Iranian Red Crescent Medical Journal
Year:2018 | Volume:20 | Issue:4|Papers Count:12

Background: The increased iron load is the main problem in beta-thalassemia major; chelation therapy is used for its counteraction. Non-compliance with iron chelation therapy leads to certain complications and the economic burden caused by them furtherhighlights the importance of therapies for reducing iron overload. Administering lower doses of the chelating agent reduces boththe complications faced by the patients and the economic burden on the health system. Objectives and Methods: This randomized clinical trial was conducted to investigate the effect of a holistic care program (HCP)on the reduction of iron overload in patients with beta-thalassemia major referring to the largest center for thalassemia patients inMashhad (Iran). Ninety eligible patients were randomly selected and enrolled in this study from September 2012 to February 2015. The subjects gave their informed consent and were then divided into an intervention (n = 45) and control group (n = 45) throughstratified randomization while taking into account the type of a chelating agent as the confounder. The HCP was conducted asa randomized trial in three parts: 1-individual counseling (4 45-60-min sessions for each patient), 2-group training (4 60-90-min sessions for each patient), and 3-rehabilitation (8 weeks). Of the 500 patients with beta-thalassemia major, 90 samples wererandomly selected. After they gave their informed consent, the samples were randomly assigned to 2 groups, i. e., an HCP groupand a control group. Before beginning the intervention and 3 months later, the patients’ levels of serum ferritin and iron, totaliron binding capacity or TIBC (to check the iron load), and hemoglobin or Hb (to prevent hemolysis) were examined and the 6-minute walk test (6MWT) was also performed for assessing their functional ability and to ensure they were able to comply with therehabilitation program. The patients in the control group received routine care only. The pre-and post-intervention evaluations inthe control group were similar to those in the intervention group. Results: Changes in serum iron and ferritin, as well as the6MWTdistance, differed significantly between the test and control groups(P < 0. 05). TIBC and Hb levels, however, showed no significant differences between the two groups (P > 0. 05). The mean changes inserum iron and ferritin, 6MWT, TIBC, and Hb equaled-71. 02 97. 28,-1172. 75 2032. 14, 65. 97 81. 1, 29. 71 80. 95, and 0. 06 1. 75 inthe intervention group and-5. 46 96. 73,-8. 08 998. 56,-33. 97 54. 28, 21. 37 90. 45, and 0. 33 1. 5 in the control group. Conclusions: It seems that any change in the mental and psychological conditions of chronic patients, especially those with thalassemia, improves their self-care behaviors and thereby, their treatment compliance. Based on the results, the HCP was effective inreducing ferritin levels in patients with thalassemia major in this study. Therefore, this is program is recommended to be used inthe care of thalassemia patients.

Background: Overproduction of reactive oxygen species (ROS) causes increased lipid peroxidation, decreased intestinal epithelialbarrier integrity, and ultimately mucosal disruption and ulceration. Several studies have confirmed the antioxidant, antiinflammatory, and immunomodulatory properties of Spirulina Platensis (SP), edible blue-green algae, in various inflammatory diseases. In addition, natural honey, a source of phenolic and flavonoid compounds, is a powerful antioxidant, which can help preventchronic oxidative stress and subsequent inflammation. Objectives: In this study, we examined and compared the protective effects of SP and honey on ulcerative colitis induced by aceticacid (AA) in rats. Methods: Forty male rats were allocated into five groups (N = 8) and received pretreatment for 32 consecutive days. The administrationswere as follows: group 1 (control) and group 2 (AA-colitis group): normal saline, group 3: 1 ml honey/day, group 4: 1 mlhoney/day plus 1 g/kg SP, and group 5: 1 g/kg SP. Colitis was induced on the 30th day in groups 2 to 5. On day 32, the clinical activityscore was determined and anesthetized animals were sacrificed. Serum interleukin-6 (IL-6), IL-1 , tumor necrosis factor- (TNF- ), glutathione peroxidase (GPx), reduced glutathione (GSH), total antioxidant capacity (TAC), superoxide dismutase (SOD), myeloperoxidase (MPO), prostaglandin E2 (PGE2), malondialdehyde (MDA), nitric oxide (NO), and colonic weight/length ratio weredetermined. In addition, histopathological changes of the colon were observed microscopically. Results: Theinflammatory markers (PGE2, MDA, NO, IL-6, IL-1 , MPO, andTNF- ) were significantly lower in the pretreatment groupsthan in the AA-colitis group (P values < 0. 05). PGE2 [median (IQR)] of the honey, SP + honey, and SP groups was [0. 76 (0. 33)], [0. 75(0. 40)], and [0. 87 (0. 86)], respectively, compared to the AA-colitis group [2. 60 (2. 23)] (P values < 0. 041). MDA values were [6. 52 (3. 57)], [6. 09 (3. 59)], and [5. 85 (4. 92)] vs. [16. 60 (12. 03)] (P values < 0. 046) and IL-1 values were [42. 20 (8. 2)], [41. 76 (18. 10)], and [42. 93 (14. 09)]vs. [79. 54 (40. 79)] (P values < 0. 044). Also, SOD, GSH, GPx, and TAC [median (IQR)] were significantly higher in the pretreatmentgroups than in the AA-colitis group (P values < 0. 05). For example, TAC values of the honey, SP + honey, and SP groups were [0. 164(0. 08)], [0. 14 (0. 05)], and [0. 16 (0. 10)], respectively, vs. the AA-colitis group [0. 08 (0. 01)] (P values < 0. 028). Conclusions: Honey and SP are favorable foods in preventing oxidative stress and inflammatory diseases such as ulcerative colitis.

Background: Osteoarthritis is a common chronic degenerative disorder. Exercise is regarded as a common practice for the elderly, especially those with knee osteoarthritis. Objectives: This study aimed to examine and compare the effects of Tai Chi and closed kinetic chain exercises on patients with kneeosteoarthritis. Methods: Forty-eight patients with knee osteoarthritis participated in this clinical trial study, which was carried out in a privateclinic (2016) in district thirteen of Tehran, Iran. They were randomly assigned equally to closed kinetic chain exercise (CKCE) group, Tai Chi Exercise (TCE) group, andnoexercise group. All three groups were equally treated using a standard physical therapy protocol. The CKCE group performed static stretching and CKCE, and the TCE group performed Tai Chi warm-up and cool-down and the form6 of Yang style of Tai Chi exercises. All three groups were evaluated at baseline, sixth, and twelfth sessions of treatment and onemonthpost-treatment using a six-minute walk test and the knee injury and osteoarthritis outcome score (KOOS) questionnaire. Results: According to KOOS subscale, the TCE improved the symptoms (68. 94  9. 24) (P < 0. 001), pain (75. 13  12. 33) (P < 0. 001), ADL (76. 50  12. 03) (P = 0. 01), and the total score (72. 12  8. 63) (P < 0. 001) significantly more than the CKCE (55. 50  13. 61, 64. 75 10. 58, 67. 25  9. 96, 67. 25  7. 82, respectively) and routine physiotherapy (34. 62  11. 34, 53. 06  9. 36, 61. 69  10. 32, 51. 50  7. 24, respectively) in patients with knee OA. Both the TCE (376. 43 88. 18) (P < 0. 001) and CKCE (353. 50 78. 15) (P < 0. 001) groups showedimproved walking distance significantly more than the no exercise group (315. 35 66. 33) in patients with knee OA. Conclusions: In patients with knee OA, Tai Chi exercise relieved pain and symptom even in a short time, and improved QOL, sport, and recreational activities, and ADL. The effects of both TCE and CKCE on the improvement of QOL were similar.

Background: Familial adenomatous polyposis (FAP) is an inherited autosomal dominant disorder, which can develop into cancerin early adulthood (100%) and is a result of germline mutations in the adenomatous polyposis coli (APC) genes. Objectives: Identify APC germline mutations and assessed relationships between genotypes and phenotypes. Methods: In a census-based cross-sectional study, FAP patients were selected from the referral medical centers of East Azarbaijanprovince between 2013 and 2016. Written informed consent was obtained from all patients for blood sampling and genetic testing. Patients undergo genetic counseling, and the pedigree was drawn. After peripheral blood sampling and DNA extraction, thepotential mutation of the APC gene was detected by polymerase chain reaction (PCR), and DNA sequencing. Statistical tests werecarried out using SPSS version 16. 0. Categorical data between two groups were compared using the chi-square test. Independentsample t-test was used for comparison of continuous variables between two groups. The P-value < 0. 05 was considered statisticallysignificant. Results: We identified APC gene mutations in 18 of the 30 unrelated patients with FAP (60%), including one novel frame shiftmutation, three nonsense mutations, and 14 novel missense mutations (78%). The most frequent mutations were in codon 1308 and 1350. Meanwhile, we found a novel polymorphism. Conclusions: Our study results indicated that the APC gene has a high mutation detection rate (60%) between codons 999 and 1410, and codons 1308, and 1350 are two mutation hotspot regions.

Background: Considering the undesirable consequences of stress and anxiety in pregnancy and the role of midwives in providingemotional support for pregnant women, it is essential to utilize non-medical therapies, such as spiritual counseling. Objectives: The present study aimed to determine the effect of spiritual counseling on stress and anxiety in pregnant women. Methods: This randomized controlled clinical trial recruited 112 pregnant women presenting to the health centers in Maragheh, Iran, in 2016-17. The participants were assigned to two 56-member groups of control and intervention with a randomized blockdesign. A socio-demographic questionnaire, the perceived stress scale, and the Spielberger state-trait anxiety inventory (STAI) werecompleted before and four weeks after the intervention through interviews with participants. Results: 55 participants in the counseling group and 56 in the control group were followed up and analyzed until the end of thestudy. The mean ( SD) scores of stress, state anxiety, and trait anxiety were 35. 4 ( 4. 5), 48. 5 ( 4. 8), and 47. 4 ( 4. 6) in the counselinggroup and 34. 8 ( 3. 6), 47. 8 ( 4. 1), and 49. 0 ( 4. 1) in the control group before the intervention, respectively. The mean ( SD) scores of stress, state anxiety, and trait anxiety were 34. 8 ( 3. 5), 48. 0 ( 4. 5), and 44. 7 ( 4. 0) in the counseling group and 37. 8( 3. 7), 49. 7 ( 4. 2), and 46. 0 ( 3. 8) in the control group four weeks after the intervention, respectively. According to ANCOVA forcontrolling the baseline scores after the intervention, the mean scores of perceived stress (adjusted mean difference =-3. 4; 95% confidenceinterval =-2. 3 to-4. 4; P < 0. 001) and state anxiety (-2. 1;-3. 6 to-5. 5; P < 0. 001) were significantly lower in the counseling group, while the two groups had no significant difference in terms of the mean scores of trait anxiety after the intervention. Conclusions: Spiritual counseling can control perceived stress and state anxiety of pregnant women. Therefore, spiritual counselingis recommended as a complementary and effective intervention in managing the psychological problems of pregnant mothers.

Introduction: Determination of suicide as the cause of death due to shotguns can be challenging because shotguns are usuallydesigned for hunting, sport, and recreation. Therefore, the impact of their bullets on the human body may present several unclearsigns. In this case, pellets were reported to spread in contact wounds. The manner of death seemed to be initially murder yet afterthe autopsy, it seemed suicidal. Case Presentation: The incident occurred during March 2015 in a house in the capital city of Iran, Tehran. The case was a 39-year-oldman, who upon initial examination, was reported to have committed suicide using a shotgun. This was evident by the presence ofdistributed pellets in the chest and pelvis, which confirmed a contact shot. Conclusions: The following were hypothesized: 1-After the plastic cap of the bullet hit the sternum, it was fragmented, and pelletswere scattered. 2-Regarding the existence of the pellets in the heart’ s ventricles, it seemed the pellets were distributed immediatelythrough the aorta, to the chest, and through to the abdominal aorta, and the pelvis.

Background: Abnormal levels of hormones during the second trimester of pregnancy may predict genetic disorders and complicationsof pregnancy. Objectives: This study was performed to evaluate the clinical significance of abnormal results in second-trimester markers in theabsence of aneuploidy. Methods: This case-control study was conducted between May 2014 and December 2015 in the maternal-fetal unit, Trakya UniversityFaculty of Medicine in Turkey. Overall, 108 Turkish pregnant females were included in this study. This research recruited patients(n = 46) with normal karyotype, who underwent invasive prenatal tests because of abnormal levels of second-trimester hormones, along with a cohort of controls (n = 31) with hormonal results within normal ranges. For each patient, the researchers recordedthe mode of delivery, gestational age at delivery, birth weight, complications, and adverse outcome of the pregnancy. Data wereanalyzed using Fisher’ s exact tests and Yates continuity correction tests for qualitative variables, and t-test and Mann-Whitney Utest for quantitative variables. Results: Maternal age (mean SD) of the entire group was 31. 77 5. 68 years (study group: 31. 23 4. 39; controls: 32. 13 6. 43, P >0. 05). Preterm delivery and preeclampsia were significantly higher in the study group (P = 0. 02). In the study group, Alpha Fetoprotein(AFP) levels were significantly higher in patients with preeclampsia yet not in the controls. The AFP values under 0. 77 multipleof the median in patients with elevated test results in the absence of aneuploidy appeared to be associated with the developmentof preeclampsia later in pregnancy. Conclusions: Although the significance of higher AFP values have been discussed in the literature in terms of the development ofadverse outcomes, the present study suggests that lower values must also be taken into account during patient follow-up.

Background: Epistaxis is the most common otolaryngologic emergency. Objectives: The current study aimed at evaluating the therapeutic effect of the Celox® bandage to manage non-traumatic epistaxisin the emergency department. Methods: In the current randomized, clinical trial, 150 patients with non-traumatic epistaxis admitted to the emergency departmentin Imam Reza and Sina hospitals affiliated to Tabriz University of Medical Sciences, Tabriz, Iran, during years 2015-2016. Thepatients were randomly divided intotwogroups: group 1 dressing with the Celox® bandandgroup 2 dressing with the anterior nasaltampon. The convenient sampling method was employed. Bleeding control (minute), patients’ satisfaction, and lack of rebleedingwithin the first 24 hours of administration were compared between the two groups. Results: There was no statistically significant difference between the two groups in terms of demographic variables, vital signs, and paraclinical testing results (P > 0. 05). With respect to the control of bleeding in the first 5 minutes after management, 93. 3%of the bleeding was controlled in the Celox® , and 96% of the bleeding was controlled in the anterior tampon groups (P = 0. 467). The satisfaction level of the patients in the Celox® group was greater than that of the tampon group, and the difference was statisticallysignificant (P < 0. 001). Lack of rebleeding within 24 hours after management had the most significant effect on the patientsatisfaction [odds ratio (OR) = 3. 969]. Conclusions: Based on the results of the current study, there was no significant difference in bleeding control and the success ratebetween the two groups in the study. Ease of usage, however, makes Celox® a better alternative to control epistaxis. Furthermore, the treatment of epistaxis with Celox® leads to higher satisfaction levels.

Background: In type 2 diabetes, adaptation to the disease and the treatment process is extremely important. The main methodsemployed to treat and manage type 2 diabetes are education, medication, nutrition, exercise, and insulin therapy. Objectives: The current study aimed at determining the effects of education based the Roy adaptation model on diabetes careprofile (DCP) of patients with type 2 diabetes. Methods: The current clinical and experimental study was conducted on 130 patients with type 2 diabetes referred to Atatü rk UniversityResearch Hospital Endocrinology Policlinic, Erzurum, Turkey from April 2015 to August 2016, possessing the inclusion (N =388). The study was conducted as a pre-test post-test control group. The study was conducted on 61 patients in the experimental and65 in the control groups. The experimental group referred on Monday, Wednesday, and Friday. Control group referred on TuesdaysandThursdays. The patient identification formandTurkish version of diabetes care profile scale, developed by Ozcan wereemployedfor data collection. The education and follow-up processes were completed in 12 weeks. The percentile, distribution, Chi-square, andthe t-tests were employed to evaluate the data of the independent and paired groups. P < 0. 05 was considered as significant. Results: The patients in the control group had pre-test and post-test scores of 2. 43  0. 16 and 2. 44  00. 15 in medical barriers, respectively (P = 0. 269). In the experimental group, the scores of medical barriers were 2. 45 0. 17 in the pre-test and 2. 23 0. 37 inpost-test (P < 0. 05). Further, the patients in the control group had the pre-test and post-test scores of 2. 49 0. 32 and 2. 55 0. 31 insupportive attitude, respectively (P = 0. 136). In the experimental group, the pre-test and post-test scores of supportive attitude were2. 55 0. 33 and 2. 89 0. 48, respectively (P < 0. 05). Conclusions: A positive impact was observed in the education of DCP based on Roy’ s adaptation model.

Background: Regional techniques both reduce opioid requirements and provide quality pain control in patients, especially inpediatrics. Objectives: The aim of this study was to compare the contributions of ilioinguinal/iliohypogastric (II/IH) block and transversusabdominis plane (TAP) block combined with sedation to intraoperative anesthesia and analgesia in pediatric surgery. Methods: In this randomized controlled study, 100 patients aged 2-6 years were enrolled and divided into five groups: TAP blockwith ketamine; II/IH block with ketamine; TAP block with Sevoflurane; II/IH block with Sevoflurane; and the control group withSevoflurane alone. Hemodynamics (mean arterial pressure (MAP) and heart rate (HR)), depth of anesthesia, Sevoflurane usage, painscore, number of children who needed analgesia, and the time to start rescue analgesia of all patients were recorded. Results: There was no significant difference between the study groups, in HR and MAP during operations (P > 0. 05). The amountof Sevoflurane used in the group supported with both blocks decreased significantly compared to the control group (P < 0. 001). Inthe groups where the block was added until the 6th hour in the postoperative period, there were lower HR and MAP (P < 0. 05). Painscores were high in the first six hours in the control group (P < 0. 05). There was a longer duration of analgesia in the ketamine + TAPgroup and the Ketamine + II/IH block group (P < 0. 001) in comparison to others. A higher analgesic need was found in the controlgroup (P < 0. 05). Conclusions: This study revealed that transversus abdominis plane or ilioinguinal/iliohypogastric regional blocks could have sameintraoperative/ postoperative effects regarding hemodynamics and intraoperative analgesia in lower abdominal pediatric surgery. Anesthesia can be maintained using sedative medicines only.

Background: Cardioplegia is used for protection of myocardium during cardiac operations. Del Nido® (DN) and Custodiol® cardioplegia(CC) solutions are used for prolonged protection of the myocardium during cardiopulmonary bypass (CPB). Custodiol® cardioplegia solution is gaining popularity for myocardial protection during cardiopulmonary bypass. Objectives: This study aimed to compare the effects of Custodiol® with another cardioplegia solution, Del Nido® , on myocardialprotection during cardiopulmonary bypass. Methods: In a randomized controlled clinical trial, forty patients were randomly allocated to DelNido® and Custodiol® (CC) groups. Patients in both groups received a standard anesthesia protocol. For cardioplegia, in the DN group, the Del Nido® solution wasadministered every 90 minutes by the antegrade route. In the CC, group, the Custodiol® solution was administered in the same wayat the beginning of the cardioplegia. Demographic information, blood chemistry parameters and other related perioperative andpostoperative clinical indices were recorded. Results: Frequency of female patients was 14/21 (66. 66%) in the DN and 12/19 (63. 15%) in the CC group (P = 0. 816), age was 57. 14 12. 48years versus 59. 47 11. 96 years (P = 0. 551), weight was 70. 95 9. 56 kilograms versus 69. 63 7. 64 kilograms (P = 0. 635), CPB time was103. 19 23. 43 minutes versus 97. 36 16. 7 minutes (P = 0. 376), and cross-clamp time was 73. 76 19. 66 minutes versus 83. 95 16. 14minutes (P = 0. 083). Blood chemistry and blood gas analysis revealed a similar trend between the two groups in these parameters (P> 0. 05) except for higher sodium levels after cardioplegia (P = 0. 016) and end of CPB (P = 0. 002), potassium levels after cardioplegia(P = 0. 029), and bicarbonate anions at the end of bypass (P = 0. 03) in the Custodiol® group. Conclusions: In conclusion, CC and DN offer effective myocardial protection during cardiopulmonary bypass. It is recommendedto restrict the use of CC in patients susceptible to electrolyte disturbances.

Background: The correlation between gut microbiota with body mass index is controversial. This study aimed to explore the correlationbetween gut microbiota profiles, Bacteroidetes and Firmicutes, with a body mass index in 7-12-year-old school aged children, Iran. Methods: This cross-sectional study was carried out on school-age children. A total of 188 elementary school children were selectedthrough cluster sampling frame. Data collection tool was the international physical activity questionnaire (IPAQ), therefore, wechecked the anthropometric characteristics. Fecal sampling was obtained from all study samples, Langround, Iran. Obese (BMI =25. 8  3. 40 kg/m2), normal-weight (BMI = 15. 54  1. 19 kg/m2), and lean (BMI = 12. 79  1. 8 kg/m2) among Langroud children aged7-12 years. The total stool bacterial genomic DNA was extracted by quantitative real-time PCR (Q-PCR) to determine the colonyforming units (CFU) of Bacteroidetes and Firmicutes. Q_PCR data were analyzed by using SPSS version 19. 0, and analyzed interpretedstatistical exams such as Spearman’ s rank correlation coefficient and Kruskal Wallis test. Since data was not normal, P < 0. 05 wasset as a significant level. Results: Gut microbiota, Firmicutes and Bacteroidetes CFU, and so bact/firm ratio were significantly different among the threegroup fecal samples (P < 0. 0001, P = 0. 025, P = 0. 004). Bacteroidetes and bact/firm ratio had a significant difference among girls (P= 0. 037, P = 0 0013); however, there is no significant difference among boys. The results indicate that there is a significant negativecorrelation between bact/firm ratio with BMI and waist circumference (r =-176, P = 0. 016, r =-151, P =-0. 3). Conclusions: The amount of Bacteroidetes and so bact/firm ratio were decreased among obese children; however; Firmicutes increased. It was suggested that obesity in children might be associated with the imbalance of gut microbes.