Journal of Research in Medical Sciences
Volume:24 Issue: 7, Jul 2019

Protease inhibitors (PIs) are a vital part of the antiretroviral therapy. Long‑term use of PIs may cause lipodystrophy, a clinical syndrome characterized by peripheral lipoatrophy and central fat accumulation, which may increase the risk of developing obstructive sleep apnea (OSA) in HIV‑infected patients. We hypothesize that a longer duration of PIs’ use might be associated with increasing severity of OSA in HIV‑infected patients. This was a retrospective cohort study of HIV‑infected patients who were treated with PIs, who presented with symptoms suggestive of OSA, and underwent nocturnal polysomnography. The primary objective of the study is to evaluate the association between the duration of PIs’ use and the severity of OSA. The duration of PIs’ use measured in months was recorded for each patient. The primary outcome of interest was the apnea–hypopnea index (AHI) obtained at the time of the sleep study. Data were analyzed using univariate and multivariate linear regression between AHIs with PIs’ use as well as other predictors. A total of 54 patients diagnosed with HIV and OSA were included in the study cohort for the analysis. Sleep study body mass index (BMI; P = 0.042) and change in BMI (ΔBMI; P = 0.027) were the only statistically significant independent predictors of AHI. The association between AHI and PIs’ use duration was found to be nonlinear and nonsignificant. Gender differences evaluation suggested possible duration‑related effect relationship between PIs and OSA severity among HIV‑infected men exposed to PIs within a 66‑month duration. We did not observe a significant association between PIs’ use duration and the severity of OSA.

Na+/K+ ATPase enzyme is essential for nerve cell membrane integrity, and reduction in its activity, probably due to ATP1A1 gene polymorphisms, is related to diabetic neuropathy progression. Therefore, the goal of the existent study is to evaluate the Na+/K+ ATPase activity in type 2 diabetes mellitus (T2DM) Egyptian patients with or without neuropathy, search for polymorphism(s) in the highly polymorphic region of ATP1A1 gene, exon 2, and study its (their) associations with T2DM with and without neuropathy. A total number of 150 individuals were subclassified into healthy controls (n = 30), T2DM without complications (n = 60), and T2DM with neuropathy (n = 60). The biochemical results exhibited a significant reduction in fasting C‑Peptide and activity of Na+/K+ ATPase in T2DM patients with neuropathy followed by T2DM without complication in comparison with healthy controls. ATP1A1 exon2 was amplified by polymerase chain reaction (PCR) then digested by the PstI restriction enzyme, and the obtained data from restriction fragment length polymorphism‑PCR and sequencing revealed the existence of a novel synonymous G94A single nucleotide polymorphism (SNP) at nucleotide 27 in exon 2 of ATP1A1 gene (rs1060366). Diabetic groups had only allele A, while the control group had G allele. Interestingly, individuals carrying AA genotype had a significantly lower Na+/K+ ATPase, C‑peptide, and higher glycosylated hemoglobin (HBA1c %) than those having GG genotype, suggesting a possible association for this SNP, and this developed phenomenon of not only T2DM but also diabetic neuropathy. Thus, allele A of G94A SNP (rs1060366) could be a risk allele for diabetes susceptibility among Egyptian patients.

Considering the increasing incidence rate of ovarian cancer in worldwide and the utility of Gynecologic Imaging Reporting and Data System (GI‑RADS) in diagnosing malignant adnexal lesions such as ovarian cancer, we aimed to evaluate the diagnostic performance of this reporting system in differentiating between malignant and benign adnexal lesions. In this cross‑sectional study, women with suspected adnexal lesions were enrolled. For differentiating of malignant adnexal lesions, Grade II and III of GI‑RADS system were classified as low risk for malignancy and Grades IV and V as high risk. Results of histopathologic diagnosis were compared with the results of the mentioned GI‑RADS system classification, and the diagnosed accuracy of the system was determined. Patients who did not have histopathologic diagnosis were followed up. In this study, 197 women with suspected adnexal lesions were evaluated. Frequency of GI‑RADS II, III, IV, and V were 34.5% (69 cases), 38.0% (76 cases), 19.5% (39 cases), and 6.5% (13 cases), respectively. According to the low‑ and high‑risk classification of GI‑RADS, 72.5% were classified as GI‑RADS II and III and 26% as GI‑RADS IV and V, respectively. Definitive histopathologic diagnosis was reported for 158 cases. Histopathologic evaluation indicated that 12 (7.6%) of the masses were malignant and 146 (92.6%) were benign. Comparing with the histopathologic diagnosis, the GI‑RADS system sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio (LR), and negative LR were 91.6%, 80.82%, 28.2%, 99.1%, 4.77, and 0.10, respectively. The accuracy of the scoring system was 81.64%. Our findings indicated that using GI‑RADS, we could quantify the risk of malignancy by such a structured as well as simple reporting system so that the system could be useful for clinicians for performing an appropriate clinical management.

Sleep is essential in maintaining health and quality of life. Inflammatory bowel disease (IBD) patients suffer from poor sleep quality. This study aimed to investigate the prevalence of sleep disturbances in Iranian IBD patients as well as the variables which can be attributed to the quality of sleep in IBD patients. Seventy‑one patients filled in Pittsburg Sleep Quality Index (PSQI) questionnaire and a sociodemographic questionnaire. Disease activity was assessed by Crohn’s Disease (CD) Activity Index and Ulcerative Colitis (UC) Activity Index. Regression analysis was used to identify the association between sociodemographic and disease characteristics with sleep quality. We found that 32.4% of all patients, 23.1% of patients with “in remission to mild” disease, and 66.7% of patients with “moderate” disease, had poor sleep quality. CD patients were more likely to have poor sleep quality comparing UC ones in crude (odds ratio [OR] =2.14; 95% confidence interval [CI] 1.14–4.04) and adjusted (OR = 6.19; 95% CI 1.13, 34.07) models. Patients with good quality of sleep had lower systolic blood pressure and diastolic blood pressure (P = 0.09 and 0.035 respectively). Notable percentage of IBD patients suffer from poor sleep quality even in the remission phase. Treatment of sleep disturbances, especially in CD patients, is recommended in the IBD patient‑care program.

The main purpose of this study was to evaluate the effectiveness of triamcinolone acetonide (TA) mucoadhesive films versus placebo as a preventive and therapeutic intervention of oral mucositis (OM) induced by radiotherapy for head‑and‑neck cancer (HNC) patients. In this double‑blind, randomized case‑controlled clinical trial, 60 HNC patients were randomized to receive TA mucoadhesive films (n = 30) or placebo mucoadhesive films (n = 30) taken four times daily. Mucositis severity was assessed during the course of radiation therapy using the World Health Organization scales, and pain scores were assessed using visual analog scale. Repeated measures ANOVA was used for data analysis. Mean ± standard deviation age of the TA group was 58.53 ± 8.89 years and 60% were male, whereas in the placebo group, it was 56.46 ± 9.36 years and 56.7% were male (P > 0.05). The mean value of pain score was significantly reduced in the TA group (5.36 ± 1.29 vs. 2.20 ± 2.02) compared with the placebo group (5.34 ± 0.78 vs. 4.69 ± 0.77) during 4 weeks (P < 0.001); repeated measures ANOVA analysis showed that the mean value of grade mucositis was significantly reduced in the TA group (2.40 ± 0.49 vs. 0.96 ± 0.81) compared with the placebo group (2.36 ± 0.80 vs. 1.86 ± 0.93) during 4 weeks (P < 0.001). TA film could be considered as an effective approach for reducing the mucositis grading and pain score in the patients with OM.

Generalized anxiety disorder (GAD) is a common disorder in infertile people. The aim of this study was the identification of associated risk factors for the severity of GAD in infertile people using an ordinal model with a flexible link function. This cross‑sectional study was conducted on 1146 individuals with a couple’s infertility problem selected from an infertility center in Tehran, Iran. Data collected using self‑administered questionnaires include demographic/clinical information and GAD‑7. We used a Bayesian‑ordered symmetric power logit (splogit) model to identify the risk factors for the severity of GAD. Furthermore, we implemented standard ordinal models to compare with the ordered splogit model. Female gender (B coefficient 0.48, 95% credible interval [CrI]: 0.34–0.62), longer duration of infertility (B coefficient 0.03, 95% CrI: 0.01–0.04), previous treatment failure (B coefficient 0.17, 95% CrI: 0.03–0.30), and self‑cause of infertility (B coefficient 0.12, 95% CrI: 0.01–0.23) were associated factors with the severity of GAD. The splogit model had a better fit and performance to determine the associated risk factor for the severity of GAD as compared to standard models. It provided more precise estimates of risk factors and one more significant risk factor. Infertile people with female gender, longer duration of infertility, failure in previous treatments, and self‑cause infertility are more likely to experience higher severity levels of GAD and require additional psychological, and support interventions. Furthermore, it can be argued that the ordinal splogit model is more powerful to identify the associated risk factors for the severity of GAD.

Diabetes mellitus (DM), named Ziabites in Persian medicine (PM), was categorized as hot or cold Ziabites according to the Mizaj of patients. This study aimed to compare the Mizaj of patients with newly diagnosed type 1 DM (T1DM) with chronic cases and healthy children. In a case–control study, three groups including chronic T1DM patients (n = 31), newly diagnosed T1DM patients (n = 37), and healthy children as the control group (n = 80) were recruited. Mojahedi Mizaj Questionnaire was used to measure two subscales, hot/cold and wet/dry, of Mizaj for participants. The mean scores of the Mizaj subscales were compared between the groups. Cutoff values were determined using receiver operating characteristic analysis, and the corresponding odds ratio (OR) for each subscale was identified. Overall 148 participants, with a mean age of 10.0 ± 6.2 years, were enrolled in the study. Analysis showed that the mean total heat and total dryness scores were significantly higher in new T1DM than that of chronic patients and healthy children (19.59 ± 1.7 vs. 16.6 ± 2.1 and 18.17 ± 1.9, P < 0.001 for hot/cold and 4.70 ± 1.0 vs. 4.09 ± 0.9 and 4.31±0.8, P = 0.02 for wet/dry). “Extra heat” based on the cutoff value of >18.5 was found to be a risk factor for T1DM (OR = 3.62, 95% confidence interval = 1.52–8.63). New T1DM patients have higher frequency of hot and dry Mizaj, which is consistent with the concept of hot Ziabites in PM. Most importantly, we found that “extra heat” in children can be considered as a risk factor for T1DM.

Migraine is a common disorder which affects quality of life. There has been an increasing interest for discovering the association of gastrointestinal (GI) disorders with migraine during past years. This study aims to evaluate the association of Helicobacter pylori contamination, gastroesophageal reflux disease (GERD), gastric ulcer (GU), and duodenal ulcer (DU) with migraine in patients who underwent upper GI endoscopy due to refractory dyspepsia. In this observational cross‑sectional study, 341 dyspeptic patients who underwent upper GI endoscopy in Shahid Beheshti Hospital, Qom, Iran, included during 2016–2018. A checklist was used for collecting demographics, symptoms, and results from endoscopy and H. pylori testing. Diagnosis of migraine was made according to the International Headache Society criteria in patients who had headache. Data were analyzed using Chi‑square and independent samples t‑tests in SPSS 16 (SPSS Inc., Chicago, IL, USA) with P < 0.05 as significance level. Among 341 patients, 141 (% 41.3) were male and 200 (58.7%) were female. 149 (43.7%) patients were diagnosed with migraine, from which 48 (32.2%) were male and 101 (67.8%) were female. The observed difference in migraine prevalence among male and female was statistically significant (P = 0.003). 198 (58.06%) patients were H. pylori contaminated, among these 138 (69.7%) suffered from migraine. Among 143 H. pylori‑negative patients, there were 11 (7.7%) migraineurs. The difference in the prevalence of migraine among H. pylori positive and negative patients was significant. H. pylori and GERD were associated with migraine with P < 0.001. Patients with DU were more commonly suffering from migraine (P = 0.001). The association in patients with GU was not statistically significant (P = 0.863). Migraine might be associated with GERD, H. pylori infection, and DU, and the treatment of the underlying GI disorder may control headaches.

The basic reproduction number (R0) has a key role in epidemics and can be utilized for preventing epidemics. In this study, different methods are used for estimating R0’s and their vaccination coverage to find the formula with the best performance. We estimated R0 for cumulative cases count data from April 18 to July 6, 2009 and 35-2017 to 34-2018 weeks in Canada: maximum likelihood (ML), exponential growth rate (EG), time‑dependent reproduction numbers (TD), attack rate (AR), gamma‑distributed generation time (GT), and the final size of the epidemic. Gamma distribution with mean and standard deviation 3.6 ± 1.4 is used as GT. The AR method obtained a R0 (95% confidence interval [CI]) value of 1.116 (1.1163, 1.1165) and an EG (95%CI) value of 1.46 (1.41, 1.52). The R0 (95%CI) estimate was 1.42 (1.27, 1.57) for the obtained ML, 1.71 (1.12, 2.03) for the obtained TD, 1.49 (1.0, 1.97) for the gamma‑distributed GT, and 1.00 (0.91, 1.09) for the final size of the epidemic. The minimum and maximum vaccination coverage were related to AR and TD methods, respectively, where the TD method has minimum mean squared error (MSE). Finally, the R0 (95%CI) for 2018 data was 1.52 (1.11, 1.94) by TD method, and vaccination coverage was estimated as 34.2%. For the purposes of our study, the estimation of TD was the most useful tool for computing the R0, because it has the minimum MSE. The estimation R0 > 1 indicating that the epidemic has occurred. Thus, it is required to vaccinate at least 41.5% to prevent and control the next epidemic.

Advances in the technology for percutaneous coronary angioplasty, such as coated stents, have reduced its complications, but restenosis remains an important clinical problem. The factors associated with an increased risk of restenosis include diabetes mellitus and multiple coronary artery disease. It is also possible that genetic factors play a role in restenosis although there are little data on this. We have investigated the association of three genetic markers of genes involved in inflammation leading to restenosis. In this case–control study, 306 unrelated Iranian patients who were thought to have restenosis on clinical grounds were investigated. Based on the results of angiography, 104 patients were found to have >50% stenosis within an implanted stent, and these were allocated to the in‑stent restenosis (ISR) group; 202 patients with no in‑stent stenosis or stenosis ≤50% were allocated to the non‑ISR (NISR) group. Demographic data were collected from medical records. Biochemical parameters were measured using routine methods. Genotypes of the interleukin‑10 (IL‑10), annexin A5 (AnxA5), and tumor necrosis factor‑alpha (TNFα) loci were determined using real‑time polymerase chain reaction and a high‑resolution melting assay. Fasting blood glucose, serum triglycerides, and serum high‑sensitivity C‑reactive protein (hs‑CRP) concentrations were higher in the ISR group than in the NISR group (P < 0.05), and a history of diabetes mellitus was significantly related to the presence of restenosis (P < 0.001). There were no significant differences in the frequency of the genetic polymorphisms of IL‑10, AnxA5, and TNFα genes and the presence of ISR. After adjustment for clinical variables, the genetic polymorphisms at the IL‑10, TNFα, and ANXA5 gene loci do not appear to be risk factors for >50% ISR in our population. However, our data suggested a significant association between diabetes mellitus, serum hs‑CRP, stent type, and restenosis.