ACTA MEDICA IRANICA
Year:2015 | Volume:53 | Issue:2|Papers Count:12

A recent paper by Ghamar-Chehreh et al., about predictive value of positive family history of some common risk factors in nonalcoholic fatty liver disease patients (1) has a useful look at this issue; but, some methodological and statistical shortcomings present that are discussed. I believe that the quality of the analysis can considerably increase with the same data without the need for any additional work except the design of the analysis. Instead of only mentioning two percentages in two different groups and P-value (table 3), authors could calculate odds ratio (OR) and 95% confidence interval (CI) showing both the strength of each difference/ association in two groups (positive/negative family history) for each variable and significant difference/association. When 95% CI does not cover the number “one”, it means that the difference is significant. More advanced, they could also able to do logistic regression for estimating adjusted OR of the most important family histories for determining the status of different dependent variables such as HDL, TG, albumin, ALT, and so on.

Helicobacter pylori (H. pylori) is a spiral-shaped gram negative bacterium that naturally colonizes the human gastric epithelium. In recent years, large evidence has come to the literature strongly proposing causal link between H. pylori and extra gastric disorders. Cardiovascular system is one of the extra gastric organs that can be affected by H. pylori infection. The first evidence suggestive of such an association comes from seroepidemiological evaluations, but histopathological and eradication studies have strongly confirmed existence of a causal association between H. pylori infection and cardiovascular events.

S100b, a neurotrophic factor mainly released by astrocytes, has been implicated in the pathogenesis of bipolar disorder. Thus, lithium may exert its neuroprotective effects to some extent through S100b. Furthermore, the possible effects of lithium on astrocytes as well as on interactions between neurons and astrocytes as a part of its mechanisms of actions are unknown. This study was undertaken to determine the effect of lithium on S100b in neurons, astrocytes and a mixture of neurons and astrocytes. Rat primary astrocyte, neuronal and mixed neuro-astroglia cultures were prepared from cortices of 18-day's embryos. Cell cultures were exposed to lithium (1mM) or vehicle for 1day (acute) or 7 days (chronic). RT-PCR and ELISA determined S100b mRNA and intra- and extracellular protein levels. Chronic lithium treatment significantly increased intracellular S100b in neuronal and neuro-astroglia cultures in comparison to control cultures (P<0.05). Acute and chronic lithium treatments exerted no significant effects on intracellular S100b protein levels in astrocytes, and extracellular S100b protein levels in three studied cultures as compared to control cultures. Acute and chronic lithium treatments did not significantly alter S100b mRNA levels in three studied cultures, compared to control cultures. Chronic lithium treatment increased intracellular S100b protein levels in a cell-type specific manner which may favor its neuroprotective action. The findings of this study suggest that lithium may exert its neuroprotective action, at least partly, by increasing neuronal S100b level, with no effect on astrocytes or interaction between neurons and astrocytes.

Insulin is currently the drug of choice in treating patients with gestational diabetes mellitus but insulin is expensive, inconvenient to store and use and probably associated with more risks of asymptomatic hypoglycemia in comparison with some oral agents. This randomized clinical trial was conducted to evaluate the efficacy and safety of glyburide in patients with gestational diabetes mellitus in comparison with insulin therapy. Pregnant women aged between 18-45 years with singleton pregnancies and in their 24-36 weeks of gestation were assessed for eligibility. Women with gestational diabetes mellitus were randomly allocated to two insulin and glyburide groups and compared with maternal and neonatal outcome. Ninety-six women with gestational diabetes mellitus enrolled in the study. At screen and treated fasting and post-prandial blood glucose levels were similar in both groups. Time for beginning the treatment to control the glycemic index was 28.30 (±20.60) days in the insulin group and 22.56 (±18.86) in the glyburide group. There was no statistically significant difference in time-to-control the blood glucose level in two studied group. Time, between beginning the treatment of GDM and delivery, was 53.22 (±28.96) days in the insulin group and 56.67 (±30.47) in the glyburide group. There was no statistically significant difference between the times of treatment-to-delivery in two studied groups. There were no statistically significant differences between maternal and neonatal outcomes in two studied groups. Glyburide can effectively and safely control the glycemic index in women with gestational diabetes mellitus in comparison with insulin.

This trial was performed to determine if a continuous low-dose infusion of methylprednisolone is as effective as its bolus of high-dose in reducing inflammatory response. The study was single-center, doubleblinded randomized clinical trial and performed in a surgical intensive care unit of an academic hospital. In this study, 72 consecutive patients undergoing elective coronary artery bypass grafting (CABG) were assigned to receive either a methylprednisolone loading dose (1mg/kg) followed by continuous infusion (2mg/Kg/24 hours for 1 day) (low-dose regime) or a single dose of methylprednisolone (15 mg/kg) before cardiopulmonary bypass (high dose regime). Serum concentrations of IL-6 and C- reactive protein (CRP) were measured preoperatively and 6, 24 and 48 hours after surgery, and serum creatinine was measured before the operation and 24, 48 and 72 hours postoperatively. The measurements were then compared between the groups to evaluate the efficacy of each regimen. The basic characteristics and measurements were not different between the study groups. There was no significant difference in IL-6 and CRP elevation (P=0.52 and P=0.46, respectively). Early outcomes such as the length of stay in the intensive care unit, intubation time, changes in serum creatinine and blood glucose levels, inotropic support, insulin requirements, and rate of infection were also similar in both groups. A continuous low dose infusion of methylprednisolone was as effective as a single high dose methylprednisolone in reducing the inflammatory response after CABG with extracorporeal circulation with no significant difference in the postoperative measurements and outcomes.

Glutathione S-transferases (GSTs) are members of multigenic family which have the essential functionin cells as an antioxidant. In the present study we studied the polymorphism of GSTT1 and GSTM1 deletion genotypes in Iranian patients with primary closed angle glaucoma (PCAG) compared to healthy subjects. We conducted a study of 41 PCAG patients (24 women, 17 men) and 100 healthy participants (57 women, 43 men) to determine the prevalence of GSTT1 and GSTM1 deletion genotypes and the risk of PCAG, which were determined by multiplex polymerase chain reaction. Genotypes of GSTM1 and GSTT1 null deletions were determined in 22 (53.7%) and 7 (17.1%) patients with PCAG and 34 (34%) and 15 (15%) in healthy participants. Comparison of patients and healthy ones regarding GSTM1 and GSTT1 genotypes revealed increase of GSTM1 null deletions genotypes’ in patients with PCAG (P=0.03). It was concluded that the increased frequencies of GSTM1 null in patients with PCAG could be associated with a risk factor for incidence of PCAG in the Iranian population.

Laryngeal mask is a supraglothic instrument for ventilation of patients who are under anesthesia. Insertion of laryngeal mask requires maintaining sufficient depth of anesthesia to avoid airway reflex (gagging, coughing and spasms). The present study investigated two techniques of anesthesia with propofol-atracurium and thiopental-atracurium to facilitate insertion of the laryngeal mask, term of recovery and postoperative nausea and vomiting. In this prospective, randomized and double-blinded clinical trial, 224 patients undergoing elective laparoscopic class ASA one and two were studied. Patients were divided into two groups of 112 patients – one group with propofol anesthetic and thiopental-atracurium. Then after the induction of anesthesia neuromuscular hemodynamic changes, airway reflex (gagging, coughing and spasms), the ease of insertion of laryngeal mask and the frequency of patient movements’ were recorded. The data were analyzed by SPSS V.18. Results indicated that anesthetic technique with propofol-atracurium provides better and more comfortable condition for insertion of laryngeal mask significantly (P<0.05). Hemodynamic changes during induction of anesthesia and five minutes after insertion of the laryngeal mask in first group was more than second one (P<0.05), and nausea and vomiting during recovery in propofol group was significantly lower than thiopental group (P<0.05). Using techniques of anesthesia with propofol - atracurium in inserting laryngeal mask airway in patients who have an indication for the use of this technique is better than anesthesia with thiopental –atracurium.

Socioeconomic basis of children obesity is of high importance for preventive policies. This study aimed to compare the prevalence of obesity among children living in two different levels of welfare regions in Mashhad northeast of Iran. A total of 625 primary school girls and boys aged 78-127 months were randomly selected, and values of their body mass index (BMI) were measured. The prevalence of both overweight and obesity were higher among students of enriched area in comparison with that of resource restricted (P<0.05).The prevalence of overweight concerns in urban and rural areas. These results highlight the relation between socio-economic status and prevalence of obesity among children.

To evaluate Overactive bladder (OAB) with detrusor overactivity (DOA) following oxybutynin or tolterodine treatment in recommended doses at a four-week course. A total of 100 Iranian women 45 years or older with urgency that also showed idiopathic detrusor overactivity (IDO) in the filling phase of their cystometry were included in the current study. In this double-blinded trial two parallel groups were randomized by using two kinds of the antimuscarinic drugs for a four- week course [oxybutinin 5mg, t.d.s. or Tolterodin 2mg, b.i.d.] in the same packages. Data were collected from three-day frequency volume chart (FVC) one month before and after the treatment course. The effectiveness of each drug was compared using the paired, samples t-test. Patients’ improvement regarding urinary urgency, frequency and urge incontinence after treatment in both groups was seen, but mean improvements in the terms of urgency and urge incontinence were larger in patients who were treated by oxybutynin. Night-time frequency was shown to be improved by a significantly larger score by tolterodine. Discontinuation of treatment due to adverse events had no significant difference in two groups. Four-week treatment with oxybutynin was better than tolterodine IR in improving urgency and urge incontinence, but there were not statistically significant difference between them. In planning a course of treatment especially in the elderly, the difference in the group of symptoms that reduce patients’ quality of life should be considered. Physicians should consider the patient's prominent symptom in selection of anti-muscarinic drugs for the treatment of overactive bladder syndrome especially in elderly patients.

Optimal reduction in blood pressure with antihypertensive agents helps to prevent microvascular and macrovascular complications of diabetes. The objective of the study was to evaluate the current utilization pattern of antihypertensive medications among patients with diabetes and coexistent hypertension as per the JNC seventh report guidelines. A Cross-sectional survey was conducted among patients with diabetes attending outpatient department of Internal Medicine at a hospital at Ajman. Medical records of patients were used to obtain diagnostic, demographic and drug use information. Univariate analysis was performed using Chi-square and t- test followed by logistic regression to compute independent predictors. Of 132 patients with diabetes, uncomplicated hypertension (HTN) was coexistent in 81% (107/132) of patients.Males constituted 49.5% (53/107) of the total. Mean (SD) age of patients with HTN was 55.1 (10.1) years higher than those without HTN 49.6 (9.9) years (P<0.01). Higher number of patients with HTN had duration of diabetes<5years than those>5 years (P=0.04). While adjusting the significant factors, only duration of diabetes was statistically significant (adjusted OR=1.06; CI 95% (1.003-1.116) P=0.03 among patients with HTN.63.6% (68/107) prescriptions contained one drug antihypertensive drug, 27.1 % (29/107) two drugs and 7.4% (8/107) no anti-hypertensive drug were prescribed. Angiotensin converting enzyme inhibitors/ Angiotensin receptor blockers (ACEI/ARBs) followed by diuretics were commonly prescribed drugs. ARBs with diuretics were the most frequent two drug combinations. The antihypertensive utilization pattern was similar in both gender and age groups. Results represent the current prescribing trend for anti-hypertensive agents among patients with diabetes that is in accordance with JNC-7 recommendations.

Prematurity and poor weight gaining are important causes for neonatal hospitalization. The present study aimed to investigate the role of medium-chain triglyceride (MCT) oil via massage therapy as a supplementary nutritional method on the weight gain of Neonatal Intensive Care Units (NICU) -hospitalized neonates. This randomized clinical trial performed among 121 stable premature neonates hospitalized in the NICU of Qaem Educational Hospital, Mashhad, Iran. They were randomly divided into three groups: oilmassage, massage alone and control groups. These groups were compared on the basis of weight gain during a one-week interval. The three groups were matched for sex, mean gestational age, birth weight, head circumference, delivery, and feeding type (P>0.05). The mean weight gain on the 7th day in the oil massage group was 105±1.3gr and 52±0.1gr in the massage group; whereas 54±1.3gr weight loss was observed in the control group. Significant differences were observed between the oil-massage group and the other two groups, respectively (P=0.002 and P=0.000). The findings of this study suggest that transcutaneous feeding with MCT oil massage therapy in premature neonates can result in accelerated weight gain in this age group with no risk of NEC.

Aneurysmal bone cyst (ABC) is blood filled expansile cystic lesion that most commonly occurs in patients during the second decade of their lives. Traditionally it has been described as a benign lesion but can be locally aggressive and result in the destruction of the involved bone. Treatment methods include surgical excision and curettage with or without bone grafting. We report a proximal femur aneurysmal bone cyst, which resulted in the amputation of the lower extremity, even though all available classic methods of treatment were applied for it.