Iranian Red Crescent Medical Journal
Year:2017 | Volume:19 | Issue:8|Papers Count:19

Background: Diabetes leads to complications such as cardiovascular diseases. There are limited data about the effect of dark chocolate on cardiovascular function in patients with diabetes.Objectives: The current study aimed at determining the effect of dark chocolate on cardiovascular health and body composition among people with diabetes.Methods: The current parallel, randomized, clinical trial was conducted on 44 patients with diabetes (Ahvaz, Iran). They were randomly assigned into the intervention (n=21, 30 g dark chocolate daily for 8 weeks) and the control groups (n=23). At the beginning and end of the intervention period, fasting blood samples were collected to measure nitric oxide (NO) and angiotensin II. Also, anthropometric measurement, body composition analyses, and blood pressure were compared between the 2 groups before and after the intervention.Results: A significant reduction in systolic (-6.9 ± 7.3 vs.0.3 ± 1.9; P=0.001) and diastolic blood pressure (-5.8 ± 6.7 vs.0.5 ± 3.9; P=0.001), waist circumference (WC) (-0.7 ± 1.0 vs.0.1 ± 1.2; P=0.007), and significant increase in soft lean mass (P=0.045) was observed in the intervention group. There were no significant changes in NOlevels, but a trend close to significance for angiotensin II (P=0.052) at end of the intervention between the 2 groups.Conclusions: The current study findings showed that dark chocolate consumption in patients with diabetes might improve their WC, body composition, and blood pressure, but had no effect on NO in this dosage.

Mental health is a private matter, which refers to an individual’s cognition and emotion; more precisely, it describes the condition of one’s mind. The slogan “no health without mental health” has been proposed by the world health organization (WHO) for a few years (1). According to statistics, almost 450 million people suffer from mental or neurological diseases. ...

Background: Diabetic peripheral neuropathic pain (DPNP) is a common type of diabetic neuropathy. Blood sugar control is the first step for management of DPNP and drug treatment may be prescribed for the pain relief.Objectives: This study assessed the efficacy and safety of duloxetine and nortriptyline in patients with DPNP.Methods: This double-blind randomized clinical trial was conducted in the diabetes clinic of Golestan Hospital (Ahvaz, Iran). Convenience sampling and simple random allocation were used in the study.134 patients with DPNP were randomly divided into two groups (67 patients in each group). The duloxetine group received 30 to 60 mg/day and nortriptyline group received 25 to 75 mg/day for a period of 6 weeks. Pain assessment was conducted based on a Visual analogue scale (VAS) and drug side effects were assessed on a weekly basis.Results: The study showed that both groups had significant reduction in pain severity at the end of the study (P<0.05). The proportion of patients achieving 50% reduction in pain severity was significantly greater in the duloxetine group than the nortriptyline group (P<0.05). The treatment side effects observed in the two groups were not significantly different (P=0.298).Conclusions: Monotherapy with duloxetine and nortriptyline is safe and effective in the management of patients with DPNP.

Background: Liver cancer is considered as the 6th common cancer from which people are suffering all around the world. Poor prognosis is the main challenge regarding this disease.Objectives: The aim of this study was to compare the changing trends in the liver cancer death rate in Asian countries from 1990 to 2015.Methods: This ecological longitudinal study was performed to compare the death rate resulting from liver cancer. The data were gathered from all Asian countries provided by the global burden of disease’s (GBD) online database in the global health research center at the University of Washington published in October 2016. The classification was done based on the death rate using the growth mixed model (GMM).Results: The rate of liver cancer death in men was higher than women, there were 2 optimal classes. Both classes had an increasing trend. The first class had a steeper slope by a higher intercept. Taiwan, Thailand, Mongolia, North Korea, South Korea, China, and Japan were countries classified in this class. The mean of the intercept was estimated as 21.1 deaths per 100, 000 people and the mean of the slope was 2.4. The other class had an increasing rate with a lower slope.Conclusions: In general, our statistical analyses showed that most Asian countries had an increasing trend in the rate of their liver cancer mortality. Therefore, it is highly recommended that officials in the health policy-making identify the reasons for the increase in the mortality rate and take due actions such as interventional programs of countries which have succeeded in taking under control the ramifications of liver cancer.

Background: Tissue engineering mainly focuses on creating appropriate conditions for the regeneration of tissues. Scaffolds, signal molecules, and stem cells interact with each other and compose the essential components of this field.Objectives: This study aimed at investigating the osteogenic induction ability of PLA Poly Lactic Acid (PLA) scaffolds and comparing the osteogenic differentiation behavior of Stem Cells from Human Exfoliated Deciduous Teeth (hSHEDs) in standard culture medium and on PLA scaffolds.Methods: The current clinical experimental study was conducted between April 2016 and October 2016 at the Near East University cell culture laboratory located in North Cyprus. The pulp tissues of deciduous teeth (non-decayed and in the absence of abscess, fistula or periapical lesion) were sampled from 10 healthy children aged between 6 and 11 years. The isolated hSHEDs were divided to 4 groups. The control group/Group1 consisted of cells, which were cultivated in standard culture medium, and Group2 cells were differentiated into an osteogenic lineage using osteogenic differentiation medium. Group 3 represented the non-differentiated group, which was transferred onto three dimensional (3D) printed PLA scaffolds and Group 4 cells were differentiated to the osteogenic lineage and transferred onto 3D printed PLA scaffolds. All groups were analyzed immunohistochemically and by immune-labeling, and were evaluated semi-quantitatively using the HSCORE.Results: Cultivation of hSHEDS on PLA scaffolds was assessed for 14 and 21 days; osteogenic differentiation was detected both histochemically and immunohistochemically. Generally, Osteocalcin (OCN) immunoreactivities were higher than Osteonectin (ON) immunoreactions in all groups. Despite higher OCN immunoreactivities, the intensities of OCN between 14 days and 21 days in group 4 (497.3 ± 0.57% and 486.7 ± 5.77%, respectively) were similar (P>0.05). While the intensity of ON was 280.010% in group 4, in group 2 the intensity of ON was 206.7 ± 5.77%, and on the 14th day the results were statistically significant (P<0.0001).Conclusions: Poly lactic acid is a suitable scaffold material for osteogenic induction of the hSHEDs. The expression patterns of both markers showed that a 14-day cultivation period is adequate for hSHEDs with/without PLA scaffolds to differentiate into osteoblasts.

Background: Maintaining optimal oral health behavior (OHB) during pregnancy could preserve short-term and long-term health of women and their children.Objectives: By applying the health belief model (HBM), this study aimed at developing and analyzing the psychometric properties of an instrument evaluating pregnant women’s beliefs regarding OHB.Methods: In this instrument development study that carried out in Tehran (2015 - 2016), a preliminary 134-item questionnaire was developed, and content and face validity were assessed. The construct, convergent, discriminant, and criterion-oriented validity of the questionnaire were evaluated through a pilot study on 221 pregnant women, attending public health centers, by performing confirmatory factor analysis (CFA) and Linear Regression analysis. Cronbach’s alpha coefficient, composite reliability (CR) and intraclass correlation coefficient (ICC) were calculated to examine reliability.Results: The mean age of participants was 27.5 ± 5.6 years with mean gestational age of 21.5 ± 8.5 weeks. Based on CFA, the data fitted the HBM model. Root Mean Square Error of Approximation (RMSEA) was 0.052, Non-Normed Fit Index (NNFI) was 0.95, and Comparative Fit Index (CFI) was 0.96. The final HBM-based questionnaire with 79 items was associated with individual OHB (P= 0.001 and B=0.4). The overall Cronbach’s alpha was 0.94 and ICC ranged between 0.84 and 0.99.Conclusions: This valid and reliable HBM-based questionnairemayidentify the potential barriers of optimal OHB among pregnant women.

Introduction: Gossypiboma is defined as retained foreign object (sponge, needle, and instrument) in patient’s corpus after operation that is recognized as a medical error. It may induce catastrophic implications for the patient and medical care providers. We present a case with a 17-year-old gossypiboma after cesarean section.Case Presentation: A 49-year-old woman was admitted to the outpatient clinic of Rasool-e-Akram hospital of Tehran, Iran, in 2016 presenting with abnormal uterine bleeding (AUB), abdominal pain, and urinary symptoms for many years. She underwent hysteroscopy. Operative findings included intrauterine synechiae and a polypoid lesion. Besides, a thread-like foreign body was observed in the anterior surface of the uterine cavity, which was suspected as a cesarean section suture material that was extracted. After hysteroscopy, uterine bleeding stopped although abdominal pain and urinary symptoms maintained. Voiding cystourethrogram (VCUG) and MRI revealed a mass between uterus and bladder. Then, laparotomy was performed. After opening the abdominal wall under general anesthesia, we explored internal organs and encountered a necrotic mass revealing an old organized gauze between bladder and uterus, which infiltrated the uterus and trigon. It was extracted and then, hysterectomy and bladder repair were carried out. Conclusions: Surgical sponges are the most common foreign materials retained in abdominal cavity.

Introduction: Solitary rectal ulcer syndrome (SRUS) is rarely observed in young people and its clinical manifestations and endoscopic observations in young patients are atypical. Except for histopathological observations, SRUS can be hardly differentiated from other bowel diseases such as rectal carcinoma or ulceration.Case Report: The current report presented a case of SRUS in an 18-year-old male living in Harbin, China. The patient complained of gastrointestinal hemorrhage and abdominal pain as his first symptoms. SURS was diagnosed after colonoscopy supported by his complete recovery following the treatment with Etiasa. Issues relevant to the diagnosis and treatment of SURS were discussed in the current article.Conclusions: Employment of colonoscopy is a great help in the early diagnosis of SURS; thus, this technique has benefits for the treatment and recovery of patients.

Background: There is some evidence suggesting that Body Mass Index (BMI) may increase plasma lipoprotein levels.Objectives: This study aimed to evaluate the possible association between BMI and dyslipidemia among the government staff of Kermanshah.Methods: This descriptive-analytical cross-sectional study was performed on the staff of 13 governmental organizations in Kermanshah (a city located in the west of Iran) in 2012. The staff was recruited using census method. We obtained information of 1496 staff aged 22 - 69 through the standardized stepwise questionnaire for NCDs risk factor surveillance. The staff was then physically examined by trained persons. Finally, their blood samples were obtained.Results: The prevalence of dyslipidemia was 16.6% in the study group, with the prevalence of 18.2% inmenand 7.9% in women. There were also 53% (55.8% in men and 7.9% in women) and 17.8% (17.6% in men and 38.1% in women) prevalence rates for overweight and obesity, respectively. Dyslipidemia was significantly associated with factors such as BMI (P value=0.004), gender (P value<0.001), marital status (P value=0.01), cigarette smoking (P value=0.008), and hookah smoking (P value=0.002), but not with passive smoking, age, education level, physical activity, FBS (fast blood sugar), WHR (waist to hip ratio), hypertension, waist size, andhip size. In the adjusted model, there was a link merely between obesity and dyslipidemia while no statistically significant association was found between dyslipidemia and overweight. Moreover, a non-linear dose-response association was observed between dyslipidemia and BMI.Conclusions: Since dyslipidemia was significantly prevalent among men, fat people, and smokers, a particular attention is crucial to be paid to these groups.

Background: Smoking among adolescents is a universal matter. Several findings suggest that smoking can lead to impaired oral health.Objectives: The current study was undertaken to evaluate the normative and subjective oral health status of 13-year-old smokers and nonsmokers in Qazvin, Iran.Methods: This cross-sectional study was carried out on a multistage cluster sample of 519 adolescents in Qazvin, Iran, in 2015. A self-administered questionnaire comprising three parts pertaining to oral health behavior (frequency of tooth brushing and dental visits, snacking, and the use of fluoride toothpaste) was administered. The socio-demographic and subjective characteristics of the study participants, including self-reported smoking, gum bleeding, and halitosis, were determined. The simplified oral hygiene index (OHI-S) was used to evaluate their clinical condition. Binary logistic regression analysis was performed separately for the smokers and nonsmokers. Correlation, kappa agreement, sensitivity, and specificity between the subjective and normative measurements were calculated.Results: 26% of the male adolescents and 15% of the female adolescents claimed that they smoked cigarettes or used water pipe. Infrequent dental visits (³ 2 years) [odds ratio (OR) =3.0, 95% confidence interval (CI): 1.1–7.8, P=0.030), frequent snacking (³ 3 times between meals) (OR=3.5, 95% CI: 1.5 - 8.4, P=0.001), and halitosis were significantly associated with poor self-perceived oral health. Poor oral hygiene index, which represents normative measurement, was similar among smokers and nonsmokers in this age group. Sensitivity and specificity were reported to be 81% and 85% for smokers and 30% and 21% for nonsmokers, respectively.Conclusions: Normative and subjective oral health evaluations were not in the same line among smoking and nonsmoking adolescents. Professional screening is necessary to evaluate oral health in this age group, especially in countries with developing oral health care systems.

Introduction: Gastrointestinal stromal tumors (GIST) represent less than 1% of all gastrointestinal tumors. The GIST diagnosis in a patient with a newly discovered myasthenia gravis (MG) raises the problem of evolution and treatment.Case Presentation: We present the case of a 58-year-old patient, who has been diagnosed withMGon December 2015 at emergency clinical county hospital Brasov, Romania. After further investigations, a localized gastric GIST was discovered. The treatment was surgical (January 2016) and the one-year evolution after the surgery was without relapse. Genetic mutations in the KIT and PDGFR genes were investigated.Conclusions: GIST may be accidentally discovered in asymptomatic patients. Genetic mutation examinations are needed in order to provide evidence. MG in association with GIST is rare and raises problems of diagnosis and treatment.

Introduction: Invasive fungal sinusitis is a potentially lethal infection inimmunocompromisedpatients, with a reported incidence of around 2%. Neutropenia due to aplastic anemia or secondary to chemotherapy is the main cause of acute invasive fungal sinusitis.Case Presentation: We present the case of a 6-month-old boy with hem ophagocytic syndrome. During the follow-up for fever and pancytopenia at the medical faculty hospital of Hacettepe University, Ankara, Turkey, the patient developed discoloration and black crusting of the nasal columella. Antifungal medical treatment and biopsy were recommended owing to the suspicion of invasive fungal infection. The premaxilla, nasal columella, and nasal cartilages were necrotic. Medical and surgical treatments were performed to prevent the spread of infection. After controlling the underlying immunosuppression, nasal reconstruction was advised.Conclusions: Invasive fungal sinonasal disease is a rare clinical phenomenon in immunocompromised patients. Although it is associated with high mortality rates, it can be successfully managed with a combination of surgical and medical treatments.

Background: In recent decades, unsafe use of pesticides has caused different cancers in human beings as well as damages to environment and organisms.Objectives: The present study aimed to determine the predictors of safety behavior among greenhouses spray workers in Jiroft city based on Protection Motivation Theory (PMT).Methods: This cross-sectional study with descriptive-correlation approach was conducted in 2016 on 229 greenhouse spray workers in Jiroft city selected via proportional stratified random sampling using a researcher-made questionnaire. The questionnaire consisted of demographic variables and PMT constructs such as perceived vulnerability, perceived severity, costs, rewards, fear, selfefficacy, response-efficacy, and protection motivation, as well as safety behaviors.Results: All workers were male in the age range of 19 to 72 years, most of whom (47.6%) had previously been poisoned by pesticides. The mean scores of all the PMT constructs were in range of 50% to 75% except for perceived rewards that its mean score was between 75% and 100%. There was a significant correlation between response-efficacy and all the constructs at P<0.01, except for the perceived rewards that was significant at P<0.05. Moreover, a significant correlation was found between all the constructs other than perceived rewards and fear (P<0.01). The predicted amount of spray workers’ preventive behaviors by protection motivation theory constructs was 41% and the role of perceived vulnerability (b=0.310), perceived severity (b=0.303), self-efficacy (b=0.166), and response-efficacy (b=0.140) was greater than the role of other constructs.Conclusions: Concerning predictive power of protection motivation theory constructs for safety behaviors related to spray workers’health and due to the important role of perceived vulnerability, perceived severity, self-efficacy, and response-efficacy, educational interventions are necessary for training protective principles to prevent health problems resulted from exposure to pesticides in workers.

Background: Hepatitis B is a life-threatening viral infection that is mainly transmitted through blood; due to the presence of this virus in semen, vaginal fluids, and saliva, the possibility of transmission among couples during marital life still exists.Objectives: This study was conducted to specify the patients’ perception of their marital problems.Methods: In this descriptive qualitative research conducted in Iran, 32 patients with chronic hepatitis B were selected through purposive sampling. The data were collected through semi-structured interviews and field notes during 23 months in 2015 and 2016. The interview transcripts were coded by using MAXQDA10 software®. The utilization of thematic analysis approach was to extract categories and themes.Results: Participants of this study were in the chronic and inactive phase of hepatitis B. Participants’ age varied from 24 to 57 years. Three major themes were extracted: premarriage challenges, conjugal life with suffering, and lack of marital adjustment.Conclusions: Like other chronic diseases, chronic hepatitis B causes numerous marital challenges for the carriers of the disease. The partners of patients with hepatitis Bcan be used as self-care facilitating agents in the family to promote self-care of these patients and help better manage their marital challenges.

Background: One of the most challenging issues in public health is childhood obesity in the 21st century. In Iran, the overall prevalence of overweight has increased and the total rate of obesity was estimated to be 12.3% (calculated as 6.5% for individuals less than 18 years).Objectives: The present study aimed at determining the diet knowledge and diet behavior among students in Shiraz, Iran.Methods: This cross-sectional study was conducted among 2040 students in 8 selected public high schools in 2013 in Shiraz, Iran. Random sampling method with proportionate allocation to size was used. To collect data, a standardized pretested questionnaire was used. The data were analyzed using SPSS.Results: Response rate was 97.1%. Most (52.1%) of the students were male. The mean age of the respondents was 13.02 ± 0.724 and ranged from 11 to 15 years. About 61.3% of the students did not notice the label of food calories, and 73.8% did not know that family history of obesity would increase the risk of obesity. Only 16.5% of the respondents ate vegetables 4 to 5 times a week, and 23.6% ate fresh fruit per week; but 64.2% drank soft drink more than 2 times a week, and 82.2% ate fast foods more than 2 times a week.Conclusions: The findings revealed that student’s perception about diet knowledge and diet behavior was low. Thus, targeted education should be implemented to improve healthy lifestyle in this age group.

The latest official report on the risk of no ncommunicable diseases (NCDs) in Iran (2014) reveals that NCDs are accounted for 76% of total deaths in the country, of which, an estimated 46% is due to coronary heart disease and cardiovascular diseases (1). It is believed that obesity and being overweight are the main risk factors for NCDs. The most likely causes of being overweight and obesity are low physical activity and imbalanced intake of different food groups.

Introduction: Hydrops fetalis (HF) secondary to cytomegalovirus (CMV) is a rare but potentially fatal entity in neonates. This study aimed at providing data for diagnosis, management, and prevention of CMV associated HF in neonates. Herein, a case of non-immune hydrops fetalis (NIHF) associated with CMV infection is described and a review of the literature is presented.Case Presentation: A female neonate was born at 373.7 weeks of gestational age with clinical findings of HF in Istanbul, Turkey, during year 2015. The infant was admitted to the Neonatal Intensive Care Unit (NICU) due to respiratory distress. The CMV Ig Mwas positive for both the baby and the mother. Polymerase chain reaction (PCR) demonstrated 6640 copies of CMV in the urine sample.Therefore, CMV infection was considered as the main cause of NIHF and ganciclovir therapy was initiated. As the patient responded well and survived, to the best of our knowledge, this is the first long-term survived case of CMV associated HF.Conclusions: Congenital CMV infection should be kept in mind as a seldom and life-threatening cause of NIHF. Because serologic tests are not sensitive, antenatal son ographical, postnatal clinical and laboratory findings are crucial for accurate diagnosis and early treatment. All these cautions may be associated with for a better prognosis.

Background: Having a stroke, which is a devastating condition, is a major cause of deaths worldwide and is also accountable for long time disability with high personal and social cost in adults. Hyperlipidemia plays an important role in atherothrombosis, which is the precursor to stroke. One way for decreasing the risk of a stroke is treatment of dyslipidemia. Alpha-lipoic acid (ALA) is aneight-carbon, sulfur-containingcompoundwith antioxidant properties and effective in protecting against hypercholesterolemia and hepatic fat accumulation.Objectives: We designed this trial to scrutinize the possible effects of ALAconsumptiononlipid profiles in patientswhoexperienced a stroke.Methods: In this randomized, double blind, placebo-controlled clinical trial, 67 patients who experienced a stroke were randomly allocated into 2 groups (taking a 600mgALA supplement or placebo daily for 12 weeks). The triglyceride (TG), total cholesterol (TC), LDL-cholesterol (LDL), and HDL-cholesterol (HDL) were measured and LDL-cholesterol/ HDL-cholesterol (LDL/ HDL) as well as total cholesterol/ HDL-cholesterol (TC/ HDL) were calculated before and after intervention in this study. Dietary intake and statistical analyses were carried out using the N4 and SPSS16 software, respectively.Results: Primary features were similar in the intervention and placebo groups (P<0.05). After the intervention period, serum levels of TG (123.21 ± 49.63 vs.152.97 ± 58.83) (P<0.001), TC (148.67 ± 37.71 vs.174.35 ± 36.86) (P<0.001), and LDL (85.09 ± 23.81 vs.107.56 ± 31.73) (P=0.002) decreased, and HDL level (58 ± 9.33 vs.42.97 ± 8.07) (P<0.001) increased significantly in ALA group compared with the placebo. In addition, LDL/ HDL (P<0.001) and TC/ HDL (P<0.001) reduced significantly.Conclusions: Results of this trial indicated that 12 weeks of supplementation with 600 mg alpha-lipoic acid has beneficial effects on lipid profile (TG, TC, LDL, HDL, LDL-/HDL, and TC/HDL) in patients who have experienced a stroke.

Introduction: Lymphomas comprise a diverse group of neoplasms derived from B cells, T cells, or NK cells. Although GI tract is a current site for the secondry spread of non-hodgkin lymphoma, it’s involvment as the primary site is less common noticeably showing only 10% - 15%. The more lymphoid tissue is in parts of small intestine, the more incidence of lymphoma is depicted; thus, as expected, ileocecal region is the most frequent site and the duodenum remains as the most infrequent site.Case Report: An 18-year-old woman with no pervious history of any disease was admitted to the emergency room of Shohaday-e-Tajrish hospital that is a tertiary hospital in Tehran, Iran. The patient presented with weakness, nausea, and retractile vomiting. The CT scan was performed, showing that stomach and proximal of duodenum were dilated significantly and wall thickening of duodenum, 2nd and 3rd portions, was obvious. No pathological lymph node or invasion to adjacent organs was seen. The patient was explored; operation findings were dilatation of stomach and duodenum; thickening of duodenojejunal junction with 10 cm extension was mentioned. Biopsied tissue during operation showed diffuse large B cell lymphoma.Conclusions: Duodenal lymphoma is infrequent and it is rare to represent with obstruction. Thus, if there is any clinical indication and no definite diagnosis in such patient, biopsy and histopathological investigation is necessary after radiological studies.