Journal of Research in Medical Sciences
Volume:21 Issue: 8, 2016 Aug

Pre?eclampsia as a hypertensive disorder of pregnancy complicates up to 5–10% of pregnancies worldwide. Endothelial dysfunction plays an important role in the pathogenesis of pre?eclampsia. In this study, we aim to evaluate the effect of high?dose folic acid on endothelial dysfunction in pre?eclamptic patients.
In this triple?blinded randomized clinical trial, the enrolled patients were divided randomly into two groups. Folic acid 5.0 mg or placebo was taken daily by oral administration from the initiation of diagnosis until 2 months after delivery by the participants. Every patient’s flow?mediated dilation (FMD) was evaluated at the beginning of the study and 2 months after delivery with the same experienced operator at the same period of time (3–5 p.m.) by high?resolution B?mode ultrasonography. Potential confounding variables were included in the independent samples t?test. t?test or Mann–Whitney U?test was used in the comparison of means between the intervention and placebo groups. To compare FMD in each group, before and after the intervention, paired t?test was used.
Mean value of FMD in intervention (9.64 ± 5.57) and control group (9.30 ± 4.25) has no significant difference before the consumption of drugs (P > 0.05). FMD in intervention group (13.72 ± 7.89) significantly increases after daily consumption of 5 mg folic acid in comparison with control group (10.02 ± 4.81) after daily consumption of placebo (P = 0.002).
Increased mean of FMD in intervention group shows that this supplement can improve endothelial function and can be significantly affected by maternal blood pressure during pregnancy and some endothelium?dependent disease such as pre?eclampsia and its associated adverse outcomes.

Despite a general consensus regarding the impacts of early excision and grafting (EE and G) of burned hand on the reducing of treatment cost and hospital stay, there are some controversial issues about its eff ect on the outcome of hand function.Th is study conducted to compare the results of the EE and G and delayed skin grafting in deep hand burns regarding the hand functional outcome.
Th is study was conducted from April 2012 to November 2013 in sixty patients with deep thermal burns of the dorsal hand with total body surface area (TBSA) Th e average percentage of TBSA in the EE and G group was more than the delayed excision group (17.34% ±5.12% vs. 15.64% ±5.83%), this diff erence was not signifi cant (P = 0.23). After 6 months, the average of the TAM and grip strength in the EE and G group was signifi cantly more than that of the delayed group (P Th e present study showed that EE and G with proper physical therapy and rehabilitation management provides a higher functional outcome in dorsal deep burned hand.

Cardiopulmonary bypass is associated with increased fluid accumulation around the heart which influences pulmonary and cardiac diastolic function. The aim of this study was to compare the effects of modified ultrafiltration (MUF) versus conventional ultrafiltration (CUF) on duration of mechanical ventilation and hemodynamic status in children undergoing congenital heart surgery.
A randomized clinical trial was conducted on 46 pediatric patients undergoing cardiopulmonary bypass throughout their congenital heart surgery. Arteriovenous MUF plus CUF was performed in 23 patients (intervention group) and sole CUF was performed for other 23 patients (control group). In MUF group, arterial cannula was linked to the filter inlet through the arterial line, and for 10 min, 10 ml/kg/min of blood was filtered and returned via cardioplegia line to the right atrium. Different parameters including hemodynamic variables, length of mechanical ventilation, Intensive Care Unit (ICU) stay, and inotrope requirement were compared between the two groups.
At immediate post?MUF phase, there was a statistically significant increase in the mean arterial pressure, systolic blood pressure, and diastolic blood pressure (P Administration of MUF following surgery improves hemodynamic status of patients and also significantly decreases the duration of mechanical ventilation and inotrope requirement within 48 h after surgery.

This study attempted to determine the effects of long-term use of vitamin C on vascular endothelial function.
During a pilot clinical trial study conducted at Imam Hussein Hospital (Isfahan) in 2014-2015, a total of 40 diabetic patients were selected and then assigned randomly into two 20-subject groups receiving Vitamin C and placebo tablets. The patients were treated with vitamin C or placebo for 6 months. All patients were examined through Echocardiography in terms of cardiac function before and after treatment. In order to evaluate the endothelial function (FMD, IMT), they underwent Arterial Doppler. Moreover, the chemical indices of vascular function were tested through intr cellular adhesion molecule(ICAM) and vascular cell adhesion molecule (VCAM). Finally, the results were compared between the two groups.
Based on the results, the mean LV mass significantly reduced after the intervention in the group treated with vitamin C (from 76.35±25.6 to 68.62±22.66; p=0.015) , while there was no significant difference observed in the control group( from 67.58±25.38 to 71.63±26.84; p=0.19) but no statistically difference between the two groups based repeated measures ANOVA test(p=0.6). Also the mean of VCAM changes was significantly difference between the two groups (P Long-term use of vitamin C in diabetic patients can improve certain echocardiographic parameters such as EF, FS and FMD, which in turn enhances vascular endothelial function.

This study was designed to investigate the eff ect of clopidogrel-related gene polymorphisms on platelet reactivity and clinical outcome in Chinese Han patients.
Th ree hundred and thirty-six percutaneous coronary intervention - treated patients were recruited and followed for 1 year. Blood samples were collected from all patients for DNA genotyping. Th e platelet reactivity unit was measured by the VerifyNow technique. Th e CYP2C19*2, CYP2C19*3, CYP2C19*17,ATP-binding cassette subfamily B member 1, ITGB3, CYP2C9*3, CYP2B6*9, and P2Y12 alleles were assessed.
Th e clinical endpoints were related to previous heart disease history (11.90% vs. 28.57%, P = 0.017), stroke (12.24% vs. 16.67%, P = 0.039), and diabetes (27.55% vs. 52.38%, P = 0.047). High on-treatment platelet reactivity (HTPR) was frequent in advanced age (P = 0.019), male gender (P = 0.016), hypertension (P = 0.033), and chronic renal failure (P = 0.040). Th ere were more endpoints in the CYP2C19*2 and P2Y12 mutant carriers (76.19% vs. 43.20%, P In Han Chinese people of mainland China, clopidogrel-related gene polymorphisms are related to variable platelet reactivity after clopidogrel maintenance dosing, which infl uences major adverse cardiovascular events, without an eff ect on cardiac death.

Most of the cardiovascular diseases can be prevented by doing regular physical exercises and using herbal supplements.The present study is aimed at assessing ginger supplement and high?intensity interval training (HIIT) on inflammatory indices contributing to atherosclerosis in overweight women.
The present study is a randomized, experimental,and controlled one in which thirty healthy overweight women aged 20–30 years were randomly divided into three equal groups,namely, ginger, ginger HIIT, and placebo HIIT. The training groups performed high?intensity interval exercises (i.e. 40?m maximal shuttle run) for ten consecutive weeks. The supplement groups daily took 3 g of ginger pills and the third group took placebo.
Paired t?test revealed a significant decrease in the density of type 1 monocytes’ chemotactic protein (MCP?1) in HIIT ginger (P = 0.026) and HIIT placebo (P = 0.001) groups. Besides, maximum aerobic capacity in the two training groups significantly increased P = 0.002 and P = 0.000, respectively. In spite of this, analysis of variance showed no significant differences in three groups regarding the three indices such as intercellular adhesion molecule?1 (ICAM?1) (P = 0.093), MCP?1(P = 0.075),and serum interleukin?10 (IL?10) (P = 0.164).
A 10?week intensive interval exercise, by itself or together with ginger supplement, improved MCP?1 and maximum oxygen consumption in overweight women, without any significant effect on soluble ICAM?1 and IL?10. These findings indicate the relative and efficient role of HIIT in overweight women without the necessity to combine with ginger as an antioxidant/anti?inflammatory supplement.

The current study was designed to compare the complications and adverse eff ects of central venous catheter (CVC) insertion under ultrasound guidance in patients with and without coagulopathy.
In this clinical trial,59 patients who needed CVC for various reasons were enrolled. Patients were divided into two groups of those with and without coagulopathy based on complete blood count, prothrombin time, partial thromboplastin time, and international normalized ratio test results, and then, CVC was inserted with ultrasound guidance in both groups. Th e CVC inserting site was examined for hematoma and hemorrhage in four stages at diff erent times.
There was no signifi cant diff erence in the terms of demographic features, catheter lumen size (P = 0.43), and number of attempting for CVC placement (odds ratio [OR] =2.35, 95% confi dence interval [CI] = 0.36–15.3, P = 0.39) between two groups. Seven out of 59 patients suff ered from complications (11.9%) that the complications in coagulopathic patients were oozing (5.7%) and superficial hematoma (8.6%) while in noncoagulopathic patients were 4.2% for both complications (OR = 0.54, 95% CI = 0.09–3.07, P = 0.767).
According to our results, it can be concluded that inserting CVC with ultrasound guidance under emergency conditions causes no serious and life-threatening complications in coagulopathic patients.

The objective of this study was an investigation of the association between depression and sleep quality.
Th is cross-sectional study was performed on 360 delivered women that referred to thirty health-care centers in Ardabil, Iran. The Standard Pittsburgh Sleep Quality Index questionnaire was used to the investigation of sleep quality. We used the Edinburgh Postnatal Depression Questionnaire to assess postpartum depression. Logistic regression was used to examine the association of sleep quality with postpartum depression.
Chance of depression in women with poor sleep quality was 3.34 times higher than those with good sleep quality (odds ratio = 3.34; 95% confi dence interval: 2.04–5.48; P we found an association between sleep quality in women who had given birth in the last 3 months and symptoms of postpartum depression.

The aim of this study was to prevent of increasing End Tidal Co2(ET CO2) with changing of vital capacity and respiratory rate, when using of birthing filter in infants.
In a randomized clinical trial study, Ninety four infant' patients were studied in three groups . Basic values, such as: Peak inspiratory pressure, Tidal volume, Minute ventilation, respiratory rate and partial pressure of ET(PET CO2 )level had been evaluated after intubation, 10 minute after intubation and 10 minutes after filter insertion .In first group patients only observed for changing in ETCO2 level. In the second and the third groups, respiratory rates and tidal volume had been increased retrospectively, until that ET CO2 ? 35mmHg was received. We used ANOVA, Chi x2 and, descriptive test for data analysis. P Tidal volume 10 minutes after filter insertion was statistically higher in group 3 (145.0±26.3 ml) versus 129.3±38.9 ml in group1 and 118.7±20.8 ml in group 2 (P=0.02). Also, respiratory rate at this time was statistically higher in group 2(25.82±0.43) versus group 1 and 3 (21.05±0.20 ml and 21.02±0.60 ml respectively) (P=0.001). Minute volume and PET CO2 level were statistically significant between group1 and the other two groups after filter insertion (P=0.01 and P=0.001 respectively).
With changing the vital capacity and respiratory rate we can control PET CO2 level ? 35mmHg during using of birthing filters in infants. We recommend this instrument during anesthesia of infants.

Participation of Iranian women with a family history of breast cancer in breast cancer screening programs is low.This study evaluates compliance of women having a family history of breast cancer with Clinical Breast Exam (CBE) according to stage of Trans Theoretical Model (TTM) and Health Belief Model (HBM).
Material and In this cross-sectional study, we used Persian version of champion’s HBM scale to collect factors associated with TTM stages applied to screening from women 20 years and older. The obtained data were analyzed by SPSS, using descriptive statistics, Chi Square test, Independent T- test and Analysis of Covariance.
Final sample size was 162 women. 33% were in action/maintenance stage. Older women, family history of breast cancer in first degree relatives, personal history of breast disease, insurance coverage, and a history of breast self-examination (BSE) were associated with action/maintenance stage. Furthermore, women in action/maintenance stages had significantly fewer perceived barriers in terms of CBE in comparison to women in other stages(p0.05).
The finding indicates that the rate of women in action/maintenance stage of CBE is low. Also, results show a strong association between perceived barriers and having a regular CBE. These clarifies the necessity of promoting national target programs for breast cancer screening, which should be considered as the first preference for reducing CBE barriers.

Osteoporosis affects quality of life and may lead to depression in women. The purpose of this study was to evaluate the effects of zoledronic acid (ZA) treatment on depression and quality of life (QoL) in women with postmenopausal osteoporosis (PO).
A total of 88 newly diagnosed women with PO were included in this study. All patients were treated with once-yearly ZA (5 mg). A quality of life questionnaire from the European Foundation for Osteoporosis (QUALEFFO) and Beck Depression Inventory (BDI) were given to patients at baseline and at twelve months. The results for baseline and post-twelfth month were compared and bone mineral density (BMD) levels were compared.
the consumption of Once-yearly ZA( 5 mg) treatment increases bone mineral density (BMD) at levels of lumbers 1-4 (p:0.026), total hip, and femoral neck (p:0.033). ZA 5mg treatment also improved QoL (p:0.001) and reduced depression (p:0.001).
Zoledronic acid treatment increases BMD levels and QoL while reducing depression. Once-yearly ZA (5 mg) may be considered for postmenopausal women as a first-line treatment.

This study aims to investigate the concentrations of lead, cadmium, and arsenic in the human milk, and to assess the effect of jujube fruit consumption by lactating mothers in reducing the concentration of these heavy metals in their milk.
This randomized controlled trial was conducted in 2014 among forty postpartum mothers in Isfahan,the second largest and polluted city in Iran. Mothers were randomized into two groups; the intervention group received 15 g/day of fresh jujube fruit, and the controls received routine care for 8 weeks.
In the beginning, the concentrations of lead,cadmium, and arsenic were high, without significant difference between groups. The mean (standard deviation) concentrations of lead, cadmium, and arsenic were 29.49 (16.6), 4.65 (3.51), and 1.23 (0.63) ?g/L, respectively. The smoothed empirical distribution of environmental pollutants showed that in both groups the mean values and variance of toxic metals decreased after 8 weeks, with a sharper decline in the intervention group. Quantile regression analysis showed that in the intervention group, lead concentration decreased by 2.54 ?g/L at the 90th quintile, and cadmium decreased by 0.19 ?g/Lat 75th quintile; without significant change in arsenic level. The corresponding figures were not significant in the control group.
The concentrations of heavy metals were high in human milk, and the consumption of jujube fruit had some beneficial effects in reducing these harmful elements. Pregnant and lactating mothers should be advised to reduce their exposure to environmental pollutants, and consumption of some natural medicinal foods can be useful in reducing the concentration of pollutants in human milk. Because of numerous benefits of breast milk, in spite of the existence of some toxic trace elements, breastfeeding must be encouraged because such contaminants are also found in water and formula. The impact of the current findings on the primary prevention of chronic disease should be determined in future longitudinal studies.

Obesity is a major risk factor for chronic diseases and has a role on high blood pressure, diabetes type II, etc., This review assesses the prevalence of Iranian children obesity and overweight for different age categories and compares the three standard definitions of obesity.
To retrieve desirable studies concerning childhood anthropometric data from different area of Iran, the MEDLINE, Scopus, and different local databases such as Scientific Information database were used. The studies reported the prevalence of obesity or overweight of children Our review covered 75 articles reported the prevalence of overweight or obesity among children and adolescents for different age groups in Iran. Our meta?regression analysis showed that the prevalence of obesity and overweight did not vary significantly in gender and age categories, but different definitions provide different prevalence of overweight and obesity.
The effective factors on obesity and overweight included administration policy and organizational, interpersonal,intrapersonal, and social factors. CDC and WHO references intended in monitoring children’s growth and the IOTF cutoffs would rather provide a common set of definitions that researchers and policymakers could use for descriptive and comparative purposes.

We discuss here an uncommon condition of neurogenic hypotension in the context of immunoglobulin light chain (amyloid light-chain) amyloidosis. Th e most serious feature was autonomic nervous system impairment, mainly characterized by severe refractory orthostatic hypotension, which became progressively invalidating, forcing the patient to bed. Moreover, since the systemic involvement of the disease, the patient presented also diarrhea, dysphagia, asthenia, peripheral edema because of gastrointestinal,and kidney dysfunction. Eventually, the massive myocardial depression and infi ltration led to a fatal outcome.