care are recommended in HF patients. There is a need for a season-based approach for better handling of acute coronary syndrome (ACS).

Background: The objective of the present study was to determine the impacts of an educational program by using group discussion on perceived stigma among family caregivers of people with Alzheimer’ s disease (AD). Methods: This nonequivalent non-randomized controlled trial was performed in 2015. A sample of 66 family caregivers of people with AD was recruited conveniently. The caregivers were non-randomly allocated to a control and an experimental group. Initially, the perceived stigma of all participants was measured by using the Stigma Impact Scale. Then a fi ve-session educational program by using group discussion was held over fi ve weeks for the caregivers in the experimental group. The caregivers in the control group received no intervention. The level of caregivers’ perceived stress was re-assessed both immediately and one month after the intervention. Results: The diff erence between the groups in terms of pretest perceived stigma was not statistically signifi cant (P = 0. 146). However, immediately and one month after the intervention, the mean score of perceived stigma in the experimental group was signifi cantly lower than in the control group (P < 0. 05). The results of repeated measures ANOVA for the between-subject factor of the group also showed that the intervention had signifi cant eff ects on the caregivers’ perceived stigma (P = 0. 004). Conclusions: The fi ndings of the present study showed the noticeable eff ects of the educational program using group discussion on the perceived stigma of family caregivers of people with AD. This fi nding can denote the importance of experience sharing in the psychological well-being of family caregivers. Through group discussion and experience sharing, caregivers learn the necessary skills for coping with their own problems. Given their eff ectiveness, educational interventions by using group discussion are recommended to reduce perceived stigma among family caregivers.

Universal health coverage guarantees access for all people to healthcare services. Global public health policy has a strong focus on patients with chronic diseases, but despite the clinical diff erences across people with certain medical conditions, all of these chronic states represent unique concerns for every patient at the personal level as coronavirus disease aff ects their follow-up care. The novel coronavirus pandemic has raised signifi cant concerns among healthcare professionals for the patients because worldwide health authorities put hospitals on lockdown by providing only emergency treatment and surgery. On the frontline, the COVID-19 evokes anxieties and fears in, and more than ever before, health professionals need to protect and defend the fundamental rights and safety of their patients now. This article indicates that we need to fi nd the best response of the hospital care management for patients with chronic diseases without allocating other important diseases and keep the patient informed on the risks and the needs of certain medical behavior. International Council of the Patient Ombudsman has a strong consensus on improving the communication to follow universal source control by diplomatic relations to provide non-COVID-19 clinical care during the pandemic.

Background: Research evidence shows that non-alcoholic fatty liver disease (NAFLD) is closely related to infl ammation. Objectives: This study aimed to evaluate the response of infl ammatory biomarkers to 10 weeks of aerobic resistance exercise in inactive postmenopausal women with NAFLD. Methods: In this purposeful quasi-experimental study, conducted in Mahshahr, Iran, in 2019, 24 inactive women aged 50-68 years who were diagnosed with fatty liver disease by ultrasound were randomly divided into training or control groups. The training group performed aerobic resistance training for 10 weeks using treadmills and bodybuilding machines. At the beginning and end of the study, serum interleukin 18 (IL18), interleukin 10 (IL10), and other blood parameters were measured, and the subjects underwent liver ultrasound and anthropometric evaluations. Results: The results of intergroup ANCOVA, intragroup paired t-test, and Wilcoxon showed that in response to 10 weeks of training, IL18 levels, anthropometric parameters, insulin resistance (HOMA-IR), liver enzymes, fasting glucose, triglyceride (TG), and liver fat were signifi cantly decreased and plasma IL10 was signifi cantly increased when compared to baseline results (P < 0. 05). Also, the results of the Spearman correlation test showed a signifi cant positive relationship between IL18 and waist circumference (WC), alanine aminotransferase (ALT), and HOMA-IR and a signifi cant negative relationship between IL10 and weight, WC, TG, HOMA-IR, and liver fat (P < 0. 05). Conclusions: Ten weeks of aerobic resistance training has a signifi cant eff ect on reducing serum IL18 and increasing IL10 levels in postmenopausal women with fatty liver and can be eff ective in improving NAFLD by losing weight, improving body composition, and reducing insulin resistance.

Background: Breast cancer (BC) is a major public health problem worldwide. Considering the high prevalence and mortality of BC in postmenopausal women, and since the population of Iran is aging, this study aimed to investigate the knowledge and attitude of postmenopausal women in Jahrom, Iran regarding BC screening. Methods: This cross-sectional study was performed on postmenopausal women referred to Honari Clinic of Jahrom in 2019. To select the samples, 120 women were randomly selected from the existing medical files. Data collection tools included a demographic information questionnaire and the knowledge and attitude questionnaire on BC screening behavior. After explaining the objectives of the research to the participants and obtaining a consent form, the questionnaire was answered by them. The data were entered into SPSS software version 21 and tested by descriptive statistics, chi-square, Kruskal-Wallis, and one-way ANOVA tests. Descriptive statistics were used to examine demographic data. Results: The level of knowledge of most participants (49. 2%) was moderate, and the majority of them (94. 2%) had a positive attitude. There was a significant association between the mean score of knowledge and attitude in postmenopausal women with source of information (P = 0. 004). Most information came from radio and television, physician, health system staff, and friends and relatives. There was no significant association between the mean score of knowledge and attitude of postmenopausal women with breastrelated diseases and family history of BC. Conclusions: The mass media, especially radio and television, as well as physician and health system staff, play an important role in raising women's awareness to increase their participation in BC screening programs.

Objective: Cyclin D1 is an essential protein that acts as a mitogenic sensor. In this manuscript, we discuss the importance of cyclin D1 in oncology and cardio-oncology, and we challenge the prognostic and therapeutic response values of cyclin D1 to figure out if it can be a beneficial marker. We also discuss the agents and microRNAs that can be used as a potential therapeutic approach via regulating cyclin D1 expression in oncology and cardio-oncology. Discussion: Clinical significance of cyclin D1 is defined not only in several cancers such as breast cancer, melanoma, and glioblastoma but also in cardiomyocyte regeneration and cardiac hypertrophic growth. Several studies have indicated that the injection of cardiotoxic agents such as doxorubicin (DOX) induces damage to the cardiac system and increases cyclin D expression at single injection, which might be related to DXO-mediated damage in the adult heart. However, cyclin D1 overexpression leads to hypertrophic growth of cardiomyocytes, and cyclin-dependent kinase (CDK)) inhibitors such as p16 do not inhibit the hypertrophic growth of cardiomyocytes. Thus, the reaction is CDK-independent. Conclusions: Cyclin D1 overexpression is positively correlated with tumor progression, treatment response, cardiotoxicity, and poor prognosis. Cyclin D1 expression has an important role in cardiac hypertrophy, and it can be a promising marker in monitoring cardiomyocyte treatment responses, cardioprotection, and cardiotoxicity. Finally, cyclin D1 plays an important role in hypertrophic growth of cardiomyocytes via a novel mechanism. Given all these pieces of evidence, cyclin D1 can be introduced as a favorable biomarker in future cardiology and cardio-oncology.

Background: The COVID-19 pandemic is one of the greatest challenges the world has faced during the last decades that has aff ected every aspect of human life. Objectives: This study aimed to identify the eff ects of the age composition of the countries on global mortality and the fi nal outcome of the COVID-19 outbreak. Methods: This ecological observational study used the World Health Organization (WHO) reports for information on COVID-19 in 42 countries with more than 1000 formal COVID-19 reports. The correlation coeffi cient between age composition pattern and COVID-19 deaths was calculated in selected countries by SPSS. Results: This study demonstrated a positive relationship between COVID-19-attributed death and the country population share of the 50-64 years age group at the signifi cance level of 90. 8%. The only age range that could aff ect the nationwide mortality rate was the age range of 50-64 years. There was not a signifi cant correlation between COVID-19-attributed death and the population share of 65 years and over. Conclusions: The young population is protective against COVID-19-related death, and they are productive and responsible for community needs during this pandemic crisis. Population aging and the increasing share of the elderly in population is one of the most critical social changes in the 21st century, and its consequences aff ect almost all sections of the society.

Background: Schizophrenia is one of the most serious mental disorders presenting in adolescence. Antipsychotic drugs are the basis of treatment and clinical management of patients with schizophrenia. Despite the effi cacy of risperidone as one of the antipsychotic drugs, about two-thirds of patients may experience both positive and negative symptoms during their life. Objectives: We evaluated the effi cacy of galantamine as an adjunctive treatment for ameliorating the negative symptoms of schizophrenia patients. Methods: This is a randomized double-blind phase II clinical trial study carried out on schizophrenia patients admitted to a psychiatric department. The patients were randomly divided into two equal groups using the block randomization method. The intervention group received 24 mg galantamine plus 2-6 mg risperidone, and controls received 24 mg placebo along with 2-6 mg risperidone. Neurological tests included the Scale for the Assessment of Negative Symptoms (SANS) and the Positive and Negative Syndrome Scale (PANSS) at baseline and weeks 2, 4, and 8 after treatment. Results: We studied 28 patients. The mean age of the participants was 44  3. 1 and 47  2. 7 years in the placebo and intervention groups, respectively. The PANSS score signifi cantly decreased over study time. The intervention group showed signifi cantly greater reduction slopes than the control group (P = 0. 034). Alogia (P = 0. 0016) and attention (P = 0. 0108) reduced more intensely in the intervention group than in the control group. Conclusions: Our fi ndings indicated that galantamine could signifi cantly aff ect the severity of the symptoms of schizophrenia patients. The fi ndings suggest galantine as an appropriate adjunctive treatment for ameliorating negative symptoms, especially attention and alogia.