JOURNAL OF RESEARCH IN MEDICAL SCIENCES (JRMS)
Year:2011 | Volume:16 | Issue:2|Papers Count:24

In the December issue of the Journal of Research in Medical Sciences, Alizadeh et al1 have demonstrated that consumption of a legumes-rich hypocaloric diet for 6 weeks reduced some anthropometric measures such as waist, hip, triceps, biceps, subscapular and suprailiac skin fold thicknesses among healthy premenopausal women with central obesity.

BACKGROUND: Considering that serum gamma-glutamyl transferase (GGT) activity could reflect several different processes relevant to diabetes pathogenesis and the increasing rate of type 2 diabetes worldwide, the aim of this study was to assess the association between serum GGT concentrations and glucose intolerance, in the first-degree relatives (FDR) of type 2 diabetic patients.METHODS: In this descriptive study, 30-80 years old, non diabetic FDRs of type 2 diabetic patients were studied. Serum GGT was measured by enzymatic photometry method in all studied population. The relationship between GGT and glucose intolerance status (normal, prediabetic and diabetics) was evaluated.RESULTS: During this study 551 non-diabetic FDRs of type 2 diabetic patients were studied. Mean of GGT was 25.3 ± 12.1 IU/L. According to glucose tolerance test, 153 were normal and 217 and 181 were diabetic and prediabetic respectively. Mean of GGT in normal, prediabetic and diabetic patients was 23.5 ± 15.9 IU/L, 29.1 ± 28.1 IU/L and 30.9 ± 24.8 IU/L respectively (p=0.000). The proportion of prediabetic and diabetic patients was higher in higher quartile of GGT and there was a significant correlation between GGT and BMI, HbA1c, FPG, cholesterol, LDL-C, and triglyceride (p < 0.05). There was a significant relation between GGT and area under the curve (AUC) of oral glucose tolerance test (p=0.00).CONCLUSIONS: Measurement of GGT in FDRs of type 2 diabetic patients may be useful in assessing the risk of diabetes; those with chronically high levels of GGT should be considered as high risk group for diabetes.

BACKGROUND: Irritable bowel syndrome (IBS) is a chronic functional bowel disorder that up to 20% of the population is suffering from it. Also benign prostatic hyperplasia (BPH) is a common problem that approximately 90 percent of men may be affected by this condition until the eighth decade of their life. Prostatectomy as a surgery and pelvic intervention can cause IBS.METHODS: It was a case-control study including 66 patients in 2 case groups and 66 patients in 2 control groups. Case groups were patients who underwent open prostatectomy and transurethral resection of the prostate (TURP) and control groups were patients who were candidate for prostatectomy.RESULTS: Ten patients in case groups and five patients in control groups had IBS. There was no significant difference in IBS between control and case groups (p=0.117).CONCLUSIONS: This is the first forward study regarding bowel symptom changes following prostatectomy. The main positive finding of this study is that open prostatectomy was followed by significant increase in diarrhea and bowel habit alternation associated with onset of abdominal pain. Specifically the change was found after open operation but not after TURP. Prostatectomy whether in form of open or transurethral may cause onset of abdominal discomfort and bowel habit change.

BACKGROUND: Various techniques are used in diagnosing cardiac diseases. The electrocardiogram is one of these tools in common use. In this study vectorcardiogram (VCG) signals are used as a tool for detection of cardiac ischemia.METHODS: VCG signals used in this study were obtained form 60 patients suspected to have ischemia disease and 10 normal candidates. Verification of the ischemia had done by the cardiologist during strain test by the evaluation of electrocardiogram (ECG) records and patient's clinical history. The recorder device was Cardiax digital recorder system.The VCG signals were recorded in Frank lead configuration system.RESULTS: Extracted ischemia VCG signals have been configured with 22 features. Feature dimensionalities were reduced by the use of Independent Components Analysis and Principal Component Analysis tools. Results obtained from strain test indicated that among 60 subjects, 50 had negative results and 10 had positive results. Ischemia detection of neural network using VCG parameters indicates 86% accuracy. Classification result on neural network using ECG ischemia detection parameters is 73% accurate. Accumulative evaluation including VCG analysis and strain test indicates 90% consistency.CONCLUSIONS: Regarding the obtained results in this study, VCG has higher accuracy than ECG, so that in cases which ECG signal cannot provide certain diagnosis of existence or non-existence of ischemia, VCG signal can help in a wider range. We suggest the use of VCG as an auxiliary low cost tool in ischemia detection.

BACKGROUND: Rapid measuring of B-type natriuretic peptide (BNP) in the emergency departments effectively results in evaluating patients with acute cardiac attacks and has appeared to be a useful prognostic marker of cardiovascular risk. A current study came to address the association between plasma N-terminal pro BNP level and severity of coronary vessels' defects based on Gensini score in patients with stable angina pectoris candidate for coronary angiography.METHODS: The study population consisted of 92 consecutive patients with appearance of stable angina and candidate for coronary angiography. All participants underwent selective left and right coronary angiography. For BNP measurement and just before the catheterization of left coronary, 5cc blood samples were drawn from coronary.RESULTS: With respect to the role of N terminal pro BNP for predicting severity of CAD based on Gensini scoring, linear regression analysis confirmed that plasma BNP level was a strong predictor for CAD severity (p=0.009) in the presence of study cofounders. A significant correlation was also observed between N terminal pro BNP and left ventricular ejection fraction, so that all patients with left ventricular dysfunction (EF < 40%) had plasma N terminal pro BNP level higher than 100 pg/ml.CONCLUSIONS: NT-pro BNP can be a good parameter for predicting the severity of coronary vessels' involvement besides other diagnostic tools. In all patients with left ventricular ejection fraction less than 40%, plasma NT-pro BNP level was higher than 100 pg/ml.

BACKGROUND: The aim of this study was to determine the efficacy of two methods of colon preparation for colon cleansing in a randomized controlled trial.METHODS: In this prospective randomized investigator-blinded trial, consecutive outpatients indicated for elective colonoscopy were randomized into two groups. Patients in Senna group took 24 tablets of 11 mg Senna in two divided doses 24 hour before colonoscopy. In Poly Ethylene Glycol {PEG) group they solved 4 sachets in 4 liters of water the day before the procedure and were asked to drink 250 ml every 15 minutes. The overall quality of colon cleansing was evaluated using the Aronchick scoring scale. Difficulty of the procedure, patients' tolerance and compliance and adverse events were also evaluated.RESULTS: 322 patients were enrolled in the study. There was no significant difference in the quality of colon cleansing, patients' tolerance, compliance and the difficulty of the procedure between two groups (p>0.05). The incidence 9f adverse effects was similar between two groups except for abdominal pain that was more severe in Senna group (p<0.05) and nausea and vomiting that was more common in PEG group (p<0.05) CONCLUSIONIS: In conclusion we deduce that Senna has the same efficacy and patient's acceptance as Polyethylene glycol- electrolyte solution (PEG-ES) and it could be prescribed as an alternative method for bowel preparation.

BACKGROUND: Antropometric measures with biochemical indicators have been used as screening tools for metabolic abnormalities in adolescents and adults. A few studies have assessed the relation of EWET (Enlarge waist Elevated triglyceride) phenotype with diabetes, especially among individuals with first relative history of diabetes. This study aimed to evaluate the association of EWET phenotype with diabetes among individuals with family history of diabetes.METHODS: Antropometric and biochemical measurments were evaluated in a population – based cross – sectional study of 332 male and 991 female Isfahani adults aged 35-55 year. The EWET phenotype was defined as serum trigcylglycerol concentrations ³ 150 mg/dl and concurrent waist circumference (WC) ³ 88 cm in females and ³ 102 cm in males.RESULTS: The prevalence of EWET phenotype was respectively 9.6% and 23.6% among male and female. Individuals with the phenotype had significantly higher BMI and WHR (waist to hip ratio) as compared to other groups. After control for age and physical activity, male with EWET phenotype were significantly more likely to have high serum triglyceride levels (p < 0.001), cholesterol (p < 0.001). Even after additional control for BMI, the significant associations remained except for low HDL Cholestrol. Female with EWET phenotype had significantly adverse metabolic risks as compared to other groups, either before or after control for BMI (p < 0.001). Individuals with the phenotype were more likely to have diabetes (both gender) and (IGT) Impaired Glucose Tolerance (female only).CONCLUSIONS: Our results showed that EWET phenotype has significantly associated with diabetes. This phenotype could be used for early identification of diabetes and IGT.

BACKGROUND: The aim of this study was to determine the effect of Ramadan fasting on fetal growth and Doppler indices of pregnancy.METHODS: Fifty two healthy pregnant women of second or third trimester, 25 in fasting group and 27 in non fasting group were included. Growth parameters including biparietal diameter (BPD), femoral length (FL), abdominal circumference (AC), estimated fetal weight, amniotic fluid index and also Doppler indices of both uterine and umbilical arteries (including peak systolic and end diastolic velocity, systolic to diastolic ratio, resistive and pulsatility indices) were evaluated by Gray scale and colour Doppler imaging for each women two times, in the beginning and at the end of Ramadan.RESULTS: Increases in BPD, FL, AC and fetal weight within one month were similar in two groups. Amniotic fluid index also were similar in two groups. There was not any statistically significant difference in abnormal Doppler indices of uterine or umbilical artery between two groups.CONCLUSIONS: The results of present study show that Ramadan fasting has no adverse effect on fetal growth, amniotic fluid volume or maternofetal circulation.

BACKGROUND: Insulin-like growth factor 1 (IGF-I) is an anabolic growth factor that affects nitrogen balance and its changing trend is not clearly understood in critically ill patients. This study was carried out to evaluate the association between serum IGF-I levels and its changing trend in critically ill patients.METHODS: In this nested case-control study, all consecutive patients admitted to the medical ICU of Rasoul-e-Akram and Firuzgar hospital (Tehran, Iran) from January through October 2008 were included. IGF1 concentration was measured within the first 24h of ICU admission and the fourth, seventh and tenth day since admission. Patients were followed until discharge from ICU or expiration.RESULTS: The study population consisted of 90 patients (mean age: 58.01 ± 22.56), 31 (34.4%) of who died and 59 (65.6%) were discharged. On admission, 43 patients (47.7%) had low IGF-I levels, whereas 47 (52.3%) had normal or high levels. The concentration of IGF-I was not significantly different in every 4 measurements between expired and discharged patients. Significant decrease was seen between first to fourth day IGF-I concentration (p=0.005). Changing trend was not statistically different in two groups of patients.CONCLUSIONS: There was no relation between low IGF-I concentration on admission day and increased adverse outcome, but overall these patients had lower IGF1. No clear association was found between changing trend of IGF1 and mortality. Stress on admission time may cause decreasing pattern of IGF-I in the first 4 days of admission.

BACKGROUND: Diabetes mellitus is one of the most important epidemics of our era. Complications of this disease are diverse and include retinopathy, nephropathy and neuropathy. This study has been designed to evaluate hearing loss patterns in young children suffering from IDDM and define risk factors for this complication.METHODS: This descriptive analytic study includes 200 youngsters divided into two groups: 100 patients in diabetic group and 100 healthy individual in control group. Hearing thresholds are determined in 250, 500, 1000, 2000, 4000 and 8000 Hz and metabolic controls are evaluated as average of one year HbA1C, dividing diabetic group into well control and poor control subgroups.RESULTS: Twenty one out of 100 patients in diabetic group showed significant hearing loss. Hearing loss is correlated with metabolic control, showing less loss in patients with HbA1C less than 7.5%. Results showed that hearing loss is not related to sex of patients but duration of disease (more or less than 5 years) affects degree of hearing loss in some frequencies.CONCLUSIONS: Hearing loss in children suffering from IDDM is sensorineural, bilateral and symmetrical and is related to the duration of disease and state of metabolic control (HbA1C).

BACKGROUND: The prevalence of Helicobacter pylori infection, which may increase the risk of gastritis, peptic ulcers, and cancer, has increased worldwide. This number is estimated to be around 70–90% in developing countries and 25–50% in developed countries. It is possible that the bacterium can be transmitted via food and water as well as zoonotically and iatrogenically. Because of high prevalence of this infection in Iran, the aim of this study is to examine whether H. pylori infection might be transmitted from cow's milk and faeces.METHODS: The existence of the H. pylori antibody and antigen was investigated in samples of serum, milk, and faeces from 92 lactating Holstein cows in Shahrekord, Iran. The H. pylori antigen and antibody were detected using ELISA and were confirmed by PCR.RESULTS: It was found that out of 92 serum specimens, 25 (27%) of the cows were positive for the H. pylori antibody and 67 specimens were negative. From these 25 seropositive cows, 10 (40%) faeces samples and four (16%) milk samples were antigen positive for H. pylori. Four of the antigen-positive milk specimens were also antigen positive for faeces.The existence of the UreC gene was also confirmed in positive samples of milk and faeces.CONCLUSIONS: There is a possibility that cow's milk is a transmission mode in H. pylori infection and faecal contamination and inappropriate management processes could transfer H. pylori to humans. The awareness of the H. pylori epidemiology and its method of distribution are necessary for public health measures and controlling the spread of this bacterium. Further investigation with a greater sample number is necessary to verify the ability of H. pylori transmission via milk consumption.

BACKGROUND: Analysis of venous blood gas (VBG) can represent arterial blood gas (ABG) analysis in patients with various diseases. The effects of hypotension on differences between the results of simultaneous venous and arterial blood gas analyses were reviewed.METHODS: This observational, cross-sectional study was conducted from March to October 2010 in emergency departments of two university hospitals in Tehran (Iran) on consecutive adult patients for whom ABG had been indicated for diagnosis/treatment. Arterial and peripheral venous bloods were simultaneously sampled with blood pressure measurement.The VBG-ABG amount of difference regarding pH, HCO3, PCO2, PO2, SO2, and Base Excess (BE) was compared between those with and without hypotension.RESULTS: During the study, 192 patients (51.6 ± 23.6 years, 67.7% males) were entered into the hypotension (n=78) and normotensive groups (n=114). The average VBG-ABG amount of difference (95% limits of agreement) in the hypotension versus normotensive group were -0.030 (-0.09 to 0.03) vs. -0.016 (-0.1 to 0.068) for pH (p=0.01), 1.79 (-1.91 to 5.49) vs.1.32 (-1.94 to 4.58) mEq/L for HCO3 (p=0.032), 2.69 (-20.43 to 25.81) vs.2.03 (-7.75 to 11.81) mmHg for PCO2 (p=0.295), -35.97 (-130.17 to 58.23) vs. -32.65 (-104.79 to 39.49) mmHg for PO2 (p=0.293), -18.58 (-14.66 to 51.82) vs. -9.06 (-31.28 to 13.16) percent (p < 0.001) for SO2, and 0.25 (-3.73 to 4.23) vs.0.79 (-2.51 to 4.09) for BE (p=0.036).CONCLUSIONS: Hypotensive status is associated with an increase in the amount of difference between VBG and ABG analysis regarding pH, HCO3, and BE, though the amount of increase does not seem to be clinically important. Studying the precise effects of replacing ABG with VBG on the clinical decision-making and the following outcomes is worthwhile.

BACKGROUND: Ischemic heart diseases are the most common cardiovascular diseases. This study aimed to assess the effects of video training about risk factors based on health belief model on knowledge and attitude of myocardial infarction patients after discharge.METHODS: This was a quasi-experimental study conducted in 2010. Eighty patients were randomly assigned to either intervention or control group. Data was collected by a researcher-made questionnaire.RESULTS: Study results showed that the mean score of knowledge about disease, diet, physical activity and perceived benefit, severity, and susceptibility after video training was increased significantly.CONCLUSIONS: Using videos for educating myocardial infarction patients is a useful method for preventing recurrence of the disease.

BACKGROUND: The symptoms of irritable bowel syndrome (IBS) are common in the general population. The aim of this population-based study was to determine the prevalence of IBS and describe the associated factors including demographic, life style and health-seeking behaviors in Shiraz city, southern Iran.METHODS: From April to September 2004, 1978 subjects aged > 35 years old completed a validated and reliable questionnaire on IBS.RESULTS: The prevalence rate of IBS was 10.9%, higher in females, in 35-44 years old age group and among subjects eating fast food (14.1%) but was lower in those taking more fruits and vegetables (10.5%). The occurrence of anxiety, nightmare and restlessness was also significantly higher in subjects with IBS. It had an association with psychological distress and recurrent headaches but not with drinking tea/coffee, smoking or physical activity.CONCLUSIONS: In our area, IBS was correlated with gender, age, psychological distress, recurrent headaches and consumption of fast foods that necessitate health planning programs by health policy makers.

BACKGROUND: The purpose of this study is to discuss a possible new risk factor for the bacterial meningitis.METHODS: Cerebrospinal fluid collected from 270 patients was assayed. An enzyme immunosorbent assay for the detection of Staphylococcal enterotoxins A to E was used.RESULTS: The results indicated that the frequency of Coagulase Negative Staphylococci (CoNS) was 35 (20.46%). An important finding of this research was that the CoNS isolates produced enterotoxin C and D or enterotoxin C and E.CONCLUSIONS: This is the first report of enterotoxin-producing Coagulase Negative Staphylococci isolated from CSF patients. Therefore, these enterotoxins probably act as risk factors in the bacterial invasion into central nervous system.

The physician's acquittal has obsessed Iranian legislator's mind to a large extent. This is exclusively observed in Iranian statuses and specifically in Shi' ite school of though. Muslim jurists' opinions play a very important role in enacting legal articles related to it. After reviewing the literature, the authors tried to pick and collect common features of physician' s responsibilities and duties to introduce Iranian Acts with respect to the subject. Also, Iranian Acts are analyzed and the challenging medical topics such as emergency situations and infectious diseases are discussed.Iranian legislator didn' t specify a kind of physician's acquittal which received from the patient knowingly and is based on his/her free will. There are also some medical and legal gaps. Patients are not often informed of all exact and scientific information and results of their treatments. Furthermore, the forms prepared to receive the patient's consent do not provide what Iranian legislator meant.

A 77-year-old male patient with a history of tuberculosis applied to emergency service with complaints of confusion, shortness of breath, tachycardia, hypothermia and hypotension. A bronchoalveolar lavage culture was collected because a fungus ball was seen on repeat chest X-ray and thoracic CT of the patient. Aspergillus fumigatus grew and voriconazole treatment was started, but the patient was lost from multiple organ failure (MOF). In diagnosis of patients with SIRS clinic, causative factor may be aspergillus located in an old tuberculosis cavity, and this may have a fatal course in an old patient having previous pulmonary and systemic diseases.

Cemento-ossifying fibroma is a lesion containing both fibrous and osseous components. Such lesions include fibrous dysplasia, ossifying fibroma, cemento-ossifying fibroma and cementifying fibroma. Periodontal membrane is the origin of fibro-osseous lesions other than fibrous dysplasia.Here a clinical case of a young woman referred for evaluation of a mass in the right side of face between eye and nose is presented. The first time she noticed the mass was 2 years ago and was growing larger inwards. She was treated with surgical resection.In this case of a cemento-ossifying fibroma, histological interpretation was critical, and was the basis of correct treatment.

A male patient with muscle weakness had clinical findings of ptosis, diplopia, proximal leg weakness, and positive repetitive nerve stimulation (RNS) test. He demonstrated positive acetylcholine receptor antibody. This lung cancer patient was presenting myasthenia gravis. The causal association between non-small-cell lung cancer and nonthymomatous myasthenia gravis has not been clarified yet. To date, there has been no evidence supporting the speculation that association of myasthenia gravis with lung cancer might be one of the phenotypes of paraneoplastic syndrome.

A 73 years old female presented to emergency department (ED) with 3 days history of swollen, painful right ankle without trauma; unable to weight bear on the right side. On examination she had decreased range of motion (ROM) in the right ankle, with a palpable gap in the area of Achilles tendon. Radiographs confirmed fracture of ossified Achilles tendon.This patient treated conservatively in a plaster for 6 weeks (Figure 1).Discussion Ossification of Achilles tendon is a rare condition, 1 and very few cases have been reported in the literature.2 It is more common in males, and is usually associated with prior surgery or trauma. It is usually asymptomatic, and has clinical importance only in case of rupture.3 The exact mechanism of ossification of tendo Achilles is not clear. It is thought that it can arise from calcareous (periosteal origin) or from the tendon diagnosis made with radiographs.