Iranian Red Crescent Medical Journal
Year:2016 | Volume:18 | Issue:8|Papers Count:13

Background: Diabetes mellitus is assumed to be a strong risk factor for cardiovascular diseases (CVD) and is frequently associated with other CVD risk factors.Objectives: The aims of this study were to assess the prevalence of different patterns of dyslipidemia in individuals with diabetes compared with non-diabetic subjects and evaluate other accompanied CVD risk factors between the two groups.Patients and Methods: This was an analytical cross-sectional study on 230 participants, aged 28 - 66 years old, who were referred to different urban health centers of Khorasan Razavi province (north-east of Iran). Data from the participants were collected during their first visit by primary care physicians. Statistical package for social science (version 11.5) was used to analyze the data. The chisquare or Fisher’s exact, student’s t or the Mann-Whitney U and correlation tests were used in the analysis.Results: The age and gender of the participants were not different between the two groups (P=0.1 and P=0.4, respectively). The most common patterns of dyslipidemia in both groups were isolated dyslipidemia followed by combined dyslipidemia. Prevalence of dyslipidemia as a whole (one, two or three lipid profile abnormalities) in patients with diabetes and non-diabetic participants was 89.3% and 82.6%, respectively and the difference between the two groups was not statistically significant (P=0.1). Subjects with diabetes had higher systolic blood pressure (P<0.001), higher diastolic blood pressure (P=0.002) and higher body mass index (P =0.09) compared to non-diabetics. Moreover, they were more likely to have higher levels of total cholesterol (P=0.01), triglycerides (P=0.001) and low density lipoprotein cholesterol (P=0.009) and lower levels of high density lipoprotein cholesterol (P=0.2).Conclusions: Cardiovascular diseases risk factors are more common in patients with diabetes; however, non-diabetic individuals also had a high prevalence of risk factors in our region, predisposing them to diabetes. Therefore, further attention by the medical community is necessary to choose effective strategies for a more a aggressive approach to prevent and manage these risk factors.

Background: Fever is a reliable sign of illness, but it also evokes fear and anxiety. It is not the fever itself but the fear of possible complications and accompanying symptoms that is important for pediatricians and parents.Objectives: We aimed to investigate maternal understanding of fever, its potential consequences, and impacts on the treatment of children.Patients and Methods: A questionnaire was use to explore the attitudes, knowledge, and practices of mothers of 861 children brought to four medical centers in different regions of Turkey in 2012, with fever being the chief complaint. All the children were aged 3 months - 15 years.Results: Among the 861 mothers, 92.2% favored antipyretics for fever, either alone or in addition to external cooling measures. Most favored paracetamol or ibuprofen. In this study, the appropriate use of antipyretics was 75.2%, which was higher than that reported in the literature. In common with previous reports, seizures and brain damage were perceived as the most frightening and harmful effects of fever. All the mothers expressed concerns about fever, but they were most common among the highly educated or those with one child.Conclusions: Fever phobia remains common, not only among low socioeconomic status mothers but also among those of high socioeconomic status. Healthcare providers should take fever phobia into account and provide correct information to caregivers about fever at all visits.

Background: Warts are common dermatological lesion caused by skin epithelial cells’ infection with human Papillomavirus (HPV).Objectives: This study aimed to assess the efficacy of a new method for the treatment of dermal warts.Patients and Methods: In this clinical trial study, 60 patients (older than 10 years) with dermal warts living in Baneh city, west of Iran, were allocated into the intervention and control groups using the block randomized method in 2012. In the intervention group, outer layers of the dermal wart carved using scalpel and HD tablet set on it and covered with adhesive. In the second and third days, it was repeated again. All stages in the intervention group were similar to the placebo group. Placebo was prepared by a pharmacologist, which was similar to the HD tablet. In both groups, patients were examined one week and one month after taking the last tablet by the physician in terms of improvement or lack of improvement. Data were analyzed by SPSS software version 18 using chi-square test, Fisher’s exact test, Mann-Whitney test and ANOVA for repeated measures.Results: In the first week after the intervention, warts were changed in 93.3% of the cases; however, no changes were recorded in the control group. One month after follow-up, the mean was 0.4±0.7 in the intervention group and 5.5±4.9 in the control group (P=0.0001). Based on ANOVA for repeated measures and t-test, the average number of warts, before, one week and one month after the intervention was statistically significant for both intervention (P=0.009) and control groups (P=0.0001).Conclusions: This method is recommended for the treatment of dermal warts, owing to the effectiveness, short duration of treatment, and low cost of topical treatment for dermal warts using HD tablets.

Background: Coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB) triggers an inflammatory reaction, leading to the development of myocardial damage and dysfunction. It is suggested that selenium (Se), an essential trace element, has a protective role against oxidative stress. Decreased intraoperative Se levels might be an independent predictive factor for postoperative multiorgan failure. In spite of its proposed advantages, however, the optimal timing and dosage are not well known. Objectives: To determine whether 600  g of intravenous Se administration before induction of anesthesia for CABG surgery could attenuate inflammatory reactions in an Iranian population. Methods: This randomized triple-blind clinical trial took place in the department of cardiac surgery of an academic hospital affiliated with Guilan University of Medical Sciences (GUMS) from May 2015 to September 2015. Eighty-eight eligible patients scheduled for elective on-pump CABG surgery were divided into two groups using randomized fixed quadripartite blocks. They received either an intravenous bolus of 600  g Se before induction of anesthesia, or normal saline as a placebo. We had four measurement time-points: just before induction of anesthesia (T0), immediately after the end of CPB (T1), 24 hours after surgery (T2), and 48 hours after surgery (T3). Interleukin 6 (IL-6), tumor necrosis factor-alpha (TNF- ), and C-reactive protein (CRP) serum levels were measured using the enzyme-linked immunosorbent assay (ELISA). Results: Data from a total of 81 patients were analyzed: group S (n = 41) and group C (n = 40). There was no significant difference between the two groups with regard to baseline characteristics. In both groups, CPB caused markedly increased IL-6, TNF- , and CRP plasma concentrations compared with baseline (P = 0. 0001). However, the pattern of changes was not significantly different between group S (P = 0. 068) and group C (P = 0. 26). The IL-6 and TNF- change trends were significant in each group (P=0. 0001). However, comparing the two groups showed no significant difference. With regard to IL-6, there was no significant difference between the two groups at the time-points of T1 (P = 0. 34), T2 (P = 0. 17), and T3 (P = 0. 056), and the same was found for TNF- at T1 (P = 0. 34), T2 (P = 0. 17), and T3 (P = 0. 056). With regard to CRP, the trend of the changes was significant in each group (P = 0. 0001). However, comparing two groups showed a borderline significant difference between them at T1 (P = 0. 039), but not at T2 (P = 0. 075) or T3 (P = 0. 11). Conclusions: This study revealed that the administration of 600  g of intravenous Se immediately before induction of anesthesia was safe, but when compared to a placebo, no predominant clinical effects or modifications in the systemic inflammatory response induced by on-pump CABG were observed.

Introduction: Encapsulating peritoneal sclerosis (EPS) is a rare but devastating complication of peritoneal dialysis (PD). Tamoxifen has been generally well-tolerated, even without randomized controlled trials.Case Presentation: Herein, we report a case of a patient undergoing 12 years of PD who developed EPS and calciphylaxis simultaneously.We also provide a comprehensive discussion about the association between EPS and calciphylaxis. Moreover, although tamoxifen is used in EPS due to its inhibition of fibroblast-transforming growth factor beta (TGFb) production, it may worsen the calciphylaxis due to a hypercoagulable state.Conclusions: We suggest avoiding the use of tamoxifen for EPS in patients with superimposed calciphylaxis.

Background: Recently, the radiation application research center for the atomic energy organization of Yazd (Iran) has developed a hydrogel dressing which was evaluated for quality and safety in 2008. Its efficacy for assisting in the wound healing process was approved for animal use, and its use has proven to be more effective than a related Syrian material.Objectives: We have already confirmed the safety and efficacy of Irgel use on mice (1, 2), so this study was conducted in order to further evaluate its effectiveness on human burn wounds, and to compare its efficacy with MaxGel, another hydrogel. A randomized clinical trial study was conducted to compare the efficacy of hydrogel produced by the radiation application research center (Yazd Branch) with MaxGel and routine dressing on burn repair in the Yazd Burn hospital.Materials and Methods: In this study, 90 patients with second-degree burn injuries who were admitted to the Yazd Burn hospital were randomly divided into three equal groups. In the negative control group, the wounds were covered with sterile vaseline gauze followed by double sterile dry gauze and ultimately bandaged. In the test group, the wounds were covered by an Iranian hydrogel sheet (Irgel) instead of vaseline gauze, while in the positive control group, the wounds were covered by MaxGel instead of Irgel. At each visit (every other day), each dressing was renewed by its respective method and the wound area, pain score, and body temperature were recorded. At the beginning and at the end of the first and second week, five milliliters of venous blood were taken from all patients to evaluate hematologic parameters such as peripheral blood cell count, liver function, blood urea nitrogen, and creatinine.Results: Before the intervention, the extent of the burns and pain sensations were quite similar among the different groups, but at the second week, the burn areas and pain scores for the Irgel group were significantly less than those of the normal control and the positive control groups (P<0.05).Conclusions: Based on our findings, both gels assist in the process of burn wound healing and pain reduction more effectively as compared with routine dressing. However, Irgel had better effects on wound healing and pain relief than MaxGel, which indicates a better quality of Irgel for this particular kind of treatment.

Background: Acute liver damage may be followed by biochemical, behavioral, and pathological alterations, which can result in serious complications and even death.Objectives: In this experimental study we determined whether coenzymeQ10 (CoQ10), a common supplementary medicine known to have protective, antioxidative, and anti-inflammatory effects in cells, has any protective effect against thioacetamide (TAA) - induced liver damage and its related neurobehavioral alterations in rats.Materials and Methods: In this experimental study forty-eight Wistar rats were divided randomly into four groups (n=12): C1 was the control group; C2 received a single-dose of TAA (350mg/kg; intraperitoneally) without any other treatment; E1 received TAA +5 mg/kg CoQ10 (intraperitoneally); and E2 received TAA+10 mg/kg CoQ10. After sacrificing the rats, liver enzymes and plasmaammonia (NH4) were measured and histopathological analyses of the livers were carried out. Elevated-plus-maze, open-field, and forced-swimming tests were also performed to investigate behavioral correlations.Results: The serum levels of alanine-aminotransferase (ALT), aspartate-aminotransferase (AST), and NH4 show significant increases (P<0.05). The groups treated withCoQ10wereshowntohave significantly lower clinical grade of encephalopathy (P=0.001), higher locomotor activity (P=0.000), and lower levels of depression (P=0.000). Furthermore, it was also shown that CoQ10 treatment may lead to significant decreases in scores of centrilobular necrosis, apoptosis, inflammatory cell infiltration, vacuolization, and liver necrosis (P<0.05).Conclusions: Overall, CoQ10 was determined to have positive effects on liver injury and its related behavioral and biochemical changes.

Background: Salvia, known as Maryam Goli in the Persian language, is an important genus that includes approximately900species in the Lamiaceae family. There are 58 Salvia species growing naturally in Iran, including Salvia chloroleuca Rech. f. and Allen., which grows wild in the northeastern and central parts of the country.Objectives: This study was designed to determine the chemical composition, in vitro antioxidant activity, and total phenol content of various extracts of S. chloroleuca.Materials and Methods: Dried aerial parts of the plant were crushed, then sequentially extracted with n-hexane, ethyl acetate, and methanol. The fractions of S. chloroleuca were subjected to silica gel column chromatography and Sephedex LH-20. The antioxidant activities of these extracts were measured by ferric reducing antioxidant power (FRAP), and the total phenolic contents of the extracts were evaluated using Folin-Ciocalteu reagent.Results: The separation and purification processes were carried out using different chromatographic methods. Structural elucidation wasonthe basis 1H-NMRand 13C-NMR spectral data, in comparison with that reported in the literature. The isolatedcompounds were salvigenin (1), luteolin (2), cirsiliol (3), b-sitosterol (4), and daucosterol (5). Ethyl acetate extract displayed the highest level of total antioxidants and total polyphenols compared to the other analyzed extracts (n-hexane and methanol). In the FRAP assay, ethyl acetate extract had the highest (230.4±10.5) FRAP value, followed by methanol (211.4±8.3) and n-hexane (143.4±12.04). Total phenol contents were calculated to be 13.8±0.3, 58.25±0.05, and 43.48±0.38 mg of gallic acid/100 g in the n-hexane, ethyl acetate, and methanol extracts, respectively.Conclusions: The above-mentioned compounds were isolated for the first time from S. chloroleuca. The antioxidant activity of this plant could be in part related to isolated flavonoids and sterols. The results of this study indicated that S. chloroleuca could be an important dietary source of phenolic compounds with high antioxidant capacity.

Background: Anxiety disorder is common during the postpartum period. Back massage relaxation techniques are one of the most important nonpharmacological interventions to prevent and control postpartum-related anxiety.Objectives: To determine the effectiveness of slow-stroke back massage on the anxiety levels of primiparous mothers in the first days after delivery.Materials and Methods: This single-blind controlled clinical trial consisted of 100 primiparous mothers with normal deliveries.The mothers were randomly allocated to interventional (n=50) or control (n=50) groups using binary blocks. Both groups were followed up just before, immediately after, and the morning after the intervention. Data were collected using a demographic questionnaire and Spielberger’s state anxiety inventory (STAI) questionnaire.Results: The mean age of the mothers was 22 years. There were no significant between-group differences in age (P=0.333), education (P=0.427), and medication during labor and the postpartum period (P=0.412). There was no statistically significant difference between the mean anxiety scores of the experimental (6.66±35.48) and control groups (9.05±37.42) before the intervention (P=0.268). Immediately after the massage and the next morning, there was a significant between-group difference in the anxiety scores (P<0.001).Conclusions: The findings demonstrate that slow-stroke back massage is a simple, inexpensive, noninvasive, and effective method to reduce the anxiety levels of primiparous women during the first postpartum day.

Background: The consumption of tobacco through a hookah is growing in popularity, especially among children and adolescents, but little is known about the determinants of hookah smoking.Objectives: The current study aimed to assess the determinants of tobacco smoking and hookah smoking in a nationally representative sample of Iranian children and adolescents.Patients and Methods: This study was conducted as part of the fourth cross-sectional survey of a national school-based program.Using a cluster random sampling method, a validated questionnaire was completed anonymously by 14, 880 students who were aged 6 - 18 years and living in urban and rural areas of 30 provinces in Iran.Results: The final study group consisted of 13, 486 children and adolescents (participation rate of 90.6%), of whom 49.2% were girls and 75.6% were urban residents. The mean age was 12.47±3.36 years. According to the self-reports of the students, 2.6% (3.5% of boys and 1.7% of girls) were current tobacco smokers, 5.9% (7.5% of boys and 4.2% of girls) were ever tobacco smokers, and 1.8% (2.49% of boys and 1.14% of girls) were current hookah smokers. Based on a multiple logistic regression (MLR) model, the following factors increased the risk of current smoking: age, number of days spent with friends per week, hookah smoking or cigarette smoking by the father, hookah smoking by siblings, hookah smoking by other members of the family, and screen time. The age, number of days spent with friends, hookah or cigarette smoking by the father, hookah smoking by siblings, and screen time increased the risk of hookah smoking. Female gender and living in rural areas decreased the risk of current tobacco and hookah smoking.Conclusions: Preventive measures against tobacco use should be underscored for Iranian families. The preparation of strategies on the promotion of a healthy lifestyle should be considered a health priority.

Background: Health-promoting behaviors can enhance physical and mental health among individuals with disability, particularly veterans.Objectives: The current study aimed to examine both one-way direct and indirect effects of the factors of the Health Promotion Model (HPM) on health-promoting behaviors in chemical veterans from Ilam province in Iran.Materials and Methods: This cross-sectional study was conducted in 2014. In this study, 239 moderate-to-severe chemical veterans from Illam province supported by the veterans’ affairs department of Ilam were evaluated via census sampling. Data including health-promoting behaviors, perceived self-efficacy, perceived barriers and benefits, perceived social support, and perceived health status were collected using standard questionnaires.Results: The results show that the HPM is a poor predictor of the health-promoting lifestyles of chemical veterans (R2=15%). Social support (factor loading=0.38) is the strongest predictor of health-promoting behaviors and it influences such behaviors directly, while perceived barriers (factor loading=-0.11) and perceived self-efficacy (factor loading=0.02) indirectly predict behavior through social support.Conclusions: Perceived social support is the most important factor that influences health-promoting behaviors. Increasing social support by enhancing self-efficacy and decreasing perceived barriers can improve health-promoting behaviors among veterans.

Introduction: Septic cavernous sinus thrombosis (CST) is a rare condition that can result in high mortality and morbidity rates if not treated immediately. CST may be aseptic or septic. Less common primary sites of infection include the tonsils, soft palate, middle ear, and orbit. Reported cases of middle ear infection are very rare, and response to treatment is poor.Case Presentation: The present study is a case report of acute otitis media which led to septic cavernous sinus thrombosis in a 56-year-old woman in Bojnord city, North Khorasan, Iran.Conclusions: Findings of laboratory tests and magnetic resonance imaging (MRI) confirmed the clinical diagnosis. Clinical-based medical care led to successful management of the patient with broad spectrum intravenous antibiotics that prevented serious complications.