Iranian Red Crescent Medical Journal
Year:2018 | Volume:20 | Issue:3|Papers Count:15

Background: Knee osteoarthritis is one of the most prevalent and disabling diseases worldwide, which decreases patients’ qualityof life (QoL). However, pharmacological and non-pharmacological treatments, apart from complications, could not desirablycontrol the disease. Objectives: The current study aimed at evaluating the effect of two methods of intra-articular injection of Platelet-Rich Plasma (PRP)and corticosteroid on pain control of knee osteoarthritis. Methods: A randomized clinical trial was performed on 67-patients with grades II-III of knee osteoarthritis (OA) referring to painclinic of a referral, university-affiliated hospital, Rasht, Iran, from April 2016 to June 2017. Patients were randomly divided into twogroups: Triamcinolone (T) (n=34) and PRP (P) (n=33) by quadruple block. In the group T, 40mgTriamcinolone and in the group P, PRPwas injected intra-articularly, under ultrasound-guidance, once a month, for three consecutive months. Patients’ pain intensity wasevaluated based on the Visual Analog Scale (VAS), and their outcome was determined based on the Knee injury and OsteoarthritisOutcome Score (KOOS) monthly for three consecutive months, as well as six months after the treatment. Results: There were no significant differences between the groups regarding demographic characteristics. VAS assessments indicatedlower pain scores in the group P than group T; the difference between the groups was statistically significant two, three, andsix months after the injections. In the group P, the mean initial VAS was 7. 36  0. 92 compared with 7. 12  1. 29 in the group T (P =0. 385). After six months, the scores dropped to 3. 45 0. 86 and 4. 81 1. 4, respectively (P = 0. 0001). Examination of the KOOS parametersshowed a significant association between treatment outcomes in the group P than the group T. Therefore, the test showed asignificant difference between the groups regarding relief of pain, improvement of symptoms and activities of daily living (ADL)two, three, and six months after treatment. There was also a significant difference between the groups in terms of the quality oflife (QoL) and doing sport activities three and six months after the treatment (P < 0. 05). Based on the repeated measures analysis, asignificant inter-and intra-group differences in themeanscore of KOOSparameters was observed between the intervals (P = 0. 0001). Conclusions: The current study resultsshowedthat three intra-articular injections of TriamcinoloneandPRP could reduce painandimprove articular function in patients with grades II-III knee osteoarthritis. However, pain relief and improvement in the outcomeswere more effective and more prolonged secondary to PRP injections than corticosteroids.

Introduction: A hydatid cyst of the breast is an extremely rare condition caused by Echinococcus granulosus, even in endemic countries, which accounts for 0.27% of all cases. Only a few reports have been published in the literature about breast hydatid cysts. Patients usually present with a palpable and painless lump in the breast. Clinically, it is difficult to differentiate breast hydatid cysts from more common breast lesions. However, imaging plays an important role, and often helps to distinguish this rare cystic disease of the breast from other breast masses.Case Presentation: Iran is an endemic area for Echinococcus granulosus, and we present six cases of primary breast hydatid cysts which were diagnosed over the course of 10 years in our institution. We aimed to present the mammographic and ultrasonographic findings for these patients.Conclusions: Hydatid cysts should be considered in the diagnosis of cystic lesions of the breast, particularly in endemic areas.

Background: There are several therapeutic strategies available from the viewpoint of Traditional Persian Medicine (TPM) to treat hepatic diseases.Objectives: This study aimed at assessing the efficacy and safety of Nigella sativa and Melissa officinalis in patients with Non-Alcoholic Fatty Liver Disease (NAFLD).Methods: From November 2014 to May 2016, in an open-label, simple-blocked, randomized controlled clinical trial, the researchers evaluated the efficacy of Nigella sativa and Melissa officinalis compared with Orlistat capsule on the grade of fatty liver and the serum levels of Aspartate Transaminase (AST) and Alanine Transaminase (ALT) in 50 patients with NAFLD in Iran.Results: Regarding within-group changes, a significant decrease was observed in the serum level of AST, ALT, body mass index, and grade of fatty liver in both groups after the intervention compared with baseline (P<0.001). Repeated measures logistic regression analysis showed that there was a more significant reduction in the grade of fatty liver over the study period in the intervention group compared with the control group (0.58±0.50 versus 1.51±0.54, P<0.001).Conclusion: Traditional Persian Medicine-based preparations of Nigella sativa and Melissa officinalis could reduce body weight and liver enzymes and improves the grade of fatty liver in Non-Alcoholic Fatty Liver Disease.

Background: Insulin resistance has a pivotal role in the occurrence of impaired glucose tolerance and dyslipidemia in patientswith Non-Alcoholic Fatty Liver Disease (NAFLD). There is evidence of possible beneficial effects of Alpha-Lipoic Acid (ALA) on insulinresistance and metabolic disorders. Objectives: This studyaimedatexaminingthe effects of ALAsupplementationonliver enzymes, insulin sensitivity, glucose markers, and lipid profile in obese patients with NAFLD. Methods: In this double-blind placebo-controlled randomized clinical trial, 50 obese patients with NAFLD were randomly allocatedto “ ALA group” (received 1200 mg ALA as two capsules per day) or “ Placebo group” (received placebo containing cornstarch as twocapsules per day) for 12 weeks. Anthropometric measures, dietary intakes, liver enzymes as well as glucose markers and lipid profilewere assessed at baseline and after 12 weeks of intervention. Results: Forty-five patients completed the study (ALA group = 23; placebo group = 22). Liver enzymes were not significantly alteredby the intervention group. Alpha Lipoic Acid supplementation led to a significant attenuation in serum levels of insulin (13. 4 5. 4vs. 18. 1  8. 6; P = 0. 019) and triglyceride (146. 9  60. 6 vs. 186. 3  54. 2; P = 0. 037) in comparison with the placebo group, yet didnot affect other lipid profile parameters, Fasting Serum Glucose (FSG) and -cell function index (HOMA-B) in patients with NAFLD. furthermore, quantitative insulin sensitivity check index (QUICKI) increased significantly in the ALA group compared to the placebo(0. 329 0. 025 versus 0. 317 0. 020; P = 0. 033). Conclusions: Patients with NAFLD may benefit from ALA supplementation, at least partially through augmented insulin sensitivityand improvement of lipid profile.

Background: Non-small cell lung cancer (NSCLC) is the most common type of lung Neoplasms, which accounts for about 85% of alllung cancer types. However, critical biological pathways and key genes implicated in NSCLC remain ambiguous. Objectives: The present study aimed at identifying the critical biological pathways and key genes implicated in NSCLC, and providinginsight into the molecular mechanism underlying NSCLC. Methods: In this case-control bioinformatics study, the researchers used four microarray data of NSCLC from public gene expressionomnibus (GEO) database at the national center for biotechnology information (NCBI) website. The microarray data came fromstudies of American, Spanish, and Taiwanese NSCLC patients, and in total contained 190 NSCLC tissue and 180 normal lung tissue. A standardized-microarray preprocessing and gene set enrichment analysis (GSEA) were used to analyze each microarray data andobtained significantly regulated pathways. Venn analysis was used to identify the common significantly regulated biological pathways. Protein and protein interaction (PPI) network analysis was used to identify the key genes within common significantly regulatedpathways. The PPI information was retrieved from the STRING database, and Cytoscape software was used to construct andvisualize the PPI network. Results: Through integrating GSEA results of four microarray data, finally, the researchers identified 22 common up-regulated and85 common down-regulated pathways. Many genes within 107 common significantly regulated pathways were significantly enrichedwithin cell cycle pathway (P value of 2. 58e-79) and focal adhesion pathway (P value of 2. 44e-81). The PPI network showed thatup-regulated CDK1 (P value = 1. 33e-18 and logFC = 1. 41) and down-regulated PIK3R1 (P value = 5. 09e-22 and logFC =-1. 13) genes sharedthe most abundant edges, and were associated with NSCLC. Conclusions: This cross-sectional study showed increased concordance between gene expression profiling data. These identifiedpathways and genes provide some insight into the molecular mechanisms of NSCLC, and the genes may serve as candidate diagnosticand therapeutic targets of NSCLC.

Background: Polycystic ovarian syndrome (PCOS) is a common endocrine disorder that can cause mental and psychological manifestationssuch as depression in addition to medical aspects like obesity. Objectives: Theaimof this studywasto evaluate the effect of cognitive-behavioral therapyonbodymassindex (BMI)anddepressionin women with PCOS. Methods: This randomized controlled trial was conducted on 74 women in Saqez-Iran, 2017. Participants were assigned into twogroups of intervention and control through blocked randomization. The intervention group received cognitive-behavioral therapyin 8 sessions of 45 to 60 minutes. Beck’ s depression questionnaire was completed, and body mass index (BMI) was calculated beforeand four weeks after the end of the intervention. ANCOVA test was used to analyze the data. Results: There was no significant difference between the two groups in terms of socio-demographic characteristics (P > 0. 05). Afterthe intervention, the mean (SD) of depression score in the intervention group was 4. 5 (3. 9) and in the control group 16. 5 (8. 6). Basedon the ANCOVA test and with adjusting the baseline values, the mean depression score of the intervention group significantly waslower than the control group (adjustedmeandifference:-13. 8; confidence interval 95% =-10. 9 to-16. 7; P< 0. 001). In addition, after theintervention, themean(SD) of BMIin the interventiongroupwas27. 3 (5. 4), andin the controlgroupitwas29. 4 (5. 5). The interventiongroup was significantly lower than the control group, based on the ANCOVA test with adjusting the baseline values (-0. 6;-0. 2 to-0. 9; P < 0. 001). Conclusions: Cognitive-behavioral therapy is effective in improving depression and decreasing BMI in women with PCOS. Therefore, it is recommended to use this therapeutic approach to improve the physical and psychological health of these women.

Background: Lactobacilli are commonly used organisms in the production of probiotics. Objectives: The present study was conducted to examine the effect of probiotics isolated from dairy products on the expression ofStx1 and Stx2 genes in verotoxigenic E. coli (VTEC). Methods: This experimental study was conducted during April and January 2016 in East Azerbaijan, Iran. At first, Hundred samplesof traditional dairy products were collected. Then, using standard phenotypic and genotypic methods, the Lactobacillus casei (L. casei) and lactobacillus (L. plantarum) were studied. Subsequently, these strains were examined along with the pathogenic bacteriastrain of Escherichia coli (E. coli) (O157: H7) by neighboring cultivation. After extraction of mRNA, the expression of these genes wasdetermined using real-time PCR. Results: The results revealed that L. casei reduces the expression of Shiga toxin (Stx1 and Stx2) genes more compared to L. plantarum(P = 0. 001). Moreover, it was found that both Lactobacilli reduce the expression of Stx1 genes more than Stx2. Conclusions: Probiotics could be used to prevent and control intestinal diseases caused by E. coli.

Background: Post-anesthetic shivering can cause post- surgical pain or discomfort, and create oxygen supply/demand imbalance.Objectives: The current study aimed at evaluating the effects of Dexmedetomidine on the incidence and intensity of shivering and core temperature after general anesthesia.Methods: The current randomized, double-blind, placebo-controlled, clinical trial was conducted at a single center (Gil Medical Center, Incheon, South Korea) from January to December 2016 with convenience sampling and simple random allocation. A total of 40 patients undergoing video-assisted thoracoscopic (VATS) wedge resection were randomly assigned to receive either 1mg/kg of Dexmedetomidine (Dexmedetomidine group, n=20) or normal saline (control group, n=20) 10 minutes after skin incision. Hemodynamic variables and esophageal and tympanic temperatures were recorded five minutes after anesthetic induction, five minutes after achieving a lateral position, every five minutes after carbon dioxide insufflation to the thoracic cavity, and at the end of surgery. Incidences and intensities of post-anesthetic shivering, and postoperative pain scores were recorded.Results: Median postoperative pain score was significantly lower in the Dexmedetomidine group than the control group (4 (0-5) vs.5 (3.25-6) (median (interquartile range)), P=0.004). In the post-anesthetic care unit (PACU), the incidence of shivering was significantly lower in the Dexmedetomidine group than in the control group (0/20 (0%) vs.6/20 (30%), P=0.020); but the incidence of hypothermia was higher in the Dexmedetomidine group than in the control group (6/20 (30%) vs.0/20 (0%), P=0.020).Conclusions: A single intraoperative dose of Dexmedetomidine (1 mg/kg) may reduce postoperative shivering and pain scores, but it might also increase the incidence of postoperative hypothermia in patients undergoing Sevoflurane anesthesia for video-assisted thoracoscopic wedge resection.

Background: Episiotomy is one of the most common surgical procedures in obstetrics performed in the second stage of labor. Objectives: This study was conducted to compare the effects of Alpha® Ointment in comparison with Betadine® solution on episiotomyhealing process. Methods: The present single-blind clinical trial was conducted on 128 eligible women admitted to a university affiliated hospital inKaraj, Iran, in 2015. The subjects were divided into a casegroup (gettinganAlpha® Ointment plus a sitz bath with Betadine® solution)and a control group (getting a sitz bath with Betadine® solution). After delivery, the mothers applied 2 g of Alpha® Ointment ontheir episiotomy site three times a day. The REEDA scale was used to assess the wound healing process, and the intensity of pain wasassessed by measuring pain in the first 24 hours as well as the third and seventh day after delivery. Results: In the first 24 hours after delivery, the two groups were not significantly different in terms of their repair score (P = 0. 27), however, the mean REEDA score was 0. 25 0. 53 on the third day and 0. 203 0. 47 on the seventh day in the case group, while in thecontrol group, it was 1. 32 1. 4 and 0. 92 1. 17, suggesting a significant difference between the groups (P < 0. 001). Conclusions: Alpha® Ointment is more effective than Betadine® solution for episiotomy wound healing and pain reduction andcan, therefore, be regarded as an appropriate medication for episiotomy wound healing.

Background: Increasing evidence implies that Adipocytokines may result in cardiovascular disease (CVD) events and metabolicchanges in the general population and also increase graft failure rate in the renal transplant recipient. Objectives: To compare theserumlevels of Adipocytokinesandlipid profiles in renal transplant recipients with healthy individuals. Methods: In a case-control study undertaken from the beginning of 2015 to December 2016; 30 renal transplant recipients, with stableconditions, whose renal transplant at least survived well over six months, were randomly selected to be the case group. Besides, 30 healthy individuals who referred to the transplantation clinic as the patients’ attendants were considered as the control group. The serum levels of IL-1, IL-6, TNF- , Adiponectin, Visfatin, Leptin, and the Lipid profiles were measured after 12 hours of fasting andwere compared between the two groups. Results: The serum levels of Adipocytokines including IL-1, IL-6, TNF- , Visfatin, and Leptin were significantly higher in renal transplantrecipients than in healthy individuals (P <0. 001) and the serum level of adiponectin (P < 0. 004) was significantly lower inthe renal transplant recipients. Linear regression results indicated that in the renal transplant group, only the Visfatin had a significantnegative correlation with age (Unstandardized Coefficient =-0. 104, P = 0. 002). There were significant positive correlationsbetween Leptin with cholesterol (P = 0. 005), triglyceride (P = 0. 008), and LDL (P = 0. 014) in the healthy individuals, however, these relationshipswere not found in the renal transplant recipients and only a significant negative correlation was found between Tumornecrosis factor alpha (TNF- ) and cholesterol levels (P = 0. 01). Conclusions: The findings of the present study demonstrated that renal transplant recipients suffer from inflammation and accompanyingchanges in levels of Adipocytokines in comparison with healthy controls.

Background: With regards to the high potential of medicinal plants in the production of biopharmaceuticals, one can rely on the promising prospect of insulin production via plant resources.Objectives: This study was conducted with the aim of using plant extract for insulin-producing cells.Methods: This was a quasi-experimental study using critical case sampling. Six samples were gathered from the umbilical cord (Wharton’s jelly) in a governmental university affiliated hospital, Sari, Iran in 2017 after successful isolation of mesenchymal stem cells. Initially, Nigella sativa seeds extraction was performed to prepare the extract for cellular differentiation. Next, dithizone (DTZ) staining was used to evaluate insulin production, and insulin level was examined by the enzyme-linked immunosorbent assay (ELISA). Data were analyzed was analyzed with the SPSS version 16 software using independent sample t-test.Results: The mean of the amount of insulin secretionwas92.33±5.13 ng/ml for the interventionand0.33±0.15 ng/ml for the control group. The results showed that there was a significant difference in the average insulin in the culture obtained from Nigella sativa seeds between control and intervention groups (P=0.001). In addition, via the ELISA kit and specific dithizone staining, insulinproducing cells were proven.Conclusions: In this regard, it could be concluded that the extract of Nigella sativa seeds was capable of including differentiation of mesenchymal stem cells derived from Wharton’s jelly to Insulin-Producing Cells.

Background: Oxidative stress in the pathogenesis of diabetes is of great prominence and that Carnosine is a natural antioxidant. Objectives: This study was aimed to investigate the effect of Carnosine supplementation on different oxidative stress biomarkersin patients with type 2 diabetes mellitus (T2DM). Methods: In this randomized, double-blind placebo-controlled trial, 54 patients with T2DM were employed from Tabriz Sheikhorraeespolyclinic and Imam-Reza Hospital endocrine center, and assigned to either the intervention group (n = 27) to receive two capsulesof Carnosine 500 mg each or the control group (n = 27) to take two capsules of crystalline microcellulose for 12 weeks. Serumlevels of fasting blood sugar (FBS), malondialdehyde (MDA), protein carbonyl (PC) and erythrocytes content of catalase (CAT), andsuperoxide dismutase (SOD) were assessed before and after the supplementation. Results: A total of 44 patients completed the study. Anthropometric indices and energy intake did not show a significant changein both studied groups. Improved catalase level and decreased serum levels of fasting blood sugar, malondialdehyde and proteincarbonyl occurred in the carnosine group compared to the placebo group after adjusting for baseline values and confounders (P <0. 05). Between-group differences were not significant for other variables at the end of the research. In the placebo group, none ofthe studied biomarkers were altered significantly. Conclusions: Our findings divulge the beneficial effects of carnosine supplementation in improving the antioxidant status andattenuating some of the oxidative stress biomarkers in patients with T2DM making it a useful adjunct therapy.

Context: Mindfulness-based interventions have shown promising therapeutic outcomes in improving well-being, mental health, general health, and quality of life; however, findings in this regard are i nconsistent. The present study aimed at clarifying this inconsistency in the literature focusing on the Iranian studies through a systematic review and meta-analysis study.Evidence Acquisition: The databases of Pubmed, Scopus, Doaj, EBSCO, Iranmedex, MagIran, SID, and Comprehensive Human Sciences Portal, and additional resources were searched using the set terms of “mindfulness” OR “mindfulness-based cognitive therapy” OR “MBCT” OR “mindfulness-based stress reduction” OR “MBSR” AND “intervention” AND “well-being” OR “health” OR “quality of life” and the time limit of the records was set between March 2008 and May 2017. The language of the search was restricted to English and Farsi. The studies that conducted on Iranian populations were selected in this review, only. Thirty-five studies conducted on 3013 subjects were assessed. Cochrane Q-test and I-squared index were used to detect the heterogeneity among results, and fixed effect model with a 95% Confidence Interval (CI) was applied. The effect size of mindfulness-based interventions on w ell-being, mental health, general health, and quality of life improvement, measured by Hedge‘s g ratios, were respectively 1.54, 1.08, 0.89, and 1.87.Results: The findings showed that the effect size of mindfulness-based interventions on well-being, mental health, general health, and quality of life improvement were of high magnitude, according to the Cohen’s table.Conclusion: Mindfulness-based interventions effectively improved well-being, health, and quality of life.

Background: Incisional hernia repairs are among common abdominal wall surgeries, can be primarily required or being reconstructedusing a synthetic or biological material. Objectives: This study aimed at evaluating intra-abdominal adhesions and incisional site healing after the repair of the abdominalwall by fresh amniotic membrane-coated polypropylene mesh in comparison to only polypropylene mesh in an experimental ratstudy. Methods: The study protocol was approved by the Cumhuriyet University Institutional Ethics Committee for Animal Experiments(Sivas-Turkiye, date 24/06/2015). Sixteen pregnant female Wistar-Albino rats (mean weight, 275 g) were anesthetized on the 21st dayof pregnancy, and a 1-cm area of the abdominal wall was excised. The pregnancy was terminated, emerging amniotic membraneswere dissected, and eight pieces of the 1-cm2 polypropylene mesh were coated with these amniotic membranes without using anysuture or adhesive. The polypropylene meshes were sutured on the abdominal wall of eight rats (control group), selected by simplerandom sampling. For the remaining eight rats, the same procedure was applied with the amniotic membrane-coated polypropylenemeshes (experimental group). On the 28th postoperative day, the anterior abdominal wall was opened, and intra-abdominaladhesions were assessed macroscopically by Nair’ s adhesion scoring system. Strip-shaped biopsy samples were taken from incisionlines for histopathological examination. Results: The experimental group had significantly less intra-abdominal adhesions (i. e., Nair’ s score of 2 to 4) compared to the controlgroup (two and six rats, respectively; P = 0. 046), and had significantly lower mean score for polymorphonuclear leukocyte infiltration(P = 0. 039), hyperemia (P = 0. 039), and epithelialization (P = 0. 039). The score for the increase in connective tissue (P = 0. 018)was significantly higher in the experimental group, and the scores for edema (P = 0. 590) and macrophage infiltration (P = 0. 590)were similar between the two groups. Conclusions: The use of polypropylene mesh coated with fresh amniotic membrane provides the advantage of decreasing postoperativeintra-abdominal adhesions along with less inflammation and higher epithelialization after abdominal wall repair surgery.

Background: Identification of reliable predictors of hypertension and prehypertension in each population is essential for early detection of at-risk people and also planning preventive strategies.Objectives: The present study aimed to assess the abilities of different indices of general and central obesity in the prediction of incident prehypertension and hypertension in a large population-based study in Iran.Methods: In this cross-sectional study, we evaluated the anthropometric and blood pressure measurements in 10, 137 subjects (35 - 70 years) from Azar- Cohort study, north-west of Iran. Blood pressure was measured twice, with 10 minutes apart, from both upper extremities. Height, weight, waist, and hip circumferences measured according to the NIH guidelines. Hypertension considered as systolic blood pressure³ 140 and diastolic blood pressure³90mmHgor current use of antihypertensive medication for management of hypertension.Results: The mean BMI (kg/m2), WC (cm), waist- to- hip ratio (WHR), andwaist- to- height ratio (WHtR) were 28.75±4.83, 94.69±11.23, 0.90±0.07, and 0.58±0.07, respectively. The prevalence of prehypertension and hypertension were 16.3% and 23.3%, respectively. There was a significant association between prehypertension and hypertension with all included anthropometric indices in both men and women (All P<0.001). In men, obesity increased the risk of prehypertension and hypertension by 3.13 (95% CI: 2.48-3.94) and 4.06 (95% CI: 3.23-5.10), respectively. In women with WHtR>0.5 cm, the risk of hypertension increased by 6.27 (95% CI: 4.39-8.95) times.Conclusions: According to the result of this large population-based study, BMI is the best predictor of prehypertension and hypertension in men and also the waist- to- hip ratio combined with BMI were the best predictors of prehypertension and hypertension in women. These findings may have significant implications in using the most useful screening index for predicting hypertension in Iranian adults and also using waist- to- hip ratio for early detection of pre-hypertension.