Journal of Research in Medical Sciences
Volume:16 Issue: 1, Jan 2011

The efficacy of Mycophenolate mofetil (MMF) plus interferon beta-1a (IFNB-1a) in treatment of relapsing-remitting multiple sclerosis (RRMS) was evaluated. This was a pilot study with randomized, double-blinded, placebo-controlled design. Patients with RRMS and Expanded Disability Status Scale score (EDSS) of < 6.0 were included. Those with relapse within the previous two months and prior use of immunomodulatory/immunosuppressive drugs were excluded. Patients were randomized into MMF (n = 13) and placebo (n = 13) groups and received weekly intramuscular IFNB-1a plus either MMF or placebo. MMF started by 500 mg/d for one week and weekly escalated by 500 mg/d, until target divided dose of 2000 mg/d and continued for 12 months. Radiologic and clinical assessments were performed at baseline and then at month 12. After one year of therapy, difference between the two groups in number of new T2 lesions was not statistically significant (0.54 ± 0.77 in MMF vs. 1.85 ± 3.2 in placebo group, p = 0.169). Two patients in the placebo group had gadolinium-enhanced lesions and one patient had relapse. There were 3 patients in each group with more than one point progression in EDSS. Common side effect in the MMF group included gastrointestinal upset, but no patient discontinued the treatment. Combination of MMF with IFNB-1a in patients with RRMS is well tolerated, but the efficacy of such combination was not statistically significant in this pilot study and deserves further investigation with a larger sample size and a longer follow-up.

Ulcerative colitis (UC) is a disabling disease with increasing incidence in Iran. In spite of combined medical therapy, some patients eventually undergo total colectomy. Infliximab has proved itself as a rescue therapy and even as an early aggressive therapy for severe extensive UC. Meantime, there are concerns about its complications. The aim of this study was to evaluate the efficacy of infliximab in Iranian refractory UC patients. This multi centric case-series study included 29 UC patients receiving two to three of the drugs prednisolone, AZT/6MP and 5ASA but yet having flare-ups. At first, the extent of colon involvement was determined by colonoscopy; then the drug was administered at baseline, 2nd week and 6th week and colonoscopy repeated afterwards. Clinical and laboratory data were also recorded. In first endoscopy 18 patients (62%) out of 29 suffered from pancolitis and none had normal results. In second examination (done on 19 patients), one was normal and only 8 of 18 (27.6%) had pancolitis. Considering missing cases, at least in 33.3% of patients the drug has reduced the extreme extent of colon involvement. Also a wilcoxon signed ranks test revealed significant reduction of the disease extension after this treatment (p = 0.008). There were only one leucopenic and one hypotensive reactions in short term. The drug showed effectiveness in the term of disease modifying, too. These data show the usefulness of the drug in refractory UC. Longer follow ups and controlled trials are needed.

Adverse Drug Reactions (ADRs) constitute an enormous burden for the society. The aim of the present study was to detect, document, assess and report the suspected ADRs and preparation of guidelines to minimize the incidence of ADRs. A prospective-observational study was conducted in the Department of General Medicine of a tertiary care hospital for 12 months from April 2008 to March 2009. Detected and suspected ADRs were analyzed for causality, severity and preventability using appropriate validated scales and were reported. ADR alert card was prepared and given to patients. Therapeutic guidelines were prepared and given to the relevant departments. A total of 57 ADRs were detected, documented, assessed and reported during the study period the incidence was found to be 1.8%. Assessment of severity of the suspected ADRs revealed that 12% of suspected ADRs were severe and 49% of ADRs were moderate in severity. Causality assessment was done which revealed 63% of ADRs were possibly drug-related. The majority of patients who had suffered from ADRs were above 60 years (56%). Gastrointestinal system was most commonly affected (37%) and the drug class mostly associated with ADRs was antibiotics (23%). Preventability of ADRs was assessed; and the results revealed that 28% of ADRs were definitely preventable. Measures to improve detection and reporting of adverse drug reactions by all health care professionals is recommended to be undertaken, to ensure, and improve patient's safety. In this way, hospital/clinical pharmacists play the cornerstone role.

There are increasing evidences of endothelial dysfunction in migraine. The ACE-inhibitors have previously been shown to be effective in migraine prophylaxis. Furthermore, ACE inhibitors have beneficial effects on endothelial dysfunction. We therefore investigated whether Enalapril is effective in endothelial function improvement. In this randomized clinical trial, 10 mg Enalapril daily was compared with matched placebo in 40 patients with migraine for two months. Flow Mediated Dilation (FMD), serum total nitrite and C-reactive protein (CRP) were measured in all patients at the baseline and after 2 months. Patient's FMD increased in the case group after treatment with Enalapril (p = 0.002) while there was no significant change in control group. Total nitrite concentration increased in case group (p = 0.000), while there was no significant difference before treatment. There was no significant difference in the CRP concentrations in two groups. These results indicate that ACE inhibition can improve endothelial function in patients with migraine, as it has been shown by both FMD and serum levels of nitric oxide. The mechanism could be either that Enalapril limits the angiotensin II-induced production of superoxide radicals which would normally inactivate nitric oxide, or that it may increase bradykinin-mediated nitric oxide release.

Despite the high prevalence and morbidity, tinnitus still remains an obscure symptom. We assessed the efficacy of low-level laser for treatment of tinnitus. It was a self controlled clinical trial study on 61 outpatients with subjective tinnitus. The patients were irradiated with a 650-nm, 5-mW soft laser for twenty days and twenty minutes per day. The sensation of tinnitus was measured on a Visual Analog Scale (VAS) before and two weeks after treatment and they were compared by means of Wilcoxon signed rank-test. Thirty-eight (62.3%) patients were men and twenty-three (37.7%) were women. Fourteen patients (31.8%) worked in noisy environment. The VAS mean difference before and after the treatment was statistically significant (p < 0.0001). The best treatment effect was in the youngest group and there were significant differences between this group and the middle age and older groups (p = 0.018 and 0.001, respectively). The mean VAS score reduction was not statistically significant between male and female patients (p = 0.23). Also, the treatment outcome according to the noise level in patient’s workplaces was not significantly different in women (p = 0.693), but it was significant in men (p = 0.029). Transmeatal low-level laser irradiation is effective for the treatment of tinnitus and some variables like age and job can affect the treatment outcome.

Preoperative anxiety has become more frequent in preoperative patients and can bring negative impact on operation outcomes. Many studies have reported the effect of body acupuncture in reducing anxiety syndromes. The aim of this study is to compare the treatment effect of body acupuncture and auricular acupuncture in preoperative patients with preoperative anxiety. Thirty five elective ambulatory surgery patients were selected in the randomized and blinded trial. Subjects were randomly categorized in two intervention groups, the body acupuncture group who received acupuncture in the special points of body, and the auricular acupuncture group who received ear acupuncture. Zung Self-Rating Anxiety Scale (SAS) was used before and after the study. For the auricular acupuncture group, the mean score of SAS was 57.57 ± 8.22 before the intervention and 46.32 ± 6.37 afterward. For the body acupuncture group, the SAS score was 55.39 ± 5.41 and 44.82 ± 6.76 before and after the intervention, respectively. For both groups, the difference between pre- and post-treatment scores reached the significant level (p = 0.00). Both auricular and body acupuncture treatment methods were effective in decreasing anxiety in preoperative patients.

This study was conducted to evaluate the effect of a clinical pharmacist-led patient education program for type 2 diabetic patients at Isfahan Endocrine & Metabolism Research Center (IEMRC) from April 2008 to January 2009. In a randomized controlled clinical trial, a total of 172 patients with uncontrolled type 2 diabetes were selected and randomly allocated into control and intervention groups. After taking informed written consent, the intervention group received an educational program about oral anti-hyperglycemic medications, adherence, diabetes dairy log and pill box usage. Patient's glycemic control in the intervention group was followed for three months through either telephone or face to face interviews with the pharmacist. Fasting blood glucose and HbA1c were measured at the start and end of the pharmacist-led drug education program for both intervention and control groups. After a three months follow-up, mean fasting blood glucose and HbA1c of the patients in the intervention group decreased significantly compared to control group (p < 0.001). This study demonstrates an improvement in diabetes management of type 2 diabetics by involving a pharmacist in the multidisciplinary teams in the outpatient clinics. The results suggest the benefits of adding adherence education to the diabetic education programs.

Colorectal cancer as a mortal disease affected both sexes of all ethnic and racial human groups. Former studies have indicated some mutations in the mitochondrial DNA (mtDNA) in different human cancers. Complex I NADH has the most subunits encoded by mtDNA. For a better understanding of the mtDNA abnormality in colorectal cancer some genes of this complex is screened for existence of mutations. One of the main regions of the mtDNA encoding protein was screened by PCR-RFLP followed by DNA sequencing. The obtained sequences were aligned with the revised Cambridge Reference Sequence (rCRS). Each alteration recorded as single nucleotide polymorphisms (SNPs), deletions or insertions. Eight mutations were found in 15 samples out of 30 studied populations and no mutation detected in other 15 samples. Among these 15 mutated samples, 7 different mutations were found in 7 patients, that means one mutation per patient and the 8th mutation (T4216C) was common in the rest of 8 samples; in other words T4216C mutation in 27% of tested samples was identified (8 patients out of 30 patients). The existence of T4216C mutation was found to be significantly different (p ≤ 0.05) between tumoral patient's tissue and adjacent normal tissue. Results showed that a high frequency of somatic alterations of mtDNA occurs during the carcinogenesis and/or the progression of colorectal cancer. Based on the mtDNA mutation pattern observed in this study and other previously studies it is believed that looking for somatic mutations in mtDNA would be one of the diagnostic values in early detection of cancer.

Bipolar I Disorder (BID) considered as the sixth leading cause of disability worldwide. After remission of a manic episode, most of patients spend about 50% of the following time with mood or cognitive symptoms. The aim of this study was to investigate the 6-month outcome of BID patients following their single manic episode. Adult bipolar patients (n = 13) with single manic episode admitted to Noor Hospital, Isfahan, Iran, from December 6 2008 to June 5 2009 were evaluated using diagnostic, symptomatic, and functional assessments. Patients were also evaluated monthly for six months to assess syndromic, symptomatic, and functional outcomes, self reported treatment adherence, and serum levels of major mood stabilizers. The Kaplan-Meier method and log-rank test at a significance level of < 0.05 were used. Kaplan-Meier estimates of the cumulative probabilities of syndromal, symptomatic, and functional recovery during the first 6 months after admission for single manic episode were 0.89, 0.75, and 0.64, respectively. At the 3rd month 54% of BID patients reported full medication adherence while it decreased to 38% at the 6th month. Patients with full adherence revealed shortened time to functional recovery based on LIFE-RIFT compared with non-adherent patients (log rank: χ2 = 4.5, df = 1, p = 0.03). Substance abuse also associated with longer time to functional recovery based on LIFE-RIFT (log rank: χ2 = 4.36, p = 0.037). Despite high rates of experienced syndromic and symptomatic recoveries for BID patients in single manic episode, functional recovery was much lower following hospitalization.

Because the effects of cricoid pressure (CP) on BIS values have not been evaluated, this prospective study was designed to assess the BIS values after application of CP in adult patients during the routine induction of general anesthesia. We randomly allocated 70 patients (ASA-I) aged 18-64 years, listed for elective surgery into two groups of cricoid (CP) and non-cricoid (nCP). In the cricoid group, bimanual cricoid pressure was performed after the induction of anesthesia and in the nCP group, simple placement of hands without exerting pressure was performed. Arterial blood pressure, heart rate and BIS were measured and recorded immediately before and after application of cricoid pressure, before laryngoscopy and intubation and then every one minute after intubation until 4 minutes. The data were compared between and within groups using the mixed-design analysis of variance. One minute after application of cricoid pressure and before laryngoscopy, BIS showed significantly higher value compared with the nCP group. Furthermore, one min after intubation, BIS values and arterial blood pressure increased significantly in both groups compared with the baseline values, but the increase in BIS value was more significant in CP group than nCP group. Moreover, BIS values increased significantly 2 minutes after intubation in CP group compared with nCP group. It was concluded that the application of CP in combination with laryngoscopy and intubation increases the BIS values, which show the inadequacy of anesthesia and hypnosis during the routine induction of anesthesia.

Levobupivacaine 0.5% and bupivacaine 0.5% were shown to be equally effective in spinal anaesthesia. In previous studies, low dose bupivacaine with an intrathecal opioid was used successfully in urological surgery. The aim of this study was to evaluate the clinical effectiveness and block quality of low dose levobupivacaine, and compare it with low dose bupivacaine when they are combined with fentanyl in transurethral resection of prostate surgery. Forty nine patients undergoing transurethral prostate surgery were enrolled in this prospective, randomized and double blind study. Patients in levobupivacaine group received 5 mg levobupivacaine + 25 µg fentanyl and bupivacaine group received 5 mg bupivacaine + 25 µg fentanyl. Demographic data, surgery times, hemodynamic parameters, block qualities and patient and surgeon satisfactions were recorded. Demographic data, surgery times and patient and surgeon satisfactions were similar in both groups. Hemodynamic parameters were comparable and stable during the procedure in both groups. Sensory block characteristics were comparable and clinically effective in both groups. While 3 patients in bupivacaine group had Bromage score of 3 at the beginning of the surgery, no patient in levobupivacaine group had this score and this difference was significant (p = 0.042). Bromage scores at the end of the surgery were comparable in both groups. In conclusion, for transurethral prostate surgery 5 mg levobupivacaine with 25 µg fentanyl can provide stable hemodynamic profile, patient and surgeon satisfaction and effective sensorial blockade with less motor blockade in spinal anaesthesia; so it could be used at low doses as a good alternative to bupivacaine.

Recurrence of nasal polyposis following surgical intervention is very common. Antifungal therapy has been an appealing alternative to reduce its recurrence and severity. Early studies showed definite positive response, but recent studies have raised doubts about its efficacy in treatment of polyposis. This prospective case-control clinical trial was conducted on 50 patients suffering from nasal polyposis in Isfahan university of medical sciences. All patients underwent functional endoscopic sinus surgery. CT scanning of paranasal sinuses was done preoperatively and 6 months postoperatively to stage the disease. Patients were assigned to two groups: amphotericine B group were instructed to irrigate the nasal cavity with a solution of amphotericine B, while the normal saline group used the physiologic normal saline for 6 months. 68% of patients in Normal saline and 84% of cases in amphotericine B group reported history of allergies. In amphotericine B group, stage of the disease improved in 84% of patients and remained unchanged in the rest. In normal saline group, imaging stage improved in 22 patients and remained unchanged in 3. The two cohorts were compared for reduction in imaging stage and no significant difference was found between them. This study showed no benefits for topical amphotericin B solution over normal saline. It might be better to retreat to the traditional normal saline nasal douching following functional endoscopic sinus surgery in the treatment of polyposis.

Although many studies have investigated the relationship between perfectionism, anxiety, and depression among the adults, little is known about the manifestations of perfectionism among school-age youths. This study has investigated this relationship in an Iranian sample. Using multistage cluster random sampling, 793 Iranian school students in 2007 were studied. Data of demographic characteristics, children's depression inventory, revised children's manifest anxiety scale, and the positive and negative perfectionism scales were obtained using questionnaires. The results indicated that both aspects of perfectionism are associated with depression and anxiety. Negative and positive perfectionism have positive and negative associations, respectively, with depression and anxiety. The interaction of anxiety and depression with perfectionism reveals that depression is in association with lower scores of positive perfectionism, whereas in students with higher scores of negative perfectionism, the anxiety scores are also higher. Moreover, the accompaniment of anxiety with depression is in association with relatively lower levels of negative perfectionism. It was concluded that negative perfectionism is a risk factor for both depression and anxiety, while positive perfectionism is a protective factor. However, the interventions which encourage the positive aspects of perfectionism and decrease its negative aspects may be able to diminish psychopathological subsequence.

In cirrhotic patients peripheral vasodilatation may decrease renal blood flow and subsequently raises plasma renin activity. Octreotide with several mechanisms causes peripheral arterial vasoconstriction. Midodrine is an alpha agonist and acts as a peripheral vasoconstrictor; therefore it may reduce plasma renin activity and improve renal function. In this study the effects of these two agents were compared on cirrhotic patients to determine their ability to reduce plasma renin activity and increase GFR. This study was a randomized clinical trial and was performed in Al-Zahra hospital in 2008-2009; 34 patients with CHILD C cirrhosis enrolled in this study. They were randomly divided into two groups. First group were treated by 3 days of subcutaneous octreotide 50 µg tid (n = 17). For the second group oral midodrine 7.5 mg tid was administrated for 3 days. Plasma renin activity, blood pressure, glomerular filtration rate, and body weight were measured and compared before and after therapy in both groups. In both groups, plasma rennin activity decreased significantly after treatment. The present study showed that both midodrine and octreotide can reduce plasma renin activity but midodrine can reduce PRA and increase GFR more potently than octreotide. Midodrine has a favorable hemodynamic effect in nonazotemic cirrhotic patients by decreasing plasma renin activity and increasing GFR.

Cytokines have been suggested to participate in the pathogenesis of infectious mononucleosis (IM) and nasopharyngeal carcinoma (NPC). Serum levels and gene expression of interleukin-4 (IL-4) and interferon-γ (IFN-γ) were assessed by immunologic and PCR assays, respectively in patients with Epstein-Barr virus (EBV)-associated IM and NPC and EBV negative controls. The serum levels of IFN- γ were elevated, but those of IL-4 were decreased in IM and NPC patients as compared with those of the control group (p < 0.05). These results suggest that serum levels of IFN-γ may be predominant over those of IL-4 during the course of IM and NPC.

This study is aimed to examine the appropriacy of school furniture to Iranian pupil's anthropometric features. The participants in this cross-sectional study were 493 boys and 489 girls with the age-range of 7 to 12 years who were selected through a multistage random cluster sampling procedure. Age, weight, height, and anthropometric dimensions were determined. This study indicates that there is a significant difference between the minimum and maximum acceptable dimensions and those of the available furniture (p < 0.001). In designing suitable furniture for pupils the anthropometric differences of age and gender must be taken into account.

Cantrell's pentalogy (CP), a rare congenital malformation, consists of the supraumbilical abdominal wall defect, the sterna lower part defect and agenesis of the anterior portion of the diaphragm, an absence of the diaphragmatic part of the pericardium, and a malformation of cardia. This case report presents a female neonate, who was born at 32 weeks of conception, weighing 1300 g and was admitted one hour after delivery. She had the five anatomical defects known for Cantrell's Pentalogy. Moreover, autopsy revealed a bilateral cleft lip and palate, a patent ductus arteriosus, and an atrial and ventricular septal defect.

The classification, clinical and electrophysiological characteristics, treatment outcome and pathogenesis of paroxysmal dyskinesia were summarized and analyzed. Paroxysmal dyskinesia was classified into three types. Different types had different incentives in clinical practice. Patients were mostly male adolescents, and the attacks, which were in various forms, manifested as dysmyotonia of choreoathetosis, body torsion and facemaking; no disturbance of consciousness during attacks. Electroencephalogram and other examinations showed no specific abnormalities during both the attacks and interictal period. Paroxysmal dyskinesia was an independent disease and different from epilepsy.

A middle aged woman, having a history of diastolic hypertension and sinus bradycardia since one year ago, was referred to our center with a sudden occipital headache after shouting. To evaluate the cause of headache the brain MRI was performed reporting a slight cerebellar tonsillar herniation of about one centimeter below the foramen magnum. After the patient was diagnosed to have type I Chiari malformation, a surgery procedure was done and the symptoms were recovered after that.Type I Chiari malformation is a disease mostly caused by congenital displacement of cerebellar tonsils through the foramen magnum. The most common symptom is headache, rarely reported with hypertension or sinus bradycardia.

During the spring of 2009, a new influenza A (H1N1) virus caused human acute respiratory illness first in Mexico.1 The Iranian Ministry of Health (MoH) launched a system to monitor and report the presence of this new virus throughout the country on May 10, 2009. Here we report the first confirmed cases of influenza A (H1N1) virus that were identified from July through October 2009 in Isfahan, the second important province in Iran. In a laboratory-based reporting system, the Provincial Health Centers were supplied by the MoH with case definition and patient information forms to be disseminated to all health care institutions in their province. Any person who fulfilled the case definition criteria 2 was directed to designated health facilities. The nasopharyngeal samples were sent to the National Influenza Reference Laboratory at Tehran school of Public Health in a viral transport medium (virocult, Medical wire & Equipment, UK) and were tested with the real time RT-PCR protocol and reagents supplied by the WHO. A total of 376 samples were taken from suspected cases. Fifty from these samples were positive. The first confirmed case had traveled to Mecca (Saudi Arabia) and had already become symptomatic while staying there. The median age was 27 years (range: 10-75 years). Most travel-associated cases were returning travelers from Saudi Arabia (55.2%); followed by Malaysia (17.24%). Fever was the most common symptom, presented in 95.9% of the cases, followed by cough (85.7%) and myalgia (77.5%). Influenza A (H1N1) virus entered Isfahan through travelers, mainly coming from Saudi Arabia.3 The majority of the confirmed cases consisted of young adults and they mainly manifested clinical symptoms similar to those reported in other areas.4 Since many patients with influenza like symptoms may not visit the physicians, it is possible that the cases have been under diagnosed.