JOURNAL OF ISFAHAN MEDICAL SCHOOL (I.U.M.S)
Year:2019 | Volume:37 | Issue:518|Papers Count:5

Background: Regarding the relatively high prevalence of placenta accreta in pregnancy, and the lack of suitable methods for predicting this complication, this study aimed to determine the role of soluble fms-like tyrosine kinase-1 (SFLT-1) markers and vascular endothelial growth factor (VEGF) in comparison with color Doppler sonography in diagnosis of placenta accreta. Methods: In a cross-sectional study, 78 pregnant women who were referred to Alzahra and Shahid Beheshti hospitals in Isfahan, Iran, in 2017 and 2018 were studied. SFLT-1 and VEGF levels were measured, and embryo sonography was also performed. After surgery, the results of surgery were compared with the results of sonography, and the level of SFLT-1 and VEGF and the agreement of these markers with ultrasound were determined. Findings: There was no significant difference in mean VEGF level in terms of pregnancy outcomes (P = 0. 90), but SFLT-1 level was significantly lower in Eckert group (P = 0. 02). Meanwhile, SFLT-1/VEGT ratio was not different between the two groups (P = 0. 66). Comparison of ultrasound findings and surgical results showed that surgical outcomes and ultrasonography were normal in 38 cases (48. 7%). Moreover, in 16 cases (20. 5%), the results of surgery and ultrasound showed the presence of plementa acrata. The agreement between ultrasonography and surgery was 0. 36 (P < 0. 001). Conclusion: According to the results of our study, the two markers SFLT-1 and VEGF, compared with ultrasound, were not suitable criteria for predicting placenta accreta. At the same time, according to the limitations of this study, further studies are suggested.

Background: Considering the importance of shivering, as an important complication in patients after spinal anesthesia, in this study, we determined that the effectiveness of injection of three drugs dexamethasone, midazolam, and ondansetron, alone or in combination, on the shivering of patients. Methods: In this clinical trial study, 179 patients undergoing lower limb orthopedic surgeries referring to Kashani hospital, Isfahan, Iran, during the years 2006 to 2007 entered the study. Patients were divided into 5 groups receiving midazolam, ondansetron, dexamethasone, the combination of three drugs, and placebo. The severity of shivering and hemodynamic information were evaluated in patients. Findings: There was no significant difference between the groups according to the central and peripheral temperature at the time before the anesthesia and at 5, 10, 15, 20, 25, and 30 minutes after it (P > 0. 050). There was a significant difference between the groups based on the severity of shivering during the first, second, third, and fourth fifteen minutes (P < 0. 001); so that the shivering intensity was higher in the placebo group, and there was a significant difference between the other groups as well. (P < 0. 001). Conclusion: Combination of the three drugs midazolam, dexamethasone, and ondansetron in orthopedic surgeries with spinal anesthesia can be associated with controlling of shivering.

Background: The use of vitamin D supplementation in patients with diabetes mellitus and low levels of 25 (OH) vitamin D, especially in patients under long-term hemodialysis, is common; but the safety and efficacy of vitamin D supplementation in these patients remains uncertain. The aim of this study was to examine the efficacy of oral vitamin D supplementation (Ergocalciferol) on changes in intact parathyroid hormone (iPTH) and hemodialysis factors in patients with end-stage renal disease (ESRD). Methods: A clinical trial study was performed on 110 patients under hemodialysis referred to dialysis center of Rasoul Akram hospital, Tehran, Iran. The patients were randomly assigned into two equal groups of case and control, after informed consent. The case group received omega-3 with vitamin D (50,000 units) capsules, and the control group was only treated with omega-3 capsules weekly for six weeks. After 12 weeks from the start of the study, they were re-evaluated in the same laboratory, and the results were compared between the groups. Findings: The serum level of iPTH was significantly different between the two groups after the intervention (P < 0.001). The findings also showed that serum levels of calcium (P = 0.022) and vitamin D (P < 0.001) had a significant difference between the two groups after the intervention. On the other hand, serum albumin, phosphorus, and creatinine were not significantly different between the two groups, before and after intervention (P > 0.050). Conclusion: According to the results of this study, the administration of Ergocalciferol leads to a decrease in the serum level of iPTH, and increase in serum calcium and vitamin D in patients under hemodialysis; but does not change the serum level of albumin, phosphorus, creatinine, as well as mortality. So, the length of follow up, and the factors affecting mortality should be investigated to determine the effect of vitamin D on these patients.

Background: Previous studies have been demonstrated the effect of fasting insulin concentration in coronary artery disease of patients with diabetes mellitus. Because of discrepancy in recent studies about this association in non-diabetic patients, we evaluated this effect. Methods: In this cross-sectional study, coronary artery angiography was done for 110 non-diabetic patients, and they were divided into two groups of normal coronary artery as control group and those with coronary artery stenosis as case group. Serum levels of glucose, cholesterol, triglycerides, low-density lipoprotein (LDL), and insulin were evaluated after 12 hours fasting period. One-way ANOVA and t tests were used for statistical analysis. Findings: Fasting blood sugar (FBS) in non-diabetic patients with and without coronary artery disease was 94. 4 ± 14. 9 and 90. 52 ± 13. 82 mg/dl, respectively (P = 0. 150). The mean insulin concentration was 12. 77 ± 3. 29 mIU/l in case and 7. 01 ± 3. 25 mIU/l in control group (P = 0. 001). We did not find any difference between men and women according to their fasting insulin concentration (P = 0. 210). Conclusion: Higher serum level of fasting insulin seems to have correlation with coronary artery disease in non-diabetic patients; but further studies with larger population study are needed for better evaluation.

Background: Mental performance improvement has been among the entities with considerable attention by scientists since long time ago. Nowadays, tendency to use of chemicals, and sometimes detrimental agents, has increased. This is while hypothesis has been raised about the use of natural agents such as honey, saffron, and sedge to improve mental performance, based on their antioxidant and alkaloid ingredients. The current study aimed to assess the efficacy of triple combination of honey-saffron-sedge on university students’ mental performance. Methods: This was a pilot-controlled clinical trial study conducted on 60 students of Isfahan University of Medical Sciences, Isfahan, Iran, in years 2017-18. Students were randomly divided into two 30-member groups of intervention (30 mg saffron, 5 g honey, and 500 mg sedge) and control (500 mg starch and 5 g sugar). Students' normal diet was recorded in nutrition checklist by students in three consecutive days prior to study initiation, and then three consecutive days immediately following intervention cessation, and the micronutrients of two groups were compared and matched using Nutritionist software. Participants used mentioned agents twice a day for a period of two months. The Auditory-Visual Learning Test (AVLT) test was conducted and compared before and after two months for students. Findings: There were no significant differences between the two groups regarding age and gender (P > 0. 05). Moreover, in terms of micronutrients, the diet of the two groups was matched (P > 0. 05). According to VALT test, two groups were different in the subtests of recall following second time of words reading (P = 0. 004) for the control group before and after the test, but not intervention group. There was no significant difference between the two groups in any fields of VALT (P > 0. 05). Conclusion: Two-month use of triple combination of honey-saffron-sedge in students did not improve mental performance on the basis of VALT's questionnaire compared with the control group. There is little information in this regard, and further studies using new doses, conducting on greater number of majors and varieties of communities, and by use of more various mental assessing tests are recommended.