Journal of Research in Medical Sciences
Volume:17 Issue: 2, Feb 2012

The demonstration that adipose tissue produces numerous cytokines increases interest of investigators in their role in the pathogenesis of obesity. Resistin is one of those cytokines. There are conflicing reports as cigarette smoking impairs insulin secretion, augments insulin resistance, or has no effect on glucose metabolism. In our study, we intended to examine the relationship of obesity with resistin levels in smokers and nonsmokers. The study included 52 male smokers and 34 age matched nonsmoker male control subjects. We classified smoker and nonsmoker groups according to their body mass index as BMI < 27 and ≥27. As well as making physical and anthropometric examinations, fasting plasma glucose and insulin, postprandial plasma glucose, lipid profile, and resistin levels were measured in all male subjects. We compared all parameters in smoker and nonsmokers either having BMI < 27 or ≥ 27. In both BMI levels, resistin levels were higher in smoker groups than nonsmoker ones (p < 0.01 all), we did not find any difference in other parameters. in conclusion we may speculate that if someone smokes resistin levels increase.

On-pump coronary artery bypass graft (CABG) surgery impairs gas exchange in the early postoperative period. The main object on this study was evaluation of changes in arterial blood gas values in patients underwent on pump CABG surgery receiving different dose of intravenous nitroglycerin (NTG). sixty-seven consecutive patients undergoing elective on-pump CABG randomly enrolled into three groups receiving NTG 50 µg/min (Group N1, n =67), 100 µg/min (Group N2, n = 67), and 150 µg/min (Group N3, n = 67). Arterial blood gas (ABG) tensions were evaluated just before induction of anesthesia, during anesthesia, at the end of warming up period, and 6 h after admission to the intensive care unit. Pao2 and PH had the highest value during surgery in Group N1, Group N2, and Group N3. No significant difference was noted in mean values of Pao2 and PH during surgery between three groups (p > 0.05). There was no significant difference in HCO3 values in different time intervals among three groups (p > 0.05). our results showed that infusing three different dosage of NTG (50, 100, and 150 µg/min) had no significant effect on ABG tensions in patients underwent on-pump CABG surgery

This study was performed to evaluate the impact factors (IFs) and total citations of ISI-indexed nutrition journals in a 10-year period from 1999 to 2008 in order to assess the quality of nutrition journals. For this retrospective study, the IF and total citation data from 1998 to 2008 were collected through Journal Citation Reports of Thomson Scientific Corporation Web of Knowledge. We selected five highly cited journals in the "nutrition and dietetics" category for our analysis. These journals include Annual Reviews in Nutrition (ANNU REV NUTR), American Journal of Clinical Nutrition (AJCN), Progress in Lipid Research (PROG LIPID RES), Journal of Nutrition (J NUTR), and International Journal of Obesity (INT J OBESITY All five selected journals were ranked as one of the top ten “nutrition and dietetics” journals between 1999 and 2008 in ISI database. Most of selected journal's IF had an upward trend during the 10-year period with fluctuation in some cases. AJCN consistently received the greatest number of total citations during the study period, although its IF was not the highest among the five journals studied. The IF illustrated changes in relative rankings of five highly cited journals included in the "nutrition and dietetics" category of the Web of Knowledge. Rank according to the absolute number of citations received, however, did not correlate with rank according to IF.

early diagnosis of left ventricular mass (LVM) inappropriateness and left ventricular hypertrophy (LVH) can result in preventing diastolic left ventricular dysfunction and its related morbidity and mortality. This study was performed to determine if diastolic dysfunction is associated with LVH and inappropriate LVM. one hundred and twenty five uncomplicated hypertension from Isfahan Healthy Heart Program underwent two-dimensional echocardiography. Inappropriate LVM was defined as an LVM index greater than 88 g/m2 of body-surface area in women and greater than 102 g/m2 in men. LVH-defined septal and posterior wall thickness greater than 0/9 cm in women and greater than 1 cm in men, respectively. Echocardiographic parameters, including early diastolic peak velocity (E)/late diastolic peak velocity (A), deceleration time (DT), and E/early mitral annulus velocity (E′) were measured. the mean systolic and diastolic blood pressure at the patients’ admission day were 142.87 ± 18.12 and 88.45 ± 9.18 mmHg, respectively. Totally, 21.7% of subjects had inappropriate LV mass that moderate and severe abnormal LV mass was revealed in 5.6% and 5.6%, respectively. The mean of age and BMI was significantly higher in patients with moderate left ventricular hypertrophy (p < 0.05). Adjusted by age, gender, BMI, and systolic and diastolic blood pressures, both E/A ratio and deceleration time were higher in those with the severer ventricular hypertrophy. Subjects with severe showed significantly higher BMI 33. 7 ± 3.7 (p < 0.001). There was a slight difference between the grade of diastolic dysfunction and the severity of inappropriate LV mass (p = 0.065). But no significant difference was found between E/A, E/E′, and deceleration time and the level of inappropriate LV mass (p > 0.05). Spearman’s Rank test was used to test the correlation between diastolic dysfunction and LV mass (p = 0.025). LVH is correlated with the severity of diastolic dysfunction manifested by the E/A value and deceleration time, but inappropriate LVM can slightly predict diastolic dysfunction severity in uncomplicated hypertension.

The prevalence of anemia in HIV infected patients has not been well characterized in Iran. This study aimed to describe the prevalence of anemia and related factors in HIV positive patients. In a cross-sectional study, anemia prevalence and risk factors of 212 HIV positive patients were assessed, at the behavioral disease consulting center in Isfahan. The relationship between anemia, demographic variables, and clinical histories were analyzed. Mild to moderate anemia was defined as hemoglobin 8–13 g/dL for men and 8–12 g/dL for women. Severe anemia was defined as hemoglobin, 8 g/dL. A total of 212 HIV positive patients with a mean±SD age of 36.1 ± 9.1 years were assessed. We found that hemoglobin levels were between 4.7 and 16.5 gr/dL. In this study, the overall prevalence of anemia was 71%, with the majority of patients having mild to moderate anemia. Mild to moderate anemia and severe anemia occurred in 67% and 4% of patients, respectively. The mean absolute CD4 count was 348 ± 267.8 cells/cubic mm. Sixty one of 212 patients were at late stage of HIV infection (males=51 and female=10). Of the 212 HIV positive patients enrolled, 17 (8%) had a positive history of tuberculosis. We found a strong association between anemia and death. Normocytic anemia with decreased reticulocyte count was the most common type of anemia in overall. Prevalence of anemia in this study is relatively higher than other similar studies. Such a high prevalence of anemia needs close monitoring of patients on a zidovudine-based regimen. Better screening for anemia and infectious diseases, and modified harm reduction strategy (HRS) for injection drug users are primary needs in HIV seropositive patients.

Appropriate pain management is needed during the post-partum hospitalization period for preventing cesarean section (CS) related complications. Protocols of post-partum pain management should be planned based on the facilities of each center or region. The aim of current study was to compare the analgesic efficacy of oral methadone and intra muscular (IM) pethidine which the latter was routinely used in our center in post cesarean pain treatment. In this prospective double-blind clinical trial, women who were candidate for cesarean section were selected and randomized into two groups. All patients routinely received a single IM pethidine dose (50 mg) after CS in the recovery room. One group of patients received 0.7 mg/kg pethidine every 6 hour IM, and another group received 0.07 mg/kg oral methadone every 6 hour. Severity of pain assessed using visual analogue scale (VAS) score in 6, 12, 18 and 24 hour after surgery. Pain severity in methadone group at 6, 12, 18 and 24 hour post operation were 6.4 ± 0.9, 3.4 ± 0.8, 1.9 ± 1.1, 0.5 ± 0.5 (p < 0.05) and for patients in pethidine group were 6.6 ± 0.8, 3.4 ± 0.9, 2.1 ± 1.0 and 0.5 ± 0.5 (p < 0.05), respectively (Mean ± SD). Between groups differences in each follow up time were not statistically significant. There was no difference between groups in terms of complications and supplementary analgesic use. Considering the similar analgesic effects of methadone and pethidine, satisfaction of patients and nursing system with methadone use and the cost benefit of methadone, it can be recommended to use methadone for post operative pain relieving.

We aimed to compare hemodynamic and endocrine alterations caused by stress response due to Proseal laryngeal mask airway and endotracheal tube usage in laparoscopic cholecystectomy. Sixty-three ASA I-II patients scheduled for elective laparoscopic cholecystectomy were included in the study. Patients were randomly allocated into two groups of endotracheal tube and Proseal laryngeal mask airway. Standard general anaesthesia was performed in both groups with the same drugs in induction and maintenance of anaesthesia. After anaesthesia induction and 20 minutes after CO2 insufflations, venous blood samples were obtained for measuring adrenalin, noradrenalin, dopamine and cortisol levels. Hemodynamic and respiratory parameters were recorded at the 1st, 5th, 15th, 30th and 45th minutes after the insertion of airway devices. No statistically significant differences in age, body mass index, gender, ASA physical status, and operation time were found between the groups (p > 0.05). Changes in hemodynamic and respiratory parameters were not statistically significant when compared between and within groups (p > 0.05). Although no statistically significant differences were observed between and within groups when adrenalin, noradrenalin and dopamine values were compared, serum cortisol levels after CO2 insufflation in PLMA group were significantly lower than the ETT group (p = 0.024). When serum cortisol levels were compared within groups, cortisol levels 20 minutes after CO2 insufflation were significantly higher (46.1 (9.5-175.7) and 27.0 (8.3-119.4) in the ETT and PLMA groups, respectively) than cortisol levels after anaesthesia induction (11.3 (2.8-92.5) and 16.6 (4.4-45.4) in the ETT and PLMA groups, respectively) in both groups (p = 0.001). PLMA usage is a suitable, effective and safe alternative to ETT in laparoscopic cholecystectomy patients with lower metabolic stress.

There is an association of celiac disease (CD) with several gastrointestinal illnesses. We aimed to determine the prevalence of CD in patients with inflammatory bowel disease (IBD) to evaluate the value of the routine serological tests for CD in these patients. patients with IBD underwent screening test for CD. The screening test was based on IgA anti-tTG antibody evaluated by ELISA method and IgA EMA (endomysial antibody) measured by the indirect immunofluorescence method. Fisher exact and chi-square and t tests were used for data analysis. the study was conducted on 100 patients, with a mean age of 34.74 ± 12.03 (SD) years. The mean simplified Crohn’s disease activity index was 90 ± 17 (SE) and the mean colitis activity index was 3.46± 0.96 (SE). Seventeen patients (17%) had IgA anti-tTG antibody levels above the cutoff point (> 20). Thirty-two patients were positive for IgA EMA. IgA EMA was positive in nine IgA anti-tTG positive patients (three patients with Crohn’s Disease and six ones with ulcerative colitis). Then, the prevalence of serologic CD was 9% that was higher than that of general population. A significant correlation was found between the results of IgA EMA and those of IgA anti-tTG (p = 0.001) whereas Fisher exact test revealed significant difference between frequency distribution of positive and negative results of IgA EMA and IgA anti-tTG in patients with ulcerative colitis and Crohn’s disease (p < 0.001). the prevalence of serologic CD in general population in Iran has been reported to be 0.6–0.96%. Then, its prevalence in our sample size was about ten times more than that in general population.

CD117 is a thyrosin kinase receptor encoded by c-kit proto-oncogene. It is expressed during normal development in some tissues and also in a subset of neoplasia especially gastrointestinal stromal tumors (GISTs). Treatment with thyrosin kinase inhibitors (e.g., Imatinib) is useful in CD117- positive GISTs. The goal of this study is to investigate the expression of CD117 in glial tumors as a potential diagnostic marker and target for therapy. in this descriptive-analytical study, paraffin- embedded tissue blocks from 50 cases of glial tumors (various histological types and grades) were selected in a convenience sampling for the CD117 immunhistochemical study including expression of the marker, staining intensity, and percentage of the stained cells. The results were analyzed by chi-square and Mann–Whitney tests. CD117 expression was detected in about 76% of glial tumors but the frequency of the expression showed no statistically significant relationship with the tumor type (p = 0.829). Although CD117 immunoreactivity was more frequent in high-grade tumors (84%) compared to the low-grade ones (68%), no statistically significant relationship was found between the CD117 expression and grade of the tumor (p = 0.09). Staining intensity and percentage of stained cells in high-grade tumors were significantly more than in low-grade tumors (p-values of 0.046 and 0.023, respectively). according to the statistically significant difference in the staining intensity and percentage of the stained cells between the low-grade and high-grade glial tumors, these two parameters may be useful for making distinction between various grades of these tumors. Moreover, according to the prominent expression of CD117 in high-grade gliomas, these tumors may be potential candidates for treatment with thyrosin kinase inhibitors.

The measuring serum ferritin level as a sensitive inflammatory biomarker might effectively predict preterm delivery, but the power and the best cut-off point of this biomarker for predicting preterm labor in Iranian population has not been substantially identified. Our purpose was to determine what concentrations of serum ferritin could identify patients at risk for preterm delivery in Iranian population for the first time. This case control study involved 222 singleton pregnancies that were referred to referral university hospitals clinics in Isfahan. Women with spontaneous preterm delivery before 24–26 weeks (preterm delivery group, n = 69) and those who delivered at term (term delivery group, n = 153) were compared with respect to serum ferritin concentration. Venous blood samples were analyzed for the serum ferritin level using the ferritin quantitative test system-sensitive for the normal ferritin range. Women who delivered before 37 weeks had a higher mean serum ferritin concentration than those who delivered after 37 weeks of gestation (26.7 ± 5.5 ng/ml versus 19.8 ± 3.6 ng/ml, p < 0.001). A serum ferritin level of 22.5 ng/ml yielded the best combination with sensitivity of 78.3%, specificity of 83.0%, positive predictive value of 67.5%, and negative predictive value of 89.4% for prediction of preterm delivery. The serum ferritin level provides an appropriate discrimination in predicting preterm delivery with an optimal cut-off value of 22.5 ng/ml in Iranian population.

The metabolic syndrome has known as an independent risk factor of stroke. The occurrence of this syndrome is due to genetic factors and lifestyle. This study was performed on the frequency of metabolic syndrome prevalence in ischemic stroke patients compare to control. One hundred ischemic stroke patients and 100 controls (with the same age and sex) were evaluated for this study. 62% of patient and 34% of controls had metabolic syndrome criteria according to National Cholesterol Education Program (NCEP) {OR: 3.2; 95% CI (1.9–9.7), p = 0.001} Prevalence of metabolic syndrome in women was more than men (52% vs. 44%) {OR: 0.72; 95% CI (0.4, 1.3)}. Beside of metabolic syndrome, prevalence of metabolic syndrome components was significantly higher in stroke patients compare to controls. Metabolic syndrome prevalence are more common in stroke patients compare to controls, but it should be noticed that the controls are in a risk of future stroke so they need special treatment to prevent it.

Scientific journals are the most credible and updated information resources for valid information in the various fields of science and technology. The present study investigates the status of Iranian scientific journals in disseminating medical information to the world of science. Total 163 Iranian medical journals accredited by national medical journals commission of Iranian ministry of health and medical education were evaluated through a cross-sectional study. The results were represented in descriptive statistics in the form of table and chart. The study showed that 89.6% of Iranian medical journals were covered by regional information databases. Web of Science database indexed 22 (13.5%) Iranian journals in the field of medical science. Only six (6.7%) journals were indexed by Medline. Fifty-eight (35.6%) journals were in English, 102 (62.6%) in Persian, and three (1.8%) were bilingual which published their articles both in Persian and English languages. The highest Impact factor belonged to Iranian Journal of Allergy Asthma and Immunology. Improving scientific credibility of Iranian scholarly journals and their influence in disseminating medical information calls for a precise scientific and executive administration in publishing standards and also in the quality of content.

Hyperbaric and isobaric bupivacaine has been shown to reduce bispectral index (BIS) during spinal anesthesia. The aim of this study was to compare the effect of isobaric bupivacaine and hyperbaric bupivacaine on the BIS during cesarean section with spinal anesthesia. In this double-blind randomized controlled clinical trial, 84 pregnant women with ASA (American Society of Anesthesiologists) class I or II were randomly assigned to receive isobaric or hyperbaric bupivacaine. BIS was measured using electro encephalography (EEG) and recorded at the baseline and 5th, 10th, 15th, 30th, 45th, 60th, 90th and 120th minutes after spinal injection. The heart rate (HR), mean arterial pressure (MAP), signal quality index (SQI), electromyography (EMG) and the temperature were also recorded during surgery. From recruited subjects, 41 completed the study in each group and their data were analyzed. The BIS score began to reduce until 30th minute for isobaric bupivacaine and 45th minute for hyperbaric bupivacaine after spinal injection. The recorded BIS was not significantly different between two groups at all the time points. Difference of BIS from baseline was not significant between two groups at most time points except for the 45th minute after injection that it was 5.9 ± 9 vs. 2.7 ± 4.6 for hyperbaric and isobaric bupivacaine, respectively (p = 0.047). The changing trend was not significantly different between groups with hyperbaric and isobaric bupivacaine. According to the present study, the BIS score during surgery began to decrease when the patients were injected spinally by both of these drugs. The greatest decrease from baseline BIS values occurred at 30 and 45 minutes after induction of spinal anesthesia. However, hyperbaric or isobaric bupivacaine did not have different effects on the BIS during spinal anesthesia.

To assess the practicability of a new algorithm in decreasing the rate of incorrect diagnoses and inappropriate antibiotic usage in pediatric Acute Respiratory Tract Infection (ARTI( Children between 1 month to15 years brought to outpatient clinics of a children’s hospital with acute respiratory symptoms were managed according to the steps recommended in the algorithm. Upper Respiratory Tract Infection, Lower Respiratory Tract Infection, and undifferentiated ARTI accounted for 82%, 14.5%, and 3.5% of 1 209 cases, respectively. Antibiotics were prescribed in 33%; for: Common cold, 4.1%; Sinusitis, 85.7%; Otitis media, 96.9%; Pharyngotonsillitis, 63.3%; Croup, 6.5%; Bronchitis, 15.6%; Pertussis-like syndrome, 82.1%; Bronchiolitis, 4.1%; and Pneumonia, 50%. Implementation of the ARTIs algorithm is practicable and can help to reduce diagnostic errors and rate of antibiotic prescription in children with ARTIs.

Lack of insight in patients with bipolar I disorder has been associated with poor course and clinical outcome and compromised therapeutic compliance. Therefore, it is important to evaluate insight and use more specialized scales such as Mood Disorder Insight Scale (MDIS) in these patients. Our objective in this study was to assess validity and reliability of Persian version of MDIS. A hundred forty five bipolar patients were selected from Iran Hospital of Psychiatry. They were interviewed by The Persian Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorder, 4th edition's (DSM-IV) axis I disorders (SCID-I) and the Scale to Assess Unawareness of Mental Disorder (SUMD). The translated version of MDIS in Persian was subsequently completed by patients. The internal consistency was satisfactory (Cronbach alpha coefficients = 0.8). The test-retest reliability (coefficient alpha) was 0.95 (p < 0.01). Construct validity and concurrent validity were supported by factor analysis and Spearman rank correlation between MDIS and SUMD (0.85). Persian version of the MDIS could be a useful instrument for assessing insight in patients with bipolar I disorder.

Despite its inevitable significance, the effect of in-service English education on medical professionals has rarely been studied longitudinally. The reason can be issues such as physicians’ heavy workload, commuting problems, inappropriate class times, and inexperienced teaching staff. A needs assessment worksheet was administered to faculty members of Shahid Beheshti University of Medical Sciences in Tehran and the responses were analyzed. A project for the promotion of faculty members’ English proficiency was formulated. Then, following a placement test, 235 applicants from the university colleges and hospitals were classified into 28 homogeneous groups. After four terms of instruction, the participants’ scores on the pre- and post- assessments were analyzed. There was significant improvement in participants’ total scores on different communicative skills (p < 0.001). Regarding individual skills also, they achieved meaningful gains on listening (p < 0.001), writing (p = 0.038), and grammar (p < 0.001), but failed to progress significantly on reading comprehension (p = 0.523). The administration of in-service education for skill-oriented courses, over a long period, can be quite encouraging and should be further strengthened. Regular instructions on each individual skill on the one hand and on their combination on the other are essential for success in such education.

•Progressive supranuclear palsy (PSP) is characterized by slowness, rigidity, bradykinesia, repeated falls, downgaze limitation and dementia. Midbrain atrophy on magnetic resonance imaging is highly suggestive of PSP and is described as "hummingbird sign". This sign is very helpful in differentiating PSP patients from those with Parkinson's disease. We hereby report a 72-year-old female case of PSP primarily diagnosed with Parkinson's disease.

•The breast tuberculosis (TB) is an extremely rare manifestation for the reason that mammary cells offer great resistance to the survival and multiplication of Mycobacterium infection. The diagnosis is difficult because of nonspecific clinical and radiological findings. It is usually suspected in a multiparous, reproductive woman. We report three cases of tubercular infection of breast confirmed by either mycobacteriology, pathology or both. We described their diagnostic confirmation and six month follow-up after antitubercular treatment (ATT).

In Asia, Illicit opium and cannabis are produced mainly in Afghanistan, which makes major social and health problems for some countries, particularly Iran as the neighborhood.[1] In Iran, opium and hashish have been used for near 300 years,[2] but other drugs such as heroin, buprenorphine, cocaine, tramadol, and ecstasy are new drugs of abuse in this country.[3-6] Abuses of the new drugs in Iran are now a major health problem, particularly for the youth and young adults.[3,4]In Iran, drugs which have been named by substance abusers may have a similar western name, but with different chemical entity. For example, crack is one of the popular names among the substance abuser in Iran, but is totally different with the western crack. In the other parts of the world, the main ingredient of Crack is cocaine, but in Iran it is heroin which may also contain morphine, codeine, caffeine, noscapine, papaverine, dextromethorphan, and acetyl codeine or corticosteroids with different amounts that make it even more harmful than pure heroin or any other drugs.[7]"Crystal meth," is the smokable form of methamphetamine hydrochloride. Crystal meth is more likely to cause dependence than other forms of methamphetamine. Crystal meth is a cheap and easily available drug in the western countries, which is a common abused drug among youths in these countries.[8]

I read with interest the study conducted by Karrari and colleagues regarding “Iranian crystal a misunderstanding of the crystal-meth” published in your journal.[1] In this study, the authors have explained that the pattern of substances of abuse is varied in different parts of the world, also in Iran, and the main ingredient of street named drugs is different according to city or country, for example Crack is kind of cocaine, but in Iran is heroin that may also contain amphetamine, ecstasy, and/or corticosteroids with different amounts that make it even more harmful than pure heroin or any other drugs. Two major points should be mentioned about this study; first, the appearance and physical characteristics of crystal and heroin or crack are completely different so it can be easily differentiated each other, but it must be remember in mind that these substances may be delivered as a mixture of different substances. Second, In order to find out the ingredients of a substance, especially an illicit drug, it seems relying on urine qualitative screening toxicological test, as the authors have mentioned, is not reasonable because of false positive or negative results, and it is recommended to sampling some kind of heroin that used or distributed in theirs society and then analyze for clarify or diagnose its ingredients. Again according to my own experience during years in point of management of poisoned patient and treatment of addicted man and in the present study, as the authors have themselves declared, heroin is a mixture of impurities and adulterants. Thanks for this interesting study