Iranian Red Crescent Medical Journal
Year:2018 | Volume:20 | Issue:6|Papers Count:10

Background: Non-alcoholic fatty liver disease (NAFLD) is one of the most frequent liver diseases worldwide. There are several commonrisk factors between NAFLD and coronary artery disease (CAD). Objectives: This study aims to evaluate the relationship between the prevalence of Non-alcoholic fatty liver disease (NAFLD) withseverity of Coronary Artery Disease (CAD) in patients undergoing coronary artery angiography. Methods: This study was a cross-sectional, descriptive-analysis research that included 514 patients who underwent angiography. The severity of CAD was assessed by the number of vessels involved (vessel score: vd). An ultrasound was performed for all thepatients also, intensity of fatty liver involvement was graded from zero (absence of steatosis) to three (severe steatosis). Results: Ultrasonographic examination proven NAFLD in 59. 1% of patients with different grades. Patients with NAFLD had significantlyhigher body mass index (P < 0. 001), waist circumference (P = 0. 03), and age (P < 0. 001). In addition, there were significantdifferences between ALT and AST within the normal group and NAFLD patients (P < 0. 001). Moreover, coronary angiographic dataindicated that the presence of NAFLD significantly correlated with the CAD severity score as so: 64% of people with 2vd and 60. 5% ofpeople with three-vessle lisense had fatty liver that was statistically significant (df = 4; P = 0. 014). Conclusions: This study showed a high prevalence of NAFLD in patients with documented CAD. It is extremely important sinceknowing risk factors, designing screening programs, and early treatment of fatty liver could lead to reducing the risk of cardiovasculardiseases.

Background: Varicocele is the leading cause of male infertility throughout the world. Objectives: This study aimed to identify the effects of varicocele on oxidative stress, total antioxidant capacity (TAC), and semenparameters. Methods: In this cross-sectional study, serum and semen samples were collected from subjects with no varicocele (n, 35) and patientswith varicocele (n, 86), who were referred to infertility and in vitro fertilization (IVF) centers of Babol Clinic Hospital, Babol, Iran during 2015-2016. The semen samples were analyzed according to the world health organization (WHO) guidelines. Afterthe ultrasound and physical examinations, varicoceles were classified into three grades: G1, G2, and G3. TAC and malondialdehyde(MDA) levels were measured in the serum and seminal plasma of subjects, using the ferric reducing ability of plasma (FRAP) andthiobarbituric acid reaction (TBAR) methods, respectively. Nitric oxide (NO) was also measured using Nitric Oxide assay kit. Results: The mean total sperm count in the G1, G2, and G3 groups were significantly lower than the control group (P = 0. 037; P =0. 003, and P = 0. 044, respectively). A trend of lower semen volume was observed in the G3 group, compared with the control group(P = 0. 06). A significant positive correlation was observed between elevated serum MDA level and varicocele degree (P < 0. 05). TheMDA level from the highest to the lowest is as follows: G3 > G2 > G1 > controls. There was also a significant negative correlationbetween the serum and seminal plasma TAC levels (P < 0. 05). Varicocele patients with G3 degree had a significantly lower meanTAC level in the serum and seminal plasma, compared with the control group (P = 0. 001 and P = 0. 008, respectively). No significantdifference was found in the mean Nitric Oxide level between the groups. However, an increasing trend for the mean Nitric Oxidelevel was observed in the serum and seminal plasma of varicocele patients. Conclusions: The reduced level of seminal plasma antioxidants, which is associated with increased lipid peroxidation, is one of themain reasons for low sperm quality in patients with varicocele. Antioxidant therapy may be useful in decreasing oxidative stressintensity and improving the condition of varicocele patients.

Background: Patellofemoral pain syndrome (PFPS) is characterized by anterior knee pain due to arthralgia in the joint betweenthe patella and femur. Many factors, including improper biomechanics and skeletal disorders, are associated with PFPS. The role ofVitamin D deficiency in the pathogenesis of patellar chondromalacia has been known for several years. Objectives: The aim of the present study was to determine the prevalence of Vitamin D deficiency in young people withPatellofemoral Pain Syndrome (PFPS) and compare this with the prevalence in a healthymatched control group and to determinethe correlation between the occurrence of biomechanical abnormalities and serum levels of 25(OH)D in patients with PFPS. Methods: In this case-control study, 40 patients aged 15 to 40 years old with a diagnosis of PFPS, that had referred to the rehabilitationclinic of a university hospital in Tabriz, Iran, were selected as the case group and 40 normal subjects of the same age range wereselected as the controls. Serum 25(OH)D levels were assessed, and a postural examination was performed on both groups, while theseverity of knee pain, plain knee radiographs, and serum levels of calcium and phosphorous were assessed only in PFPS patients. Results: Among the 80 participants, Vitamin D deficiency (cut-off level of 25(OH)D  20 ng/mL) was observed in 55 participants(68. 75%), including 35 (87. 5%) patients and 20 (50%) controls, with a statistically significant difference (P < 0. 001). Females had ahigher prevalence of Vitamin D deficiency than males, yet the difference was not statistically significant (71. 21% versus 57. 14%, P =0. 348). The serum levels of VitaminDand pain severity were significantly and inversely related in the case group (P = 0. 005). Clinicaland imaging findings showed that 18 (45%) of the patients and two (5%) of the controls had abnormalities, such as genu varus, genuvalgus, or patellar tracking, indicating a high coexistence of biomechanical deficits in PFPS (P < 0. 001). Conclusions: Severe and moderate Vitamin D deficiencies were more prevalent in young adults with PFPS than in normal adults. Knee pain severity and joint deformities were correlated with low levels of Vitamin D in the case group. Therefore, attention to diet, vitamin supplementations, and biomechanical correction are the mainstay treatment of PFPS.

Background: Stroke is the main cause of adult inability and dependency on caregiver in performing activities of daily living (ADLs). Studies showed that the caregivers of such patients experienced high levels of dependency-induced caring pressure and, consequently, physical-psychological problems. Objectives: The present study aimed to examine the effect of the instructional intervention on family caregivers’ perceived threatof stroke patients dependency risk. Methods: In a randomized controlled clinical trial study, a total of 45 pairs of stroke patients and their family caregivers were selectedbased on inclusion and exclusion criteria and randomly divided into the intervention and control groups. Sampling lastedfrom July 2016 to March 2017 and was performed in Tehran, Iran. Instructional intervention for family caregivers in the interventiongroup was in the form of four one-hour sessions. The data were collected before and immediately after instructional interventionat the hospital as well as two weeks and two months following the intervention via postal service. Results: Themeanrank of family caregivers’ perceived threat was 1. 44 and 2. 76 in pre-intervention stage of intervention and controlgroups, which became 2. 49 and 2. 49 two months after intervention, respectively. The Friedman test showed that there was a significantdifference in all post instructional intervention stages compared with pre-intervention (P < 0. 001), whereas no such differencewas observed in the control group (P = 0. 245). The Mann-Whitney U test also showed that the pre-intervention family caregivers perceivedthreat was also not significantly different in the two groups (P = 0. 591). However, it was increased immediately, two weeks, and two months following the intervention compared with the control group (P < 0. 001). Conclusions: It is recommended that stroke patients’ caregivers be provided with instructional programs to enhance their understandingof patient dependency risks and challenges.

Background: Osteoarthritis (OA) is a highly prevalent chronic degenerative joint disease with different risk factors, which need tobe investigated in order to perform more appropriate interventions in earlier phases of Osteoarthritis. Objectives: Therefore, the aim of this study was to determine the correlation between hip morphology and hip Osteoarthritis. Methods: This cross-sectional study was conducted on patients aged 15 to 60 years old with hip problems, diagnosed with hip Osteoarthritis, comparedwith healthy individuals as the controlgroup. Thenradiographic parameters, such as alpha angle, acetabularangle of sharp (AA), lateral center-edge angle (LCEA), femoral neck-shaft angle (FNA), coxa profunda, acetabular protrusio, crossoversign, posterior wall sign, and the ischial sign were measured by pelvic (AP) X-ray, using PACS systems in both groups. Results: This study found that alpha angle and AA were significantly greater in OA patients as compared to healthy individuals(P < 0. 001). Furthermore, LCEA was significantly greater in the Osteoarthritis group on the left side as compared to the controlgroup (38. 93 8. 43 versus 36. 81 4. 74, P = 0. 042) yet LCEA on the right side and total amount were not different between the twogroups (P>0. 05). By grouping studied angles, it was found that the frequency of alpha angle > 55° , AA > 38° , and LCEA > 40° weresignificantly higher in theOAgroup as compared to the control group (P< 0. 05). Furthermore, the researchers observed that the frequencyof acetabular protrusio (P = 0. 013) and posterior wall sign were significantly higher in the OA group as compared to healthyindividuals (P < 0. 05). Conclusions: The current results showed that the higher Body Mass Index (BMI), greater alpha and acetabular angles, sharp, lateralcenter-edge angle center-edge angle, the higher rate of a posterior wall sign, and acetabular protrusio increased the risk of OA, whichsupport that these structural changes are major contributors to OA development.

Background: Toxoplasma gondii is a zoonotic protozoan that threatens the health of the people infected with human immunodeficiencyvirus (HIV). HIV-positive subjects are at risk of cerebral toxoplasmosis. Objectives: The current study was designed to find out the seroprevalence of toxoplasmosis in HIV-infected individuals in Farsprovince, in the South of Iran. Methods: This cross-sectional study was performed on 251 HIV-infected individuals referred to Shiraz HIV/AIDS Research Centerin Fars province, Southern Iran, in 2016. Blood samples (5 mL) were collected from each individual and sera as well as buffy coatwere isolated from each sample. Demographic and HIV-associated data were obtained from the patients’ medical records. Anti-Toxoplasma antibodies (both IgG and IgM) were determined by ELISA, using a commercial kit. In addition, PCR, targeting a 529 bpgene of T. gondii was performed on the patients’ buffy coats for detection of Toxoplasma DNA. Results: Anti-Toxoplasma antibodies were detected in the sera of 42 out of 251 (16. 7%) HIV infected patients. Of these, 39 cases (15. 5%)were seropositive only for IgG and 3 (1. 2%) were positive only for IgM. Seropositive subjects mainly belonged to 40-49 year age group. None of the subjects were positive for Toxoplasma DNA when evaluated by the PCR. No significant associations were found betweenToxoplasma seropositivity and gender, age, and CD4+ cell level (P > 0. 05). Conclusions: Findings of this study demonstrated a significant rate of seroprevalence of Toxoplasma in HIV infected subjects inFars province, Southern Iran. The seropositive cases are at risk of Toxoplasma reactivation and subsequent cerebral encephalitis. Treatment and also prevention of toxoplasmosis in HIV positive people should be considered.

Introduction: Almost 50% of infertilities are associated with males andamongthem30to 50% are idiopathic. Empirical treatmentsare used in idiopathic male infertility, yet not enough scientific evidence is available for the application of such remedies. Date palmpollen (DPP) is one of the drugs suggested for such patients in Iranian traditional medicine (ITM). Case Presentation: This study was performed on a 35-year-old male patient with idiopathic infertility. He previously had severeoligoasthenoteratozoospermia and was under medical supervision at Yas hospital of the Tehran University of Medical Sciences, Tehran, Iran from August 2016 to February 2017, where he was treated with DPP at a dose of 3 g twice daily, for three months. Thesecond semen analysis was carried out after a quarter of the treatment period, followed by re-analyses after one and three monthsof finalizing the treatment period. The results obtained showed an impressive improvement in the quality of semen parameters. Within six months, the initial values of normal morphology (1%), total motility (3%), progressive motility (0. 0), and sperm concentration(0. 1 million) increased to 20%, 60%, 10%, and 10 million, respectively. Conclusions: Date palm pollen could be helpful in improving semen parameters in such patients. Clinical studies are required tofind the exact effect.

Background: Metabolic syndrome (Mets) is accompanied by oxidative stress and low-grade inflammation. Green coffee is rich inpolyphenols called chlorogenic acids (CGA), which possess anti-inflammatory and anti-oxidative characteristics. Objectives: The aim of this study was to evaluate the effects of green coffee extract (GCE) on the oxidative stress as well as the systemicand vascular inflammation in patients having Mets. Methods: This randomized clinical trial was conducted in 2016 in Iran. Forty-three individuals (21 in the intervention and 22 inthe control group) with Mets were randomly assigned to take 400 mg GCE supplements twice a day in the intervention group orplacebo capsules in the control group for 8-weeks. The serum levels of intercellular adhesion molecule-1 (ICAM-1), interleukin-6 (IL-6), high sensitivity C-reactive protein (hs-CRP), and malondialdehyde (MDA) were evaluated at the beginning and 8-weeks after theintervention. Results: No significant discrepancy was observed regarding serum levels of IL-6, MDA, hs-CRP, and ICAM-1 between the interventionand control group at the beginning and the end of the trial. After eight weeks of intervention, the mean changes of IL6 in thetreatment and the placebo group were respectively (-0. 73 2. 65 VS 1. 70 10. 51 Pg/mL, P value = 0. 3), hs-CRP (-0. 28 3. 12 VS-0. 08 4. 15mg/L, P value = 0. 86), MDA (0. 44  1. 68 VS 0. 32  2. 28  mol/L, P value = 0. 84), and ICAM-1 (-0. 05  0. 45 VS 0. 02  0. 45ng/mL, Pvalue = 0. 54). Conclusions: In this trial, the green coffee extract (GCE) administration did not affect oxidative stress, systemic, and vascular inflammationin subjects with metabolic syndrome.

Background: Helicobacter pylori (H. pylori) plays the primary role in increasing oxidative stress and causing stomach inflammation, peptic ulcers, and gastric malignancy in the infected patients. L-arginine (Arg) has antibacterial and anti-inflammatory effects. Objectives: The current study aimed at investigating the beneficial effects of L-arginine on inflammation and oxidative stress inpatients infected with H. pylori with dyspeptic symptoms. Methods: The current randomized, double-blind controlled, clinical trial was conducted on 34 patients with H. pylori infection referredto the center of digestive disorders affiliated to Isfahan University of Medical Sciences, Isfahan, Iran, in order to undergo endoscopyfrom December 2016 to September 2017. Patients were classified into two groups (control and treatment); the control grouponly received triple-drug therapy (including Amoxicillin, Clarithromycin, and Omeprazole), and the treatment group received standardtriple-drug therapy and L-Arg capsules for three weeks. Gastric biopsies and serum samples were taken from all patients beforeand after the study. H. pylori infection was examined by a rapid urease test and antioxidant indices including superoxide dismutase(SOD), glutathione peroxidase (GPX), and total antioxidant capacity (TAC) were evaluated in gastric biopsies. In addition, serumsamples were used to measure the inflammation factors including interleukin (IL)-8 and tumor necrosis factor (TNF)- . Results: Level of SODactivity increased significantly in the treatment groupcomparedwith that of the control group (4. 91 95. 21 vs. 4. 0 44. 11 IU/mg) (P = 0. 001). In the treatment group, compared with the control group, the level of TAC increased significantly (0. 35 0. 60 vs. 0. 30 0. 9 mM/L) (P = 0. 006) and the level of GPX activity increased significantly in the treatment group compared withthe control group (10. 68  2. 39 vs. 5. 16  2. 12 IU/mg) (P = 0. 000). Regarding the inflammation factor, IL-8 decreased significantlyin the treatment group compared with the control group (8. 00  1. 94 vs. 10. 28  2. 10 pg/mL) (P = 0. 002); also TNF- decreasedsignificantly in the treatment group compared with the control group (9. 71  2. 69 vs. 12. 24  3. 29 pg/mL) (P = 0. 036), while therewas no significant difference in high sensitivity C-reactive protein (hs-CRP) decrease between the treatment and the control groups(2. 34 1. 28 vs. 3. 04 1. 58 mg/L) (P = 0. 16). Conclusions: Consumption of L-arginine increased antioxidant indices and decreased inflammation in patients infected with H. pylori.

Background: Captopril, a short-acting antihypertensive agent, is widely used in case of emergency to control blood pressure. Althoughsublingual Captopril has a faster onset of action, it is less tolerated. Objectives: This study aimed to evaluate the efficacy, side effects, and tolerability of sublingual versus oral captopril in an emergencysetting. Methods: Hypertensive patients, without acute target organ damage were randomly administered 25mgCaptopril sublingually ororally (35 patients in each group) using block randomization. Blood pressure was measured at 0, 10, 20, 30, 45, 60, and 120 minutesafter the administration. Patient satisfaction was subjectively scored on a scale of 1-10, and any side effect was recorded (Iranianregistered clinical trials # IRCT2015110924963N1). Results: The mean age of the study groups was 59. 61  9. 34 years. Systolic and mean blood pressure significantly decreased after10, 20, and 30 minutes of sublingual administration (P < 0. 05), but diastolic blood pressure did not decrease. This difference in theblood pressure reducing effect decreased by 60 and 90 minutes and almost equalized after 90 minutes. Headache was observed asa side effect in two patients in the sublingual group. The convenience and satisfaction scores were much lower in the sublingualgroup (median of 6 (25th percentile: 6, 75th percentile: 7) in sublingual group versus median of 10 (9, 10) in Captopril group, P <0. 001). Conclusions: In our study, the systolic and mean blood pressure decreased more rapidly in the sublingual Captopril group thanin the oral Captopril group in the first 30 minutes after administration. Patients better tolerated the oral preparation, and thedifference in the blood pressure reducing effect between the groups almost equalized after 90 minutes.