Journal of Isfahan Medical School
Year:2011 | Volume:28 | Issue:115|Papers Count:18

Background: Lactose intolerance is common in Asian population. Enzyme replacement therapy facilitates consumption of milk and dairy products for patients with lactose intolerance. Clinical evidence in our clinics indicates a nonhomogeneity in improvement of symptoms after ingestion of solid form of exogenous lactase enzyme in patients. Therefore, we designed this study to evaluate the effectiveness of oral solid lactase enzyme in the clinical symptoms of patients with lactose intolerance in Arak city.Methods: This randomized double blind placebo controlled trial was performed on 50 adult symptomatic patients with lactose intolerance. Average age of the patients was 37.4 years and 44% were men. Every patient took lactase and placebo for one week respectively. Effects of these treatments on gastrointestinal symptom of patients were gathered by symptom evaluation questionnaire. Results were analyzed by SPSS software.Finding: The mean improvement of abdominal pain score after lactase was 1.56 ± 2.51 (P<0.001) and after placebo was 0.54 ± 0 (P<0.001). The mean improvement of flatulence score after lactase was 1.6 ± 1.91 (P<0.001) and after placebo was 0.42 ± 0.94 (P=0.03). The mean improvement of bloating score after lactase was 1.62 ± 1.79 (P<0.001) and after placebo was 0.56 (P<0.001) ± 0.88. The mean improvement of diarrhea score after lactase was 2.70 ± 3.06 (P<0.001) and after placebo was 0.54 ± 0.99 (P<0.001). The mean improvement of nausea and vomiting score after lactase was 0.24 ± 0.89 (P=0.63) and after placebo was 0.04 ± 0.19 (P=0.15). After ingestion of lactase, 19 patients had no improvement in abdominal pain score, 12 patients in flatulence score, 3 patients in nausea and vomiting score, 17 patients in bloating score, and 7 patients had no improvement in diarrhea score.Conclusion: Lactase tablets significantly reduced clinical symptoms associated with lactose intolerance compared with placebo; but improvement of symptoms were variable between patients.

Background: Some chronic diseases like cancer, and its side effects such as depression, are considered as stressful life events. But, these reactions are not the real results of the mentioned disease and depend on the pressure compensatory factors, like social support, and the performance of confront methods with stress, such as religious coping. The purpose of this research was to investigate the relation of depression, religious coping, and social support in the women with breast cancer.Methods: In our research, 240 patients with breast cancer were selected randomly (without considering of the disease stage) and were assisted with self report questionnaires (Beck depression test, religious coping, and social support).Finding: The correlation between religious coping and depression was significant and negative (-0.61; P<0.01). Also, the correlation between depression and social support was significant and negative (- 0.84; P<0.01). But the correlation between social support and religious coping was significant and positive (0.62; P<0.001). The results showed that as the score of religious coping and social support decrease, an increase in the depression score is observed and vice versa. Corresponding to the Beck depression test, 34.2% of the patients had moderate and severe depression.Conclusion: This research showed the effective role of social support and religious coping in decreasing depression score in the women with breast cancer which should be considered in therapeutic counseling services. Incidentally, the high rate of depression prevalence in these patients should be highlighted for the people in charged.

Background: This study aimed to evaluate the difference between the effect of standard photorefractive keratectomy (PRK) and Q-value adjusted ablation PRK with Allegretto Eye-Q on the ocular refraction.Methods: In this clinical trial study performed in Parsian clinic of Isfahan, 75 candidates for photorefractive surgery were included. All of these patients underwent standard PRK in one eye and Q-value adjusted ablation PRK in the other eye. The efficacy of therapy was measured by visual acuity, contrast sensitivity, subjective refraction and patients’ satisfaction, 3 months after the surgery.Finding: The mean score of postoperative visual acuity in standard PRK group and Q-value adjusted group was 10.48 ± 1.38 and 10.51 ± 1.22 respectively without correction. The mean postoperative refraction of standard PRK and Q-value adjusted PRK was 0 ± 0.37 and 0.05 ± 0.3 respectively. There was no significant statistical difference in visual acuity, refraction, contrast sensitivity and postoperative satisfaction between the two groups.Conclusion: There is no significant difference between efficacy of standard PRK and Q-value adjusted PRK in optimizing visual acuity, subjective refraction, contrast sensitivity and patient satisfaction.

Background: The expression profile, signal transduction, molecular function and cell growth modulation of adenosine receptor subtypes in the human breast cancer cell lines are described; we decided to investigate the possible roles of adenosine receptors in the human breast tissues. In this study, we used RT-PCR to assess A2A and A2B gene expression in normal and tumoral breast tissues.Methods: Breast tumors and non-neoplastic mammary tissues (n=15) were collected immediately after mastectomy and stored at -80oC until use. All tumors were histologically confirmed to be breast cancer. Total RNA was extracted and reverse transcribed to cDNA. PCR primers were synthesized from human adenosine receptor cDNA sequences. PCR was performed under optimized condition for each receptor subtype. Amplification of beta-actin mRNA served as control for RT-PCR. The PCR products were separated on 1.5% agarose gels.Finding: To elucidate the expression of A2A and A2B mRNA in breast carcinoma and normal tissues, we compared the level of A2A and A2B mRNA expression by RT-PCR analysis. All breast tumor and normal tissue specimens expressed A2A and A2B adenosine receptor transcripts. We observed that expression of A2B in tumor tissues is 1.36 fold of normal tissues but there was no difference between the expressions of A2A in tumor and normal tissues of the breast, when normalized against that of betaactin.Conclusion: These results indicated for the first time, to our knowledge, the expression profile of A2A and A2B adenosine receptors in the human breast carcinoma. The present study showed that a high A2B gene expression level was found in breast tumor tissues in comparison with the normal tissues. However, further studies based on the Real-time quantitative RT-PCR are needed to confirm gene expression levels.

Background: Many studies showed that heart rate recovery (1 min) and exercise capacity at exercise test are both strong predictors of cardiovascular events in various populations. This study compared heart rate recovery (1min) and exercise capacity in individuals with and without metabolic syndrome in Iranian community.Methods: This cross-sectional study was performed on 470 individuals aged ³ 35 years who followed in Isfahan Cohort Study. A questionnaire including questions on demographic and lifestyle information as well as weight, height, blood pressure, and waist circumference was completed. Triglyceride, fasting blood glucose (FBS), total cholesterol, HDL, and LDL levels were measured as well. All subjects performed a symptom limited exercise test under the standard Bruce protocol. Heart rate recovery (1 min) and exercise capacity were calculated. Data were analyzed by generalized linear model SPSS15 software.Finding: The prevalence of diabetes mellitus, hypertension, and dyslipidemia were higher in individuals with metabolic syndrome (P=0.001). Heart rate recovery (1 min) was in normal range in individuals with and without metabolic syndrome (>18 bpm) but in subjects without metabolic syndrome it was higher (41.48 versus 37.07; P=0.007). There was no difference between men and women in individuals with and without metabolic syndrome (P=0.645 and 0.39 respectively). Exercise capacity was lower in individuals without metabolic syndrome (P=0.022).Conclusion: Our findings suggested that among exercise capacity and heart rate recovery, this is exercise capacity which has a stronger relationship with metabolic syndrome in our community. Also, it seems that there is a need for reconsideration on heart rate recovery threshold.

Introduction: Phacoemulsification is a new and modern cataract surgery; although surgically induced astigmatism is an unavoidable complication. The site of incision is an important factor in complication.The horizontal incision is a safer method of surgery; but in practice, surgeons prefer to make easier oblique incision. So we compared surgically induced astigmatism after these incisions.Methods: In a randomized prospective clinical study, 66 patients with £ 1 diopter (D) astigmatism were evaluated. Horizontal and oblique clear corneal incisions were performed. Topography values were evaluated and changes in surgically induced astigmatism were calculated by vector analysis; independent t-test was used to compare mean values.Finding: The mean surgically induced astigmatism was 0.95 ± 0.57 diopters (D) in the oblique incision group and 0.83 ± 0.56 (D) in horizontal incision group. The difference in surgical induced astigmatism between two incision types was not statistically significant (P=0.73) Conclusion: There is not any statistically significant difference in surgical induced astigmatism between oblique and horizontal incision groups.

Background: Standard isolation precautions are designed to reduce the risk of acquiring occupational infections from both known and unknown sources in the healthcare setting. Awareness and compliance with these recommendations is crucial for the prevention of occupational nosocomial infections in healthcare workers. Improving the compliance of standard precautions (SP) is one of the most important ways to reduce healthcare associated infections, but also the most difficult to achieve. The aim of this study was to evaluate the levels of knowledge, attitude and practice of surgeons and surgical residents in Isfahan, regarding standard precautions.Methods: In a cross-sectional, 140 surgeons and surgical residents were evaluated about standard precaution in Isfahan University of Medical Sciences. Questionnaires were handed to participants who were willing to take part in the survey. The questionnaire included demographic data and also knowledge, attitude and practice of standard precaution. The questionnaire was self-administered. Descriptive and inferential statistics including Spearman and Mann-Withney tests were performed.Finding: In this study, 91 residents and 48 surgeons were assessed with the mean age of 38.26±10.86 years. The mean for surgeons’ knowledge was 8.25±1.22 and mean for surgical residents’ knowledge was 7.94±1.37 (P>0.05). The mean for surgeons’ attitude was 40.56±3.46 and mean for residents’ was 38.68±3.70 (P<0.05). The mean of surgeons’ practice was 4.78±2.29 and mean of surgical residents’ practice was 3.80±2.21 (P<0.05).Conclusion: The results suggest that among study groups, the levels of knowledge and attitude regarding standard isolation precautions were acceptable; although compliance level was moderate. Therfore, for better acting attitude and practice, we have to educate and update healthcare worker especially who had poor practice.

Background: Acute otitis media is a common childhood disease with high cost in each community. Therefore, recognition of predisposing factors for acute otitis media has significant role in prevention of it and is cost-effective. There is conflicting results in previous studies for role of passive smoking in acute otitis media. The present study was designed to compare frequency of smoking in family of children with acute otitis media with control group.Methods: In a cross sectional case-control study, 90 children aged 7-12 years with acute otitis media were selected by simple convenient method and compared with 90 children who had not acute otitis media; both groups were matched for age and gender. Data were analyzed by SPSS (chi square test and logistic regression). P value less than 0.05 considered as significant.Finding: The frequency of smoking among family members of children with acute otitis media was significantly more than the relative of children without it. The odds ratio for passive smoking was 1.85. In other words, there was a significant correlation between passive smoking and occurrence of acute otitis media.Conclusion: In the present study, occurrence of acute otitis media was more than many studies carried out in other countries. This can be due to race differences between communities as an independent factor. To know risk factors of acute otitis media, it is recommended carrying out more studies with larger sample sizes in our community.

Background: Infection is a major problem in intravenous drug users (IVDUs). Skeletal infections, especially osteomyelitis and septic arthritis are common causes for admitting these patients. In addition to antibiotic therapy, surgical intervention for diagnosis or treatment is often needed. The aim of this survey was to determine the frequency of location, type of microorganisms and surgical intervention in intravenous drug users with skeletal infection.Methods: In a cross-sectional survey, all intravenous drug users with skeletal infections admitted in infections ward and orthopedic ward of Al-Zahra hospital in Isfahan, Iran were enrolled in this study. Data were collected by questionnaire and were analyzed by descriptive statistics.Finding: Thirty three patients were admitted during this period; among them 6 patients (18%) were diagnosed as osteomyelitis and 27 (81%) as septic arthritis. Knee was the most foci of infection. Staphilococus aurous was the most etiologic agent. Seven patients with septic arthritis and one with osteomyelitis went under surgical operation.Conclusion: Skeletal infections are common among intravenous drug users. Skeletal infections always should be considered especially if the patient has soft tissue infections to prevent more complications.

Background: Diabetic retinopathy occurs in the retina due to changes in blood vessels. It may cause fluid or blood leakage and fragile vascular bundles which make the sent image to the brain blurry. About half of patients with diabetes mellitus have some degrees of diabetic retinopathty. Most of the patients with diabetic retinopathy initially have mild problems in visual sense; but this situation could get worse and threaten the patients' visual power. This study aimed to compare axial length of eyes in patients suffering from proliferative and non-proliferative diabetic retinopathy.Methods: In this case-control study, from patients with type II diabetes admitted to Feyz Hospital in Isfahan, 130 patients with more than 15 years duration of diabetes, were selected. Fluorescein angiography initially was done to identify the type of retinopathy in the patients. Then, 50 patients with proliferative retinopathy (PDR) and 50 patients with non-proliferative retinopathy (NPDR) were selected among them and with the aid of IOL Master, their axial length of eyes were measurements. Data were analyzed using chi square and Student t tests via SPSS software.Finding: The mean axial length of eyes in patients (both eyes) was 23.1±0.89 mm with a minimum of 20.51 and a maximum of 27.19 mm. A significant difference between the axial length of eyes in patients with proliferative (22.85±0.82 mm) and non-proliferative (23.36±0.89 mm) diabetic retinopathy was determined (P=0.004).Conclusion: The mean axial length of eyes in patients with proliferative and non-proliferative retinopathy is different. Some factors such as increased intraocular pressure, myopia, hypertension, hypercholesterolemia, may also affect the axial length and the effect of these factors should also be considered in reviews.

Background: Due to the similarities between clinical signs of toxicity with pyrethroids and cholinesterase inhibitors, if the mistake between these two was made and the patient was treatment with atropine, severe atropine poisoning and even death could occur. This study was conducted to compare the clinical signs of two types of poisoning.Methods: In this cross-sectionsl study, 167 patients with pyrethroids poisoning and 167 patients with cholinesterase inhibitors poisoning refered to Noor hospital, Isfahan were assessed. The patients were selected by simple sampelling method and were clinically examined.Finding: The mean age of patients with pyrethroids poisoning was 22.47 and of patients with cholinesterase inhibitors poisoning was 28.80 years. In both groups, men were more than women and poisening by eating was the most prevalent way. The intentional cases were more than accidental ones. The most prevalent signs of cholinesterase inhibitors poisoning were nausea (68.9%), vomiting (43.1%), diarrhea (43.1%), myosis (40.7%), sweating (38.3%) and sialorrhea (36.5%) respectively; also, the most prevalent signs of pyrethroids poisoning were nausea (74.9%), vomiting (61.7%), abdominal cramp (20%), sialorrhea (15.6%), and muscle weakness (12.6%) respectively.Conclusion: Based on this study, the difference between these two types of poisoning symptoms can help the differential diagnosis.

Background: Gastrointestinal stromal tumors (GIST) includes a group of mesenchimal tumors. One of the studied issues is the relation between the survival of the patient and protein S-100. We intended to study these types of tumors to understand whether there is any relationship between protein S-100 and survival rate.Methods: In this survival study, 40 patients who with stromal cancer of gastrointestinal tract admitted in AL-Zahra hospital, Isfahan were assessed. These patients were found by studying all the pathological reports recorded in hospital archives.Finding: Forty patients (62.5% male vs 37.5% female) with the mean age of 58.4±16.6 enrolled in study.12.5% of patients were younger than 40 years old. Protein S-100 was positive just in 17.5% of these patients.80% of patients have been alive since the end of the study and 20% were dead. The average time of survival from the beginning of diagnosis was 63±4.4 months.Conclusion: Although there are different results about the effect of this protein on prognosis and survival of patients, but protein S-100 is yet considered to be an effective factor on survival and prognosis of these types of tumors and more studies should be carried out to in this field.

Background: Anemia is one of the major problems of dialysis patients The primary mechanism of anemia in these patients is Erythropoietin insufficient production by kidneys. Often, this kind of anemia is caused by inflammatory reactions. A large number of dialysis patients, despite receiving adequate doses of erythropoietin, are anemic. Therefore it seems the use of a pharmaceutical composition that can control the inflammatory reactions is an appropriate strategy. This study was done to investigate the effect of Pentoxyfilline on hemoglobin level and Erythropoietin dose in these patientsMethods: This study was a clinical trial that performed on anemic peritoneal dialysis patients. Study patients were randomized to two groups of 25 person recipients Pentoxyfilline and control groups. The amount of blood hemoglobin and serum albumin, iron, Total Iron Binding Capacity (TIBC), ferritin and Parathormone (PTH) were measured at the beginning and the end of the study. Collected data were analyzed by SPSS software.Finding: 45 patients were studied (20 cases and 25 controls). The results of this study have not shown the significant differences in hemoglobin and serum albumin levels changes between two groups. According to results of this study the change of erythropoietin dose was not significant in both goups.Conclusions: According to the results, conducted another study with higher sample size and longer time for investigation of the effect Pentoxyfilline is recommended.

Background: Melasma is an irregular brown pigmentation, especially in Asian middle-aged women that may cause several psychological problems. Peeling with Glycolic acid 70% (GA) is one the melasma treatment methods. Considering the efficiency of low concentrations Tretinoin in lightening daily cream, peeling with higher concentrations of Tritenoin in a shorter time may be more effective than topical treatments to eliminate melasma. This study was done to compare the effect and side effects of Tritenoin peeling with Glycolic acid 70%.Methods: This study was a randomized double-blind clinical trial in 63 women with bilateral melasma.One percent Tretinoin peel was applied on one-half of the face, whereas 70% glycolic acid was applied on the other in 4 sessions with 2 weeks interval. At the same time, Melasma Area and Severity Score (MASI Score), side effects and patients tolerence were compared.Finding: Tretinoin 1% effectiveness in reducing MASI Score and its side effects, patient satisfaction and onset of treatment was the same as Glycolic acid 70% (P<0.05 in all). Discomfort caused by the peeling action of Tretinoin 1% was significantly less than Glycolic acid 70% (P<0.05).Conclusion: Regarding the effectiveness of similar onset of treatment, similar side effects and minimal discomfort during and after peeling and also cheaper prices of Tretinoin 1% compared with Glycolic acid 70%, Tretinoin 1% can be a suitable method for treatment of melasma.