Iranian Red Crescent Medical Journal
Volume:20 Issue: 4, Apr 2018

Familial adenomatous polyposis (FAP) is an inherited autosomal dominant disorder, which can develop into cancer in early adulthood (100%) and is a result of germline mutations in the adenomatous polyposis coli (APC) genes.
Identify APC germline mutations and assessed relationships between genotypes and phenotypes.
In a census-based cross-sectional study, FAP patients were selected from the referral medical centers of East Azarbaijan province between 2013 and 2016. Written informed consent was obtained from all patients for blood sampling and genetic testing. Patients undergo genetic counseling, and the pedigree was drawn. After peripheral blood sampling and DNA extraction, the potential mutation of the APC gene was detected by polymerase chain reaction (PCR), and DNA sequencing. Statistical tests were carried out using SPSS version 16.0. Categorical data between two groups were compared using chi-square test. Independent sample t- test was used for comparison of continuous variables between two groups. The P-value We identified APC gene mutations in 18 of the 30 unrelated patients with FAP (60%), including one novel frame shiftmutation, three nonsense mutations, and 14 novel missense mutations (78%). The most frequent mutations were in codon 1308 and 1350. Meanwhile, we found a novel polymorphism.
Our study results indicated that the APC gene has a high mutation detection rate (60%) between codons 999 and 1410, and codons 1308, and 1350 are two mutation hotspot regions.

Regional techniques both reduce opioid requirements and provide quality pain control in patients, especially in pediatrics.
The aim of this study was to compare the contributions of ilioinguinal/iliohypogastric (II/IH) block and transversus abdominis plane (TAP) block combined with sedation to intraoperative anesthesia and analgesia in pediatric surgery.
In this randomized controlled study, 100 patients aged 2 - 6 years were enrolled and divided into five groups: TAP block with ketamine; II/IH block with ketamine; TAP block with sevoflurane; II/IH block with sevoflurane; and the control group with sevoflurane alone. Hemodynamics (mean arterial pressure (MAP) and heart rate (HR)), depth of anesthesia, sevoflurane usage, pain score, number of children who needed analgesia, and the time to start rescue analgesia of all patients were recorded.
There was nosignificant difference between the study groups, in HR and MAP during operations (P > 0.05). The amount of sevoflurane used in the group supported with both blocks decreased significantly compared to the control group (P This study revealed that transversus abdominis plane or ilioinguinal/iliohypogastric regional blocks could have same intraoperative/ postoperative effects regarding hemodynamics and intraoperative analgesia in lower abdominal pediatric surgery. Anesthesia can be maintained using sedative medicines only.

Abnormal levels of hormones during second trimester of pregnancy may predict genetic disorders and complications of pregnancy.
This study was performed to evaluate the clinical significance of abnormal results in second trimester markers in the absence of aneuploidy.
This case-control study was conducted between May 2014 and December 2015 at the maternal fetal unit, Trakya University Faculty of Medicine in Turkey. Overall, 108 Turkısh pregnant females were included in this study. This research recruited patients (n = 46) with normal karyotype, who underwent prenatal invasive tests because of abnormal levels of second trimester hormones, along with a cohort of controls (n = 31) with hormonal results within normal ranges. For each patient, the researchers recorded the mode of delivery, gestational age at delivery, birth weight, complications, and adverse outcome of the pregnancy. Data were analyzed using Fisher’s exact tests and Yates contiunity correction tests for qualitative variables, and t- test and Mann-Whitney U test for quantitative variables.
Maternal age (mean ± SD) of the entire group was 31.77 ± 5.68 years (study group: 31.23 ± 4.39; controls: 32.13 ± 6.43, P > 0.05). Preterm delivery and preeclampsia was significantly higher in the study group (P = 0.02). In the study group, Alpha Fetoprotein (AFP) levels were significantly higher in patients with preeclampsia yet not in the controls. The AFP values under 0.77 multiple of the median in patients with elevated test results in the absence of aneuploidy appeared to be associated with the development of preeclampsia later in pregnancy.
Although the significance of higher AFP values have been discussed in the literature in terms of the development of adverse outcomes, the present study suggests that lower values must also be taken into account during patient follow-up.

In type 2 diabetes, adaptation to the disease and the treatment process is extremely important. The main methods employed to treat and manage type 2 diabetes are education, medication, nutrition, exercise, and insulin therapy.
The current study aimed at determining the effects of education based on Roy adaptation model on diabetes care profile (DCP) of patients with type 2 diabetes.
The current clinical and experimental study was conducted on 130 patients with type 2 diabetes referred to Atatürk University Research Hospital Endocrinology Policlinic, Erzurum, Turkey from April 2015 to August 2016, possessing the inclusion (N = 388). The study was conducted as a pre-test post-test control group. The study was conducted on 61 patients in the experimental and 65 in the control groups. Experimental group referred on Monday, Wednesday, and Friday. Control group referred on Tuesdays and Thursdays. The patient identification form and Turkish version of diabetes care profile scale, developed by Ozcan were employed for data collection. The education and follow-up processes were completed in 12 weeks. The percentile, distribution, Chi-square, and the t-tests were employed to evaluate the data of the independent and paired groups. P The patients in the control group had pre-test and post-test scores of 2.43 ± 0.16 and 2.44 ± 00.15 in medical barriers, respectively (P = 0.269). In the experimental group, the scores of medical barriers were 2.45 ± 0.17 in pre-test and 2.23 ± 0.37 in post-test (P A positive impact was observed in the education of DCP based on Roy’s adaptation model.

Cardioplegia is used for protection of myocardium during cardiac operations. Del Nido (DN) and Custodiol cardioplegia solutions are used for prolonged protection of the myocardium during cardiopulmonary bypass (CPB). Custodiol cardioplegia (CC) solution is gaining popularity for myocardial protection during cardiopulmonary bypass.
This study aimed to compare the effects of Custodiol with another cardioplegia solution, Del Nido, on myocardial protection during cardiopulmonary bypass.
In a randomized controlled clinical trial, forty patients were randomly allocated to DN and Custodiol (CC) groups. Patients in both groups received a normal anesthesia protocol. For cardioplegia, in the DN group, the DN solution was administered every 90 minutes by the antegrade route. In the Custodiol group, the Custodiol solution was administered in the same way at the beginning of the cardioplegia. Demographic information, blood chemistry parameters and other related perioperative and postoperative clinical indices were recorded.
Frequency of female patients was 14/21 (66.66%) in the DN and 12/19 (63.15%) in the CC group (P = 0.816), age was 57.14 ± 12.48 years in the DN and 59.47 ± 11.96 years in the CC group (P = 0.551), weight was 70.95 ± 9.56 kilograms in the DN and 69.63 ± 7.64 kilograms in the CC group (P = 0.635), CPB time was103.19 ± 23.43 minutes in the DN versus 97.36 ± 16.7 minutes in the CC group (P = 0.376), and cross-clamp time was 73.76 ± 19.66 minutes in the DN and 83.95 ± 16.14 minutes in the CC group (P = 0.083). Blood chemistry and blood gas analysis revealed a similar trend between the two groups in these parameters (P > 0.05) except for higher sodium levels after cardioplegia (P = 0.016) and end of CPB (P = 0.002), potassium levels after cardioplegia (P = 0.029), and bicarbonate anions at the end of bypass (P = 0.03) in the custodiol group.
In conclusion, CC and DN offer effective myocardial protection during cardiopulmonary bypass. It is recommended to restrict the use of CC in patients susceptible to electrolyte disturbances.

Considering the undesirable consequences of stress and anxiety in pregnancy and the role of midwives in providing emotional support for pregnant women, it is crucial to utilize non-medical therapies, such as spiritual counseling.

The present study aimed to determine the effect of spiritual counseling on stress and anxiety in pregnant women.

This randomized controlled clinical trial recruited 112 pregnant women presenting to the health centers in Maragheh, Iran, in 2016 - 17. The participants were assigned to two 56-member groups of control and intervention with a randomized block design. A socio-demographic questionnaire, the perceived stress scale, and the Spielberger state-trait anxiety inventory (STAI) were completed before and four weeks after the intervention through interviews with participants.

55 participants in the counseling group and 56 in the control group were followed up and analyzed until the end of the study. The mean (± SD) scores of stress, state anxiety, and trait anxiety were 35.4 (± 4.5), 48.5 (± 4.8), and 47.4 (± 4.6) in the counseling group and 34.8 (± 3.6), 47.8 (± 4.1), and 49.0 (± 4.1) in the control group before the intervention, respectively. The mean (± SD) scores of stress, state anxiety, and trait anxiety were 34.8 (± 3.5), 48.0 (± 4.5), and 44.7 (± 4.0) in the counseling group and 37.8 (± 3.7), 49.7 (± 4.2), and 46.0 (± 3.8) in the control group four weeks after the intervention, respectively. According to ANCOVA for controlling the baseline scores after the intervention, the mean scores of perceived stress (adjusted mean difference = -3.4; 95% confidence interval = -2.3 to -4.4; P

Spiritual counseling can control perceived stress and state anxiety of pregnant women. Therefore, spiritual counseling is recommended as a complementary and effective intervention in managing the psychological problems of pregnant mothers.

Overproduction of reactive oxygen species (ROS) causes increased lipid peroxidation, decreased intestinal epithelial barrier integrity, and ultimately mucosal disruption and ulceration. Several studies have confirmed the antioxidant, anti-inflammatory, and immunomodulatory properties of Spirulina Platensis (SP), edible blue - green algae, in various inflammatory diseases. In addition, natural honey, a source of phenolic and flavonoid compounds, is a powerful antioxidant, which can help prevent chronic oxidative stress and subsequent inflammation.
In this study, we examined and compared the protective effects of SP and honey on ulcerative colitis induced by acetic acid (AA) in rats.
Forty male rats were allocated into five groups (N = 8) and received pretreatment for 32 consecutive days. The administrations were as follows: group 1 (control) and group 2 (AA-colitis group): normal saline, group 3: 1 ml honey/day, group 4: 1 ml honey/day plus 1 g/kg SP, and group 5: 1 g/kg SP. Colitis was induced on the 30th day in groups 2 to 5. On day 32, the clinical activity score was determined and anesthetized animals were sacrificed. Serum interleukin-6 (IL-6), IL-1β, tumor necrosis factor-α (TNF-α), glutathione peroxidase (GPx), reduced glutathione (GSH), total antioxidant capacity (TAC), superoxide dismutase (SOD), myeloperoxidase (MPO), prostaglandin E2 (PGE2), malondialdehyde (MDA), nitric oxide (NO), and colonic weight/length ratio were determined. In addition, histopathological changes of the colon were observed microscopically.
The inflammatory markers (PGE2, MDA, NO, IL-6, IL-1β, MPO, and TNF-α) were significantly lower in the pretreatment groups than in the AA-colitis group (P values Honey and SP are favorable foods in preventing oxidative stress and inflammatory diseases such as ulcerative colitis.

Osteoarthritis is a common chronic degenerative disorder. Exercise is regarded as a common practice for the elderly, especially those with knee osteoarthritis.
This study aimed to examine and compare the effects of Tai Chi and closed kinetic chain exercises on patients with knee osteoarthritis.
Forty-eight patients with knee osteoarthritis participated in this clinical trial study, which was carried out in a private clinic (2016) in district thirteen of Tehran, Iran. They were randomly assigned equally to closed kinetic chain exercise (CKCE) group, Tai Chi Exercise (TCE) group, and no exercise group. All three groups were equally treated using a standard physical therapy protocol. The CKCE group performed static stretching and CKCE, and the TCE group performed Tai Chi warm-up and cool-down and the form 6 of Yang style of Tai Chi exercises. All three groups were evaluated at baseline, sixth, and twelfth sessions of treatment and one- month post- treatment using a six-minute walk test and the knee injury and osteoarthritis outcome score (KOOS) questionnaire.
According to KOOS subscale, the TCE improved the symptoms (68.94 ± 9.24) (P In patients with knee OA, Tai Chi exercise relieved pain and symptom even in a short time, and improved QOL, sport, and recreational activities, and ADL. The effects of both TCE and CKCE on the improvement of QOL were similar.

Today, one of the newest products used to control any bleeding is band Celox®.
The current study aimed at evaluating the therapeutic effect of the Celox® bandage to manage non - traumatic epistaxis in the emergency department (ED).
In the current randomized, clinical trial, 150 patients with non - traumatic epistaxis admitted to the ED in Imam Reza and Sina hospitals affiliated to Tabriz University of Medical Sciences were enrolled. All patients were randomly divided into 2 groups: group 1 dressing with the Celox® band and group 2 dressing with anterior nasal tampon. The convenient sampling method was employed. Bleeding control (minute), patients’ satisfaction, and lack of rebleeding within the first 24 hours of administration were compared between the 2 groups.
There was no statistically significant difference between the 2 groups in terms of demographic variables, vital signs, and paraclinical testing results (P > 0.05). With respect to the control of bleeding in the first 5 minutes after management, 93.3% of the bleeding was controlled in the Celox® and 96% of the bleeding was controlled in the anterior tampon groups (P = 0.467). The satisfaction level of the patients in the Celox® group was greater than that of the tampon group, and the difference was statistically significant (P Based on the results of the current study, there was no significant difference in bleeding control and the success rate between the 2 groups of the study. Ease of usage, however, makes Celox® a better alternative to control epistaxis. Furthermore, the treatment of epistaxis with Celox® leads to greater satisfaction levels.

The correlation between gut microbiota with body mass index is controversial. This study aimed to explore the correlation between gut microbiota profiles, bacteroidetes and Firmicutes, with a body mass index in 7 - 12- year- old school aged children, Iran.
This cross-sectional study was carried out on school-age children. A total of 188 elementary school children were selected through cluster sampling frame. Data collection tool was the international physical activity questionnaire (IPAQ), therefore, we checked the anthropometric characteristics. Fecal sampling was obtained from all study samples, Langround, Iran. Obese (BMI = 25.8 ± 3.40 kg/m2), normal-weight (BMI = 15.54 ± 1.19 kg/m2), and lean (BMI = 12.79 ± 1.8 kg/m2) among langroud children aged 7 - 12 years. The total stool bacterial genomic DNA was extracted by quantitative real-time PCR (Q-PCR) to determine the colony forming units (CFU) of bacteroidetes and firmicutes. Q_PCR data were analyzed by using SPSS version 19.0, and analyzed interpreted statistical exams such as Spearman’s rank correlation coefficient and Kruskal Wallis test. Due to the fact that the data was not normal, P Gut microbiota, Firmicutes and Bacteroidetes CFU, and so bact/firm ratio were significantly different among the three group fecal samples (P The amount of Bacteroidetes and so bact/firm ratio were decreased among obese children; however; firmicutes increased. It was suggested that obesity in children might be associated with the imbalance of gut microbes.

Increased iron load is the main problem in beta-thalassemia major; chelation therapy is used for its counteraction. Non-compliance with iron chelation therapy leads to certain complications and the economic burden caused by them further highlights the importance of therapies for reducing iron over load. Administering lower doses of the chelating agent reduces both the complications faced by the patients and the economic burden on the health system.
Objectives and This randomized clinical trial was conducted to investigate the effect of a holistic care program (HCP) on the reduction of iron over load in patients with beta-thalassemia major had been referred to the largest center for thalassemic patients in Mashhad (Iran). The study lasted from September 2012 to February 2015. Based on the estimated sample size, 90 of the eligible subjects were randomly selected. The subjects gave their informed consent and were then divided into an intervention (n = 45) and control group (n = 45) through stratified randomization while taking into account the type of chelator agent as the confounder. The HCP was conducted as a randomized trial in 3 parts: 1- individual counseling (4 45 - 60-min sessions for each patient), 2- group training (4 60 - 90-min sessions for each patient), and 3- rehabilitation (8 weeks). Of the 500 patients with beta-thalassemia major, 90 samples were randomly selected. After they gave their informed consent, the samples were randomly assigned to 2 groups, i.e. an HCP group and a control group. Before beginning the intervention and 3 months later, the patients’ levels of serum ferritin and iron, total iron binding capacity or TIBC (to check the iron load), and hemoglobin or Hgb (to prevent hemolysis) were examined and the 6-minute walk test (6MWT) was also performed for assessing their functional ability and to ensure they were able to comply with the rehabilitation program. The patients in the control group received routine care only. The pre- and post-intervention evaluations in the control group were similar to those in the intervention group.
Changes in serum iron and ferritin as well as the 6MWT distance differed significantly between the test and control groups (P 0.05). The mean changes in serum iron and ferritin, 6MWT, TIBC, and Hb equaled -71.02 ± 97.28, -1172.75 ± 2032.14, 65.97 ± 81.1, 29.71 ± 80.95, and 0.06 ± 1.75 in the intervention group and -5.46 ± 96.73, -8.08 ± 998.56, -33.97 ± 54.28, 21.37 ± 90.45, and 0.33 ± 1.5 in the control group.
It seems that any change in the mental and psychological conditions of chronic patients, especially those with thalassemia, improves their self-care behaviors and thereby, their treatment compliance. Based on the results, the HCP was effective in reducing ferritin levels in patients with thalassemia major in this study. Therefore, this is program is recommended to be used in the care of thalassemia patients.

Determination of suicide as the cause of death due to shotguns can be challenging, because shotguns are usually designed for hunting, sport, and recreation. Therefore, the impact of their bullets on the human body may present several unclear signs. In this case, pellets were reported to spread in contact wounds. Manner of death seemed to be initially murder yet after autopsy, it seemed suicidal.
The incident occurred during March 2015 in a house in the capital city of Iran, Tehran. The case was a 39-year-old man, who upon initial examination, was reported to have committed suicide using a shotgun. This was evident by the presence of distributed pellets in the chest and pelvis, which confirmed a contact shot.
The following were hypothesized: 1- After the plastic cap of the bullet hit the sternum, it was fragmented and pellets were scattered. 2- Regarding the existence of the pellets in the heart's ventricles, it seemed the pellets were distributed immediately through the aorta, to the chest, and through to the abdominal aorta, and the pelvis.