Journal of Research in Medical Sciences
Volume:29 Issue: 3, Mar 2024

Demoralization is a syndrome of existential distress and despair in patients with cancer and other severe medical illnesses. The Demoralization Scale (DS?II) is self?administered and contains 16 items, and it has two factors: meaning and purpose and distress and coping ability.

Women with breast cancer (240) completed the scales DS?II, positive and negative affect, state hope, patient health, and quality of life. Confirmatory factor analysis (CFA) and divergent and convergent validity were used to measure the construct validity of DS?II. CFA was chosen to check the fit of the two?factor model. Divergent and convergent validity were investigated using Pearson’s correlation test. The  eliability of DS?II was evaluated by the internal consistency method. Cronbach’s alpha was used to calcul te the internal consistency of the DS?II.

The Cronbach’s alpha coefficient for the subscales of meaning and purpose, distress and coping ability, and the total score was obtained: 0.67, 0.72, and 0.81, respectively, indicated this scale’s good reliability. Furthermore, the Pearson  correlation coefficient results showed the appropriate convergent validity and good divergent validity of the DS?II.

The DS?II has sound psychometric properties and can be recommended as a reliable tool for assessing demoralization in women with breast cancer.

This guideline is the first Iranian guideline developed for the diagnosis, management, and treatment of hyperlipidemia in adults. The members of the guideline developing group (GDG) selected 9 relevant clinical questions and provided recommendations or suggestions to answer them based on the latest scientific evidence. Recommendations include the low?density lipoprotein cholesterol (LDL?C) threshold for starting drug treatment in adults lacking comorbidities was determined to be over 190 mg/dL and the triglyceride (TG) threshold had to be >500 mg/dl. In addition to perform fasting lipid profile tests at the beginning and continuation of treatment, while it was suggested to perform cardiovascular diseases (CVDs) risk assessment using valid Iranian models. Some recommendations were also provided on lifestyle modification as the first therapeutic intervention. Statins were recommended as the first line of drug treatment to reduce LDL?C, and if its level was high despite the maximum allowed or maximum tolerated drug treatment, combined treatment with ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors, or bile acid sequestrants was suggested. In adults with hypertriglyceridemia, pharmacotherapy with statin or fibrate was recommended. The target of drug therapy in adults with increased LDL?C without comorbidities and risk factors was considered an LDL?C level of <130 mg/dl, and in adults with increased TG without comorbidities and risk factors, TG levels of <200 mg/dl. In this guideline, specific recommendations and suggestions were provided for the subgroups of the general population, such as those with CVD, stroke, diabetes, chronic kidney disease, elderly, and women.

Oral mucositis is one of the main complications of radiotherapy (RT) while treating head?and?neck cancers and can affect the patients’ treatment process and life. Therefore, this study evaluated the effect of Aloe vera on the prevention and treatment of radiotherapy?induced oral mucositis (RIOM) in patients with head?and?neck cancer.

This was a double?blind clinical trial performed in 2019 on 75 patients with head?and?neck cancer. Patients were randomly assigned totwo groups receiving gargles of 5 cc Aloe vera and the same dose of placebo mouthwash three times a day, respectively. Then, the incidence and severity of RIOM were evaluated and compared between the two groups over 6 weeks of RT.

There was no significant difference between the two groups in terms of the severity of RIOM from the 1st to 3rd weeks of RT (P > 0.05). However, the severity of RIOM in the 4th, 5th, and 6th weeks of RT was significantly lower in the Aloe vera group compared with the placebo group (P < 0.05).

According to the results of the present study, the long?term use of Aloe vera mouthwash can reduce the severity of RIOM.

The objective is to evaluate the prevalence of acute kidney injury (AKI) as an early complication of the percutaneous nephrolithotomy (PCNL) procedure.

From May 2022 to October 2022, we conducted a retrospective study on patients undergoing PCNL procedures in two of the tertiary medical centers affiliated with Isfahan University of Medical Sciences. Patients’ baseline characteristics, laboratory values, perioperative data, and stone features were documented. AKI was defined either as a ?0.3 mg/dL increase in the serum creatinine level within 2 days, or a ?1.5?fold increase in baseline serum creatinine level within 7 days after the operation. Laboratory values were measured 1 day before PCNL and daily thereafter until discharge. Patients were followed 1 week later to detect all of the possible cases of AKI.

The final analysis was performed on 347 individuals. AKI developed in 16 (4.61%) cases. The two groups were comparable regarding age (P = 0.887), gender (P = 0.566), and underlying comorbidities including diabetes mellitus (P = 0.577) and hypertension (P = 0.383). The mean body mass index (BMI) (P < 0.001) and both frequency and severity of hydronephrosis (P < 0.001) were significantly different. A higher mean PCNL duration (P < 0.001), period of hospitalization (P < 0.001), and blood loss volume (P < 0.001) were observed in those who developed AKI. Overall, 56.3% (9) of patients in the AKI group and 2.7% (9) in the non?AKI group required the establishment of more than one access tract, during the procedure (P < 0.001). A lower preoperative hemoglobin level was observed in the AKI group (P < 0.001). Those with AKI had significantly larger stones (3.08 ± 0.46 vs. 2.41 ± 0.23 cm, P < 0.001) and higher Hounsfield units (P < 0.001). In addition, in the AKI group, most of the calculi (81.3%, 13) were of staghorn type, whereas in the non?AKI group, calculi were most frequently located in the middle calyx (30.2%, 100), (P < 0.001).

The prevalence of post?PCNL AKI is approximately 4.61%. The mean BMI, preoperative hemoglobin level, PCNL duration, intraoperative blood loss volume, and hospitalization period were significantly higher among patients who developed AKI. Those with AKI had significantly larger stones with higher Hounsfield units and more frequently of staghorn type. The two groups were not statistically different regarding age, gender, and presence of comorbidities (hypertension and diabetes mellitus).

This study aims to estimate the risk factors of gastrointestinal (GI) bleeding in patients with acute coronary syndrome (ACS) and to evaluate the optimal duration of dual antiplatelet therapy (DAPT).

We enrolled 1266 patients with ACS in a telephone follow?up program to determine whether any of the patients were hospitalized for GI bleeding. We collected baseline data, laboratory tests, electrocardiograms, and echocardiography covering all ACS patients. Multivariable regression was performed to adjust for confounders and predictors of GI bleeding. At the same time, the optimal duration of DAPT for ACS patients was evaluated.

A total of 1061 ACS patients were included in the study. After 13–68 months, 48 patients (4.5%) were hospitalized for GI bleeding. The risk of GI bleeding was significantly increased in patients treated with DAPT for more than 18 months (hazard ratio 12.792, 5.607–29.185, P < 0.01). Receiver Operating Characteristic curve showed that the duration of DAPT using a cutoff of 14.5  months resulted in a sensitivity of 66.7% and a specificity of 77%.

In patients with ACS, DAPT time are the main risk factors of GI bleeding. The optimal duration of DAPT is 14.5 months.

Type 2 diabetes mellitus (T2DM) is prone to opportunistic infections, including toxoplasmosis, due to an immunodeficiency system. This study aimed to evaluate the serum of people with T2DM to determine the titer of anti?toxoplasmaantibodies in patients and compare it with the control group.

720 blood samples have been carried out between October and the end of January 2017 in Sistan, and Baluchestan provinces in southeastern Iran, of these, 360 samples were related to healthy individuals (control), and 360 samples were related to T2DM individuals. The immunoglobulin (Ig) M and IgG enzyme?linked immunosorbent assay methods have been used to detect toxoplasmosis. The data were analyzed using SPSS?19,Chi?square, and Fisher’s exact test to compare statistical parameters.

In this cross?sectional study, out of 360 samples of T2DMby ELISA method, 60% samples in diabetic patients and 48.1% in control group were IgG positive (P < 0.05). Nearly 2.5% samples in diabetic patients and 0.3% in control group were IgM positive (P < 0.05).

Anti?toxoplasma antibodies including IgG and IgM were higher in diabetic patient in comparison to control group.

Zinc is vital for cellular functions, but kidney failure increases zinc deficiency risk. We compared zinc levels in hemodialysis (HD) and peritoneal dialysis (PD) patients in Isfahan, Iran.

A retrospective study included150 patients (75 PD and 75 HD). Serum zinc levels were assessed through  photometry. Statistical analysis employed Chi?square, independent t?test, and correlation.

Serum zinc was below normal in both groups (P < 0.01). HD patients had lower zinc levels (70.85 ± 7.68 mg/dL) compared to PD (75.04 ± 13.55 mg/dL, P = 0.021), remaining significant after adjusting for confounders (P = 0.011).

Zinc levels in PD and HD patients are lower than in the general population, with HD patients having lower levels than PD patients.