JOURNAL OF RESEARCH IN MEDICAL SCIENCES (JRMS)
Year:2011 | Volume:17 | Issue:1|Papers Count:20

BACKGROUND: Carpal tunnel syndrome (CTS) is the most prevalent form of peripheral neuropathy. The efficacy of acupuncture in management of mild to moderate CTS has been investigated in limited studies with controversial results. The aim of this study was to assess the short-term effects of acupuncture in treatment of mild to moderate carpal tunnel syndrome.METHODS: In a randomized controlled trial study, participants were randomly assigned to either control group which night splinting, vitamin B1, B6 and sham acupuncture for four weeks were administered, or intervention group that underwent acupuncture in 8 sessions over 4 weeks and night splinting. The clinical symptoms using global symptom score (GSS) and electrophysiological parameters were assessed at baseline and four weeks after the intervention.RESULTS: Of 72 patients met the inclusion criteria, 64 patients actually completed the 4 week intervention and were evaluated for the outcome. There was a statistically significant difference in GSS between two arms of treatment after the intervention (p<0.001) Using repeated measure ANOVA, the GSS in acupuncture group was significantly different after 4 weeks (p<0.001). Among electrophysiological parameters, nerve conduction velocity (NCV) was significantly different between two groups after 4 weeks (p=0.02). Other parameters showed no statistically significant difference after intervention (p>0.05).CONCLUSIONS: Our findings indicated that the acupuncture can improve the overall subjective symptoms of carpal tunnel syndrome and could be adopted in comprehensive care programs of these patients.

BACKGROUND: The aim of the study was to assess the effects of combination of bortezomib moderate dose and continuous oral low dose melphalan and thalidomide and dexamethasone (BMTD regimen) in elderly patients aged ³65 years with relapsed multiple myeloma (MM).METHODS: Twenty four patients with advanced MM were enrolled to receive eight 3-week treatment cycles with bortezomib 1.3 mg/m2 on days 1, 4, 8, and 11 followed by three 5-week cycles with bortezomib 1.3 mg/m2 on days 1, 8, 15, and 22. Within all cycles, dexamethasone 24 mg/d was given intravenously on the day of bortezomib injection and the day thereafter. In addition, patients received oral treatment of melphalan at a dose of 5 mg/d continuously for twenty days for every cycle.RESULTS: Mean age of study patients was 72.8±6.4 years. All patients that completed at least one treatment cycle were evaluated for response. Complete, partial, and minor responses occurred in 19%, 65% and 6% of patients, respectively. Overall response rate was 90% (efficacy analysis).CONCLUSIONS: This study demonstrated potent in vivo activity of combination therapy with BMTD regimen in patients with relapsed MM, with an acceptable safety profile and high overall response rate.

BACKGROUND: Circulating endothelial cells (CECs) and E-selectin are known as sensitive and specific markers of endothelial dysfunction. This study investigated whether CECs and E-selectin are surrogate biomarkers of preeclampsia and if measurement of CECs and E-selectin, early in the third trimester, could be a means of predicting preeclampsia.METHODS: In this prospective, descriptive-analytic study, rollover test was performed on 523 pregnant women during 28-30 weeks of gestation. CECs were measured by anti-CD 146-driven immunomagnetic isolation in women with positive rollover test. They were followed up prospectively until delivery without any active intervention. Women with and without preeclampsia were determined. The number of CECs and level of E-selectin were compared in the two studied groups.RESULTS: From the 47 pregnant women with positive rollover test who were selected and followed up, 22 individuals were diagnosed with preeclampsia while the remainder were normotensive. Mean CEC numbers was significantly higher in preeclamptic women than normal pregnancies (24.7 cells/mL vs.13 cells/mL). The best cut-off point for CEC numbers was 6.5 with a sensitivity of 78.9% and a specificity of 69.1%. The level of E-selectin was significantly higher in mothers with preeclampsia (p<0.05).CONCLUSIONS: Higher levels of CECs and E-selectin in women with positive rollover test who developed preeclampsia prior to onset of the complication were predictive of preeclampsia. However, larger studies are needed to confirm these findings.

BACKGROUND: Hypertension and tachycardia caused by tracheal intubation can be detrimental in hypertensive patients.This study was conducted in order to compare the effects of dexmedetomidine on hemodynamic response to tracheal intubation in hypertensive patients with esmolol and sufentanyl.METHODS: Sixty hypertensive patients scheduled for noncardiac surgery under general anesthesia were randomly assigned to receive one of the three drugs before induction of anesthesia. Groups I, II, and III respectively received esmolol (100 mg) dexmedetomidine (1mg/kg) and sufentanyl (0.25 mg/kg). Heart Rate (HR), systolic (SAP) and diastolic (DAP) arterial pressures were recorded before drug administration (baseline; T1), after drug administration (T2), after induction of anesthesia (T3), immediately after intubation (T4) and 3, 5 and 10 minutes after intubation (T5, T6, and T7, respectively). The mean percentage variations from T1 to T4 were calculated for all variables (HR, SAP and DAP). Thiopental dose, onset time of vecuronium and intubation time were also assessed.RESULTS: No differences were observed between the three groups regarding demographic data (p>0.05). Median thiopental dose was significantly lower in Group II (325 mg; range: 250-500) compared to Group I (425 mg; range: 325-500; p<0.01) and Group III (375 mg; range: 275-500; p=0.02). The onset time of vecuronium was longest in Group I (245.2± 63 s vs.193.9±46.6 s and 205.5±43.5 s; p<0.01 and p<0.05). In Group I, HR significantly decreased after drug administration compared to baseline (83.8±20.4 vs.71.7±14.8; p=0.002). Compared to the baseline (90.4±8.4), DAP decreased after induction and remained below baseline values at T5, T6 and T7 (71.3±12.8, 76.2±10.7, 68.9±10.8 and 62.1±8.7, respectively; p<0.05) in Group II. According to the mean percentage variation, a significant reduction in HR was assessed in Group II compared to Group III (-13.4±17.6% vs.11.±27.8%; p=0.003). Increment in SAP was significant in Group I when compared to Group II (9.8±20.9% vs. -9.2±20.2%; p<0.05). Increment in DAP in Group III was significant compared to Group II (0.07±19.8 vs.24.5±39.1; p<0.05).CONCLUSIONS: In hypertensive patients, administration of dexmedetomidine before anesthesia induction blunts the hemodynamic response to tracheal intubation and reduces the thiopental dose.

BACKGROUND: The aim of this study was to determine the correlation between corneal hysteresis (CH) and the corneal resistance factor (CRF), which are both novel methods of analyzing ocular rigidity/elasticity, and various corneal characteristics, mainly corneal volume in normal subjects.METHODS: This cross-sectional study included 500 normal eyes of volunteers. An ocular response analyzer (ORA) was used to measure CH and CRF. Patient age and the Pentacam-measured corneal volume (CV), posterior elevation, anterior elevation, corneal curvature, central corneal thickness (CCT), corneal thickness of apex (CTA), and corneal thinnest thickness (CTT) were compared with CH and CRF. Statistical significance was defined at p<0.05.RESULTS: The mean CH and CRF for all eyes were 9.9±1.4 mmHg and 10.1±1.6 mmHg, respectively. The mean CVs of the 3, 5, 7, and 10 mm zones for all eyes were 3.8±0.2 mm3, 11.2±0.6 mm3, 24.3±1.4 mm3, and 60.1±3.5 mm3, respectively. The correlations between CV and the hysteresis or CRF were significant in all zones. The CV of the 7-mm zone had the strongest correlation with CH (r=0.438) and the CV of the 5-mm zone had the strongest correlation with CRF (r=0.574).CONCLUSIONS: CH and CRF correlate with CV. Moreover, the correlation between CV and CRF is stronger than that between CV and CH. The CV may be valuable for determining patient's qualification for and predicting the outcome of refractive surgery. It would also be helpful in other cases in which corneal biomechanics are important.

BACKGROUND: According to Beck theory, dysfunctional attitude has a central role in emergence of depression. The aim of this study was to determine contributions of dysfunctional attitude and general health index to depression.METHODS: In this case-control study, two groups of subjects participated. The first group consisted of 65 patients with major depression and dysthymic disorder, who were recruited from Noor and Navab Safavi Psychiatry Clinics in Isfahan. The control group was consisted of 65 non-patient individuals who were accompanied or relatives of the patients and was matched with them based on age, sex and education. Both groups completed 26-item Dysfunctional Attitude Scale (DAS-26) and 28-item General Health Questionnaire (GHQ-28). Logistic regression and correlation methods were applied for statistical analysis.RESULTS: Logistic regression analysis showed that by an increase of one level in categorized DAS-26 scores and one score in the physical symptoms, anxiety, social dysfunction and depression subscales of GHQ-28 the risk of depression increase by 6.8, 1.6, 1.9, 3.7, 4.78 times, respectively.CONCLUSIONS: Capability of dysfunctional attitude and general health subscales to predict depression supports the Beck's cognitive diathesis stress theory of depression that dysfunctional attitude may be a predisposing risk factor for depression.

BACKGROUND: Coblation tonsillectomy is a new surgical technique and demands further research to be proven as a suitable and standard method of tonsillectomy. This study compares coblation and traditional tonsillectomy techniques in view of their advantages and complications.METHODS: In a prospective double-blind randomized controlled trial information on operation time, intraoperative blood loss, postoperative pain, time needed to regain the normal diet and activity and post-operative hemorrhage were gathered and compared between two groups containing 47 patients in each group.RESULTS: We found statistically significant differences in operation time (p<0.05), intraoperative blood loss (p<0.05), postoperative pain (p<0.001), time needed to find back the normal diet (p<0.001) and normal activity (p<0.001). However, post operation hemorrhage (p>0.5) was not significantly different between two groups.CONCLUSIONS: This study revealed a significantly less intraoperative or postoperative complications and morbidity in coblation tonsillectomy in comparison with traditional method. Coblation was associated with less pain and quick return to normal diet and daily activity. These findings addressed coblation tonsillectomy as an advanced method.

BACKGROUND: Erythropoietin (EPO) as a major stimulator of red blood cell (RBC) production play a key role on brain protection and have a caring effect on neurons from hypoxic or traumatic injury. The objective of this trial was to study the safety and efficacy of recombinant human EPO (rhEPO) on level of consciousness and other outcomes in patient with post traumatic diffuse axonal injury (PTDAI).METHODS: In a controlled double-blind randomized clinical trial, 54 patients aged 20-47 years were randomly allocated to 2 groups. Subjects in intervention group (n=27) received 2000U open-label rhEPO (Erythropoietin-b; Roche, Grenzach- Wyhlen, Germany) subcutaneously for six doses in two weeks (on days: 2, 4, 6, 8 and 10). The efficacies of the intervention were evaluated by GCS (Glasgow Coma Scale) and GOS (Glasgow Outcome Scale).RESULTS: The patients that were treated by rhEPO improved earlier with the difference between the treatment groups occurring on the day 10 (score differences of 9.6 for GCS and 1.9 for GOS). The better course of the rhEPO-treated patients continued throughout the remaining study period. The hematocrit and red blood cell counts did not increase to levels exceeding the normal range in rhEPO patients.CONCLUSIONS: Intravenous EPO was well tolerated in diffuse axonal injury and was associated with an improvement in patients’ outcome in 2 weeks.

BACKGROUND: The beneficial effects of Lactobacillus species have been reported but the role of these species including Lactobacillus casei (L. casei)on oral health is not well documented. The purpose of this study was to evaluate the effects of conventional or probiotic cheese containing L. casei on salivary Streptococcus mutans (SM) and Lactobacilli levels.METHODS: In this double-blind controlled trial (IRCT201009144745N1), 60 adults were randomly allocated in 2 parallel blocks. SM and Lactobacilli count assessment were performed three times. Subjects consumed either cheese containing L. casei (1´106 Cfu /g) (probiotic block, n=29) or cheese without any probiotic (control block, n=31) twice daily for two weeks. Bacterial levels changes were compared using Wilcoxon and Mann-Whitney Tests. Logistic regression compared changes in number of subjects with lowest and highest SM or Lactobacilli levels.RESULTS: Statistically significant (p=0.001) reduction of salivary SM was found in probiotic group. SM levels reduction was not significant between placebo and trial groups (p=0.46, 62% in probiotic vs.32% in placebo group). Lactobacilli count changes during trial were not statistically significant inter and intra blocks (p=0.12). Probiotic intervention was significantly effective in high levels (>105 cfu/ml) of SM (Odds Ratio 11.6, 95% CI 1.56–86.17, p=0.017).CONCLUSIONS: Probiotic cheese containing L. casei was not effective in salivary SM levels reduction comparing to conventional cheese. Adding L. casei to cheese could be useful in decreasing SM counts in adults 18-37 years old with highest level of SM.

BACKGROUND: There is a lack of data on familial aggregation of colorectal cancer (CRC) in Iran. We aimed to determine the frequency of hereditary nonpolyposis colorectal cancer (HNPCC) and familial colorectal cancer (FCC) and to determine the frequency of extracolonic cancers in these families in Isfahan.METHODS: We reviewed documents of all patients with a pathologically confirmed diagnosis of CRC admitted to Isfahan referral hospitals between 1995 and 2006. We also studied our CRC registry at Poursina Hakim Research Institute from 2003 to 2008. We found HNPCC and FCC families based on the Amsterdam II criteria and interviewed them for family history of CRC and extracolonic tumors. The family history was taken at least up to the second-degree relatives.RESULTS: During 1996 to 2008, a total of 2580 CRC cases have been diagnosed. We found 14 HNPCC and 53 FCC families. Mean age of CRC at diagnosis was 48.0±14.6 and 49.0±13.9 years in the HNPCC and FCC families, respectively (p>0.05). The total numbers of observed extracolonic tumors were 70 (21.6%; mean age = 53.6±11.0 years) and 157 (13.8%; mean age = 54.8±18.0 years) in HNPCC and FCC families, respectively (p>0.05). CRC was respectively found in 52 and 76 members of the HNPCC and FCC families, revealing the frequency of HNPCC and FCC as 2.0% (52/2580) and 2.9% (76/2580), respectively.CONCLUSIONS: We found a relative high frequency of HNPCC (2.0%) and FCC (2.9%) among CRC cases in our society and high incidence of extracolonic tumors in their families. Further studies focusing on molecular basis in this field and designing a specific screening and national cancer registry program for HNPCC and FCC families should be conducted.

BACKGROUND: The low dose aprotinin consistently reduces blood and transfusion requirement in adults during cardiac surgical procedures but its effectiveness in some ethnical groups were debated and controversy about its effect on mortality and morbidity precludes its routine use. This study was designated to determine whether a low dose of aprotinin causes more mortality and morbidity when used after coronary artery bypass grafting (CABG) surgery.METHODS: In a clinical trial study, 380 patients in placebo and 273 patients in aprotinin group were enrolled. A test dose before skin incision and 2 million kallikrein inactivation units (KIU) during initiation of cardiopulmonary bypass (CPB) were given to patients. Differences in quantity of blood transfusion, morbidity and mortality were analyzed. Multivariable analysis was performed to determine risk factors for mortality.RESULTS: Decreased blood product transfusions and increased rate of morbidity were found in the aprotinin group. Independent predictors for increased number of transfusion were aspirin continued before operation and small body mass index (BMI) but there was a significant difference in mortality and morbidity between two groups.CONCLUSIONS: In patients undergoing CABG procedure, low dose aprotinin is effective in attenuating post bypass coagulopathy and decreasing blood product use, but it increases morbidity.

BACKGROUND: One preliminary step to strengthen medical education research would be determining the research priorities.The aim of this study was to determine the research priorities of medical education in Iran in 2007-2008.METHODS: This descriptive study was carried out in two phases. Phase one was performed in 3 stages and used Delphi technique among academic staffs of Isfahan University of Medical Sciences. The three stages included a brainstorming workshop for 140 faculty members and educational experts resulting in a list of research priorities, then, in the second and third stages 99 and 76 questionnaires were distributed among faculty members. In the second phase, the final questionnaires were mailed to educational research center managers of universities type I, II and III, and were distributed among 311 academic members and educational experts to rate the items on a numerical scale ranging from 1 to 10.RESULTS: The most important research priorities included faculty members' development methods, faculty members' motives, satisfaction and welfare, criteria and procedures of faculty members' promotion, teaching methods and learning techniques, job descriptions and professional skills of graduates, quality management in education, second language, clinical education, science production in medicine, faculty evaluation and information technology.CONCLUSIONS: This study shows the medial education research priorities in national level and in different types of medical universities in Iran. It is recommended that faculty members and research administrators consider the needs and requirements of education and plan the researches in education according to these priorities.

Intra-abdominal heterotopic ossification is extremely rare with only approximately 30 cases having been reported. While most reported cases have involved the mesentery, ossification of the peritoneum is even rarer. The pathogenesis remains undetermined but is generally considered a reactive process in response to various stimuli. Histologically, it is composed of a peripheral area with bone formation and a central area of reactive hypercellular fibrous tissue. We report a rare case of intra-abdominal heterotopic ossification of the parietal peritoneum following traumatic splenic rupture.

BACKGROUND: Fahr's disease is a rare neurodegenerative disorder of unknown cause characterized by idiopathic basal ganglia calcification that is associated with neuropsychiatric and cognitive impairment. No case of Fahr's disease with associated cardiac conduction disease has been described in the literature to date. The objective of this case report was to describe a young female with various cardiac conduction system abnormalities and bilateral basal ganglia calcification suggestive of Fahr's disease.CASE REPORT: A 19-year-old female was transferred to our hospital for a pacemaker insertion. Her past medical history included cognitive impairment and asymptomatic congenital complete heart block since birth. Her manifestations included cognitive impairment, tremors, rigidity, ataxia, bilateral basal ganglia calcification without clinical manifestations of mitochondrial cytopathy. She also had right bundle branch block, left anterior fascicular block, intermittent complete heart block, atrial arrhythmias with advanced atrioventricular blocks and ventricular asystole manifested by Stokes-Adams seizures, which was diagnosed as epilepsy.CONCLUSIONS: According to our knowledge, this was the first case report of a suspected association between Fahr's disease and isolated cardiac conduction system disease. In addition, this case illustrated that in patients with heart blocks and seizures, a diagnosis of epilepsy needs to be made with caution and such patients need further evaluations by a cardiologist or electrophysiologist to consider pacing and prevent future catastrophic events.

Cerebral amyloid angiopathy (CAA) is the most common cause of lobar intracerebral hemorrhage. Repeated bleeding may be presented with vascular dementia. We have reported a 68-year-old normotensive demented patient with probable CAA presented with hemiparesia, headache and vomiting. According to the experience of this case, it is recommended to consider CAA for normotensive elderly patients presented with multiple and superficial intracerebral hemorrhage.

Unicameral bone cysts (UBCs) are benign, osteolytic lesions which are often asymptomatic and are commonly seen in the proximal of humerus and femur. The average age at diagnosis is 9-11 years and there is a male preponderance with a male-to-female ratio of approximately 2-2.5 to 1. We describe a case of 5-year-old girl who presented to orthopedic clinic with a 4-month history of painful limping. Plain radiography of the right knee demonstrated a well-defined lytic lesion in the proximal of the tibia. Open biopsy and then curettage and bone grafting with bone- substitute was performed. The diagnosis of this condition requires a high index of suspicion. This report demonstrates that all UBCs do not have the same clinical patterns and with adequate attention good results can be achieved.

Leishmaniasis is a protozoan infection due to organisms of the genus Leishmania. The differential diagnosis of cutaneous leishmaniasis includes arthropod bites, basal cell carcinoma (BCC) and other malignancies. BCC is the most common form of skin cancer. We present a case of cutaneous leishmaniasis resistant to standard intralesional glucantime injection in an immunocompromised patient, which was proved to be BCC after surgical excision.

The matched case-control, single-centred, prospective study by Ozturk et al. was designed to compare the NT-proBNP levels between hospitalized congestive heart failure (CHF) patients and outpatients. The main purpose of their study was to define a certain cut-off NT-proBNP value for hospitalization of CHF patients.

Fever is commonest reason for hospital attendance. Fever outbreaks are mostly due to malaria; some reveal different origin.  Dengue is endemic in India. Fever cases were reported daily from girls’ hostel from 2nd September. Relevant history and investigation of Outdoor Patient Department cases was done for common causes of fever like malaria, typhoid, leptospirosis and dengue. Active surveillance was continued for twice maximum incubation period of dengue. Preventive measures like health education, elimination of mosquito breeding spots; hospitalisations and isolation of dengue cases were done.

With interest, I read the article by Khalilian et al. entitled "Relationship between echocardiographic findings and laboratory serum biomarkers in patients with and without low cardiac output" that recently published in your valuable journal. We know that in adult patients, atrial natriuretic peptides (ANP) and brainnatriuretic peptides (BNP) have been used for diagnosis, monitoring of treatment effects, and estimating the prognosis of systolic and diastolic heart failure. Furthermore, ANP would remain quite stable during storage in plasma at -80oC for even 12 months.