JOURNAL OF RESEARCH IN MEDICAL SCIENCES (JRMS)
Year:2014 | Volume:18 | Issue:1|Papers Count:19

Background: The purpose of this study was to investigate the effects of the combination of vitex agnus castus extract, as a source of phytoestrogens, plus magnesium supplementation on osteogenic and angiogenic factors and callus formation in women with long bone fracture.Material and Methods: In a double-blind randomized placebo controlled trial, 64 women with long bone fracture, 20-45 years old, were randomly allocated to receive 1) one Agnugol tablet (4 mg dried fruit extract of vitex agnus castus) plus 250 mg magnesium oxide (VAC+Mg group (n=10)), 2) one Agnugol tablet plus placebo (VAC group (n=15)), 3) placebo plus 250 mg magnesium oxide (Mg group (n=12)), or 4) placebo plus placebo (placebo group (n=14)) per day for 8 weeks. At baseline and endpoint of the trial, serum alkaline phosphatase, osteocalcin, and vascular endothelial growth factor (VEGF) were measured together with radiological bone assessment.Results: There were no significant differences in the characteristic aspects of concern between the four groups at baseline. Despite the increased level of alkaline phosphatase in the VAC group (188.33±16.27 to 240.40±21.49, P=0.05), administration of VAC+Mg could not increase alkaline phosphatase activity. However, treatment with VAC+Mg significantly enhanced the osteocalcin level. The serum concentration of VEGF was increased in the VAC group (269.04±116.63 to 640.03±240.16, P<0.05). Callus formation in the VAC+Mg group was higher than the other groups but the differences between the four groups were not significant (P=0.39). No relevant side effect was observed in patients in each group.Conclusion: Our results suggest that administration of vitex agnus castus plus magnesium may promote fracture healing. However, more studies need to further explore the roles of vitex agnus castus in fracture repair processes.

Background: Hypercoagulability has been reported in primary brain tumors which can lead to thrombotic complications. Hydroxyethyl starch (hetastarch) is a synthetic colloid solution with adverse effects on blood coagulation. Th e aim of this study was to evaluate the protective effect of hetastarch in reducing thromboembolic events in these patients.Materials and Methods: In a double-blinded clinical trial, 60 brain tumor surgery patients were randomly divided into two groups and given 10 mL/kg hetastarch or normal saline during surgery. Blood coagulation was compared before and after infusion of these fluids within and between groups by thromboelastography (TEG).Results: There were no significant differences in bleeding (P=0.126), duration of surgery (P=0.504), and fluid intake (0.09L) between the two groups. Percentage of changes in R (R: Time to initiate fibrin formation), K (K: Measure of the speed taken to reach a specific level of clot strength), and Ly30 (Ly30: Percent of fibrin distraction after 30 minutes of clot formation) in the crystalloid group were –20.61±26.46, –30.02±49.10, and 1.27±22.63, and that in the colloid group were 22.10±26.11, 41.79±37.15, and 59.09±37.12, respectively. Deterioration in hemostasis during and after surgery was not observed.Conclusion: There was a reduction in the speed of clot formation and increase in clot lysis in the hetastarch group. Coagulability was decreased in the colloid group. Infusion of 10 mL/kg hetastarch in brain tumor resection surgeries can probably decrease susceptibility of these patients to deep vein thrombosis (DVT) and thromboembolic events.

Background: The correlation of metabolic syndrome and migraine headache was evaluated in some previous studies. However there is no study that compared the prevalence of metabolic syndrome in the patients with and without migraine. Control of coincidental factors such as metabolic syndrome reduces therapeutic resistance in migrainous patients. The aim of this study was to compare prevalence of metabolic syndrome in patients with and without migraine headache.Materials and Methods: 200 migrainous patients diagnosed according to International Headache Society and 200 healthy controls without migraine enrolled in this study. Metabolic syndrome was diagnosed according to ATP III criteria in these two groups and compared with each other.Results: In this study, 17% (34) of migrainous patients and 15% (30) of healthy control without migraine had metabolic syndrome. (P=0.585). Of the metabolic syndrome components, body mass index (P=0.05) and waist circumference in migrainous (P=0.03) were significantly more frequent.Conclusion: Our results demonstrate that metabolic syndrome and migraine headache had not significant correlation, however, higher body mass index and waist circumference as metabolic syndrome components had correlated with migraine headache.

Background: Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disease with autoimmune etiology, characterized by synovial inflammation and destruction of joint cartilage and bone. There are controversial data about the profile of interleukin-17 (IL-17A), interleukin-4 (IL-4), and interferon-gamma (INFg), indicating in some studies the key role of IL-17, while in others the Th1 cytokines.Materials and Methods: Serum samples of 31 early RA patients were evaluated for erythrocytes sedimentation rate (ESR), rheumatoid factor (RF), C-reactive protein (CRP), anti-cyclic citrullinated peptide antibodies (anti-CCP), and for the tested cytokines (IL-17A, IL-4, and INFg). Disease activity score (DAS28) calculation was done for all patients. Control serum samples were obtained from 29 healthy volunteers.Results: The levels of tested cytokines were significantly higher (IL-17A, p<0.001, INFg, p<0.001, IL-4, p<0.01) in patients with early RA, compared to the healthy controls. In early RA patients, a strong correlation of serum IL-17A was found with DAS28, ESR, and CRP.Also, significant negative correlation was found between serum INFg levels and the DAS28 score, indicating that INFg may play a key role in maintaining immune homeostasis in patients with RA.Conclusion: The mean serum IL-17A levels in patients with early RA, corresponded with the disease activity and severity. This might highlight the usefulness of the serum IL-17A level in defining the activity and predictive patterns, for aggressive disease therapy, and it might express specific therapeutically targets.

Background: Blunt abdominal trauma is one of the causes of mortality in emergency department. Free fluid in the abdomen due to intra-abdominal blunt trauma can be determined by the surface probe of ultrasound. Since the importance of this free fluid in hemodynamic stable patients with blunt trauma is associated with the unknown outcome for surgeons, this study was performed to evaluate the role of ultrasound surface probe as a screening method in evaluating the patients with blunt abdominal trauma.Materials and Methods: A descriptive-analytical study was done on 45 patients with blunt abdominal trauma and hemodynamic stability. The patients were evaluated twice during the three-hours, including repeated ultrasound surface probe and clinical examinations. Computerized tomography was also performed. The patients were divided based on the amount of the free fluid in the abdomen during the evaluations into two groups: Fixed or increased, and decreased free fluid. The results of the different evaluated methods were compared using the sensitivity and specificity.Results: From 17 patients with CT abnormalities, free fluid increased in 14 patients (82.4%). Free fluid was decreased in three patients who were discharged well from the surgery service without any complication. Surface probe in prognosis detection had a sensitivity of 82.4% and specificity of 92.9%. The percentage of false positive and negative ultrasound compared with CT scan was 7.1% and 17.6%. Also, positive and negative predictive value of the ultrasound with surface probe was 87.5% and 89.7% respectively.Conclusion: The use of the ultrasound with surface probe in the diagnosis of free fluid in blunt abdominal trauma in hemodynamic stable patients can be considered as a useful screening method.

Background: The aim of this study is to investigate the effect of vitamin A and C, as the agents that improve wound healing, on the adhesion formation process.Materials and Methods: Sixty male Wistar rats were used. They underwent midline laparotomy, for repair of a peritoneal injury, and were then assigned to four groups. Group 1 (Vitamin A) received 2000 units/kg intramuscular injection of vitamin A daily, post surgery, for two weeks, Group 2 (Vitamin C) received 100 mg/kg oral vitamin C daily, after laparotomy, for two weeks, Group 3 (vitamins A and C) received 2000 units/kg intramuscular injection of vitamin A and 100 mg/kg oral vitamin C daily, after laparotomy, for two weeks, and Group four (Sham) rats did not receive any drugs. The adhesion, inflammation, fibrosis scores, and wound integrity were evaluated after two weeks.Results: Rats in the vitamin C group had the lowest mean adhesion formation score (1±0.27) and the values of p were<0.0001 for the vitamin A group and vitamin A and C groups and 0.003 for the sham group. Vitamin C also had the lowest fibrosis score (0.50±0.17) among the study groups and the values of p were<0.0001 for the vitamin A group and vitamin A and C groups and 0.002 for the sham group. The mean inflammation score did not differ significantly among the study groups. The wound disruption strength was the highest in the vitamin C group and the difference was statistically significant in the sham group (1188.69±281.92 vs.893.04±187.46, p:0.003).Conclusion: Administration of oral vitamin C reduces adhesion formation and improves wound healing.

Background: Information on the epidemiology of venomous snake species responsible for envenomation to humans in Iran has not been well documented. In the Kashan city, venomous snakebite remains a recurring medical problem. Information providing the correct identification of snake species responsible for envenomation in this geographic region would be useful to regional medical clinics and personnel for the effective and optimal management of the patients.Materials and Methods: In this cross-sectional study, all patient data was collected from Kashan city and its suburbs. The specific data relating to the taxonomic identification of snakes responsible for envenomation were evaluated. A general approach to the diagnosis and management of patients was also provided. Snakes responsible for bites were transported to a laboratory, where their taxonomic classification was confirmed based on key anatomical features and morphological characteristics.Results: A total of 46 snakes were examined. Of these, 37 (80%) were non-venomous species, and 9 (20%) were identified as venomous. Seven of the nine venomous snake species (78%) were of the family Viperidae, and two specimens (22%) were in the family Colubridae. Specifically, the viperid species were Macrovipera lebetina obtusa, Pseudocerastes persicus, Pseudocerastes fieldi, and Echis carinatus. The two colubrid species were Malpolon monspessulanus insignitus and Psammophis schkari.Conclusion: Five different species of venomous snakes responsible for envenomation in the Kashan city region were confirmed. The viper, P. fieldi, was reported for the first time in the central part of Iran.

Background: Co-authorship is one of the most tangible forms of research collaboration. A co-authorship network is a social network in which the authors through participation in one or more publication through an indirect path have linked to each other. The present research using the social network analysis studied co-authorship network of 681 articles published in Journal of Research in Medical Sciences (JRMS) during 2008-2012.Materials and Methods: The study was carried out with the scientometrics approach and using co-authorship network analysis of authors. The topology of the co-authorship network of 681 published articles in JRMS between 2008 and 2012 was analyzed using macro-level metrics indicators of network analysis such as density, clustering coefficient, components and mean distance. In addition, in order to evaluate the performance of each authors and countries in the network, the micro-level indicators such as degree centrality, closeness centrality and betweenness centrality as well as productivity index were used. The UCINET and NetDraw softwares were used to draw and analyze the co-authorship network of the papers.Results: The assessment of the authors productivity in this journal showed that the first ranks were belonged to only five authors, respectively.Furthermore, analysis of the co-authorship of the authors in the network demonstrated that in the betweenness centrality index, three authors of them had the good position in the network. They can be considered as the network leaders able to control the flow of information in the network compared with the other members based on the shortest paths. On the other hand, the key role of the network according to the productivity and centrality indexes was belonged to Iran, Malaysia and United States of America.Conclusion: Co-authorship network of JRMS has the characteristics of a small world network. In addition, the theory of 6o separation is valid in this network was also true.

Background: selecting the correct statistical test and data mining method depends highly on the measurement scale of data, type of variables, and purpose of the analysis. Different measurement scales are studied in details and statistical comparison, modeling, and data mining methods are studied based upon using several medical examples. We have presented two ordinal–variables clustering examples, as more challenging variable in analysis, using Wisconsin Breast Cancer Data (WBCD).Ordinal-to-Interval scale conversion example: a breast cancer database of nine 10-level ordinal variables for 683 patients was analyzed by two ordinal scale clustering methods. The performance of the clustering methods was assessed by comparison with the gold standard groups of malignant and benign cases that had been identified by clinical tests.Results: the sensitivity and accuracy of the two clustering methods were 98% and 96%, respectively. Their specificity was comparable.Conclusion: by using appropriate clustering algorithm based on the measurement scale of the variables in the study, high performance is granted. Moreover, descriptive and inferential statistics in addition to modeling approach must be selected based on the scale of the variables.

Many projects on developing Electronic Health Record (EHR) systems have been carried out in many countries. The current study was conducted to review the published data on the utilization of open source EHR systems in different countries all over the world.Using free text and keyword search techniques, six bibliographic databases were searched for related articles. The identified papers were screened and reviewed during a string of stages for the irrelevancy and validity. The findings showed that open source EHRs have been wildly used by source limited regions in all continents, especially in Sub-Saharan Africa and South America. It would create opportunities to improve national healthcare level especially in developing countries with minimal financial resources. Open source technology is a solution to overcome the problems of high-costs and inflexibility associated with the proprietary health information systems.

Background: Hepatitis B with its complications has become one of the universal problems. Injection drug use is one of the most important risk factors in the transmission of hepatitis B. Therefore, we assessed hepatitis B virus prevalence among cases with a history of intravenous drug use (IVDU) as the first announcement-based study in this regard.Materials and Methods: The announcement based detection of hepatitis B seroprevalence in volunteers with a history of intravenous drug use was conducted in the Isfahan province. A comprehensive community announcement was made in all the public places and to all physicians, in all the regions.One thousand five hundred and eighty-eight volunteers were invited to the Isfahan reference laboratories and serum samples were tested for HBs-Ag, HBc Ab, and HBs-Ab, using the enzyme-linked immunosorbent assay (ELISA) method.Results: In this study, 1588 individuals volunteered, who were estimated to be 50% of all the expected intravenous drug users in the community. HBs Ag was detected in 4.2% of them. HBc Ab and HBs Ab were detected in order in 11.4 and 17.3%, respectively.Conclusion: We estimated that the seroprevalence of hepatitis B positivity in intravenous drug users was moderate to high. Therefore, it was suggested that this group be encouraged to prevent acquiring infection by vaccination, education, counseling for risk reduction, and treatment of substance abuse, and finally hepatitis B virus (HBV) screening.

We report the case of a male patient with community-acquired quadruple-valve endocarditis on presumed normal native valves. This patient had originally presented elsewhere with generalized edema and malaise and had been diagnosed with suspicious endocarditis and renal dysfunction, for which he unfortunately received incomplete treatment. Transthoracic and transesophageal echocardiographic examinations confirmed quadruple-valve endocarditis and ventricular septal defect.

Mucormycosis is an invasive fungal infection caused by filamentous fungi of the Mucoraceae family. The genera most commonly responsible are Mucor or Rhizopus. The disease occurs mostly in association with diabetic ketoacidosis. Mucormycosis has an extremely high death rate even when aggressive surgery is done. Death rates range from 25-85% depending on the body area involved. A case of rhinocerebral mucormycosis in a 65-year-old diabetic male patient typically presenting as headache, especially in parietal and frontal lobes, with nose and left eye discharge. After clinical and laboratory examination, mucormycosis was diagnosed, and Rhizopus oryzaewas isolated. Systemic therapy with amphotericin B administered intravenously then replaced by posaconazole by a combination of aggressive surgery. The patient was treated and followed up for one year. We emphasize the importance of early detection and aggressive treatment in the management of this fatal disease.

We report a case of choroidal neovascularization (CNV) secondary to methylenetetrahydrofolate reductase (MTHFR) gene mutation in a 20-year-old male patient with hypopituitarism. Treatment with three consecutive injections of intravitreal ranibizumab (anti-vascular endothelial growth factor) resulted in significant improvement of the patient's vision and the appearance of the macula. A search of the literature produced no previously reported case of MTHFR gene mutation associated both CNV and possibly hypopituitarism. With hormone replacement therapy of hypopituitarism, acetyl salicylic acid 100 mg/day also was started. The patient was clinically stable both for CNV and other thromboembolic disorders over a 6-month follow-up and also 1-year follow-up period.

Sir: I was interested to read the paper by Sabour and colleagues published in the March 2011edition of the Journal of Research in Medical Sciences. [1] The purpose of the authors was to assess obesity predictors of people with spinal cord injury (SCI) according to age, time since injury, level, and completeness of injury. Obesity predictors were measured in 162 patients in a cross sectional study.

Sir: Diabetes mellitus refers to a number of metabolic disorders, which are caused by an increase in the level of fasting plasma glucose. Type 2 diabetes mellitus (T2DM) can affect the bone, which causes osteopenia and impairs the healing of fractures.[1]

Sir: Diabetes mellitus is a common chronic disease affecting a lot of people. [1-3] More than 10% of deaths are attributable to diabetes mellitus and its related complications in patients over 35 years old. Sustained hyperglycemia can damage the kidneys, nerves, heart and eyes. [4-6] Macrovascular (atherosclerotic) and microvascular (nephropathy and retinopathy) disorders are the leading causes of morbidity and mortality in diabetic patients.[4]

Sir: Although in recent years health system network of Iran has improved considerably to provide primary health care, and subsequently the infant mortality rate has decreased significantly, infant mortality rate is higher than in developed countries.[1]

Sir: Cervico-isthmic pregnancy may occur in women with a history of previous cesarean section. In first trimester, it is best diagnosed by transvaginal ultrasound. [1] As soon as the diagnosis is confirmed, special care is necessary. Based on the location, gestational age, size, and viability of the embryo/fetus, conservative treatment or termination of pregnancy should be recommended. In early diagnosis, treatment options are capable of preserving the uterus and subsequent fertility. However, a delay in either diagnosis or treatment may lead to uterine rupture, inevitable hysterectomy, and significant maternal morbidity.