فهرست مطالب

Medical Sciences - Volume:41 Issue: 6, Nov 2016

Iranian Journal of Medical Sciences
Volume:41 Issue: 6, Nov 2016

  • تاریخ انتشار: 1395/07/11
  • تعداد عناوین: 13
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  • Ramin Mehrdad, Narges Sadat Shams, Hosseini, Sara Aghdaei, Mina Yosefian Pages 467-478
    Background
    There are few research studies evaluating the significance of low back pain (LBP) in Iran, even though the majority of locally published surveys are written in the Persian language. In the present review study, we aimed at appraising published articles related to the burden of LBP and its divergence among different jobs.
    Methods
    A comprehensive search was conducted in all accessible national and international electronic databases from 1948 to mid-2012. The international electronic databases were MEDLINE (PubMed), Web of Sciences, Google Scholar, Scopus, CINAHL, and the Iranian equivalents were SID, IRANDOC, IranMedex, and Magiran. The main search terms were musculoskeletal disorders, musculoskeletal symptoms, low back pain, back pain, and Iran. All keywords were searched electronically by three Boolean operators. The inclusion criteria were age ≥10 years, study focus on LBP prevalence, inclusion of both genders, and no limitation to the study design. A dedicated STROBE questionnaire was developed as a critical appraisal tool and the quality of the identified literature was examined according to the 5-point Linker scale. Articles scoring ≥3 on the Linker scale were appraised. Each literature was screened by four reviewers independently and possible disagreements were streamlined in a joint review meeting. The extracted data were entered into a dedicated table using Microsoft Office Excel program. Data were analyzed for homogeneity using the STATA software (version 11).
    Results
    Of the 51 articles that were included in the present review study, 35 articles reported 1-year LBP with Nordic questionnaire and 3 articles reported point prevalence of LBP. The calculated global prevalence of 1-year LBP in workers was 25% and LBP was the most prevalent issue among health care workers. There was no association between the prevalence of LBP and job classification among workers.
    Conclusion
    LBP is the most common issue among health care workers. It is recommended that future research should focus on this job category for investigating LBP prevalence. This allows parameters that increase the frequency of LBP to be assessed and subsequently permits the reduction or elimination of such factors.
    Keywords: Low back pain, Musculoskeletal diseases, Prevalence, Epidemiology, Healthy worker effect, Health personnel
  • Fatemeh Keikhah, Fahimeh Ghotbizadeh Vahdani, Sahar Latifi Pages 479-485
    Background
    Opium is one of the most commonly abused opiates in developing countries including Iran. Considering the importance of maternal health on the newborn, we aimed to assess the effect of opium abuse on fetal heart rate (FHR) characteristics in a sample of pregnant women in Zahedan, Southeast Iran.
    Methods
    This cross-sectional study was done on 100 pregnant women referring to Ali-Ibn-Abi Talib Hospital in Zahedan, during 2011-2013. The participants were divided into two groups comprising of opium abusers and healthy individuals. The participants received 500cc intravenous fluid containing dextrose and then non-stress test results were recorded for 20 minutes.
    Results
    We found no significant difference between the two groups with respect to their demographic characteristics. Fetal movements, variability, acceleration, and reactivity were significantly higher among addicted women (P
    Conclusion
    Considering significant abnormal patterns in FHR characteristics among the opium abuser group, mothers addicted to opium need specific prenatal care.
    Keywords: Opium, Opioid, related disorders, Fetal distress
  • Seyed Mohammad Rasoul Khalkhali, Kiomars Najafi, Reza Ahmadi, Azadeh Yousefnezhad, Azam Hamidi, Masoumeh Ellahi, Ali Amiri, Afsar Montakhabi, Maryam Zavarmousavi Pages 486-493
    Background
    Domestic violence is a serious threat to the physical and mental health of women. The aim of the present study was to find and compare the frequency of domestic violence between methamphetamine users, patients with psychiatric disorders, and healthy people.
    Methods
    In this analytical cross-sectional study, methamphetamine users (n=30) and patients with psychiatric disorders (n=30) were women whose husbands were hospitalized during 2014 in Shafa Psychiatric Hospital in Guilan. Diagnosis was done with DSMIV-TR. Healthy people (n=60) were women whose husbands had no primary or drug induced psychiatric disorder or addiction. CTS-2 test was used to evaluate violence.
    Results
    The frequency of psychological, physical and sexual violence in the groups suffering from psychiatric disease and methamphetamine users was higher than the healthy group (P=0.001). We observed a direct correlation between the mean of psychological and physical violence in the three groups (r=0.9, P=0.001), (r=0.7, P=0.0001) and (r=0.53, P=0.005), respectively. Direct correlation between the psychological and physical violence was only observed in the healthy group (r=0.8, P=0.007).
    Conclusion
    The results showed that methamphetamine users such as psychiatric patients are at increased risk of violence. Domestic violence screening of these patients is necessary. It seems that this substance is a new source of increasing domestic violence with more undesirable outcomes in Iran.
    Keywords: Domestic violence, Methamphetamine, Psychotic disorders, Inpatients
  • Maliheh Kadivar, Ziba Mosayebi, Nosrat Razi, Shahin Nariman, Razieh Sangsari Pages 494-500
    Background
    In recent years, various noninvasive respiratory support (NRS) of ventilation has been provided more in neonates. The aim of this study was to compare the effect of HFNC with NCPAP in post-extubation of preterm infants with RDS after INSURE method (intubation, surfactant, extubation).
    Methods
    A total of 54 preterm infants with RDS (respiratory distress syndrome) were enrolled in this study. Using a randomized sequence, they were assigned into two groups after INSURE method. The first group received HFNC while the second group received NCPAP for respiratory support after extubation. A comparison was made between these two groups by the rate of reintubation, air leak syndrome, duration of oxygen therapy, hospitalization, the rate of bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP), and mortality. Data were analyzed by using the SPSS version 18 software. The statistical analyses included Student’s t-test for continuous data and compared proportions using Chi-squared test and Fisher‘s exact test for categorical data.
    Result
    The rate of reintubation was higher in the HFNC compared with the NCPAP group. The rate of either IVH or ROP had no significant differences between the two groups. In addition, duration of oxygen requirement and hospitalization were not statistically different. There was no case of BPD or mortality among these patients.
    Conclusion
    This study showed that preterm infants with RDS could manage post-extubation after INSURE method with either NCPAP or HFNC. However, in this single-center study, the rate of reintubation was higher in the HFNC group while further multicenter study might be assigned.
    Keywords: Oxygen inhalation therapy infant, newborn, Premature birth, Pulmonary surfactants
  • Sam Moslemi, Sajjad Ahmadi Joraghi, Reza Roshanravan, Leila Ghahramani, Mohammad Mohammadianpanah, Masood Hosseinzadeh, Abbas Rezaianzadeh, Ahmed Mohammed Ali Hussein, Neda Najibpour, Seyed Vahid Hosseini Pages 501-506
    Background
    Radiotherapy is one of the most important factors which results in negative effects on wound healing and increases anastomosis leakage. Diverting loop ileostomy has been usually performed after colorectal anastomosis in cases of colorectal cancer with a history of neoadjuvant radiotherapy to decrease the chance of leakage. Considering the side effects of diverting loop ileostomy, the objective of the present study is to investigate the effect of human amniotic membrane (HAM) on colorectal anastomosis leakage after neo-adjuvant radiotherapy.
    Methods
    In this experimental animal study, 20 crossbreed rabbits were randomly divided into two groups (case group: 13 rabbits, control group: 7 rabbits) after receiving an equal dose of external beam radiation. Four weeks after irradiation, resection of 4 cm of colorectal segment and end-to-end single layer anastomosis were conducted. In the case group, a 2×2 cm wrap of HAM applied around the site of anastomosis. Eight weeks later, all the survived rabbits were sacrificed. A segment of anastomotic sites was resected in all expired and survived rabbits and sent for pathological evaluation. Mann-Whitney U Test (SPSS for Windows, Ver. 16, Chicago, IL) was applied to analyze healing scores between the two groups.
    Results
    Due to anastomosis dehiscence, 5 rabbits expired in the control group, but all the 13 rabbits (case group) survived after 8 weeks and showed no leakage. In addition, pathological evaluation revealed significant epithelialization and neovascularization in the case group. Statistically, healing score was higher in the case group rather than the control group (P
    Conclusion
    To prevent post irradiation colorectal anastomosis leakage, the use of HAM might play a significant role and a feasible technical approach.
    Keywords: Human amniotic membrane, Colonic anastomosis, Radiotherapy, Anastomotic leak, Rectal neoplasms
  • Soghra Bahmanpour, Maryam Ghasemi, Mohsen Sadeghi, Naini, Iraj Ragerdi Kashani Pages 507-517
    Background
    The purpose of this study was to create biomaterial scaffolds like platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) containing stromal cell-derived factor-1 (SDF1) as a chemokine to induce hyaline cartilage regeneration of rabbit knee in a full thickness defect.
    Methods
    We created a full thickness defect in the trochlear groove of thirty-six bilateral knees of eighteen mature male rabbits. The knees were randomly divided into six groups (group I: untreated control, group II: PRP, group III: PRF, group IV: Gelatin䠱, group V: PRP䠱, and group VI: PRF䠱). After four weeks, the tissue specimens were evaluated by macroscopic examination and histological grading, immunofluorescent staining for collagen type II, and analyzed for cartilage marker genes by real-time PCR. The data were compared using statistical methods (SPSS 20, Kruskal-Wallis test, Bonferroni post hoc test and P
    Results
    Macroscopic evaluations revealed that international cartilage repair society (ICRS) scores of the PRF䠱 group were higher than other groups. Microscopic analysis showed that the ICRS score of the PRP group was significantly lower than other groups. Immunofluorescent staining for collagen II demonstrated a remarkable distribution of type II collagen in the Gel䠱, PRP䠱 and PRF䠱 groups compared with other groups. Real-time PCR analysis revealed that mRNA expression of SOX9 and aggrecan were significantly greater in the PRF䠱, PRP䠱, Gel䠱 and PRF groups than the control group (P
    Conclusion
    Our results indicate that implantation of PRF scaffold containing SDF1 led to the greatest evaluation scores of full-thickness lesions in rabbits.
    Keywords: Platelet, rich plasma, Platelet rich fibrin, Chemokine CXCL12, Cartilage, Knee
  • Zahra Mousavi, Majid Hassanpourezatti, Parvaneh Najafizadeh, Shiva Rezagholian, Mohammad Safi Rhamanifar, Nahid Nosrati Pages 518-524
    Background
    The use of nanotechnology has led to rapid growth in various areas. Thus, health and safety issues of nanoparticles (NPs) should be promptly addressed. Manganese oxide (MnO2) nanoparticles (NPs) are typically used for biomedical and industrial applications. However, characterizing the potential human health effects of MnO2 NPs is required before fully exploiting these materials. The aim of this study was to investigate the toxicity of MnO2 micro- and nanoparticles on blood glucose level and lipid profile in male Wistar rats.
    Methods
    A total of 105 rats were divided into one control and two experimental groups. Each experimental group received a single subcutaneous injection of MnO2 micro- and nanoparticles (100 μg/kg), respectively, every two weeks for 14 weeks. Their blood glucose, cholesterol, triglycerides, LDL, and HDL levels were then measured. The data presented as mean±SEM and compared with the repeated measures using the Prism statistical software (version 6.0).
    Results
    Biochemical assessment in plasma samples showed that MnO2 micro- and nanoparticles injection significantly (P
    Conclusion
    Our results show that exposure to nanosized particles at subchronic doses caused adverse changes in animal biochemical profiles, especially in glucose level. It seems that the high oxidative power of these particles is the main reason for these disturbances.
    Keywords: MnO2, Blood glucose self, monitoring, Cholesterol, Triglycerides, Nanoparticles
  • Zahra Sourani, Batoul Pourgheysari, Pezhman Beshkar, Hedayatollah Shirzad, Moein Shirzad Pages 525-530
    Leukemia is known as the world’s fifth most prevalent cancer. New cytotoxic drugs have created considerable progress in the treatment, but side effects are still the important cause of mortality. Plant derivatives have been recently considered as important sources for the treatment of various diseases, including cancer. Gallic acid (GA) is a polyhydroxyphenolic compound with a wide range of biological functions. The aim of the present study was to evaluate the effect of GA on proliferation inhibition and apoptosis induction of a lymphoblastic leukemia cell line. Jurkat cell (C121) line was cultured in RPMI 1640 supplemented with 10% heat-inactivated fetal bovine serum (FBS) with different concentrations of GA (10, 20, 30, 40, 50, 60, 70, 80, 90, and 100 μM) for 24, 48 and 72 hours. The effect of GA on cell viability was measured using MTS assay. Induction of apoptosis was evaluated with Annexin V-FITC/PI kit and flow cytometry. Data were analyzed by SPSS version 20 using Kruskal-Wallis and Dunn’s multiple comparison tests. Decline of cell viability to less than 50% was observed at 60.3±1.6, 50.9±1.5, and 30.9±2.8 μM concentration after 24, 48, and 72 hours incubation, respectively. All concentrations of GA (10, 30, 50 and 80 μM) enhanced apoptosis compared to the control (P
    Keywords: Gallic acid, Apoptosis, Jurkat cells, Precursor cell lymphoblastic leukemia, lymphoma
  • Mohammad Hossein Gozashti, Nazanin Eslami, Mohammad Hadi Radfar, Hamid Pakmanesh Pages 531-538
    Sleep disturbances have been shown to be associated with diabetes control, but the relation between planned wakings or napping with glycemic indices has not been evaluated yet. This study evaluated the relation between sleep quality, duration, and pattern, including daytime napping of people with diabetes and their glycemic control. A cross-sectional correlation research design was used for this study. We enrolled 118 people with type 2 diabetes receiving oral agents without major complications at the Shahid Bahonar Center, Kerman. The age, weight, height, serum HbA1c, as well as other glycemic indices and lipid profile were measured. BMI was also calculated. All participants were requested to fill in the Pittsburgh Sleep Quality Index (PSQI) questionnaire to evaluate their sleep quality. In addition, they were inquired about their sleep schedule during day and night. Pearson correlation and multiple regression analyses were conducted to examine the correlation between HbA1c and sleep pattern variables. The variables were also compared between participants with or without napping using t-test. All analyses were performed with the SPSS version 19 (SPSS, Chicago, IL, USA). The mean age was 58±11 years and mean HbA1c (%) was 7.8±11 (62±13 mmol/mol). Sleep duration and the number of sleep segments significantly predicted HbA1c (F (2,114)=5.232, P=0.007, R2=0.084). A one-hour increment in sleep duration was associated with a 0.174% (1.4 mmol/mol) decrement in HbA1c. PSQI score did not contribute to the regression model. Moreover, participants who napped (66%) had a lower HbA1c (7.6±1) compared to others (8.1±1.3) (P=0.04). We concluded that napping and segmented sleep are associated with a better glycemic control in type 2 diabetes and there is a linear correlation between sleep duration and better glycemic control.
    Keywords: Sleep_Diabetes mellitus type 2_Hemoglobin A glycosylated_Split sleep pattern_Nap
  • Rakumar Parakh, Dhananjaya Matapadi Nairy Pages 539-542
    Bardet-Biedl syndrome (BBS) is one of the rare autosomal recessive disorders that affect multiple organs of the body. The signs and symptoms of this condition vary among affected individuals, even among members of the same family. We present a case of BBS with features of hypogonadism and features such as marked central obesity, retinitis pigmentosa, polydactyly, renal abnormalities and mental retardation, along with a brief review of the literature. The patient had end stage renal disease and managed with dialysis. This case also exemplifies the need for multidisciplinary approach in the management of such cases.
    Keywords: Bardet–Biedl syndrome, Hypogonadism, Retinitis pigmentosa, Chronic kidney failure, Dialysis
  • Mahmood Soveid, Ghanbar Ali Rais, Jalali Pages 543-547
    Congenital adrenal hyperplasia comprises a group of disorders resulting from defects in enzymes required for the synthesis of cortisol. The clinical presentation depends on the specific enzyme defect. We report a rare case of congenital adrenal hyperplasia due to 17 alpha-hydroxylase deficiency. A 26-year-old female patient referred with hypertension and hypokalemia. She also had primary amenorrhea and lack of sexual development. The karyotype was 46, XY. Hormonal evaluation showed low serum levels of all steroid hormones, requiring alpha-hydroxylation, which included cortisol, 17 alpha-hydroxy progesterone, dehydroepiandrosterone sulfate, estradiol, and testosterone. The levels of adrenocorticotropic, follicle-stimulating, and luteinizing hormones were high. Radiological and surgical investigations failed to show a gonad. She also had a large myelolipoma. Treatment was commenced with low-dose dexamethasone and conjugated estrogen. Her hypertension and hypokalemia were resolved. The myelolipoma was removed by laparoscopy due to pain and sensation of heaviness. Our review of literature revealed that a combination of this disorder with either agonadism or myelolipoma is very rare and that only 2 previous cases have been reported for each entity.
    Keywords: Steroid 17, alpha, hydroxylase, Adrenal hyperplasia, congenital, Male pseudohermaphroditi, Gonads, Myelolipoma
  • Rommel Singh Mohi, Ashish Moudgil, Suresh Kumar Bhatia, Kaushal Seth, Tajinder Kaur Pages 548-551
    he incidence of the diverticulum of the small bowel varies from 0.2-1.3% in autopsy studies to 2.3% when assessed on enteroclysis. It occurs mostly in patients in the 6th decade of their life. Of all the small bowel diverticuli, jejunal diverticulum is the most common type. This rare entity is usually asymptomatic. However, they may cause chronic non-specific symptoms for a long period of time like dyspepsia, chronic postprandial pain, nausea, vomiting, borborgymi, alternating diarrhoea and constipation, weight loss, anaemia, steatorrhea or rarely lead to complications like haemorrhage, obstruction, perforation. Obstruction can be due to enterolith, adhesions, intussusception, and volvulus. The condition is difficult to diagnose because patients are generally presented with symptoms that mimic other diseases. It is important for clinicians to have awareness of this entity. Here, we present a case of multiple jejunal diverticuli with a history of repeated attacks of diverticulitis over past 20 years, which were misdiagnosed and now presented with intestinal obstruction due to volvulus of the involved segment along with mesentery around its axis. Resection of the diverticuli segment of jejunum was done with end-to-end jejuno-jejunal anastomosis. The patient is asymptomatic since 10 months of follow-up.
    Keywords: Diverticulitis, Small intestinal diverticulosis, Intestinal obstruction, Intestinal volvulus, Laparotomy
  • Mohd. Habib Raza, Rafiulimad Finan, Sadik Akhtar, Manzoor Ahmad Pages 552-556
    Primary enterolithiasis is a rare surgical ailment. The underlying cause is intestinal stasis. Numerous anatomical and micro environmental factors such as enteritis, incarcerated hernia, malignancy, diverticula, blind loops, and enteroenterostomy predispose to clinically significant concretions. Enterolithiasis in tuberculosis can be due to the presence of strictures, intestinal bands, or interbowel/parietal adhesions, leading to intestinal stasis. Secondary enterolithiasis is generally caused by gallstones or renal stones migrating to the gastrointestinal tract due to fistula formation. During stasis, food particles act as a nidus and calcium salts are deposited over the food particles, leading to stone formation. A 57-year-old male patient presented to the Emergency Department of Jawaharlal Nehru Medical College, AMU, Aligarh, with features of intestinal obstruction. The patient underwent emergency laparotomy, revealing 2 strictures in the distal ileum with 15.24cm of the bowel between them containing a 2×2 cm enterolith. The strictured segment was resected, and end ileostomy and mucus fistula were created. The patient’s postoperative recovery was fine, and he wasdischarged with ileostomy on antitubercular treatment (after histopathologicalconfirmation). Ileostomy closure wasplanned after 6 weeks. The incidence and prevalence of enterolithiasis has been on the rise recently because of advancement in radiological imaging studies. Endoscopic and surgical stone removal along with the treatment of the underlying pathology is recommended.
    Keywords: Enterolithiasis, Tuberculosis, Intestinal obstruction, Laparotomy