فهرست مطالب
Journal of Analytical Research in Clinical Medicine
Volume:10 Issue: 1, Winter 2022
- تاریخ انتشار: 1400/12/23
- تعداد عناوین: 21
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Page 1Introduction
Osteoarthritis (OA) is a progressive disease, which directly influences individual’s quality of life (QOL). In current study, we decided to assess the QOL in patients with lower limb OA to find an association between patients’ QOL and demographic factors.
MethodsIn this cross-sectional study, a total of 203 OA patients aged over 50 years and 200 healthy controls matched with regard to age and gender were included. Short Form 12-item Health Survey (SF-12) was used to evaluate QOL.
ResultsThe mean±standard deviation (SD) age of OA patients and control group was 69.82±11.49 and 68.18±10.54 years, respectively. 63% of patients and 56% of control group were females. Most of SF-12 domains including physical functioning, role physical, general health, social functioning, and role emotional were significantly lower in OA patients compared with the control group (P<0.05). Moreover, bodily pain domain was significantly higher in OA patients compared with the control group (P=0.038). There was a considerable correlation between most SF-12 domains with age and sex (P<0.05); whereas considerable correlation was just noticed between role physical domain with body mass index (BMI) (P<0.001). Additionally, Vitality considerably was associated with marital status (P=0.038).
ConclusionQOL in lower limb OA patients was compared with healthy subjects and this impairment was in association with some demographic factors.
Keywords: Lower extremity, Osteoarthritis, Quality of life -
Page 2Introduction
Since retinopathy of prematurity (ROP) is a preventable cause of blindness in children, evaluation of declared criteria for their screening is crucial. The aim of this study is to evaluate the incidence of the disease in Nikukari Eye Hospital according to gestational age and neonatal birth weight.
MethodsIn this cross-sectional study, after determining the frequency of neonatal retinopathy based on patients referred to the ROP clinic, neonates were divided into groups of 500 to 1000 g, 1001 to 1500 g, 1501 to 2000 g, and above 2000 g, and 28 weeks, 28-30 weeks, 30-32 weeks, 32-34 weeks, and over 34 weeks, and the frequency of ROP in each group was compared.
ResultsIn the present study, 661 cases were evaluated, of which 93 infants (14.1%) had ROP. The mean±standard deviation of birth weight of patients with ROP was 1199.51±406.80 g and was significantly lower than those without ROP who had a mean birth weight of 2022.69±649.73 g (P=0.001). The mean±standard deviation (SD) of gestational age of patients with ROP was 29.22±2.67 weeks and was significantly lower than non-ROP patients, who had a mean gestational age of 33.41±2.73 weeks (P=0.001).
ConclusionThe results of our study showed that 13 newborns weighing between 1500 and 2000 g were affected by the disease, which indicates the importance of ongoing screening in this group of children.
Keywords: Retinopathy of prematurity, Birth weight, Gestational age -
Page 3Introduction
The idea that oral infections spread to other systems has long been of interest to clinicians. On the other hand, there are researches suggesting the possibility of periodontitis and dental caries being a risk factor for low birth weight (LBW) and preterm birth (PTB). The purpose of this study is to investigate the relationship between periodontal and dental health status with PTB.
MethodsIn this case-control study, 82 pregnant women were evaluated. The case group included mothers with preterm infants (gestational age of less than 37 weeks), while the control group involved mothers who had term labors (gestational age of 37-42 weeks). Oral examinations were carried out up to 48 hours after delivery. Periodontal and dental health indicators, including decayed, missed, filled teeth (DMFT), periodontal pocket depth, clinical attachment loss (CAL), bleeding on probing (BOP) and gingival index (GI) were recorded. The data were analyzed using SPSS 17 software through Kolmogorov–Smirnov, Mann-Whitney U and Fisher exact tests.
ResultsDMFT was 7.34±4.45 and 5.68±4.29 for mothers with preterm infants and mothers in control group, respectively (P=0.023). CAL (P=0.001) and BOP (P=0.012) were significantly higher in mothers with preterm infants, but there was no significant difference in Pocket depth (P=0.57) and GI (P=0.51) between the studied groups.
ConclusionThere is a relationship between some maternal periodontal and dental health indicators and PTBs signifying that elimination of any oral sources of inflammation may reduce the risk of premature birth.
Keywords: Dental caries, Periodontitis, Pregnancy, Premature birth -
Page 4
The patient is a 23-year-old Caucasian male farmer who, after topical eye contact with an insecticide, developed accommodative spasm and blurred vision in one eye. He was treated with frequent doses of 2% homatropine drop and recovered within a week.
Keywords: Insecticides, Organophosphates, Pesticides, Accommodative spasm, Ciliary spasm, Ocular toxicity, Homatropine -
Page 5Introduction
Coronavirus disease 2019 (COVID-19) pandemic, affects almost every aspect of human life. To confront this crisis, a separate ward called gray area was designed for emergency departments (EDs) and applied at the provincial level in East-Azerbaijan, Iran. This study aimed to evaluate the effectiveness of this project, increase the serviceability and segregation of the location of infected patients, and show how feasible and fruitful it can be.
MethodsThis study is an analytical study. The statistical data collection from 39 hospitals was performed between 20 March to 21 September 2020. Descriptive Statistics as well as correlation coefficients were calculated using the 26th version of IBM SPSS.
ResultsAmong 77489 COVID-19 patients admitted to the EDs, approximately 0.38% of patients died in EDs. 22.63% of EDs area was allocated to COVID-19 patients and 70.46% of ED nurses, worked in the gray area. There was no significant correlation between area, number of patients, number of nurses, number of shifts of nurses, number of nurses for each patient, number of nurse shifts for each patient, and area for each patient with mortality rate and rates of disposition in 6 and 12 hours.
ConclusionGray area is an appropriate strategy to confront COVID-19 in EDs and if more studies approve these results, this strategy can be used to confront this pandemic and future similar conditions in resource-limited countries.
Keywords: COVID-19, Emergency service, Pandemics, SARS-CoV-2 -
Page 6Introduction
Asian countries, including Iran, experience diabetes-related stigma. Since a stigma-free identity is necessary for optimal diabetes management, the necessity of efforts to reduce diabetes-related stigma has been emphasized. This study aimed to explore the strategies to overcome diabetes-related stigma at the family level in Iran.
MethodsSeventy-four volunteered people (people with diabetes, family members, non-diabetic people, and healthcare personnel) participated in a qualitative content analysis study to extract the anti-stigma strategies. Data collection was done until data saturation through unstructured in-depth face-to-face interviews, focus groups, Email, short message service (SMS), and telephone interviews. All audio-recorded and transcribed verbatim data were analyzed using the conventional content analysis approach.
ResultsParticipants were raised “empowering families of people with diabetes” that would be possible through “family education” and “family-group formation”. Educating families about “stigmatizing behavior”, “coping skills”, “accepting the person with diabetes as the main responsible person for disease control”, and “diabetes” is necessary to help families by creating a free-stigma atmosphere. All the training could be programmed in peer groups of families to facilitate goal achievement.
ConclusionSome obtained strategies have been suggested for other stigmatizing conditions like tuberculosis or mental health. However, it must be noticed that every condition is specific and also each stigmatized person is unique and is affected by complex factors. So it is impossible to develop generic stigma reduction interventions for all health conditions. Most studies on stigma have considered families a part of society and have proposed general strategies for them.
Keywords: Diabetes-related stigma, Stigma, Family, Type 1 diabetes -
Page 7Introduction
This study aimed to evaluate the distribution of contrast sensitivity (CS) using Pelli Robson test in normal individuals over seven years old living in Zahedan and examine its relationship with age, gender, and refractive errors.
MethodsIn this cross-sectional study, simple sampling was performed on the patients aged over seven years and their attendants who had referred to Al-Zahra eye hospital in Zahedan. Complete ophthalmic examinations including vision and refraction assessment, biomicroscopy, and CS evaluation were carried out for all subjects. To evaluate CS, Pelli Robson chart was used at a distance of one meter. The logarithmic CS value of the last triplet in which the patient could accurately read two words was regarded as his/her CS value.
ResultsOf the 150 patients (300 eyes), 70 (46.66%) were male. The mean age of the subjects was 34.56±16.15 years (ranged from seven to 78 years). The mean and standard deviation of the CS score in two modes of monocular and binocular vision were 1.45±0.19 and 1.57±0.19 log unit, respectively. The mean CS score was not significantly different between men and women (P>0.454), but it decreased significantly with the age (P=0.000). CS was higher in individuals with emmetropia than those with myopia and hypermetropia (P=0.000). There was also a significant correlation between cylinder magnitude and CS (P=0.000).
ConclusionAlthough Pelli Robson test evaluates CS at low and constant spatial frequencies, its distribution is significantly different among different age groups and even among individuals with different values of refractive errors.
Keywords: Contrast sensitivity, Pelli Robson test, Refractive error -
Page 8
A 67-year-old woman was admitted to hospital with shortness of breath and acute cough for two days. Computed tomography (CT) results indicated COVID-19 pneumonia. Prophylactic anticoagulant treatment was begun using enoxaparin sodium on service. On the 10th day of her follow-up, increased respiratory distress occurred, and she was taken to the intensive care unit (ICU). Her haemoglobin level decreased to 7.5 g/dL in the intensive care follow-up (16th day). On CT scan, a massive retroperitoneal haematoma, 150 mm in diameter, was detected with a right inferior rectus sheath haematoma, 60 mm in diameter. Anticoagulant therapy was stopped, and eight units of erythrocyte suspension (ES) administered. Kidney and liver failure was added to the clinical picture, and patient died on the 18th day after admission.
Keywords: Anticoagulant, COVID-19 virus, Enoxaparin, Haematomas -
Page 9Introduction
The novel coronavirus disease (COVID-19) has spread globally. Early and dynamic detection of prognostic factors is essential to improve the ability to treat COVID-19. The present study aimed to determine clinical characteristics and risk factors associated with the length of hospital stay and disease severity in hospitalized COVID-19 patients in Tabriz, Iran.
MethodsThis retrospective cohort study included 260 early diagnosed cases with COVID-19 hospitalized at two COVID-19 specialized hospitals in Tabriz, Iran, from April 20 to June 20, 2020. Patients’ medical records were used to collect the data. Severe COVID-19 outcomes included need for intubation, admission to the intensive care unit, or death. The data were analyzed using descriptive and analytical statistics, including chi-squared test, Mann-Whitney U test, and logistic regression analysis in SPSS 16.
ResultsThe need for O2 therapy (adjusted odds ratio [AOR] = 4.23; 95% CI: 1.15‒15.51; P = 0.03), the increased creatinine levels (AOR = 2.71; 95% CI: 1.25‒5.88; P = 0.01), and the white blood cell counts (AOR = 2.44; 95% CI: 1.12‒5.33; P = 0.02) were the main risk factors associated with prolonged hospital stay. Also, having kidney diseases (AOR = 7.33; 95% CI = 1.94‒27.70; P = 0.01), elevated the white blood cell counts (AOR = 4.52; 95% CI = 1.67‒12.26; P = 0.003), and lung diseases (AOR = 3.97; 95% CI: 1.18‒13.29; P = 0.03) were significant among the predictors of the disease severity.
ConclusionAccording to the results, hypoxia and underlying diseases might lead to unwanted outcomes. The risk factors identified here confirm previous information and could be helpful to guide early clinical decision-making to reduce the mortality rates and improve the clinical outcomes of COVID-19.
Keywords: COVID-19, Length of stay, Severity of illness index -
Page 10Introduction
Two high-risk strains of human papillomavirus (HPV18 and HPV16) immortalize human mammary epithelial cells and reduce their growth factor requirements. Recent studies have identified HPV in a broad range of breast cancer samples. Therefore, the study aimed to assess the association of the mentioned high-risk HPV strains (HPV18, HPV16) with breast cancer in the patients using polymerase chain reaction (PCR) due to the increasing prevalence of breast cancer.
MethodsThe current work was a retrospective study involving 60 participants (40 patients with breast cancer and 20 healthy people) at Tabriz University of Medical Sciences in 2018-2019. The participants were selected using a convenience sampling method. PCR was used to detect DNA genomes of HPV18 and HPV16. Data was analyzed using Phi and Cramér’s V with SPSS v. 21 by taking into account OR = 95% and P = 0.05.
ResultsThere was a significant relationship (P value = 0.014) between HPV18 and HPV16 infection and breast cancer.
ConclusionA significant relationship was found between the presence of DNA genomes of HPV16 and HPV18 and breast cancer. Therefore, HPV has a significant role in breast cancer.
Keywords: Breast cancer, Human papillomavirus, Risk factor -
Page 11Introduction
The prevalence of diabetes and hypertension has been growing steadily in the last decade. These are important risk factors for stroke and the contribution of each risk factor may change due to geographical location. We conducted the present study with the aim of determining the relationship between blood pressure and diabetes history and stroke in the population covered by the Azar Cohort.
MethodsIn this case control study which was a subset of Azerbaijan province study (Azar Cohort), 357 patients were divided into patients with and without a history of stroke. The two variables of hypertension and diabetes history, in these two groups were compared. Data were collected and compared with inferential statistical tests.
ResultsThe results showed that blood pressure could increase the risk of stroke by 3.68 times (95% CI: 2.32-5.86). The history of diabetes mellitus in people with and without stroke was not statistically significant (OR=1.54; 95% CI: 0.87-2.72).
ConclusionThe results of this study showed that high blood pressure is a predictor of stroke but diabetes cannot be effective in stroke in the cohort population of Azerbaijan.
Keywords: Stroke, Risk factor, Blood pressure, Diabetes, Azar Cohort -
Page 12Introduction
Different laboratory parameters get altered in coronavirus disease 2019 (COVID-19); therefore, the changes of these parameters could help recognize the patients with severe disease. This study was conducted to achieve a comprehensive biochemical and inflammatory profile of COVID-19 among the Indian population.
MethodsThe study consisted of 730 patients admitted to Jaya Arogya Hospital, Gwalior, with COVID-19 from August 2020 to December 2020. The patients were divided into mild disease group (MDG) (n=533) and severe disease group (SDG) (n=197) depending on certain criteria, and their biochemical and inflammatory markers were collected. Data were analyzed using SPSS version 25.
ResultsStatistically significant rise in blood urea (P=0.011), serum creatinine (P=0.008), serum bilirubin (P=0.012), interleukin 6 (IL-6) (P<0.001), and troponin I (P<0.001) was observed in SDG as compared to MDG. Serum electrolytes (sodium and potassium) and serum protein (total protein and albumin) showed a significant fall in SDG as compared to MDG (P<0.001 for electrolytes and P=0.023 for proteins). The area under the receiver operating characteristic curve (AUROC) showed a high diagnostic value of IL-6.
ConclusionPatients with severe COVID-19 showed a high prevalence of hyperbilirubinemia, hypoproteinemia, electrolyte imbalance, and raised inflammatory markers (IL-6, troponin I, and procalcitonin). Results showed their effectiveness in assessing disease severity and predicting outcomes in patients with COVID-19.
Keywords: Biochemical profile, COVID-19, India, Inflammatory markers -
Page 15Introduction
The arterial hypertension leading to left ventricular remodeling induces accentuated ventricular wall thickness because of higher afterload. The several surveys about myocardial function in such cases were conducted by imaging studies for the evaluation of myocardial wall thickness without separating the different layers of each other. The aim of this investigation was the evaluation of the functional indices of each layer of the left ventricular myocardium by staining analysis of layers and demonstration of the relationship between ventricular structural remodeling and the functional changes of the ventricle myocardial layers in persons with normal and high blood pressure.
Methods88 cases (46.6% normotensive and 53.4% hypertensive) were studied by two-dimensional echocardiography and longitudinal and circumferential strain indices. These differentiated variables of heart layers (epicardium, mid myocardium, endocardium) were evaluated. All of them had been analyzed and compared in terms of diastolic dysfunction were compared. Normal diastolic function was defined as: E/A=1 to 2 and deceleration time=150 to 200 ms.
ResultsGlobal longitudinal strain (GLS) and global circumferential strain (GCS) strains remarkably declined in epicardial and middle layers of myocardial in hypertensive cases with diastolic dysfunction, although this alternation did not reveal in cases without diastolic dysfunction.
ConclusionThe decreasing of GLS and GCS indices of mid-myocardial and epicardial layers have been predicted in cases with high pressure, and the evidences of this situation had been observed in cases with ventricular diastolic dysfunction.
Keywords: Ventricular, Myocardium, Normotensive, Hypertensive -
Page 16Introduction
Warfarin is still the primary drug used to prevent vascular events in patients with atrial fibrillation (AF), especially in low-income countries. Therapeutic failure and non-adherence are common causes of recurrent embolic events. The aim of this study was to investigate possible reasons why INR was outside the therapeutic range in patients presenting with acute ischemic stroke and AF.
MethodsThis prospective study was performed over a ten-month period and all patients admitted with acute ischemic stroke were enrolled. Patients with AF who did not have INR within the therapeutic range (INR=2-3) at the time of admission were identified. During a face-to-face interview, the reasons for INR being outside the therapeutic range were assessed based on a prepared checklist.
ResultsDuring the study period, 810 patients had an acute ischemic stroke, of which 177 had AF heart rhythm (22%). The median age was 76 (IQR: 71-83), and 87 (52%) were male. Of these 177 patients, 44 (25%) had a previous history of AF (“previous AF” group) and 133 (75%) were diagnosed with AF during the current hospital admission (“new AF” group). Among patients on warfarin but with INR outside the therapeutic range (29 in all), 20 (69%) did not see a physician regularly and/or did not take medication according to the physician’s instructions.
ConclusionThe most common reason for INR being outside the therapeutic range was patients lack of awareness of their heart disease (unrecognized AF). Other reasons included irregular visits to the physician and drug non-adherence.
Keywords: Cardio-embolic stroke, Atrial Fibrillation, Warfarin, Anticoagulants, Neurologic Manifestation -
Page 17Background
The aim of this study was to evaluate the effect of the presence of hernia sac and defect size on the prognosis of CDH in our pediatric hospital.
MethodsIn this prospective study all the infants with the diagnosis of CDH that were admitted in the Tabriz Pediatric Hospital since 2016- 2019 were enrolled. Laparatomy was performed when the patients were stabilized. Presence or absence of hernia sac was evaluated and the largest diameter on diaphragmatic defect was measured before the repair. Postoperative outcome including instability, duration of mechanical ventilation, mortality rate or hospital discharge were obtained and analyzed.
ResultsFifteen cases were diagnosed during the first 24 hours of life and Sixteen cases experienced hypoxia in the first hour after birth. Left sided CDH was detected in 26 patients (86.66%), 3 patients (10%) had right sided defect and in one case diaphragmatic defect was bilateral. Hernia sac was present in the 8 cases. Mortality rate was 30% (9 cases) in postoperative period. Mean diameter of defect size in survived group was lower than nonsurvived group (4.12±0.61cm vs. 4.61±0.48; P=0.09). Postoperative death, occurred in 9 of patients without hernia sac but none of cases with hernia sac expired (P= 0.035).
ConlusionIn our study the presence of hernia sac was related to lower postoperative mortality rate. Defect size in survived group was also lower. We suggested presence of hernia sac and lower diameter of defect size acting as good prognostic factors in outcome of patients with CDH.
Keywords: Congenital diaphragmatichernia, Defect size, Hernia sac -
Page 18
Intro Thrombotic complications are quite frequent during SARS-CoV2 infection, especially during severe disease and in hospitalized patients. The incidence in mild disease is not clear and probably few cases have been identified. Case report We reported a case of a 60-year-old man with no previous history admitted in our unit for splenic infarct and a floating clot into the descending aorta without signs of severe disease. Discussion Several mechanisms to clarify prothrombotic state have been described and the exact prevalence of thromboembolic phenomenon is probably underestimated. There is no consensus about the treatment and the indication to prevent these complications in non-hospitalized patients. Conclusion Thrombotic events should be suspected also in fit patients with previous or actual symptoms suggestive for Covid 19 infection. Further analysis should be performed to stratify the risk in non hospitalized patients and the indication for prophylactic treatment.
Keywords: COVID-19, Splenic infarct, Thrombosis, Floating clot -
Page 19Background
Recently, autophagy as a highly conserved catabolic intracellular process considered to be a promising therapeutic target particularly in pathological alternations under aging condition. This systematic review is designed to qualitatively analyzed the interaction between autophagy and aging in various organs of animal models.
MethodsBased on our primary search, 9478 identified and following screening ultimately 80 full text were included to proceed further analysis. Next, by using SPSS software, data analysis of autophagy and aging related markers as well as autophagy alternation over the course of aging was performed.
ResultsDespite of debatable results, we established that the majority of studies showed that the autophagy process reduced in different aged organs significantly.
ConclusionThe outcomes showed that autophagy induction during aging were inferior to those reports that indicated the therapeutic potential of autophagy. Taken together, it should be considered that autophagy inducers could be counted as anti-aging agents.
Keywords: Aging, Aging-related biomarkers, Autophagy, Autophagic biomarkers, Cellular senescence -
Page 20Background
This study aimed to present the epidemiological and clinical effects of skiing training and use of protective equipment on skiing, sledding and snowboarding injuries.
MethodsThe patients were evaluated in two groups according to both their skiing experience and use of protective equipment. The characteristics of the patients, such as age, gender, injury area, and injury type were statistically evaluated according to the groups.
ResultsA total of 191 patients, 68 (35.6%) female and 123 (64.4%) male, were evaluated. There was a significant difference between the skiing type of the patients with and without skiing experience (p=0.001). When the patients were evaluated according to the presence of protective equipment, 25 (59.5%) patients who had no experience did not wear protective equipment, and this rate was statistically significant compared to the experienced group (p=0.001). Concerning the diagnoses of the patients according to injury areas, joint dislocation and soft tissue trauma were mostly detected in the upper extremities, bone fractures in the lower extremities, and organ injury in the thorax.
ConclusionShoulder and wrist traumas were the most common injuries among the patients with skiing experience while tibial fractures were mostly seen in those without such experience. Tibia fractures were mostly observed in the patients using protective equipment, and skin incisions in those that did not use protective equipment. Therefore, in winter sports injuries, patients’ skiing experience and protective equipment use should be questioned and more attention should be paid to the above-mentioned injuries.
Keywords: Winter Sports, Trauma, Skiing Experience, Protective Equipment, Ski, Snowboard -
Page 21
Hypothyroidism is a pathophysiological phase in which insufficient hormones are produced leading to an imbalance in basal metabolic rate and inefficiency physiological role of body systems. Vitamin D affects thyrocytes by decreasing TSH stimulated iodide uptake and cellular development. In hypothyroidism, hypovitaminosis D are due to malabsorption from the intestine and the other mechanism is inactivation of vitamin D. Thyroid hormones induce erythropoietin gene expression causing increase secretion of erythropoietin. Iron deficiency decreases activity of thyroid peroxidase enzyme. Hypothyroidism can cause microcytic anemia due to malabsorption of iron and menorrhagia. Hypothyroidism is a common but under-recognized and under-diagnosed condition in the Persian Gulf countries. Moreover, the effect of hypothyroidism on vitamin D and iron levels were inadequately evaluated. This is important to identify bi-deficiency so that, doctors can treat them earlier and can reduce the deficiency-related complications. There are plenty scopes for study on bi-deficiencies status of hypothyroid population.
Keywords: Adult female, Vitamin D, Iron, Hypothyroidism