Iranian Red Crescent Medical Journal
Year:2018 | Volume:20 | Issue:7|Papers Count:10

Background: Women with borderline gestational diabetes mellitus (BGDM) have a higher risk of complications in comparisonwith normal women. Objectives: The aim of this study was to determine the effects of garlic pill on fasting blood sugar (FBS) and relapse of prediabetessymptoms (primary outcomes), as well as blood pressure, neonatal anthropometric indices, and mode of delivery (secondary outcomes)in prediabetic pregnant women. Methods: This triple-blind, randomized clinical trial was conducted on 49 women with prediabetes at 24 to 28 weeks of gestationin Tabriz, Iran, during 2015-16. The participants were assigned to the intervention (n, 26) and control (n, 23) groups using blockrandomization. The intervention group received a 400-mg garlic pill per day, while the control group received a placebo pill perday for eight weeks. Four and eight weeks following the intervention, FBS and blood pressure were measured. The newborns’ anthropometricindices and mode of delivery were also recorded after delivery. Results: The mean FBS level in the garlic group decreased from 106. 6 (11. 1) mg/dL before the intervention to 83. 6 (6. 3) mg/dL at fourweeks after the intervention and 79. 4 (6. 1) mg/dL at eight weeks after the intervention (adjusted mean difference,-3. 7). The garlicpill also led to a significant decrease in prediabetes symptoms at four weeks after the intervention (P < 0. 001) and diastolic bloodpressure at four and eight weeks after the intervention (P = 0. 041), compared to the control group. No significant difference wasobserved between the groups in terms of systolic blood pressure at four and eight weeks after the intervention, anthropometricindices, or mode of delivery. Conclusions: The results revealed that garlic pill could reduce FBS level, prediabetes symptoms, and diastolic blood pressure. However, further research with a larger sample size is required for more accurate results.

Background: Unihemispheric concurrent dual-site anodal transcranial direct current stimulation (a-tDCSUHCDS) of the primary motorcortex (M1) and dorsolateral prefrontal cortex (DLPFC) are introduced as effective techniques on M1 corticospinal excitabilityenhancement and its after-effects. Objectives: The current study aimed at investigating the potential effects of multiple sessions of a-tDCSUHCDS of M1-DLPFC on motorskills learning in healthy individuals. Methods: The randomized, clinical trial was conducted on a total of 37 volunteers completed all sessions of the study and wererandomly divided into two groups of a-tDCSUHCDS and sham stimulation by the block randomization method. The current studywas performed from January to May 2017 in Iran. Participants attended daily 20-minute motor training sessions for three consecutivedays, while they concurrently received a-tDCS. Motor skills were assessed before the intervention (day 1), immediately after theintervention (day 3), and one week after the completion of the intervention. Results: A total of 37 participants were included in the data analysis. Immediately after the completion of the intervention on day 3, mean skills in the experimental and control groups were 0. 33 and 0. 30, respectively. One week after the completion of the intervention, mean skills in the experimental and control groups were 0. 36 and 0. 29, respectively. The trend of motor learning considerablyincreased in the experimental (0. 17; P < 0. 001) and control (0. 11; P < 0. 001) groups. No significant difference was observed in motorlearning immediately after the intervention between the groups (P = 0. 23), while there was a significant difference in long-termoffline learning between the groups (P = 0. 04). Conclusions: Greater motor skills in the a-tDCSUHCDS group compared with the sham tDCS group at one-week retention indicatedthe robustness of the a-tDCSUHCDS effect.

Introduction: Necrotizing fasciitis is not rare in clinical practice, but a Klebsiella pneumoniae-related is rare, especially in patientsundergoing hemodialysis. Manypatients with necrotizing fasciitis have a miserable outcome even though they receive amputation. Case Presentation: A 76-year-old male was initially admitted to the center due to suspected cellulitis in Taichung, Taiwan. However, the treatment response was beyond expectation, and a plain film X-ray was performed on his leg. To our surprise, it showed apparentgas and calciphylaxis. Easy examination detected the severe disease. Immediate surgical debridement was performed, andhis legs and life were successfully saved, although the outcomes of the disease were miserable. The tissue culture yielded Klebsiellapneumoniae. This pathogen, related to necrotizing fasciitis, is rare in the currently published articles. The possible risk factors werethe endemic region, diabetes mellitus, calciphylaxis, old age, frequent iron supplements, and repeated tissue hypoperfusion duringhemodialysis. Conclusion: In conclusion, meticulouslyandtimely diagnosed necrotizing fasciitis in high-risk groups is themostimportant factorto ensure a positive patient outcome.

Background: Pain after laparoscopy may still be moderate to severe due to stretching of the intraabdominal cavity and peritonealinflammation. Systemic Lidocaine with anti-inflammatory properties may reduce this pain. Objectives: The aim of this study was to evaluate the effect of perioperative intravenous infusion of Lidocaine on postoperative painrelief after the gynecologic laparoscopic procedure. Methods: A double-blind, randomized clinical trial study was conducted in Iran, during the years 2014 and 2015. A sample of 60females with American anesthesiology association (ASA) physical class I or II, who were scheduled for gynecologic laparoscopy wereselected through consecutive sampling and were randomly assigned to receive either intravenous Lidocaine or Normal saline, asplacebo, prior to induction of anesthesiaanduntil theendof surgery. The severity of postoperative painwasevaluated starting at therecovery unit until 24-hours postoperatively for a total of 8 times using the visual analogue scale (VAS) scoring system. Time to firstanalgesic request, total analgesic dose used in the first 24-hours, and any probable postoperative complications were recorded. Riskratio (RR) and number needed to treat (NNT) were used to analyze the data along with the generalized linear model for multivariateanalysis of repeated measurements over time. Results: The VAS at recovery was lower at recovery with a mean score of 2. 8 in the Lidocaine group versus 3. 9 in the control group(P = 0. 02). Results of generalized linear modeling revealed that pain intensity decreased over time in both groups (P = 0. 02), andthe groups had different trend slopes in pain intensity over repeated measurements at various time points up to 24 hours afterlaparoscopy, while controlling for the baseline VAS at recovery and ASA PS (P = 0. 016). However, when controlling for use of the painkillers, the trends were not found to be different. Patients in the Lidocaine group were 3. 8 timesmorelikely not to need postoperativeanalgesic (95% CI: 1. 4 to 9. 9). Meantotal analgesic dosewas1. 3mgin the Lidocaine group versus 38. 2mgin the control group differingsignificantly between the 2 groups (P < 0. 01). Use of Lidocaine was associated with lower postoperative nausea and agitation. Conclusions: Systemic perioperative Lidocaine could improve the pain pattern and severity as well as nausea and agitation aftergynecologic laparoscopy. Although no significant side effects were detected in this study, the benefits of the intervention should beweighed against its safety.

Background: Although gestational diabetes may result in elevated leptin, osteocalcin, and TNF- (Tumor necrosis factor) levels, impact of those parameters on the neonatal outcome is not well established. Objectives: The aim of the current study was to evaluate whether cord blood leptin, TNF (Tumor necrosis factor), and osteocalcinhave a predictive value for neonatal complications due to maternal GDM (Gestational Diabetes Mellitus). Methods: This cohort study was performed at Near East University Hospital, Nicosia, Cyprus. All pregnant females under follow-upof the department of Obstetrics and Gynecology between years 2010 and 2012 were invited to participate. Those, who gave consent, were enrolled. Expecting mothers were categorized as GDM and normal pregnancy. 41 (21. 5%) of the pregnancies were GDM and 159(78. 5%) were normal. Cord blood samples were obtained at delivery. Osteocalcin, leptin, andTNF- levelsandneonatal complicationswere evaluated thereafter. Results: Comparison of pregnancy complications between groups revealed no significant differences except for more frequentmaternal hypothyroidism in the GDM group (P < 0. 001). The GDM group’ s cord blood osteocalcin levels (44. 69  27. 6 ng/mL and35. 23 22. 9 ng/mL in the control group (P: 0. 037)) and frequency of neonatal hypoglycemia were significantly higher than controls(P: 0. 047), whereas cord blood TNF  and leptin levels were not statistically different (P > 0. 05). Newborns with hypoglycemiashowed higher cord blood osteocalcin, TNF- , and leptin. In addition, osteocalcin levels were significantly higher in cord blood ofLGA babies born from GDM mothers (50. 41 32. 79 and 35. 19 20. 18 ng/mL). Conclusions: In this study, cord blood leptin, osteocalcin, and TNF- were significantly correlated with neonatal hypoglycemia. Moreover, cord blood osteocalcin levels were significantly higher in the GDM group. This increase in osteocalcin in the GDM group, may be related to the regulation of blood glucose levels by osteocalcin.

Context: Neck pain is a prevalent complaint. Several clinical trial studies were conducted to evaluate the effects of cupping therapyon neck pain. The objective of this study was to assess the evidence for the effectiveness of cupping therapy as an intervention toconservative management of neck pain. Evidence Acquisition: We performed a systematic search in PubMed, Ovid, MEDLINE, CINAHL, EMBASE, Cochrane Library, a web ofscience, and Iranian medical databases through March 2017 without time restrictions. All clinical trials were done on non-specificneck pain, where at least one of the therapies assessed pertains to cupping therapy, were included in the study. Outcomes were painintensity (e. g., Visual Analogue Scale, VAS), disability (e. g., Neck Disability Index, NDI), quality of life on the SP36 questionnaire, andother outcomes due to neck pain. A meta-analysis was performed to assess the effectiveness of cupping in managing neck pain. Results: Meta-analysis of five trials revealed significant differences in pain relief in favor of cupping therapy compared with thecontrol group (VAS 100 cm, MD,-0. 84 (-1. 22,-0. 46), I2 = 54. 7%). Furthermore, a meta-analysis of six studies revealed that cuppingtherapy was clinically superior to the control group in patients with neck pain (SMD =-0. 60 (-0. 86,-0. 35), I2 = 16. 4%). Assessmentof quality of life using the SP36 questionnaire showed that cupping therapy increased the quality of life in patients with neck paincompared with the control group (SMD =-0. 56 (-0. 20,-0. 92), I2 = 51. 4%). Conclusions: This study provides some evidence that cupping therapy may improve treatment of patients with neck pain.

Background: Obsessive-compulsive disorder (OCD) is the fourth common psychiatric disorder. Among the anxiety disorders, OCDhas the least therapeutic response and 40-60% of OCD patients do not satisfactorily respond to the first-line standard treatmentknown as treatment-resistant OCD. One of the best therapeutic strategies is the augmentation therapy, which is adding antipsychoticsto the standard treatment (SSRIs). Objectives: This study was aimed at comparing the efficacy of Risperidone and Aripiprazole as augmentation therapy in the resistantcases of obsessive-compulsive disorder. Methods: In this double-blind randomized clinical trial, 100 patients with treatment-resistant OCD were diagnosed based on theDSM-IV-TR and were followed for 12-weeks. The patients were randomly divided into two groups of Aripiprazole and Risperidoneand received an average daily dose of 5 mg and 1. 5 mg for twelve weeks, respectively. The efficacy of treatment was measured andcompared by the Yale-brown obsessive-compulsive scale (Y-BOCS) at 4, 8 and 12 weeks. Results: The mean Y-BOCS score of patients in Risperidone and Aripiprazole groups were 25. 26 4. 17 and 25. 02 4. 46; respectivelyand had no significant difference (P = 0. 79) at the beginning of the trial. At the end of the study (12th week), it was changed for theRisperidone and Aripiprazole groups to 20. 00 4. 45 and 16. 24 4. 41, respectively (P < 0. 001). Furthermore, there was a significantdecreasing trend of Y-BOCS scores in both groups, which was demonstrated by the repeated measurement analysis (P < 00. 1). Conclusions: It was found that both Aripiprazole and Risperidone could be effective in the treatment of treatment-resistant OCDpatients. However, Aripiprazole showed a higher efficacy compared to Risperidone.

Background: The most vulnerable time to develop mood disorders such as sadness, depression, and psychosis is the postpartumperiod. Postpartum blues is the most common mood disorder and can endanger the relationships between mother, child, andfamily, and in case of lack of appropriate treatment can cause irreparable damages. Objectives: The current study aimed at investigating the effect of evening primrose oil on the intensity of postpartum blues amongprimiparous females. Methods: The current double-blind, randomized, controlled clinical trial was conducted from December 2012 to November 2013on 132 primigravida females referred to health centers of Ahvaz, Iran. They were randomly divided into two groups of 66 to receivea daily dose of 1 g of evening primrose oil capsules (intervention group) or similar placebo capsules (control group) from the beginningof the 37 weeks of pregnancy up to 2-weeks postpartum. Females in both groups were asked to complete the Edinburgquestionnaire on the days 4, 10, and 14 postpartum. Data were analyzed using the t-test, Chi-square test, and repeated measures, andP < 0. 05 was considered significant. Results: Therewasa statistically significant difference (P=0. 0001) between thetwogroups regarding the severity of the postpartumblues (the severity in the intervention group was less than that of the placebo group, P = 0. 0001). The score of Edinburgh questionnairewas significantly less in the intervention group compared with that of the control group on the days 4, 10 (P = 0. 0001), and14of postpartum (P = 0. 01) (P = 0. 014). The averages of Edinburgh score in the intervention group was significantly less comparedwith those of the control group on the days 4 (10. 5  0. 57 vs. 13. 3  3. 28; P = 0. 0001), 10 (11. 2  1. 22 vs. 14. 9  3. 6; P = 0. 001), and 14postpartum (11. 7 1. 3 vs. 13. 05 2. 6; P = 0. 08). Conclusions: The use of evening primrose oil effectively reduced the severity of postpartum blues.

Background: End-stage renal failure (ESRD) deteriorates the quality of life of patients, as it increases their dependence on othersand reduces their self-esteem. Objectives: This study was conducted to investigate whether body image perception and social functioning of dialysis patients withEnd-stage renal failure (ESRD) differed in dialysis patients with chronic renal failure (CRF). Methods: This case-control study included 120 patients, who underwent dialysis treatment in a state hospital from November 2014to January 2016. The patient information form, body image scale, and social functioning scale were used for data collection. Datawere analyzed using descriptive statistics (e. g., frequency, percentage, and mean), Chi-square test, independent t-test, and correlationtests. Results: Among ESRD patients, 88. 6% were 56 years old, 65. 7% were male, 97. 1% underwent dialysis three times a week, and 97. 1%were shunted. On the other hand, among patients with CRF, 71. 8% were  55 years old, 51. 8% were male, 52. 7% underwent dialysisthree times a week, and 50. 8% were shunted. Regarding body image, 51. 3% of ESRD patients, whose children noticed the changein their body image, felt most uncomfortable with the change in their body image, while 48. 2% and 22. 0% of CRF patients, whosechildren or others noticed the change in their body image, felt most uncomfortable, respectively; the difference between the groupswas significant (P < 0. 05). Conclusions: In the present study, there was no significant difference among CRF and ESRD patients in terms of body image perception. However, there were differences in terms of social functioning. In fact, social functioning of CRF patients was superior to theESRD group. It was concluded that better perception of body image is associated with the better social functioning of these patients.

Background: Functional dyspepsia (FD) is one of the most common problems around the world. Pistacia atlantica has beneficialeffects in gastrointestinal disorders and is used for treating functional dyspepsia in Persian Medicine. Objectives: The aim of this study was to assess the effect of “ Pistacia atlantica” (Baneh) on functional dyspepsia. Methods: This randomized, double-blind, placebo-controlled trial was carried out on 119 patients (18 to 60 years old) with functionaldyspepsia based on Rome III criteria. Subjects were randomly divided to intervention (n = 61) and placebo (n = 58) groups. Participants received capsules twice daily (500mgcapsules containing 350mgPistacia atlantica resin plus 150mgsugar in the interventiongroup, and 500 mg capsules containing 350 mg starch powder plus 150 mg sugar in the placebo group) for four weeks andthey were followed up for one month. The intensity and frequency of gastrointestinal symptoms, such as fullness, bloating, nausea, pain, and burning were assessed using the questionnaire on arrival, two and four weeks, and one month after the intervention. Results: Fifty-three patients in the Pistacia atlantica group and 48 patients in the placebo group completed the study. The severityand frequency of gastrointestinal symptoms, such as early satiation nausea, pain, and burning were significantly decreased in thePistacia atlantica group. For example, severity of early satiation was 1. 67 0. 13 in pistacia and 2. 54 0. 17 in placebo groups in eightweeks (P > 0. 001) and frequency of this symptom was 2. 39  0. 27 and 4. 41  0. 34 in Pistacia and placebo groups, respectively, ineight weeks (P > 0. 001), which was significantly decreased in the Pistacia group. No serious adverse effects were reported. Conclusions: This study revealed that Pistacia atlantica is significantly effective in functional dyspepsia symptoms.