Tehran University Medical Journal
Year:2022 | Volume:80 | Issue:5|Papers Count:11

Background: Due to the chronic nature of diabetes, children with type 1 diabetes are prone to a number of long-term complications. One of the most important complications of this disease is cardiovascular involvement due to atherosclerosis, which is directly related to the control of blood lipids. The use of probiotics may be effective in the process of complications in these patients by affecting fat metabolism. The aim of this study was to evaluate the effect of oral probiotics on lipid profiles in children with type 1 diabetes. Methods: This study was conducted at Bahrami Children's Hospital from May 2018 to May 2019. In this single-blind randomized controlled clinical trial, 52 children with type 1 diabetes (aged 2 to 16 years) were studied. We created two groups of 26 individuals. The inclusion criteria were determined as follows: Proof of T1DM by history and information of children’, s medical record. Also, the Exclusion criteria were determined in this way: Patients consuming probiotics in the last 4 weeks, gastrointestinal infections in the last 2 weeks, and presence of chronic underlying intestinal diseases. The probiotic group received, in addition to insulin therapy, a daily probiotic capsule for 90 days. The control group received only routine insulin therapy. Blood samples were taken to measure lipid profiles at the beginning and end of the trial. Results: A total of 52 patients were included. The mean age of children was 9. 3±, 2. 9 (4 to 14 years). The mean age in the probiotic and control groups was 9. 6±, 3. 5 and 9. 4±, 3. 0 respectively. The results of this study showed that HDL-C was increased in the probiotic group compared to the control group, although it was not statistically significant (P>0. 05). Also, changes in total cholesterol, LDL-C, and triglyceride were not statistically significant. Conclusion: In this study, the use of oral probiotics for 90 days in children with type 1 diabetes did not have a significant effect on blood lipid profiles compared to the control group.

Background: The vertical gastric plication technique leads to poor long-term outcomes and is associated with intolerable reflux, dysphagia, or weight gain in a high percentage of patients. Therefore, in this study, the therapeutic results of two methods with and without plication of the distal part of the stomach in gastric bypass surgery in patients with morbid obesity were compared. Methods: In this clinical trial randomized single-blind study, 40 patients with morbid obesity who were referred to one of the hospitals affiliated with Jundishapur University of Medical Sciences in Ahvaz during March 2020-February 2021, were randomly divided into two groups: with plication of the distal part of the stomach (n=20) and without plication of the distal part of the stomach (n=20) in Roux-en-Y gastric bypass surgery. Weight loss rate, complications related to surgery, outcomes and satisfaction of patient were noted and followed up for one year. Results: The mean percentage of weight loss at different times did not show a significant difference between the two groups (p>0. 05). The length of hospitalization after surgery was significantly less in the distal gastric plication group (p=0. 0001). During one year of follow-up, hypertension, diabetes, HLP, and reflux were well in the distal plication method but showed no significant difference (p>0. 05). Satisfaction of the patients was more in the distal plication method and showed no significant difference (p>0. 05). One year after the operation, the change of diet showed no significant difference in the two groups (p>0. 05). Conclusion: It looks that using the laparoscopic distal gastric plication method is an effective and safe method and is associated with early ideal weight loss, reduction of complications, and increase in satisfaction of patients with BMI>=35 kg/m2. No need to use a foreign body, stapler or bandage and the possibility of re-operation are the advantages of this technique.

Background: Congenital heart defects (CHD) are the most common type of birth defects. The main screening tests used to identify babies with congenital heart defects include prenatal echocardiography and postnatal clinical assessment. Routine pulse oximetry has been reported as an additional screening test that can potentially improve the early diagnosis of critical congenital heart disease (CCHD). Methods: This study is a multi-stage evolutionary study that was conducted for 12 months from March 2021 to March 2022 at Pediatric Cardiovascular Research Center in Cardiovascular Institute, Isfahan, Iran. In the first phase, after identifying the topic and aims of the present study, questions were designed through the PICO method including (population, intervention, control, and outcomes). Then conducting systematic searches, the quality of all existing clinical guidelines (CG) of this field were evaluated using the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument and a committee consisting of pediatric cardiologists and neonatologists in the field. Next, based on the opinions of experts, the quality of 1 out of 6 clinical guidelines for early detection of critical congenital heart disease at birth by pulse oximetry was assessed as optimal. Finally, the clinical guidelines draft was evaluated using the Delphi method and the panel of experts. After expert panel meetings and consensus between members, the final version of the guideline for early detection of critical congenital heart diseases at birth by pulse oximetry was developed. Results: In the present study, criteria of clinical practice regarding the stages of newborn screening by pulse oximetry at birth were determined based on the evidence and health conditions and were presented in twenty-eight recommendations and six sections. The final recommendations were presented in the results section. Conclusion: The finding of the present study showed that physicians, nurses, and midwives can apply the recommendations of this clinical guideline for the early detection and referral of neonates with critical congenital heart disease.

Background: Obesity and overweight are one of the components of metabolic syndrome and the cause of cardiovascular disease and sudden cardiac death. Obesity is associated with a wide range of electrocardiogram (ECG) abnormalities. Methods: This case-control study was performed on 50 children and adolescents aged 9 to 18 years in Birjand from May to October 2020. In the control group, 25 people with normal weight and in the case group, 25 people with obesity or overweight were included in the study. Individuals with a body mass index of 85-95 percent were defined as overweight, ones with a body mass index above the 95th percentile were defined as obese, and individuals with a body mass index below the 85th percentile were defined as normal. After clinical examination, height, weight and electrocardiogram indices were measured and compared by using statistical tests by SPSS (Version 19) software. Results: There were 15 boys in the control group and 17 boys in the case group. The mean age of the control and case groups was 11. 28±, 2. 13 and 10. 96±, 1. 97 years, respectively. The mean distance between the peak to the end of the T wave in the case group was 323. 72±, 120. 15 and in the control group was 79. 20±, 13. 06. The mean difference between the shortest and longest distance of TP-e in case group was 48±, 23. 04 and in control group was 18. 44±, 5. 58, respectively. There was a statistically significant difference between the two indices (P<0. 001). But in other variables, no statistically significant difference was observed between the two groups. Conclusion: The results of the present study showed that obesity can have adverse effects on the ECG of children compared to normal-weight individuals. These changes are associated with an increased risk of arrhythmias. Given that these changes can be corrected with weight control, it is recommended to warn families and educate them to prevent and control overweight and obesity.

Background: CT is the gold standard method for diagnosing kidney and urinary tract stones. This imaging technique delivers radiation dose to patients, which increases the risk of cancer, especially in patients who need frequent assessment. The aim of this study was to compare the diagnostic ability of ultrasound in Iran compared to CT for diagnosing kidney stones in patients with colic pain. Methods: The data of this cross-sectional retrospective study was gathered from the patients who were admitted to a University-affiliated hospital, Shiraz University of Medical Sciences from March 2019 to September 2019 suspected of nephrolithiasis and performed CT were collected along with their ultrasound reports. To compare sonography and CT, sensitivity, specificity, and positive and negative predictive values were calculated and the diagnostic percentage difference between the two modalities was evaluated. The diagnostic efficiency of ultrasound in stones of different sizes and locations was also evaluated. Results: The sensitivity, specificity, and positive and negative predictive values of ultrasound in the initial diagnosis of stones were 83. 47%, 62. 15%, 85. 94% and 57. 58%, respectively. Ultrasound diagnosis was not significantly different from CT p=23 actually ultrasound diagnoses were different from CT in only 2. 11% of cases. Ultrasound was the most successful in detecting bladder and urethra stones larger than 10 mm. Conclusion: The results of this study showed that although ultrasound is less sensitive than CT in the diagnosis of nephrolithiasis, the use of ultrasound could be useful as a primary diagnostic test in patients with suspected nephrolithiasis. The important point is that the strategy of starting the evaluation with ultrasound, and performing additional imaging if necessary, leads to a reduction in the radiation dose of patients with nephrolithiasis. These patients have to do this procedure many times to diagnose and follow up the disease and clearly the offered method leads to reduction of the radiation absorbed dose and the possible effects of radiation, which is in line with the principle of ALARA, the basic principle of radiation protection.

Background: Vitiligo is a multifactorial acquired disorder characterized by the complete or partial destruction of skin melanocytes in the affected areas. Vitiligo affects the personal and social life of patients negatively and causes defects in their quality of life. Since the role of psychological factors in some skin diseases and chronic disorders has been identified, the present study was conducted to understand the possible role of psychological stress in the incidence of vitiligo disease. Methods: This is a Retrospective Case-Control Study that was conducted in the Razi hospital affiliated with Tehran University of Medical Science in 2021. Razi hospital is a specific referral center for dermatologic disorders. In this study, 87 patients with onset of vitiligo not more than 3 years before evaluation (case) were compared with 130 patients affected by other skin disorders with a well-established etiology (control). Participants were selected through convenience sampling from August to February. They were studied for experienced stressful life events during the year before the diagnosis. To understand this, we utilized a validated Stressful life events (SLE) Questionnaire. Additionally, we probed a clinical record, to demographic and socioeconomic characteristics, medical history, and clinical status of the disease. The data were analyzed in SPSS version 23 with descriptive and analytical statistics. Results: The incidence of the vitiligo disease by controlling socioeconomic confounders, was related to experience of stressful life events in past year (OR=1. 89, CI=95%, P=0. 01). The chance of developing vitiligo increased by 89% per each unit increase in the mean of stressful event. Also, an increase in personal conflicts (OR =2. 23, P= 0. 00), Educational concerns (OR=1. 94, P=0. 00), job security (OR=1. 28, P=0. 03) and family life (OR=1. 57, P=0. 03) significantly (95% CI) increased the chance of developing vitiligo disease. While for other events were not significantly different between the two groups. Conclusion: stress plays a significant role in vitiligo disease as a causal factor. So, Psychosocial intervention should be considered in preventing and treatment of disease.

Background: Non-traumatic bone fractures are considered a pathologic condition with various etiologies, including cancer metastases, osteoporosis, and long-term corticosteroid consumption, which can affect people's quality of life. The main aim of this study was to investigate the etiology of pathological bone fractures in patients who were referred to the Hospital. Methods: In this cross-sectional study, all patients with non-traumatic pathological fractures were included from March 2015 to February 2019 at Imam Khomeini hospital in Urmia city. Data analysis was calculated by chi-square test using SPSS. ver. 17. Results: A total of 168 patients participated in this study, of which 108 patients (64. 3%) were female, and 60 patients (35. 7%) were male with a mean age of 58. 6±, 21. 1 with a minimum and maximum age of 7 and 90 years old, respectively. According to the results, the most common etiologies consist of osteoporosis (33. 3%), metastatic carcinoma (28. 6%), and primary tumor (11. 3%), respectively. Regarding the anatomical site involved, vertebrae (57. 1%) and the neck of the proximal femur (27. 4%) were detected as the most frequent sites with fractures, respectively. Moreover, a significant relationship was found between the fracture etiologies and demographics data (age and gender) (p<0. 001). In this regard, osteoporosis and metastatic carcinoma were reported as the most common fracture etiologies in females and males. In addition, intertrochanteric-subtrochanteric (7. 7%), distal femur (4. 8%), intertrochanteric (1. 2%), and acetabulum (1. 2%) were considered other sites of fracture with less frequency. It is worth noting that for patients with ages less than fifty years old (<50 years old), commonly reported fracture etiology was the primary osteosarcoma, while in patients with ages more than fifty (>50 years old), osteoporosis was defined as the main fracture etiology. Conclusion: Together, the present study results showed that osteoporosis and metastatic carcinoma were the most critical etiology of fractures, and there was a statistical correlation between demographic characteristics (such as gender and age) and pathological fracture etiologies. According to the statistical results, the most common sites exposed for fractures were also the vertebral and proximal femur.

Background: The training and education of competent and qualified surgeons have been one of the challenges of the surgical profession. The concept of surgical competence has been affected widely due to a series of developments in the new disease emergence, various surgical techniques and the introduction of advanced tools and equipment into the operating. The development of surgical competence and achieving this goal requires accurate identification and analysis of the dimensions of competence. This study was done to explain the concept of surgical competence using the 8-step Walker and Avant approach. Methods: This study is a qualitative study that was conducted from May-October 2016 at Shahid Beheshti University of Medical Sciences. The present study is a qualitative and conceptual analysis study, which is done with Walker&Avant's eightstep approach to determine the defining characteristics of the concept of surgical competence. A systematic search was conducted between 1990 and 2020 by keywords search such as surgery, surgical, operation OR laparoscopy AND competence competency development competency proficient, proficiency, expertise, clinical, in the database like Google Scholar, PubMed, SID, Magiran, Scopus, Web of Science. Twenty articles were included in the study based on inclusion and exclusion criteria. Moreover, the defining features of the concept were extracted from it. Results: Based on the results of this study, the concept of surgical competence was defined and the four dimensions of elements, goals, components and the process of developing surgical competence were identified. Then, by clarifying the characteristics of surgical competence, a model of surgical competence development was drawn. Surgical competence development depends on the acquisition of specialized knowledge and numerous skills that are acquired through experience and deliberated practice under the supervision of others in the surgical community of practice and over time. Conclusion: Surgical competence is a set of observable and measurable skills that allows a surgeon to manage the surgical process independently pbt while maintaining the patient's safety. It includes specialized knowledge, communication skills, cognitive and technical skills, and basic surgical skills.

Background: Infection with Strongyloides stercoralis is common in tropical and subtropical regions. To prevent and treat these diseases, information on the distribution and frequency of these parasites in different geographical areas is needed. Due to the importance of diseases in the northern provinces of Iran, the present study was performed to determine the prevalence of Strongyloides stercoralis. Methods: From April 2011 to March 2020, stool samples from patients who were referred to Rouhani hospital in Mazandaran province, Babol, were gathered. For stool samples, microscopic detection was performed immediately using the wet expansion method, followed by a formal-ether concentration process. Based on the sample size calculation, the minimum number of patients with Strongyloides stercoralis infection was considered to be 380 patients from the years 2011-2020. Mean and standard deviation indices were used to describe quantitative data and numbers and percentages were used to describe qualitative data. Results: Out of the total number of 39, 800 archived patient files that were reviewed, a total of 420 (1. 05%) patients were confirmed for the presence of Strongyloides stercoralis in their feces. The age range of patients was 3 to 89 years. The population of male patients (249 patients) was higher than females (171 patients). In patients with positive Strongyloides stercoralis, disease symptoms were positive in 206 patients and negative in 214 patients. The most common underlying disease in patients was abdominal pain (220 patients). 271 patients received steroids. Conclusion: Strongyloides stercoralis infection was detected in the northern region of Iran. The prevalence of this parasite was higher in men, the elderly, and people with underlying comorbidities. These results can be used to identify and compare areas where the prevalence of infection is higher. Therefore, revealing the effect of Strongyloides stercoralis infection on public health makes the need for in-depth clinical and diagnostic studies important. People with chronic diseases, whether symptomatic or asymptomatic, should be screened for parasitic diseases.

Background: Information on the coronavirus infection 2019 (COVID-19) which can clinically range from asymptomatic infection to severe pneumonia, in transplant recipients is still low. Infections are a major cause of death in kidney transplant recipients, and kidney transplant recipients, like other organ recipients, appear to be more vulnerable to a variety of infections due to comorbidities and immunosuppressive drugs that predispose them to infection. Case presentation: In this study, we reviewed 10 transplant recipients with a mean age of 50. 3±, 11. 25 years who were admitted to Ayatollah Rouhani Hospital in Babol due to COVID-19 From April 2019 to September 2019. Four patients were female and six ones were male. Fever (100%) and cough (60%) were the most common symptoms in patients. All patients used standard immunosuppressive drugs (tacrolimus, corticosteroids, mycophenolate, and cyclosporine). The mean level of oxygen saturation at the time of admission in these patients was 87. 9±, 11. 3 and in two patients with death outcomes of 57% and 95%, it was at the beginning of hospitalization. The mean leukocytes of patients at the beginning of hospitalization was10470±, 5784. 08 per ml and the mean lymphocytes of these patients were 1081. 5±, 516. 05. In the studied patients, the mean of previous years of transplantation was 8/05±, 7. 13 and two patients died 20 years and 5 years after their kidney transplantation. Two patients (20%), aged 57 and 50 years, died from progressive respiratory symptoms and the other eight patients recovered and were discharged from the hospital. We reported COVID-19 infection in ten kidney transplant recipients with different clinical outcomes and periods, which may be a reference for the management of COVID-19 in such patients. Conclusion: It seems that more information is needed to better understand the effect of anti-transplant immunosuppressive therapy on the outcome of COVID-19 infection in kidney transplant recipients. Long-term follow-up studies and more cases are needed to clarify the diagnosis, outcome, and treatment options for COVID-19 in these patients.