Journal of Research in Medical Sciences
Volume:16 Issue: 6, Jun 2011

Adiponectin is an adipocyte secreted protein with important biological functions. Hypoadiponectinemia is associated with obesity, insulin resistance, and type II diabetes. This study aimed to evaluate serum adiponectin level in obese subjects with type II diabetes and its correlation with metabolic parameters. This cross-sectional study was performed on 40 obese subjects with type II diabetes and 40 non-diabetic obese control subjects. Fasting lipid profile was measured by the enzymatic methods. The NycoCard HbA1c protocol was used to measure HbA1c. The Serum adiponectin, insulin and glucose levels were measured using an enzyme immunoassay and glucose oxidase methods respectively. Type II diabetes was associated with hypoadiponectinemia, in both men and women. Serum adiponectin level in non-diabetic subjects (6.44 ± 2.47 µg/ml) was significantly higher than diabetics (4.55 ± 1.88 µg/ml). Furthermore, serum adiponectin concentration in females was significantly higher than males in non-diabetics (7.18 ± 2.68 vs. 5.61 ± 0.57) and diabetic groups (5.18 ± 2.08 vs. 3.99 ± 1.5). There was a negative and significant correlation between serum adiponectin level with waist (r = -0.451; p = 0.003), waist to hip ratio (r = -0.404; p = 0.01) and BMI (r = - 0.322; p = 0.042) and a positive correlation with HDL (r = 0.337; p = 0.034) in non-diabetic group. In diabetic group, there was only found a negative correlation between adiponectin and waist size (r = -0.317; p = 0.046). Obesity and type II diabetes are associated with low serum adiponectin concentration.

This study examined the effects of health education on modification of health belief and intention among pregnant women to have smoke free home. In this randomized controlled study, 91 pregnant women completed the study in two groups. Intervention group was educated about the harms of environmental tobacco smoke (ETS) exposure. The Health Belief Model (HBM) was a framework for analyzing the beliefs. After 10-12 weeks, the HBM constructs and weekly ETS exposure at home were compared between the two groups. After performing educational program, the subjects in intervention group perceived more susceptibility and severity and reported lower weekly ETS exposure at home than subjects in control group; but, the self efficacy and perceived barrier were not different. The relationships between HBM constructs and weekly ETS exposure were significant; but, there was no significant difference in point prevalence of having smoke free home. This study indicated that the health education about ETS exposure can modify health belief and reduce EST exposure among pregnant women, but cannot affect the self efficacy and perceived barrier. To have smoke free home, they need to increase their self efficacy.

Some experimental studies revealed that exposure to air pollution increases the expression of tissue factor (TF) in atherosclerotic lesions. We aimed to investigate the role of TF +5466A>G (rs3917643) polymorphism in the association of air pollution on serum levels of TF as a biomarker of vascular injury in children. This cross-sectional study was conducted among 110 children, consisting of 58 (52.8%) girls and 52 (47.2%) boys with a mean age of 12.7 + 2.3 years, living in Isfahan, Iran. Enzyme-linked immunosorbent assay were used for measurement of serum TF. Genotype of +5466A>G (rs3917643) polymorphism was determined by the polymerase chain reaction–restriction length fragment polymorphism (PCR–RFLP) method. We identified 2 individuals with +5466AG genotype and 108 homozygous for the +5466A allele (no +5466GG homozygotes). The mean pollution standards index (PSI) value was at moderate level, the mean particular matter measuring up to 10 μm (PM10) was more than twice the normal level. Multiple linear regression analysis showed that after adjustment for confounding factors (weight status, dietary and physical activity pattern), serum TF level had significant relationship with PSI (beta: 0.55, SE: 0.07, P < 0.001) and PM10 (beta: 0.51, SE: 0.03, P = 0.001). In spite of similar genetic polymorphism of TF, air pollutants might have an independent association with systemic inflammatory and coagulation responses. The harmful effects of air pollutants on the first stages of atherosclerosis in the pediatric age group should be underscored in primordial and primary prevention of chronic diseases.

This study evaluated stress management training to improve mental health, social interaction and family function among adolescents of families with one Human Immunodeficiency Virus (HIV) positive member. There were 34 adolescents (13-18 years old) with at least one family member living with HIV from whom finally 15 attended the study and participated in 8 weekly sessions of stress management training. The tests used in this study were: Strengths and Difficulties Questionnaire (self and parent report), General Health Questionnare-28 (GHQ-28) and Family Assessment Device (FAD), conducted before, after and three months after the intervention. The collected data were analyzed by repeated measure test using SPSS software (Version 18.0). Adolescents with one HIV positive family member showed high level of emotional problem (40%) and conduct problem (33.3%). There was a significant difference between before, after and 3months after intervention based on GHQ-28 mean scores and FAD mean sores (p < 0.001). There was a significant difference between mean scores of peers’ relationship based on SDQ (self report and parents report forms) before and after intervention, but there was no significant difference between mean scores of pro social behavior based on SDQ (self report and parents report forms) in all three stages (before, after and three months after intervention). Stress management training is effective in improving mental health, family function and social interaction among adolescents living with parents infected with HIV/AIDS.

Current study addressed the predictive value of 12-lead electrocardiogram (ECG) in patients with suspected coronary artery disease (CAD). Four hundred consecutive patients with new onset of chest pain were studied. A resting standard 12-lead ECG was recorded and all patients underwent coronary angiography. ECG correctly detected significant stenosis in 176 out of 400 patients with an overall sensitivity per patient of 51.5% and specificity per patient of 66.1%. Based on artery analysis, ECG had the highest and lowest sensitivity for the detection of involvement in LAD (37.3%) and RCA (25.8%), respectively. ROC curve analysis showed that ECG changes were not good indicators of coronary arteries involvement with areas under the ROC curves 0.586 (for LAD artery), 0.524 (for RCA artery) and 0.530 (for LCX artery). ECG has low partial sensitivity and specificity for predicting coronary artery stenosis with accuracy ranged 58.5 to 62.0 percent based on coronary artery analysis.

Primary health care system is the basic core of public service provision in Iran. This study aimed to assess clients’ satisfaction with primary health care in Tehran, the capital of Iran, as a metropolitan. Through a cross-sectional study in 2009-10, four urban primary health care clinics were selected through stratified random sampling. Four hundred participants were interviewed in the selected clinics about their satisfaction with the primary health care services and setting. Six domains of satisfaction including accessibility to services, continuity of care, humaneness of staff, comprehensiveness of care, provision of health education and effectiveness of services were calculated from selected variables. The descriptive statistics, chi-square, and t-tests were used when appropriate. The mean (SD) age of users of health services was 31.3 (9.6) years. Thirteen percent of participants were male. The most common reasons for asking health services reported as vaccination, family planning and children care. Overall, primary health care services were suitable for eighty percent of the participants. The mean and standard deviation for Access to services was 2.11 (3.44), continuity of care was -0.35 (3.49), humanness of staff was 3.93 (5.70), comprehensiveness of care was -0.53 (3.66), provision of health educational materials was -1.45 (3.64) and effectiveness of services was 4.30 (7.47). Primary health care is a comprehensive and suitable strategy to provide health services in public health. Package of services in primary health care may affect clients’ satisfaction. Using family doctors may improve the indices.

Polycystic ovary syndrome (PCOS) is associated with metabolic abnormalities which are also parts of metabolic syndrome (MetS). It is debated whether all women with PCOS should be screened for MetS and Insulin resistance (IR), since they may vary in terms of PCOS phenotype, ethnicity and age. This large scale study aimed to determine the prevalence of MetS among Iranian women diagnosed with different phenotypic subgroups of PCOS based on the Rotterdam criteria. This study was conducted from January 2006 to June 2008 in Isfahan, Iran. The study population comprised females diagnosed with PCOS referred to the infertility clinic. The subjects were divided into for subgroups according to different phenotypes of PCOS based on the Rotterdam criteria. They underwent metabolic screening according to NCEP ATP III guidelines and IR screening based on homeostasis model assessment (HOMA) of insulin resistance. The prevalence of MetS and IR were 24.9% and 24.3%, respectively. A significant difference in the prevalence of MetS was documented between anovulatory women having PCOS with or without hyperandrogenism (23.1% and 13.9%, respectively; p = 0.001). Likewise, in PCOS women with hyperandrogenism, the MetS prevalence differed among those with or without polycystic ovary (23.1% and 63.8%, respectively; p = 0.001). The prevalence of MetS and IR varies between the phenotypic subgroups of PCOS. Hyperandrogenemia PCOS phenotypes of Iranian women, in particular those without sonographic polycystic ovary, are highly at risk of MetS and IR.

Induction of anesthesia is the most crucial period of general anesthesia. Inhalational induction is the most commonly used technique in pediatric anesthesia. Tracheal intubation can be done after reaching the deep levels of anesthesia. The depth of anesthesia is often difficult to be judged. Bispectral index is a measure of the effects of anesthesia on brain. This study was designed to evaluate the efficacy of bispectral index (BIS) in clarifying suitable depth of anesthesia for tracheal intubation during inhalational induction of anesthesia. In a clinical trial, ninety patients, ASA I & II, 1 to 6 years old, scheduled for elective surgery were enrolled into the study. After starting BIS monitoring, patients randomly were divided into three groups. Then, anesthesia was induced by gradual increase of halothane in 50% mixture of oxygen (O2) and N2O and continued until target BIS (60 ± 2, 50 ± 2, and 40 ± 2) achieved. After tracheal intubation, the duration of laryngoscopy and the presence of laryngospasm, bronchospasm, laryngoscopy failure, the movement of extremities and the changes in SpO2 and BIS were recorded. The data were analyzed by chi-square and ANOVA at 0.05 level of significance. BIS could not determine the appropriate level of anesthesia for tracheal intubation in this setting. There were no differences in laryngoscopy duration and the occurrence of laryngospasm, bronchospasm, laryngoscopy failure, extremity movement and awakening time among three groups. These results confirmed that there was no significant difference in the incidence of complications related to intubation at different BIS values (from 60 to 40) during inhalation induction, and probably to achieve an adequate or more reliable depth of anesthesia, the lower values of BIS is required.

Pleurotus ferulae is an edible mushroom has been widely used for nutritional and medicinal purposes. Irrespective of the medicinal importance or therapeutic potentials of Pleurotus ferulae, there have not been studies on antihyperlipidemic properties. Therefore, the present study investigates the effects of dietary Pleurotus ferulae fruiting bodies on plasma and feces biochemical and on the liver histological status in hypercholesterolemic rats. Six weeks old female Sprague-Dawley albino rats were divided into three groups of 10 rats each. Then biochemical and histological examinations were performed. Feeding of a diet containing 5% Pleurotus ferulae fruiting bodies to hypercholesterolemic rat reduced plasma total cholesterol, triglyceride, low-density lipoprotein (LDL), total lipid, phospholipids, and LDL/high-density lipoprotein ratio by 30.02, 49.31, 71.15, 30.23, 21.93, and 65.31%, respectively. Mushroom also significantly reduced body weight in hypercholesterolemic rats. However, it had no adverse effects on plasma albumin, total bilirubin, direct bilirubin, creatinin, blood urea nitrogen, uric acid, glucose, total protein, calcium, sodium, potassium, chloride, inorganic phosphate, magnesium, and enzyme profiles. Feeding mushroom increased total lipid and cholesterol excretion in feces. The plasma lipoprotein fraction, separated by agarose gel electrophoresis, indicated that Pleurotus ferulae significantly reduced plasma β and pre-β-lipoprotein, while increased the α-lipoprotein. A histological study of hepatic cells by conventional hematoxylin-eosin and oil red O staining showed normal findings for mushroom-fed hypercholesterolemic rats. The present study suggests that 5% Pleurotus ferulae diet supplement provides health benefits, at least partially, by acting on the atherogenic lipid profile in hypercholesterolemic rats.

This study aimed to evaluate the accuracy of Euroscore (European System for Cardiac Operative Risk Evaluation) in predicting perioperative mortality after cardiac surgery in Iranian patient population. Data on 1362 patients undergoing coronary bypass graft surgery (CABG) from 2007 to 2009 were collected. Calibration was assessed by Hosmer-Lemeshow goodness-of-fit. Area under the curve (AUC) was used to assess score validity. Odds ratios were measured to evaluate the predictive value of each risk factor on mortality rate. The overall perioperative in hospital mortality was 3.6% whereas the Euroscore predicted a mortality of 3.96%. Euroscore model fitted well in the validation databases. The mean AUC was 66%. Mean length of intensive care unit (ICU) stay was 2.5 ± 2.5 days. Among risk factors, only left ventricular dysfunction, age and neurologic dysfunction were found to be related to mortality rate. Euroscore did not have acceptable discriminatory ability in perioperative in hospital mortality in Iranian patients. It seems that development of a local mortality risk scores corresponding to our patients epidemiologic characteristics may improve prediction of outcome.

Internet addiction disorder is an interdisciplinary phenomenon and it has been studied from different viewpoints in terms of various sciences such as medicine, computer, sociology, law, ethics, and psychology. The aim of this study was to determine the association of psychiatric symptoms with Internet addiction while controlling for the effects of age, gender, marital status, and educational levels. It is hypothesized, that high levels of Internet addiction are associated with psychiatric symptoms and are specially correlated with obsessive-compulsive disorder symptoms. In a cross-sectional study, a total number of 250 students from Isfahan’s universities were randomly selected. Subjects completed the demographic questionnaire, the Young Diagnostic Questionnaire (YDQ) and the Symptom Checklist-90-Revision (SCL-90-R). Data was analyzed using the multiple logistic regression method. There was an association between psychiatric symptoms such as somatization, sensitivity, depression, anxiety, aggression, phobias, and psychosis with exception of paranoia; and diagnosis of Internet addiction controlling for age, sex, education level, marital status, and type of universities. A great percentage of youths in the population suffer from the adverse effects of Internet addiction. It is necessary for psychiatrists and psychologists to be aware of the mental problems caused by Internet addiction.

Recent epidemiologic studies have found that self-reported sleep duration is associated with components of metabolic syndrome (MS) such as obesity, diabetes and hypertension. This relation may be under influence of regional factors in different regions of the world. The association of sleep duration and MS in a sample of Iranian people in the central region of Iran was investigated in this study. This cross-sectional study was conducted as a part of the Isfahan Healthy Heart Program (IHHP). A total of 12492 individuals aged over 19 years, 6110 men and 6382 women entered the study. Definition of National Cholesterol Education Program was used to define MS. Sleep duration was reported by participants. Relation between sleep duration with MS was examined using categorical logistic regression in two models; unadjusted and adjusted for age and sex. In our study, 23.5 % of participants had MS. Compared with sleep duration of 7-8 hours per night; sleep duration of less than 5 hours was associated with a higher odds ratio for MS. This association remained significant even after adjustment for age and sex (OR: 1.52; 95%CI: 1.33-1.74). However, sleep duration of 9 hours or more showed a protective association with MS (OR: 0.79; 95%CI: 0.68-0.94). There was a positive relation between sleep deprivation and MS and its components. This relation was slightly affected by sex and age.

Epigenetic event is a biological regulation that influences the expression of various genes involved in cancer. DNA methylation is established by DNA methyltransferases, particularly DNAmethyltransferase 3B (DNMT3B). It seems to play an oncogenic role in the creation of abnormal methylation during tumorigenesis. The polymorphisms of the DNMT3B gene may influence DNMT3B activity in DNA methylation and increase the susceptibility to several cancers. These genetic polymorphisms have been studied in several cancers in different populations. In this study, we performed a case–control study with 125 colorectal cancer patients and 135 cancer-free controls to evaluate the association between DNMT3B G39179T polymorphism (rs1569686) in the promoter region and the risk of sporadic colorectal cancer. Up to now, few studies have investigated the role of this gene variant in sporadic colorectal cancer with no familial history of other related cancers. The genotypes of DNMT3B G39179T polymorphism was analyzed by PCR-RFLP. We found that compared with G allele carriers, statistically the DNMT3B TT genotype (%34) was significantly associated with increased risk of colorectal cancer (adjusted OR, 3.993, 95% CI, 1.726-9.238, p = 0.001). Compared with DNMT3B TT genotype, the GT and GG genotypes had lower risk of developing sporadic colorectal cancer (OR = 0.848, 95% CI = 0.436-1.650). Our findings were consistent with that of previously reported case–control studies with colorectal cancer. These results suggest that the DNMT3B G39179T polymorphism influences DNMT3B expression, thus contributing to the genetic susceptibility to colorectal cancer. Further studies are needed to unravel the basic molecular mechanisms.

Primary bone lymphoma (PBL) is a rare disease and distinct clinicopathological entity. The optimal treatment strategy is still unclear. Because of rarity of PBL, we report our institute experience in PBL clinicopathological feature and treatment results. 28 patients diagnosed with PBL were referred to Omid Hospital, cancer research center (CRC), between March 2001 and February 2009. Immunophenotype studies on 16 out of 28 pathological blocks were performed. We analyzed disease free survival (DFS) and overall survival (OS) rates. 14 patients with PBL were analyzed retrospectively. 17 patients (60.7%) were male and 11 (39.3%) were female with a median age of 41 years (range: 11-79). Long bones were the most primarily site of involvement (71%). 26 (93%) patients had diffuse large B cell lymphoma and 2 (7%) had small lymphoblastic lymphoma. One (3%) patient received radiation alone, 18 (66%) cases received combined modality (chemotherapy + radiotherapy) and 8 (30%) received only chemotherapy during their treatment period. The median follow up was 18 months (range: 1-82). Mean DFS was 51 months (range: 37-66). Overall survival (OS) was 54 months (range: 40-68). OS was significantly better in the chemoradiotherapy group compared with other two groups (64 versus 27 months, respectively, p = 0.014). DFS was also significantly better in combined modality arm compared with other two groups (64 versus 21 months, respectively, p = 0.003). In spite of small number of patients reported in this study, combined modality treatment (chemotherapy and radiotherapy) was shown to be useful as an effective treatment strategy in PBL.

It is reported that prevalence of overweight and obesity have increased in all age groups, but little is known about prevalence of overweight and obesity in preschool children. Therefore, the purpose of this study was to survey the prevalence of underweight, overweight and obesity in 3-6 year-old Tehranian children in 2009-2010. This cross-sectional study was performed on a total of 756 (378 boys and 378 girls) preschool children aged 3-6. Subjects were selected through stratified sampling from 5 geographic regions of Tehran (east, west, north, south, and center). Body weight and height were measured directly. Underweight, overweight and obesity was defined as body mass index (BMI) ≤ 5th percentile (underweight), 5th to 85th percentile (normal weight), 85th to 95th percentile (overweight), and > 95th percentile (obesity); based on recommendation of Centers for Disease Control (CDC) in 2000. Findings showed that the prevalence of underweight, overweight and obesity was 4.77%, 9.81% and 4.77% in boys and 4.77%, 10.31% and 4.49% in girls, respectively. Our findings showed a relatively high prevalence of overweight and obesity in Tehranian preschool children that is a serious problem. This result can be used in clinical setting and preventive programs.

While patients with obstructive sleep apnea or multiple sclerosis are at high risk of developing postoperative complications, both obstructive sleep apnea (OSA) and multiple sclerosis (MS) have special anesthetic considerations in intraoperative and postoperative periods. A careful preoperative evaluation, use of the optimal anesthetic regimen and close postoperative care are essential for these patients. Rarity of coexistence of both obstructive sleep apnea and multiple sclerosis in a surgical patient necessitates careful anesthetic management. We here reported anesthetic management of a woman with obstructive sleep apnea and multiple sclerosis who underwent anesthesia three times for surgery and review the literature data.

Gorlin–Goltz syndrome is an autosomal dominant and a rare hereditary disease. Diagnosis of this syndrome is based on major and minor criteria. We report a Gorlin–Goltz syndrome in a 25-year-old male who was presented with progressive pain of maxilla and mandible over 5 years. The pain was diffuse and compatible with expansile cyst in alveolar ridges on panoramic radiography. In physical examination, he had coarse face and prognathism. Computer tomography of face revealed two expansile maxillary and one mandibular cyst. Calcification of entire length in falx and tentorium were detected in bone window.

Ossifying fibroma (OF) is a benign fibro-osseous lesion which was first described by Menzel in 1872. It is commonly seen in the head and neck regions and represents an aggressive pattern when the midface and paranasal sinuses are involved. We report a 36 years old white woman with ossifying fibroma in the right ethmoid sinus. Computed Tomography (CT) scan images showed a hyperdense mass. Transnasal endoscopic resection was performed and histopathological examination confirmed the diagnosis of ossifying fibroma. The present case is notable because involvement of the ethmoid sinus is rare in this condition with only 48 cases reported in the literature until June 2011.

A 15-year-old girl with right lower extremity lymphedema praecox was treated through low level laser therapy (LLLT), by means of a GaAs and GaAlAs diodes laser-therapy device. Treatment sessions were totally 24, each cycle containing 12 every other day 15-minute sessions, and one month free between the cycles. The treatment was achieved to decrease the edema and no significant increase in circumference of involved leg was found following three months after the course of treatment. Although LLLT can be considered a beneficial treatment for Lymphedema Praecox, any definite statement around its effectiveness needs more studies on more cases.

Self medication of nutrient supplements, herbal and chemical pills have been previously reported from different countries and this problem has been remained among less developed countries.1,2 There are also some reports regarding the self medication and drugs storage in Iran.3,4 Therefore, determining the knowledge and practice of people in this regard might be important for preparing the educational interventions. The present study was conducted in 2009 aimed to determine the knowledge and practice regarding the self medication among women of Isfahan based on Health Belief Model (HBM). This was a cross-sectional study in Isfahan on 385 women who referred to the health centers. Since women can interfere with self-medication in the family, we chose this group. Women could affect on their family health behaviors and; therefore, focusing on this group is important in the health system researches. The stratified random sampling method was used for determining the samples of the present study. Therefore, we considered women from all parts of Isfahan in different regions and we selected samples from the entire regions in different health centers in Isfahan. One health center was randomly chosen from each region. For assessing the knowledge, attitude and practice a related researchers-made questionnaire was used in the present study. The validity and reliability of the questionnaire was assessed. This questionnaire included four parts. The parts included questions regarding the demographic characteristics (12 questions), knowledge and practice (12 questions), questions regarding the reporting of self medication (14 questions) and HBM structures including perceived severity, sensitivity and benefits and barriers (5 questions for each part). In knowledge section, one score was allocated for each correct answer. The score for wrong answers was zero. Regarding the HBM structures, a range of 0-4 score was considered for different items. At last, the score of each subject was calculated from 100. According to the results, 86 percent of the women had experienced self-medication at least in one disease during the past 6 months. The major cause for self-medication had been previous experience and the simple availability of the medications. The main reason for avoiding self-medication was fear of the side effects. The mean score of knowledge in this regard, was 82.9 ± 13.8 and the mean score regarding the perceived susceptibility was 72.4 ± 17.1. The scores related to perceived severity and benefits were 71.6 ± 14.7 and 68.2 ± 17.1 respectively. However, the score for barriers was 61.6 ± 19.6. The mean of the HBM structures in the present study was high comparing with other studies.5 The mean score of the perceived severity and also perceived sensitivity was also high in the present study which showed that women believe that self-medication was not an appropriate method for treating different diseases. Therefore, it seems that preparing educational programs focused on barriers’ structure and improving the perceived benefits may be helpful in reducing the self-medication rate among women. Educational programs should inform all the women regarding the side effects of the medications. Our previous study revealed that HBM could be a suitable model for educating patients.6 The results of the mentioned study confirmed that education based on this model had beneficial effects for diabetic patients6 and the present study showed another benefit of this model for health promotion.