Iranian Red Crescent Medical Journal
Year:2013 | Volume:15 | Issue:8|Papers Count:20

The Greek word, lithos means stone that is the origin of a metal named “lithium” (Li), the 27 th most abundant, the lightest alkali, highly reactive and flammable metal within chemical elements. Li is never found freely in the nature due to high reactivity and easily found as a soluble ion in water, so that it is ordinary gained from brines and clays. But, Li is commercially obtained from a mixture of Li and potassium chlorides. The Li minerals with high commercial value are belonging to silicates, micas and phosphates. Lithium has low atomic mass and is observed rarely in the solar system than other chemical elements. In nuclear physics, Li-6 deuteride is employed as a fusion fuel in staged thermonuclear weapons (1, 2)...

Context: Nocturnal enuresis has undoubtedly occurred since man's earliest days and the first references are found in the Ebers papyri of 1550 BC. The purpose of this study is to review of Rhazes opinion about diagnosis and treatment of nocturnal enuresis and compare his belief and clinical methods with modern medical practice.Evidence Acquisition: In the review study we searched all available and reliable electronic and paper sources using appropriate keywords about the views of Rhazes, and compared them with recent medical evidence about diagnosis and treatment of nocturnal in medication.Results: Our findings proved that Rhazes described the symptoms, signs, and the treatment of nocturnal enuresis in accordance with contemporary medicine.Conclusions: A review of opinion Rhazes and other ancient Islamic medical textbooks on nocturnal enuresis reveals that medical practice in those days was comparable to modern medicine yet avoiding the side effects that are commonly experienced with the modern medical approach.

Background: This study investigates the ability of quince leaf extract to prevent progression of atherosclerosis and to determine the lipid-lowering effect of it.Objectives: This study suggested that quince leaf effects on progression of atherosclerosis, and performed comparison with atorvastatin as a standard medication.Materials and Methods: The effect of 50mg/kg of the quince leaf extract on lipid profiles was assessed by measuring the levels of totalcholesterol, triglyceride, LDL, HDL, and liver enzymes (AST, ALT, and AP) in plasma and were evaluated the thickness of aortic plaques in the hypercholesterolemic rabbits after stopping. These assessments were performed using 0.5 mg/kg of atorvastatin.Results: Oral administration of cholesterol for 8 weeks resulted in a significant increase (P< 0.05) in plasma markers. Treatment with the extract at dose of 50 mg/kg and 0.5 mg/kg of atorvastatin not only were reduced lipid profile in plasma (P<0.05) but also were increased HDL-cholesterol levels. There were decrease (P=0.04) in the liver enzymes in extract treated rabbits. However, plaque thickness had no significant difference in the aorta of treated rabbits compared with studied control.Conclusions: These results indicate the lipid-lowering effects of quince leaf similar to atorvastatin and it can probably serve as a new potential natural product for atherosclerosis treatment.

Background: Diabetes is a metabolic disorder with a high worldwide prevalence. It has been reported that diabetic patients are more prone to depression and anxiety.Objectives: This study aimed to evaluate the prevalence of depression and anxiety among diabetic patients with regards to some factors such as age, gender, level of education and occupational status.Materials and Methods: One hundred and eighty four diabetic patients have participated in this study. To assess the severity of depression and anxiety Beck depression inventory and Beck anxiety inventory questionnaire were used respectively. Binary logistic regressions were used to analyze the data.Results: The results of the present study have shown that 70.7% of the diabetic patients were suffered from depression. Besides, 69.6% of them were diagnosed with anxiety. According to the result, diabetes related depression is affected by sex (OR: 2.767), age (OR: 2.222), level of education (OR: 4.145) and job status (OR: 3.901). It has been also resulted that gender (OR: 2.274), age (OR: 2.706) and Job Status (OR: 2.441) are the effective e factors leading to anxiety.Conclusions: Depression and anxiety have higher prevalence among diabetic patients and some sociological factors such as age, gender, job and education are related to these psychological disorders.

Background: Since pulmonary hypertension (PH) in patients with chronic obstructive pulmonary diseases (COPD) causes poor prognosis and inflammatory process involved in PH, it is supposed that Statins with anti-inflammatory effects might be useful in the treatment of PH.Objectives: The aim of this study was to evaluate the influence of Atorvastatin on the treatment of pulmonary hypertension in patients with COPD.Patients and Methods: A registered (IRCT201108257411N1), triple-blind, randomized controlled trial was performed in Rasoule Akram hospital, Tehran, from 2009 to 2011. Forty five patients with secondary pulmonary hypertension due to COPD were recruited and randomized to two groups receiving either Atorvastatin 40 mg/d or placebo in addition to their current treatment for 6 months. The outcomes including systolic pulmonary arterial hypertension (SPAH), cardiac output (CO), right ventricular size (RVS), CRP, 6 min walk distance test (6MWD), and spirometry parameters were measured after 6 months.Results: Baseline characteristics were similar in both groups. After 6 months, pulmonary hypertension changed from 48.5±6.9 to 42.9±9.3 mmHg for Atorvastatin users and from 49.7±11.4 to 48.2±14.6 mmHg for Placebo users (P=0.19, CI-13.57-2.89), 6MWD after 6 months was 339±155 meters in case group versus 340 ± 106 meters in control group (P=0.98, CI-92.58-91.15). There were no significant changes in other outcomes including CRP, RVS, CO and spirometry parameters.Conclusions: Although we found a trend towards decreasing SPAH and improving 6MWD, no statistically significant shift were detected in our outcomes due to inadequate sample size.

Background: Identifying perceived access barriers to preventive dental services is one of the basic steps to improve the public health.Objectives: This study aimed to determine the perceived barriers affecting access to preventive dental services in one of Tehran dental clinics in 2012.Patients and Methods: This research was a cross-sectional descriptive-analytical study conducted in one of Tehran dental clinics in 2012 using decision–making trial and evaluation laboratory (DEMATEL) method. The study sample included all patients (100 patients) who had referred to the endodontic treatment department from 26 - 31 May, 2012. The required data were collected using a questionnaire. Collected data were analyzed using SPSS 18.0 and MATLAB 7.9.0 SPSSS 18.0, as well as, some descriptive and analytical tests including Mean, Standard Deviation (SD), and Independent T- Test.Results: The five determinants of cost, inconvenience, fear, organization, and patient-dentist relationship were determined as barriers to access to dental services among which the cost and patient-dentist relationship were identified as the first and last priorities with the coordinates (1.4 and 1.4) and (1.25 and-0.65), respectively.Conclusions: High cost of dental care has led to not referring patients to the clinic. Oral health costs are too high; however insurance organizations have no commitment to support such services. Policymakers, administrators, and insurance organizations have a major role in improving access to dental services. These decision-makers in making their policies can provide the required financial resources, shift the available resources towards preventive care and periodic checkups, and consider providing proper and sufficient places for dental care facilities.

Background: Disability is more based on social, rather than medical aspects. Lack of attention and social support may impact on participation of people with physical disability in various aspects and their return to normal life in the society.Objectives: This study was conducted to determine perceived social support and related factors among physically disabled in the city of Tehran.Patients and Methods: This cross-sectional study by using simple random sampling was conducted on 136 people with physically disabled who were covered by Welfare Organization of Tehran. The Norbeck social support questionnaire was used .Multiple linear regression analysis with the backward method was used to identify the adjusted association between perceived social support as dependent variable and demographic variables as independent variables.Results: The present sample comprised of 68 (50%) male and 68 (50%) female with the mean age of 33 (SD=8.9) years. Based on the results, mean of functional support were 135. 57 (SD=98.77) and mean of structural support was 77.37 (SD=52.37). Regression analysis model, demonstrates that variables of age and marital status remained in the model as significant predictors of functional support (P=0.003,P 0.004, respectively) and structural support (P=0.002, P=0.006, respectively).Conclusions: Based on the results, participants in the study didn’t have favorable status with respect to perceived social support (in all dimensions) from their social network members. While, social support as one of the social determinants of health, plays an important role in improving psychological conditions in people’s lives; therefore, being aware of social support and designing effective interventions to improve it for the disabled is very important.

Background: Tumor necrosis factor-α (TNF-α) antibodies are currently used in patients with moderate to severe Crohn’s disease (CD) who are unresponsive to conventional therapies. Certolizumab pegol (Cp) is one of the anti-TNF-α agents introduced for the management of CD and rheumatoid arthritis.Objectives: The aim of this meta-analysis is to assess the efficacy of Cp in inducing clinical response and remission in CD and the associated adverse events. The effect of Cp in terms of CD patients’ C-reactive protein (CRP) level was also studied.Patients and Methods: Literature was searched for studies investigated the efficacy of Cp on inducing clinical response and maintaining remission in the patients with CD between 1966 and July 2012.Results: Among 165 potentially relevant studies, six with a total of 1695 patients met the inclusion criteria and were meta-analyzed. In comparison to control groups, patients who received Cp had a relative risk (RR) of 1.38 with absolute risk reduction (ARR)= 0.12; 95% CI = 0.03 to 0.21), number needed for treatment (NNT)=9; P<0.0001) for clinical response and RR of 1.54 (ARR= 0.09; 95% CI=-0.0198 to 0.2), (NNT = 12; P < 0.0001) for maintenance of clinical remission and non-significant RR of 1.24 (P=0.052) for induction of clinical remission. Baseline CRP did not significantly alter the magnitude or response. Adverse events were not significantly different among patients receiving Cp comparing to placebo.Conclusions: Cp is effective for inducing clinical response and maintenance of clinical remission in patients with moderate to severe CD with similar side-effect profile as the control arms.

Background: Breast feeding appears to play a role in determining obesity and abdominal obesity during childhood, specifically in children with a history of low birth weight.Objective: The purpose of this study is to investigate the relation of breast-feeding with either of abdominal obesity and obesity among Iranian school children.Materials and Methods: A total of 1184 students (625 girls and 559 boys), aged 10 to 13 years old, were selected from 112 governmental elementary schools in Iran. Height, weight, waist circumference and blood pressure were measured using standard instruments and a pretested standardized questionnaire was performed for compiling information about family economics and educational level, first–degree family history of obesity, history of breast feeding, food pattern and birth weight, as well.Results: 13.68% (n=160) of students had a history of low birth weight, and 26.41% of them had abdominal obesity. Of all participants, 22.04% were overweight and 5.32% were obese which was more prevalent in girls than in boys (P=0.03). First-degree family history of obesity (P=0.001), excessive gestational weight gain (P=0.001) and birth weight (P=0.01) were significantly correlated with the prevalence of obesity and abdominal obesity during childhood. Moreover the prevalence of abdominal obesity in children with low birth weight was significantly correlated with breast feeding (P=0.04); But this relation was not significantly about obesity in our participants (P=0.9). Furthermore duration of breast feeding was significantly and inversely correlated with obesity and abdominal obesity in schoolchildren with low birth weight (P=0.01).Conclusions: The results suggest that Breast feeding and its long-term consequences were important factors for preventing metabolic syndrome criteria in childhood and later years of life span. With regard to the increasing prevalence of obesity in children, more research is urgently needed to clarify whether breast feeding have negative consequences for the risk of chronic disease in children, especially in children with low birth weight.

Background: Currently, the rate of caesarean section has been substantially increased in developing and developed countries. To determine the factors causing such an increase, it is important to determine reasons for women to refuse vaginal delivery and preferring caesarean section.Objectives: To determine Turkish women’s attitudes and basal knowledge regarding vaginal delivery and caesarean section, as well as factors causing women to prefer caesarean section even when a medical indication does not exist.Patients and Methods: This descriptive study consisted of 840 women, completing the questionnaire developed by the researchers.Results: Mean age rate of participants was 39.8±11.8 years. The most significant reasons of vaginal delivery preferred by participants (n=685) were determined to be healthy and swift recovery period after delivery, whereas those preferred by participants (n=155) for caesarean section were being safer for babies, easier than vaginal delivery and a less painful method. Higher educational status, pregnancy after infertility treatment and undergoing caesarean section for the last delivery were determined to be among important factors affecting to choose caesarean section.Conclusions: Information gained misleadingly and fears related to vaginal delivery were seen as factors affecting women’s preferences for delivery. Thus, midwives are required to train both pregnant women during antenatal care and all women in society about methods of delivery and to give effective counseling.

Background: Skin cancers are the most common cancers around the world. Cutaneous malignant melanoma (CMM) is the malignancy of melanocytes that are mainly located in the skin and mucous membranes.Objective: This study tried to evaluate the incidence and mean survival time of cutaneous malignant melanoma (CMM) in Yazd, Iran. It seems that the epidemiology and clinical aspects of CMM in Iran are different from those in other parts of the world; also due to the limited and scattered studies there isn't lot in the literature regarding CMM in Iran.Materials and Methods: This study used data obtained from the cancer registry center in the province of Yazd for a period of 21 years (1988 – 2008). Population and statistical data were gathered from “National Organization for Civil Registration”. Population-based data were analyzed, focusing on the incidence and mean survival time over this 21 year period.Results: The mean incidence rate for CMM in Yazd-Iran between 1988 and 2008 was 0.40 per 100,000 for males and 0.27 per 100,000 for females per year, and the incidence of CMM was relatively constant during this period of time. The mean survival rates for women were better than men (80.5% and 76.3% respectively).Conclusions: CMM in Yazd is a low-incidence skin tumor that shows a relatively fixed incidence between 1988 and 2008, Higher incidences of CMM were found in sun-exposed areas (especially head and neck areas), with more incidence in men. Skin cancers and CMM incidence in Iran is lower than western countries, most probably due to geographical zone, genetic factors, skin type, society-related customs including clothing styles.

Background: Premenstrual disorders usually refer to Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD). This study was designed to find out the frequency of premenstrual disorders and evaluate the associated factors in a sample of Iranian adolescents.Objectives: This study was conducted to investigate the frequency of premenstrual disorders (PMS and PMDD) based on Premenstrual Assessment Scale (PAS) and also to determine the association of some demographic and menstrual characteristics with these disorders in adolescent girls.Patients and Methods: This was a cross sectional study. A sample of adolescent school girls aged between 14 and 19 years were included in the study. Diagnostic assessments were based on Premenstrual Assessment Scale (PAS). The data were analyzed in a descriptive fashion and were compared among subgroups of the study sample. In addition, demographic and menstrual factors associations with premenstrual disorders were assessed.Results: In all 1379 female students were included in the study. About 99.5 % of the students reported at least one premenstrual symptom. Of these, 66.3% was mild, 31.4% moderate and 2.3% severe. A total of 814 girls (59%) met the diagnostic criteria for premenstrual dysphoric disorder (PMDD). Most frequently reported symptoms were back pain, lethargy, fatigue and anxiety. Early menarche, lower education was associated with higher scores on PAS.Conclusion: Premenstrual disorders are common in adolescent girls. Preventive and treatment strategies are highly recommended.

Background: Toxoplasmosis is caused by the Toxoplasmagondii parasite. The parasite is intracellular and can result in severe complications leading to death in immuno-deficient patients in particular. Diabetes is an important factor that increases susceptibility and risk of various infections in the host.Objectives: The present study focused on the serologic detection of Toxoplasma gondii infection in diabetic patients.Materials and Methods: Through a case-control study, overall 184 serum samples including 91 from diabetic cases and 93 from healthy non-diabetic controls were investigated. Cases and controls were matched for age and gender. Serum samples were tested for sugar by an enzymatic method, and IgG antibodies were tested against Toxoplasma gondii by ELISA method.Results: The prevalence of Iggy antibodies against Toxoplasma gondii in diabetic patients and healthy controls were 60.43% and 38% respectively. Risk of toxoplasmosis infection in diabetic patients with was two folds higher than healthy controls (RR=2.21, 95% CI; 1.6–3.7, P=0.001).Conclusions: Diabetes may be caused by Toxoplasma gondii. Presence of T. gondii in the pancreas at the same time could directly undermines the pancreas cells. When β cells are destroyed, insulin secretion would then be affected. Probably the destruction of T. gondii affects nervous system and damages pancreatic cells leading to increased risk of diabetes.

Background: Clostridium difficile infection (CDI) is major growing problem in hospitals and its high incidence has been reported in recent years.Objectives: The aim of this study was to investigate the antimicrobial susceptibility patterns of C. difficile clinical isolates against antibiotics commonly used for treatment CDI in hospitalized patients.Material and Methods: During a 12 month study, 75 C. difficile isolates were collected from 390 patients with CDI. All samples were treated with alcohol and yeast extract broth. The treated suspensions were cultured on a selective cycloserine cefoxitin fructose agar (CCFA) supplemented with 5% sheep blood and incubated in anaerobic conditions, at 37°C for 5 days. Cdd-3, tcdA and tcdB genes were identified using PCR assay.Results: The prevalence of A+B+ , A+B- and A-B+ strains were 64(85.3%), 5(6.7%) and 6(8%) respectively. In vitro susceptibility of 75 clinical isolates of C. difficile to 5 antimicrobial agents, including metronidazole, vancomycin, clindamycin, erythromycin and cefotaxime were investigated by Clinical and Laboratory Standards Institute (CLSI) agar dilution method. Metronidazole and vancomycin had good activity against C. difficile isolates with MIC90s of 2 and 1 mg/ml, respectively. Seventy one (94.6%) of strains was inhibited by concentrations that did not exceed 2μg/ml for metronidazole. Resistant to metronidazole observed in 5.3% of isolates. Forty three (57.3%) of the isolates were resistant to erythromycin. Of 43 resistant strains to erythromycin, 9 (12%) isolates had high-level MIC of more than 64μg/ml. All strains were resistant to cefotaxime. Sixty seven (89.3%) isolates were resistant to clindamycin (MIC90s>256 μg/ml) and only 6.7% were sensitive to clindamycin. Multidrug-resistant (three or more antibiotics) was seen in 36(48%) isolates.Conclusions: Metronidazole and vancomycin still seem to be most effective drugs for treatment CDI.

  Background: The old Treatment Planning Systems (TPSs) used for intracavitary brachytherapy with Cs-137 Selectron source utilize traditional dose calculation methods, considering each source as a point source. Using such methods introduces significant errors in dose estimation. As of 1995, TG-43 is used as the main dose calculation formalism in treatment TPSs.Objectives: The purpose of this study is to design and establish a treatment planning software for Cs-137 Solectron brachytherapy source, based on TG-43U1 formalism by applying the effects of the applicator and dummy spacers.Materials and Methods: Two softwares used for treatment planning of Cs-137 sources in Iran (STPS and PLATO), are based on old formalisms. The purpose of this work is to establish and develop a TPS for Selectron source based on TG-43 formalism. In this planning system, the dosimetry parameters of each pellet in different places inside applicators were obtained by MCNP4c code. Then the dose distribution around every combination of active and inactive pellets was obtained by summing the doses. The accuracy of this algorithm was checked by comparing its results for special combination of active and inactive pellets with MC simulations. Finally, the uncertainty of old dose calculation formalism was investigated by comparing the results of STPS and PLATO softwares with those obtained by the new algorithm.Results: For a typical arrangement of 10 active pellets in the applicator, the percentage difference between doses obtained by the new algorithm at 1cm distance from the tip of the applicator and those obtained by old formalisms is about 30%, while the difference between the results of MCNP and the new algorithm is less than 5%.Conclusions: According to the results, the old dosimetry formalisms, overestimate the dose especially towards the applicator’s tip. While the TG-43U1 based software perform the calculations more accurately.

A carbamazepine intoxication with suicide attempt is a relatively common clinical problem that presenting with coma, respiratory depression, arrhythmia, hemodynamic instability and even death. We report a case of severe carbamazepine poisoning that was successfully treated with one session charcoal hemoperfusion. On admission, the patient was comatose and required ventilator support. Hemoperfusion with coated activated charcoal successfully decreased the serum carbamazepine concentration from 45 μg mL−1 to 21 μg mL−1 within 2 h, with subsequent clinical improvement.

Mobile phones as a symbol of electronic century and digital world has spared worldwide especially in youth (1, 2). Subscribers of mobile phones were increased from 12.4 million in 1990 to 500 million in 2000 to 3.3 billion in 2008 and 5.3 billion at the end of 2010 (3-6). Estimations show that the prevalence of mobile use will be increased to 95% till 2013 (2). In Iran Subscribers were increased from 4.3 million in 2004 to 41 million in 2008; it is estimated that about 53 – 55 million are subscribers of mobile phone in Iran now (2). Communication technologies (that causes to higher level in quality of life) have several benefits in our modern life; but we can’t disregard some negative effects of mobile phones that caused serious social and cultural problems in communities (2). This study tries to detect the attitude and practices among students of Yazd University of medical sciences were living in dormitories about using mobile phones.

Mesenchymal stem cells (MSCs) are characterized by ability to differentiate into several cell types and self-renewability. These stem cells have a limited capacity in cell lineage differentiation including osteogenic, adipogenic, chondrogenic, or myogenic lineage differentiations (1). Regarding their ease of isolation and specific characteristics, MSCs have been used widely in regenerative medicine and tissue engineering (2). In spite of identification of several signaling molecules in MSCs differentiation, controlling mechanisms in MSCs differentiation has not well been described. Recently, epigenetic mechanisms have been identified as the master regulatory mechanism in MSCs differentiation such as DNA methylation, histone modification and regulatory micro RNAs (2-4)…

Molar pregnancy is a disorder of chorionic villi including trophoblastic proliferation and villous stromal swelling. One case of molar pregnancy is reported per 1500-2000 pregnancies in USA. Studies showed that the incidence of hydatiform mole in Asia, Africa and Central America is more than USA, Europe and Australia (1). Hydatiform mole is classified to partial (PM) and complete (CM) mole regards to the histopathology examination (2). Suspicion arises when an ultrasound reports a fetal pole associated with an abnormal placenta. (3) Twin pregnancy of a complete hydatiform mole and a natural fetus is a rare condition and accounts for one in 22000 to one in 100000 of pregnancies. Its importance is regards to the significant increased risk of pregnancy complications like preterm labor; making decision about the true management is much harder due to the probable viable fetus(3, 4).

The most prevalent complication of cholelithiasis is chronic cholecystitis usually necessitating cholecystectomy (1). The biliary tract is usually sterile; however, if cholelithiasis is pigmented and cholestering, different microbes might be identified in and/or cultured from the bile or gallbladder wall (2). Microscopic examinations indicated that 20-50% of the patients with chronic cholecystitis have positive bile culture (3). Different reasons for biliary tract infection have been presented, e.g. ascending infection due to reflux of duodenal contents, blood-borne infection and infection spread through the portal-venues channels. Ascending infection from the duodenum is thought to be the primary mechanism by which bacteria enter the bile (4). Different microbes in the bile may be cause to post- cholecystectomy infections. Thus, understanding the most common organisms causing them and their antibacterial susceptibility pattern would be useful in prevention of these infections. The present study was carried out to achieve this aim.