Iranian Red Crescent Medical Journal
Volume:20 Issue: 9, Sep 2018

Several mechanisms have been suggested to explain the pathogenesis of nonalcoholic fatty liver disease (NAFLD) and its progression, one of which is increased oxidative stress.

This study aimed to evaluate the effect of alpha-lipoic acid (ALA) supplementation on anthropometric indices, dietary intake and oxidative stress-related parameters in obese patients with NAFLD.

In this double-blind, placebo-controlled trial, 50 NAFLD patients were assigned to two groups of receiving 1200 mg ALA (two 600 mg capsules of ALA) and placebo (two 600 mg capsules of placebo) for 12 weeks. Serum liver enzymes, malondialdehyde (MDA) level, total antioxidant status (TAS), and the activities of copper-zinc superoxide dismutase (Cu/Zn-SOD) and glutathione peroxidase (GSH-Px) were assessed at baseline and after 12 weeks of intervention.

Serum concentrations of liver enzymes decreased significantly in the ALA group (P < 0.05 for all), while a noticeable decline was observed for alanine aminotransferase (ALT) in the placebo group (32.5 ± 18.9 vs. 25.9 ± 11.2; P = 0.034). Nonetheless, there were no significant differences between the study groups concerning serum liver enzymes concentrations post-intervention. Although ALA supplementation significantly reduced the serum concentration of MDA (2.52 ± 0.35 vs. 2.77 ± 0.49; P < 0.040) and increased serum TAS (1.73 ± 0.55 vs. 1.52 ± 0.34; P < 0.048), other oxidative stress-related parameters such as Cu/Zn-SOD and GSH-Px activities were not affected.

These findings suggest that daily supplementation of 1200 mg ALA for 12 weeks improves oxidative stress markers in patients with NAFLD and it could be considered as adjunctive therapy for the prevention of NAFLD progression

Sepsis and multiple organ dysfunction syndrome (MODS) are life-threatening conditions common in intensive care units. In this regard, studies have shown that Strontium ranelate has anti-inflammatory activity by blocking tumor necrosis factor-alpha (TNFα).

This study aimed to investigate the effect of Strontium ranelate on MODS in an experimental sepsis model.

The study protocol was approved by Cumhuriyet University Institutional Ethics Committee for Animal Experiments (Sivas-Turkiye, date 07/12/2017). Twenty female Wistar-Albino rats were randomly divided into four groups of sham operation, cecal ligation and perforation (CLP), CLP + Strontium (S) (oral 40 mg/kg for 7 days), and S (40 mg/kg oral preoperative 5 days) + CLP + S (oral 40 mg/kg for 7 days). Blood samples were taken, and alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN), and creatine were studied. Tissues were removed, and inflammation scores were determined.

The mean inflammation scores of lung, liver, and renal tissues were found to be the lowest in the sham group (0.8 ± 0.45), and they increased in the S + CLP + S (1.6 ± 0.55) and CLP + S (3.4 ± 0.55) groups, respectively, with the highest score in the CLP (3.8 ± 0.45) group. It was found that there was no statistical difference between the sham and S + CLP + S groups (P > 0.05); however, there was a significant difference between the other groups (P < 0.05). The mean ALT, AST, BUN and creatine values were found to be the lowest in the sham group, and they increased in the S + CLP + S and CLP + S groups, respectively, with the highest score in the CLP group. Regarding the mean ALT results, it was noted that there was no significant difference between the sham and S + CLP + S groups (P > 0.05); however, there was a significant difference between the other groups in terms of mean ALT, and there was a significant difference between all the groups in terms of mean AST, BUN, and creatine (P < 0.05).

It was concluded that Strontium ranelate reduced the development of life-threatening MODS in patients with sepsis, especially when it was administered before the development of sepsis, by suppressing inflammatory mediators.

Even though Cisplatin (Cis) is known to be organotoxic, it is used in neoplastic chemotherapy. In skeletal muscles, the toxic effect manifests as atrophy.

The tea grape extract (TGE) is a sort of whortleberry that has various physiological effects including prevention of chemically induced cellular insults. Therefore, we examined if the TGE has a protective effect against the Cis induced skeletal muscle atrophy.

Female Sprague-Dawley rats were used in this animal experimental study. Rats were allocated into different study groups, each with eight members. The groups comprised control, solvent control, 200 mg TGE, Cis, Cis + 100 mg TGE, and Cis + 200 mg TGE.

The mean fiber area of the skeletal muscle (MFASM) decreased significantly in the Cis group in comparison to the control group (P = 0.01). MFASM showed similarities between the Cis + TGE 200 and control groups (P > 0.05, P = 0.418). Similarities were also observed for MFASM between the Cis + 100 mg TGE and Cis + 200 mg TGE groups (P > 0.05, P = 0.891). The mean serum calcium level in the Cis group (10.26 ± 0.29) was significantly higher in TGE 100 (9.13 ± 0.11) and TGE 200 groups (9.21 ± 0.13).

It is concluded that the tea grape extract has a protective effect on Cis-induced toxicity of the skeletal muscles.

Postoperative pain is a common complication after Cesarean Section (CS) and its management is essential to prevent adverse effects of pain. Various methods are used to control pain after CS. Regional anesthesia using Transversalis Fascia Plane (TFP) and Transversus Abdominis Plane (TAP) block is shown to reduce pain after abdominal surgery.

This study aimed at evaluating the efficacy of these two methods in controlling pain after CS.

In this randomized clinical trial, 56 patients undergoing elective CS under spinal anesthesia were randomly allocated to receive TFP or TAP block after surgery with ultrasound guidance. The pain severity using Visual Analogue Scale (VAS) at rest and during coughing at 0, 2, 4, 6, 12, 24, and 36 hours after surgery, time to first analgesic request, and dosage of analgesic use and complications were compared between groups.

There were no significant differences between groups in pain severity at rest or coughing at0, 2, 4, 6, 12, 24 and 36 hours, postoperatively. There was no considerable nausea and vomiting between groups (14.3% vs. 10.7%, P = 0.68), and time to the first analgesia (100.00 ± 69.28 versus 123.12 ± 50.19 minutes, P = 0.47) and total analgesic use (33.33 ± 14.43 vs. 25.00 ± 15.81 mg, P = 0.57) were comparable between groups. There were no complications in any of the groups. Patients in both groups were mostly satisfied for pain control after surgery (good to perfect, 89.3% versus 82.1%, P = 0.7).

Ultrasound-guided TFP provided pain control the same as TAP block after CS with a comparable decreased need of analgesics.

 

Vitamin E serves a major role in increasing nitric oxide (NO) and reducing lipoperoxidation progression during the menopause transition.

This study aimed to determine the effect of Vitamin E on plasma nitric oxide in menopausal women with hot flashes (HFs).

In this double-blind, randomized, cross-over clinical trial performed in a teaching hospital, 83 eligible menopausal women with HFs were randomly block allocated to Vitamin E (n = 42) and placebo (n = 41) groups. In phase I of the intervention, they were administered 400 IU per day of Vitamin E or placebo for 4- weeks. In the phase II, the group receiving Vitamin E was subsequently given placebo and vice versa after wash-out. Primary outcomes were the number and severity of hot flashes per day as determined by the recorded values by the women and using Modified Kupperman Index, respectively. The secondary outcome was plasma nitric oxide measured before and after the intervention in the two phases. Both outcomes were analyzed within and between placebo-vitamin E (P-E) and Vitamin E-placebo (E-P) groups, and in general by gathering Vitamin E and placebo groups in the two phases, separately. Data were analyzed using the Chi-Square test, independent t-test, Wilcoxon test, Mann-Whitney test, and Spearman’s correlation coefficient.

The mean number of HFs indicated a significant decreasing trend from week II of the phase I to the end of the phase II within P-E and E-P groups compared to before the intervention. Median (interquartile range [IQR]) of HFs number changes was 2.03 (2.57) in the P-E group and 1.21 (2.21) in the E-P group at the end of the first week of phase II (P = 0.043). There was a very low significant positive correlation between changes in HFs and plasma nitric oxide level in weeks I (r = 0.262, P = 0.029) and ΙΙ (r = 0.256, P = 0.034) in the Vitamin E group.

Vitamin E and placebo were both effective in reducing HFs in menopausal women. It seems that the subjective effect of placebo contributed to this decline. Vitamin E had no effect on reducing HFs via increasing plasma level of nitric oxide. These results were not in line with our hypothesis. Further research is needed to understand this issue

Plantar fasciitis (PF) is the most common cause of metatarsus pain.

The current study aimed at comparing the improvement of pain and function in patients with PF treated with extracorporeal shockwave (ESWT) and dry-needling therapy.

The current single-blinded, clinical study was conducted on 72 patients with PF selected from the outpatient and rehabilitation clinics of Tabriz University of Medical Sciences, Tabriz, Iran form August 2016 to March 2017. Patients were randomly divided into two groups and the subjects in the first group were treated with ESWT, while the second group were treated with dry-needling. The performance was evaluated based on FFI (Foot Function Index), and the pain level according to VAS (Visual Analogue Scale); subjects were evaluated at baseline, as well as four and eight weeks after treatment and the obtained results were compared and analyzed using appropriate statistical methods.

The subjects’ VAS and FFI scores significantly decreased compared with those of the baseline in both dry-needling and ESWT groups four and eight weeks after treatment (P < 0.005). Based on the criteria, no statistically significant difference was observed between the two groups four weeks after the treatment (P = 0.732 for VAS and P = 0.578 for FFI). However, eight weeks after treatment, significant changes were observed in pain reduction and FFI in the dry-needling group compared with the ESWT group (VAS: 1.7 ± 0.9 vs. 2.9 ± 1.9, P = 0.013 and FFI: 31.4 ± 28.0 vs. 50.4 ± 33.1, P = 0.008, respectively).

Both extracorporeal shockwave and dry-needling therapies were effective in plantar fasciitis treatment; despite the fact that the results of the current study revealed that dry-needling therapy was more effective than extracorporeal shockwave, at eight weeks after treatment

Previous studies have reported conflicting results concerning the association between shift work and variables such as blood pressure and lipid profile.

The present study aimed to examine the moderating effect of shift work on lipid profile and blood pressure.

This cross-sectional study was done on steelworkers who worked in Esfahan’s Mobarakeh Steel Company (EMSC) in the year 2017. In this study, workers were selected using random cluster sampling to investigate the moderating effect of shift work on lipid profile using the path analysis model in AMOS software.

A total of 1549 workers (including 926 (60%) shift workers and 623 (40%) day workers) with a mean age of 24.17 ± 6.11 years participated in this study. The path analysis model showed a good fit index (RMSEA = 0.012, P = 0.010). The path analysis results revealed that shift work moderating effect caused a decrease in the relationship between Triglyceride (TG) and Low-Density Lipoprotein (LDL) and between TG and LDL but increased the relationship between TG and Diastolic Blood Pressure.

Our findings showed a new evidence that shift work could have a moderating effect on blood pressure and lipid profile

The study aimed to investigate co-morbid immune deficiency in unresponsive asthmatic children, characterize the type of immune deficiency, and determine any possible effect of immune deficiency treatment on the applied standard guideline of asthma treatment.

This was a prospective study conducted between January 2012 and December 2014. A total of 286 children whose serum immunoglobulin (Ig) levels had been analyzed were collected. Among those children, 125 (m/f = 79:46, mean +-SD of age = 41.3 + 25.2 months) were enrolled as they had uncontrolled moderate to persistent asthma. Those 125 children were categorized as the only asthma group and the asthma + hypogammaglobulinemia (HGG) group depending on their immunoglobulin concentrations.

Seventy-six of the 125 children (60.8%) had co-morbid hypogammaglobulinemia. Atopy was higher in the Asthma + HGG group (P = 0.044). The most frequent co-morbid HGG was transient hypogammaglobulinemia of infancy (THGI) (46.1%) and IgG subclass deficiency (32.9%). Although the comparison of the percentage use of the inhaled corticosteroids (ICSs) showed no significant difference between the two groups at the initial evaluation, the dose of ICS significantly decreased only in the asthma + HGG group (P = 0.017).

The majority of asthmatic children having symptoms despite appropriate guideline-based treatment may have a co-morbid immunological abnormality. Presented data demonstrated the necessity of immunological evaluation of uncontrolled asthmatic children to prevent long-term side effects of high-dose ICS, reduce the frequency and severity of asthma symptoms, and improve the quality of life

Pain is one of the most critical symptoms of the disease in incurable and terminally -ill patients. Forty- five to 85 percent of the patients hospitalized in the intensive care units usually experience various levels of pain.

The present study aimed to test the validity and reliability of the constructs of pain management-measuring tool for incurable patients using a factor analysis method.

In this descriptive methodological study, the literature was reviewed to design and develop a pain management-measuring questionnaire, consisting of 20 questions, for incurable patients. The face and content validity of the questionnaire and its constructs were measured using a panel of experts and factor analysis method, respectively, and its reliability was measured using internal consistency (Cronbach’s Alpha) method. 100 incurable patients hospitalized in a university- affiliated hospital, in Ilam City, Iran, who were selected using a proportionate stratified sampling method, participated in this study.

The results of the factor analysis suggested that the 20 questions of the questionnaire comprised of six main factors, and each factor was renamed. The first factor, which affected four questions, with a variance rate of 14.77% was named "pain concept." The second factor, which affected five questions, with a variance rate of 12.21% was named "pain control." The third factor, which affected three questions, with a variance rate of 11.71% was named "actions for the incurable patient." The fourth factor, which affected four questions, with a variance rate of 9.66% was named "medical measures for the incurable patient." The fifth factor, which affected four questions, with a variance rate of 8.94% was named "post-demise actions for the incurable patient." The sixth factor, which affected two questions, with a variance rate of 6.54% was named "comforting incurable patient."

The present study showed that the pain management-measuring questionnaire for incurable patients could be used as a valid and reliable tool for collecting the required data in the measurement and management of incurable patients’ pain

Pachydermodactyly is a very rare type of macrodactyly. It clinically resembles juvenile rheumatoid arthritis, but it has a non-inflammatory etiology without bone, articular, or synovial involvement. In this study, we report the case of a 15-year-old boy with repetitive behavior diagnosed with a pachydermodactyly after evaluation of bilateral swelling of the proximal interphalangeal joints. Histologic examination revealed epidermal hyperorthokeratosis, thickening of the dermis with increased dermal collagen and absence of inflammatory cells. Pachydermodactyly is a very rare condition associated with compulsive behavior and results from repetitive minor trauma that causes localized proliferation of fibrous tissue. Pachydermodactyly is a dermatological sign of compulsive behavior and repetitive minor trauma, and it should be distinguished from other forms of joint enlargement to avoid unnecessary medicamentous treatment. Control examinations did not reveal clinically relevant worsening even without any treatment applied.