ARCHIVES OF IRANIAN MEDICINE
Year:2016 | Volume:19 | Issue:3|Papers Count:15

OBJECTIVE: We aimed to assess the relationship between major dietary patterns and risk of diabetes type 2 among Iranian adults.METHODS: In this population-based case-control study in Mazandaran province, we enrolled 332 subjects (110 newly diagnosed cases and 222 controls) aged 43-77 years. Dietary intakes were collected using a validated semi-quantitative food frequency questionnaire (FFQ). Data on demographic, anthropometric, socioeconomic characteristics and other covariates were collected using structured lifestyle questionnaires. Factor analysis was used to identify major dietary patterns. Odds ratios (OR) were calculated for risk of type 2 diabetes across quartiles of dietary pattern scores.RESULTS: Three major dietary patterns were identified, including: “healthy”, “transitional” and “traditional”. A significant direct association was found between the transitional dietary pattern and risk of diabetes type 2 after adjustment of potential confounders (OR = 2.17; 95% CI: 1.0, 4.50; Ptrend = 0.02). The traditional dietary pattern was significantly associated with the increased risk of diabetes type 2 after controlling for confounders (OR = 2.13; 95% CI: 1.03, 4.41; Ptrend = 0.01). There was no significant relationship between healthy dietary pattern and risk of diabetes type 2.CONCLUSIONS: In conclusion, transitional dietary pattern characterized by high consumption of salt, organ meats, dried fruits, poultry, tea, low- fat dairy and other vegetables. Traditional dietary pattern characterized by high intakes of garlic, dough, high- fat dairy, dried fruits, red meats, grains, as well as animal and hydrogenated fats were associated with an increased risk of type 2 diabetes. No significant associations were found between the healthy dietary pattern and risk of diabetes type 2.

PURPOSE: To compare the outcomes of patients undergoing uncomplicated laparoscopic gynecologic procedures with and without drainage, and investigate the effects of drainage on postoperative shoulder pain, hospital stay and analgesic medications.PATIENTS AND METHODS: In this randomized clinical trial, 92 patients undergoing uncomplicated laparoscopic gynecologic procedures at Pars Hospital, Tehran, Iran, between April 2012 and July 2014 entered the study. Patients were randomly divided into two groups: one group received a drain at the end of operation, whereas the second group didn't receive a drain. For patients closed with drainage, Hemovac plastic passive drains were inserted without negative pressure. Severity of the patients’ postoperative shoulder pain was evaluated at rest using the 10-point visual analogue scale (VAS) at 12 h, 24 h, and 48 h after surgery.RESULTS: There was no difference between the two groups regarding age, weight, height, BMI, the cause of surgery and the blood loss during the surgery. At 12 h and 24 h after surgery, the shoulder pain was statistically lower in the group with drainage (P < 0.001 for both). There was no statistically significant difference between mean VAS scores of the case and control group at 48 hours post-surgery (P = 0.806). A significantly higher postoperative demand for analgesics was observed in the control group (P < 0.001). There was no statistically significant difference between two groups regarding the length of hospital stay.CONCLUSION: Our findings suggest that drainage may be useful to prevent postoperative shoulder pain among patients undergoing gynecological laparoscopic surgeries and decrease the need for pain medication. Further studies are recommended to assess the feasibility and cost effectiveness of using this method for reducing the postoperative shoulder pain.

BACKGROUND: Nosocomial infections are public health issues that are associated with high mortality in intensive care units. This study aimed to determine nosocomial infection-associated mortality in Tunisian intensive care units and identify its risk factors.METHODS: A prospective cohort study was carried out in intensive care units of a Tunisian University Hospital. The ICUs-wide active surveillance of nosocomial infections has been performed between 1 July 2010 and 30 June 2011. Data collection was based on Rea-Raisin protocol 2009 of “Institut National de Veille Sanitaire” (InVS, Saint Maurice - France). We used Kaplan Meier survival analysis and Cox Proportional Hazard regression to identify independent risk factors of nosocomial infection-associated mortality.RESULTS: Sixty-seven patients presented nosocomial infection in the end of the surveillance. The mean age of patients was 44.71 ± 21.2 years. Of them, 67.2% were male and 32.8% female. Nosocomial bacteremia was the most frequent infection (68.6%). Nosocomial infection-associated mortality rate was 35.8% (24/67). Bacteremia (Hazard Ratio (HR)) = 3.03, 95% Confidential Interval (95% CI): [1.23 – 7.45], P=0.016) and trauma (HR = 3.6, 95% CI: [1.16 – 11.2], P = 0.026) were identified by Cox regression as independent risk factors for NI-associated mortality.CONCLUSIONS: Our rate was relatively high. We need to improve the care of trauma patients and intensify the fight against nosocomial infections especially bacteremia.

BACKGROUND: 125I is one of the important sources frequently used in brachytherapy. Up to now, several different commercial models of this source type have been introduced to the clinical radiation oncology applications. Recently, a new source model, IrSeed-125, has been added to this list. The aim of the present study is to determine the dosimetric parameters of this new source model based on the recommendations of TG-43 (U1) protocol using Monte Carlo simulation.METHODS: The dosimetric characteristics of Ir-125 including dose rate constant, radial dose function, 2D anisotropy function and 1D anisotropy function were determined inside liquid water using MCNPX code and compared to those of other commercially available iodine sources.RESULTS: The dose rate constant of this new source was found to be 0.983+0.015 cGyh-1U-1 that was in good agreement with the TLD measured data (0.965 cGyh-1U-1). The 1D anisotropy function at 3, 5, and 7 cm radial distances were obtained as 0.954, 0.953 and 0.959, respectively.CONCLUISON: The results of this study showed that the dosimetric characteristics of this new brachytherapy source are comparable with those of other commercially available sources. Furthermore, the simulated parameters were in accordance with the previously measured ones. Therefore, the Monte Carlo calculated dosimetric parameters could be employed to obtain the dose distribution around this new brachytherapy source based on TG-43 (U1) protocol.

BACKGROUND: To determine the prevalence and trends of venereal infections, including the Human Immunodeficiency Virus (HIV) and treponema pallidum in healthy blood donors over a decade.MATHERIALS AND METHODS: This cross-sectional descriptive study conducted at the Blood Bank of Liaquat National Hospital, extended from January 2005 to December 2014, in which 148268 healthy donors were enrolled. Screening for HIV was done by Microparticle Enzyme Immunoassay and Chemiluminescent immunoassay techniques. Syphilis screening was done by Treponema pallidum particle agglutination and Chemiluminescent Immunoassay methods.RESULTS: Out of the 148268 total donors, 147684 (99.6%) were replacement donors and remaining 584 (0.4%) were voluntary donors with a mean age of 29.09 ± 7.04 years. Overall, there were 147939 (99.8%) males and 329 (0.2%) females. A total of 1536 (1.03%) donors were reactive. Among the replacement donors, 1535 (1.03%) were found to be reactive for HIV and treponema pallidum. Of these, 172 (0.11%) donors were positive for HIV, while 1363 (0.91%) were positive for treponema pallidum. All reactive donors were male (99.94%), except for one female (0.06%). The prevalence of HIV and syphilis were higher in the younger age group (18 – 30 years). Out of 584 voluntary donors, only one (0.1%) donor was positive for HIV, while all donors were negative for treponema pallidum. The positive rates among replacement and voluntary donors were 1.03% and 0.1%, respectively. Co-infectivity was observed in two (0.001%) donors.CONCLUSION: The prevalence of venereal infection was higher in replacement donors as compared with voluntary donors. The prevalence of syphilis in our series was high compared with earlier studies. It emerges that syphilis positivity rate appears to escalate; however, HIV infection remains static over a decade. Higher prevalence in younger donors is alarming and adversely affects the prospective blood donation pool. Stringent donor selection, emphasis on voluntary donation, and vigilant donors screening are highly recommended to ensure the maximum safety of blood recipient.

BACKGROUND: Dysbiosis of the gut microbiota underlies non-alcoholic steatohepatitis (NASH). Ingredient of Chinese herbal medicine, berberine, has been proved to regulate the gut microbiota without systemic side effects. Therefore, we explored its effects on NASH induced by high-fat diet (HFD).METHODS: BALB/c mice were randomized into three groups, including: control, model, and berberine treatment. With the exception of the control group with the standard diet, the model, and the treatment groups were treated by HFD. Mice from treatment group were further subjected to berberine (200 mg/kg/d) gavage since the 5th week. At the end of the 13th week, gut bacteria, liver endotoxin receptor, and inflammation cytokines were assessed by real-time PCR. NASH and its predisposing factors were evaluated biochemically and pathologically.RESULTS: Compared to their decreases in the model group, berberine administration restored the relative level of Bifidobacteria (2.16 ± 0.63 vs. 0.50 ± 0.08, P < 0.01) and the ratio of Bacteroidetes/ Firmicutes (0.76 ± 0.26 vs. 0.39 ± 0.11, P < 0.01), respectively, in the treatment groups. Microbiota restoration led to significant reductions in body weight, serum levels of lipids, glucose, insulin, and homeostasis model assessment of insulin resistance. Improvements were also observed in the serum transaminase activity and nonalcoholic fatty liver disease activity score, which demonstrated the attenuation of NASH. Mechanically, expression levels of CD14, IL-1, IL-6 and TNF-a were statistically down-regulated (treatment group vs model group, P < 0.01).CONCLUSIONS: Berberine alleviates NASH and its predisposing factors. Normalization of gut microbiota might underlie its effect.

BACKGROUND: Antibiotics are among the most commonly prescribed drugs in pediatrics. Due to lack of uniformity in pediatric antimicrobial prescribing and the emergence of antibiotic resistance, appropriate drug utilization studies have been found to be crucial to evaluate whether these drugs are properly used.METHODS: Data were collected between January 2014 and February 2014 in 16 Iranian pediatric hospitals using a standardized method. The point prevalence survey included all inpatient beds.RESULTS: Of 858 children, 571 (66.6%) received one or more antimicrobials. The indications were therapeutic in 60.6%. The parenteral route was used in 92.5% of therapeutic indications. Ceftriaxone was the most prescribed antimicrobials for therapeutic indications (32.4%) and combination-therapy was the most type of therapy in pediatric intelligent care unit (PICU).CONCLUSION: According to results of this study, antibiotics’ prescribing in pediatrics wards of Iranian hospitals is empirical. Therefore, for quality improvement of antimicrobial use in children continuous audit process and antibiotic prescriptions require further investigation.

BACKGROUND: This study aimed to detect the presence of the parasite Demodex folliculorum (DF) in various obese groups according to BMI Levels.MATHERIALS AND METHODS: A total of 182 patients (40.8 ± 14.8 years, min-max age 19 – 73 years) were enrolled in the study, of those 65 (35.7%) were female and 117 (64.3%) were male. They had previously applied to Mustafa Kemal University (Faculty of Medicine, Endocrine Outpatient Clinic) during 2012. A standardized skin surface biopsy method was used to research the existence of DF. Patients were classified into four main groups, including: obese (n = 89), overweight (n = 31), normal (n = 32), and underweight (n = 30).RESULTS: There was no significant difference between groups in terms of age and sex. The total DF positivity was 19 (21.3%) in obese patients. Among those with positive DF, the mean BMI was 35.7 ± 12.1 kg/m2, while those with negative DF had a mean BMI of 29.2 ± 9.2 kg/m2. There was a significant difference between two groups (P = 0.002). Also, the underweight group has significantly higher DF positivity in comparison to the normal weight group.CONCLUSION: The DF positivity was significantly higher in obese patients in accordance with the physiopathologic nature of the disease.

INTRODUCTION: The Full Outline of Unresponsiveness (FOUR) score was developed to compensate for the limitations of Glasgow coma score (GCS) in recent years. This study aimed to assess the predictive value of GCS and FOUR score on the outcome of multiple trauma patients admitted to the emergency department.PATIENTS AND METHODS: The present prospective cross-sectional study was conducted on multiple trauma patients admitted to the emergency department. GCS and FOUR scores were evaluated at the time of admission and at the sixth and twelfth hours after admission. Then the receiver operating characteristic (ROC) curve, sensitivity, specificity, as well as positive and negative predictive value of GCS and FOUR score were evaluated to predict patients’ outcome. Patients’ outcome was divided into discharge with and without a medical injury (motor deficit, coma or death).RESULTS: Finally, 89 patients were studied. Sensitivity and specificity of GCS in predicting adverse outcome (motor deficit, coma or death) were 84.2% and 88.6% at the time of admission, 89.5% and 95.4% at the sixth hour and 89.5% and 91.5% at the twelfth hour, respectively. These values for the FOUR score were 86.9% and 88.4% at the time of admission, 89.5% and 100% at the sixth hour and 89.5% and 94.4% at the twelfth hour, respectively.CONCLUSION: Findings of this study indicate that the predictive value of FOUR score and GCS on the outcome of multiple trauma patients admitted to the emergency department is similar.

The glandular odontogenic cyst (GOC) is a rare developmental cyst that was described in 1988 by Gardner, et al. This lesion demonstrates non-specific clinical course and radiological findings. Hence, often confused with other lesions, but specific histopathlogical features help in establishing its correct diagnosis. This article presents a rare case of a maxillary glandular odontogenic cyst in a 70-year-old female patient.

Chronic abdominal pain sometimes constitute a major challenge, specially when a patient has two diseases with dominant features of abdominal pain in both. At this point, clinicians face a daunting task both in diagnosing and treating an individual’s chronic abdominal pain. Similarly, familial Mediterranean fever disease and Crohn's disease have the same clinical features in terms of chronic abdominal pain, and inflammatory properties of these diseases. The association of familial Mediterranean fever disease and Crohn's disease is very rare and may lead to a remarkable challenge in both diagnosis and treatment. Here, we report a young man with FMF disease presented with extraordinary and intolerable abdominal pain relieved only by excessive narcotic analgesics. The presented case was diagnosed with CD and successfully treated with anti-TNF (tumor necrosis factor) due to steroid refractory.

Early History of Hemophilia: The mutations giving rise to hemophilia are probably of great antiquity, because they occur in at least three orders of placental mammals: the Ungulata; the Carnivora, and the Primates. Hemophilia has been described in the horse1 and in nine breeds of dog, 2 as well as in all races of man. The orders to which these groups belong may have been distinct from the end of the Cretaceous – say, 65 million years ago, and the mutations have probably recurred independently many times in all three, since it must be lethal in the wild state.3 The mutation rate has been estimated at about 1- 4 × 10-5.

Dear Editor, Ethics has been an integral part of medical practice throughout its long history, especially when its importance was formally realized and introduced in the form of professional oaths from the Hippocrates on. Ethical (professional) codes of practice and conduct have now a well known academic and in most cases legal standing in different aspects of biomedical sciences. Interprofessional behaviors, research, knowledge production and its practical crystallization in technologies and techniques are the aspects commonly considered in ethical codes.

Dear Editor, We have read with great interest the article entitled “Risk and protective factors for suicide attempt in Iran: A matched casecontrol study” by Akbari, et al. which was published in the recent issue of AIM. According to authors, recent stressful life events, general health conditions and being problem-focused mentality can increase the risk for suicide attempts. On the other hand, intrinsic religious beliefs and close social networks were considered as preventive factors.

In response to our recent published paper entitled: “Risk and Protective Factors for Suicide Attempt in Iran: A Matched Case- Control Study”1 Zamani, et al. wrote a letter to highlight the impact of religious beliefs on health and suicide attempt. Their main message was not very compatible with our conclusion; however, we would like to elaborate this issue.