Journal of Research in Medical Sciences
Volume:17 Issue: 3, Apr 2012

Breast cancer is a common cancer in women that affects femininity and marital life because of side effect of cancer treatments on breast as a sexual organ. The aim of this study was to evaluate the marital satisfaction in patients with breast cancer compared to general population. In a cross-sectional study we recruited 60 participants in three separated groups. The first group contained breast cancer women, the second one consisted of patients with other cancers and the third group was selected from general population. Marital satisfaction and mental health status of participants were measured by Enriching and Nurturing Relationship Issues, Communication and Happiness (ENRICH) questionnaire and 28-item General Health Questionnaire (GHQ-28), respectively. ANOVA test analysis did not determine any statistically significant differences between three groups in ENRICH score (P = 0.55) and GHQ-28 as mental health score (P = 0.93). In multivariate analysis after age adjustment, we could not find any statistically significant differences between three groups for ENRICH score and GHQ-28 score. In this sample of breast cancer patients, there were not any significant differences in marital satisfaction comparing with general population.

Lumbar disc herniation (LDH) is the most common surgical intervention of spine surgery. During few days of the operation, most patients experience worrying low back pain (LBP) and radicular leg pain (RLP). Applying liquid form of bupivacaine in the vicinity of surgical field could be effective on pain relief only for few hours after operation. In a double-blind prospective randomized clinical trial on patients with single level lumbar disc herniation (LDH), we tried to show the efficacy of N-Methyl-2Pyrolidone-Ethyl heptanoate (PLGA)-bupivacaine on LBP and RLP of 38 patients with American Society of Anesthesiologists (ASA) physical status I, and aged 27-65 years old.At the end of operation, 1 cc of PLGA-bupivacaine or pure PLGA was inoculated at the vicinity of thecal sac and root. LBP and RLP were measured using McGill Pain Questionnaire and visual analogue scale (VAS), immediately after operation and then after 6, 12 and 24 hours as well as one week and one month. The mean pain severity of LBP in PLGA-bupivacaine group (A) and pure PLGA group (B) were 25.7±2.8 and 30.6±5.8 (p<0.001), one week after surgery and 23.1±1.4 and 25.2±2 (p0.002), after two weeks, respectively. After 4 weeks of operation, the severity of LBP were 22.3±1.6 and 22.9±1 in two groups respectively (p=0.01). Severity of RLP according to VAS, from preoperative intervention until one month later, did not show any significant differences between two groups before and up to the first week after operation. However, after the first week until the end of follow-up, group A showed better scores in VAS. Accordingly, application of bupivacaine-PLGA had significant effect on LBP especially two weeks after operation, but it did not have any additional positive effects on RLP.

Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders presented by bowel habit change and abdominal pain without any structural defect. Prevalence of IBS in Iran was reported between 4.2-18.4%. Although the etiology is still unknown but many factors such as motility disorders, genetics, nutrition, behavioral disorders may cause it. During pregnancy gastrointestinal symptoms like nausea and vomiting are very common. The anxiety level will also in-crease during this period. This study was designed to evaluate the IBS symptoms during pregnancy in comparison with normal objects. In a cross-sectional study, IBS symptoms in pregnancy were compared with normal objects. Patients were included to the study after full-filling the IBS questionnaire. 323 pregnant subjects and 98 controls were included. IBS was seen in 23.5% of pregnant subjects and in 13.3% of patients in control group (P < 0.05). Constipation dominant IBS had a significant increase in third trimester comparing with first and second trimester (P < 0.05). Diarrhea dominant IBS had a significant increase in second and third trimester comparing with control group (P = 0.042). Mixed symptom-subtype of IBS had a significant increase in third trimester comparing with control group (P = 0.008). Frequency of IBS symptoms was higher in pregnant subjects than in control group. This could be because of hormonal changes and psychological factors which change during pregnancy.

Postanesthetic shivering is an accompanying part of general anesthesia with different unpleasant and stressful consequences for patients undergoing surgery. Therefore, its proper management is necessary for both treatment and prevention. The aim of this study was to compare the prophylactic effects of ketamine, dexamethasone, and pethidine in preventing postoperative shivering in general anesthesia. In this prospective randomized double-blind clinical trial, 135 American Society of Anesthesiologists (ASA) I and II patients aged 18-70 years, scheduled for elective surgery under general anesthesia were randomized into three groups. Each group received 0.5 mg/kg intravenous (IV) pethidine, or 0.5 mg/kg IV ketamine, or 0.6 mg/kg IV dexamethasone. Central and environmental temperature and postoperative shivering were evaluated during surgery (at 0, 15, and 30 minutes) and in the recovery room (at 0-60 minutes). The values were compared between the three studied groups using analysis of variance (ANOVA) and chi-square test in SPSS18. Each group included 45 patients. Mean values of central temperature in the recovery room were significantly different between the 3 groups (p < 0.05). However, the differences were not significant during surgery. Postoperative shivering was reported in 37.8%, 31.1%, and 11.1% of patients in ketamine, dexamethasone, and pethidine groups, respectively. Considering the rates and severity of shivering, variations in central temperature in the three studied groups, pethidine seems to be the most appropriate choice for preventing postoperative shivering.

Streptococcus pneumonia is one of the most important pathogens in community- acquired pneumonia. Diagnosis of this disease by conventional methods is often problematic. Therefore, a sensitive and specific diagnostic method can be helpful. The aim of this study was to evaluate the sensitivity and specificity of a rapid urinary antigen detection test in patients with pneumonia. In a cross-sectional study, a total number of 66 patients including 47 (71.2%) males and 19 (28.8%) females over 18 years old were divided into two group. The case group included 33 patients with pneumococcal pneumonia while the control group consisted of 33 patients with non-pneumococcal pneumonia. We compared the sensitivity and specificity of an in-vitro rapid immunochromatography (IC) pneumococcal urinary antigen test between the two groups. While 23 patients (69.7%) in the case group had positive urine antigen test results, no control patient with positive urine antigen test result was detected. The sensitivity of urinary antigen test in the case group was 69.70% (95% CI: 51.29-84.38). The specificity of the test was determined as 100% (95% CI: 89.32-100). Positive and negative predictive values of the test were 100% (85.05-100) and 76.74% (61.36-88.23), respectively. Pneumococcal urinary antigen IC test is a sensitive and highly specific method for diagnosis of pneumococcal pneumonia.

Vaginal vault prolapse can occur in patients who had abdominal or vaginal hysterectomy. The aim of this study was to introduce a new method of vaginal vault suspension for post-hysterectomy prolapse. In this retrospective cohort study, 34 patients who were suffering from vaginal vault prolapse were undertaken two suspension procedures; 26 patients underwent abdominal round ligament colpopexy (ARLC) that the vaginal apex was tied to the remained round ligament and 8 patients experienced modified Le Fort partial colpocleisis (MLFPC). Intra operative and postoperative complications and patient’s satisfaction were assessed. The age of studied patients was 58.2 ± 5.5 (mean ± SD) ranged from 42 to 75 years. No serious complication was reported at the post operative stage and during the follow-up period among patients participated in the two groups. Minor complications including urinary retention were experienced by two patients (one in each group). In ARLC group, one superficial wound infection and two recurrent prolapses occurred. There is no statistically significant difference between two groups in terms of post-operative complications. ARLC can be considered as a simple, safe and cost-effective alternative technique for vaginal vault suspension after hysterectomy.

Several factors such as hyperlipidemia, diabetes and hypertension have a determining role in cardiovascular disease. In recent years, the effect of vitamin D deficiency on cardiovascular disease has been emphasized. This study compares vitamin D deficiency in coronary heart disease patients with the control group. In a cross-sectional study, 25-hydroxycholecalciferol level was compared in 119 individuals including 57 people with confirmed coronary heart disease and 62 normal people. 25-hydroxyvitamin D [25(OH)D] was assessed using standard protocol. The level of 25(OH)D under 20 ng/dl was determined as cutoff point. The calculated odds ratio was 3.9 (95% confidence interval 2.6-5.5). Comparison of vitamin D deficiency between patients and the control group was statistically significant difference (p = 0.01). Of 37 (31%) individuals having vitamin D deficiency 36 (97.3%) had coronary artery disease and from 57 patients with coronary artery disease 36 (63.2%) had vitamin D deficiency. Vitamin D deficiency is a relatively common disorder. Risk of cardiovascular disease in people with vitamin D deficiency is almost four times of those with normal levels of vitamin D. To confirm the casual relationship between vitamin D and cardiovascular disease clinical trial studies are suggested.

CD10 is a cell surface metalloproteinase which inactivates various biologically active peptides. Earlier studies have suggested CD10 expression in the stroma of various carcinomas to be associated with more aggressive behavior of the tumor. The aim of this study was to assess CD10 expression in stromal component of invasive breast carcinoma and its relationship with well-known clinicopathologic parameters. This study included 49 formalin-fixed and paraffin-embedded tissue specimens of invasive breast carcinoma from the pathology archive of a referral hospital. CD10 expression was detected by immunohistochemistry and scored based on the staining intensity and percentage of the stained cells. Kruskal-Wallis and Mann-Whitney tests, along with Spearman's correlation coefficients were used to determine the relationship between CD10 expression and clinicopathologic parameters. No association was found between stromal CD10 expression and age, carcinoma subtype, and HER2/neu status. A significant positive correlation was seen between stromal CD10 expression and tumor size (p = 0.01), axillary lymph node status (p = 0.02), and tumor grade (p = 0.004). Although negative correlations were detected between stromal CD10 expression and estrogen receptor and progesterone receptor status, these correlations were not statistically significant. Tumor grade is a major prognostic indicator of breast carcinoma. Tumor size and nodal status on the other hand, are important determinants of tumor stage. Therefore, our findings concerning the positive correlations between stromal CD10 expression and tumor grade, tumor size, and nodal status suggest a strong effect of stromal CD10 expression on aggressive behavior of breast carcinoma and introduce this marker as a potential prognostic determinant in breast cancer.

This double-blind clinical trial was done to attenuate post tonsillectomy pain with preoperative dextromethorphan gargling. In a clinical trial study, sixty patients who were candidate for elective surgery under general anesthesia were randomly divided into three groups. Group OD (oral dextromethorphan) received 45 mg oral dextromethorphan tablet. Group GD (gargling dextromethorphan) were asked to gargle 45 mg dextromethorphan syrup and group PB (placebo) received placebo tablet preoperatively. Pain-free period (PFP) and severity of pain at rest and swallowing saliva were recorded. Need for additional analgesic and satisfaction after 24 hours were compared between groups. Three groups were similar in age, weigh and sex (p > 0.05). The PFP was longer in OD and GD groups than placebo group (p = 0.002). The severity of pain during swallowing saliva was lower in OD and GD groups than placebo group (p = 0.047). The mean dosage of additional analgesic was more in placebo group than OD and GD groups (p = 0.005). The median satisfaction after 24 hours was higher in OD and GD groups than placebo group (p = 0.048). Preemptive analgesia by eating or gargling dextromethorphan can effectively attenuate post-operative tonsillectomy pain.

Distraction osteogenesis is an established option for reconstruction of amputated fingers. In contrast to the primary method of distraction osteogenesis, using Kirschner wire (K-wire) as an internal fixator is not common today. This study was conducted to evaluate distraction osteogenesis with and without K-wire. This randomized clinical trial was conducted on 16 amputated fingers which were divided into two equal groups. While we used both orthofix M-100 and K-wire in the first group, only orthofix M-100 was implemented in the second group. The results were analyzed by t-test in SPSS11.5. Overall, 16 fingers of 8 male patients whose one or more fingers were cut due to hand trauma were evaluated in two random groups. The mean daily lengthening rates in Groups 1 and 2 were 0.44 ± 0.17 mm and 0.4 ± 0.11 mm, respectively (p = 0.59). The mean time required for 1 cm lengthening was 18.71 ± 4.07 and 23.25 ± 4.56 days in Groups 1 and 2, respectively (p = 0.065). The mean value of overall lengthening was 16.25 ± 8.05 mm in Group 1 and 16.69 ± 4.89 mm in Group 2 (p = 0.89). Moreover, some minor complications occurred in 9 samples. There was no statistically significant difference between the two groups. However, in the K-wire group, the time needed for 1 cm lengthening was clinically shorter. In addition, fewer complications, such as non-union and length loss, were observed in Group 1.

This Study aimed to investigate the associations between macro- and micronutrients received in the first, second, and third trimesters and risk for preeclampsia considering demographic and reproductive characteristics and physical activity. In this prospective cohort study, data was collected by filling a questionnaire through interviews with 700 pregnant women who had no parameters to affect pregnancy outcome (36 parameters). In addition, 48-hour dietary recalls were completed for eligible women at 11th-15th, 26th, and 34th-37th weeks of gestation. Physical activity was also assessed using a standard questionnaire. Data on 48-hour dietary recalls was analyzed using Nutrition-IV software. Data was analyzed in SPSS18 using t-test and logistic regression analysis. The mean value of received saturated fatty acids in the first trimester in subjects who experienced preeclampsia later in pregnancy was higher than the rest of the pregnant women (p = 0.045). Manganese intake in the third trimester was significantly less in preeclamptic subjects compared to the others (p = 0.026). Moreover, vitamin C, vitamin E, fiber, and carbohydrate intakes during the third trimester were significantly less among the women with preeclampsia compared to the rest of the studied population (p = 0.034, p = 0.049, p = 0.046, and p = 0.035, respectively). Higher manganese (OR: 0.88; 95% CI: 0.76-0.90), vitamin C (OR: 0.985; 95% CI: 0.98-0.99), vitamin E (OR: 0.99; 95% CI: 0.984-0.996), fiber (OR: 0.97; 95% CI: 0.96-0.98), saturated fatty acids (OR: 1.028; 95% CI: 1.02-1.036), and carbohydrate (OR: 0.98; 95% CI: 0.97-0.99) intake increased the chance of preeclampsia in pregnant women. The amounts of received saturated fat in the first trimester and manganese, vitamin C, vitamin E, fiber, and carbohydrate during the third trimester are significantly associated with preeclampsia.

Adipose tissue as an endocrine organ secretes adiponectin that is a cardiovascular atherosclerosis-modulating factor. However, some studies showed that adiponectin reduces obesity. In the present study, adiponectin association with body mass index (BMI), waist circumference (WC), visceral adipose tissue (VAT) and subcutaneous visceral tissue (SAT) as different measurements of obesity were evaluated in patients with coronary heart disease (CHD). Sixty-eight patients with CHD were chosen using simple random sampling. Body weight, height, WC and blood pressure were measured. Fasting blood samples were taken to assess fasting blood sugar, total cholesterol, triglyceride, low and high-density lipoproteins cholesterol. Patients underwent an abdominal computerized scan (CTS) to detect VAT and SAT. Linear regression test used to assess the relation of different measurements of the obesity with adiponectin adjusting for age, sex, hypertension, dyslipidemia, and diabetes mellitus. The mean age of the study population was 50.5 ± 7.0. Females were 67.6% of study population. Multivariate analyses showed the inverse association of waist-to-height ratio (WHtR) (β = -0.25, p = 0.03), WC (β = -0.24, p = 0.24) and visceral fat (β = -0.32, p = 0.01) with adiponectin. WC and WHtR are simple proxy measures of obesity that better showed adverse metabolic effect of visceral fat in patients with CHD.

It has been shown that bispectral index (BIS) may reduce during spinal anesthesia. The aim of this study was comparing BIS scores during spinal anesthesia using hyperbaric bupivacaine alone or with intrathecal or intravenous fentanyl for cesarean section. In this double-blind randomized controlled clinical trial, 140 pregnant women with American Society of Anesthesiologists (ASA) class I or II were randomly assigned to receive 1-2.5 mL hyperbaric 0.5% plus normal saline (B), 2-2.5 mL hyperbaric 0.5% plus 20 µg fentanyl intrathecally (BFIT), or 2.5 mL hyperbaric 0.5% plus 100 µg fentanyl intravenously (BFIV). BIS was measured using electroencephalography (EEG) findings and recorded at the baseline and 5th, 10th, 15th, 30th,, 45th, and 60th minutes after spinal injection. The heart rate (HR), mean arterial pressure (MAP), signal quality index (SQI), and temperature were also recorded during surgery. A total number of 140 subjects completed the study and underwent analysis. The recorded BIS was significantly different between the three groups at all time points (p = 0.004). At all the times, the BIS values were lower in the BFIV group compared to other groups (p < 0.05). The BIS scores in group B were significantly higher in most time points compared to other groups. After spinal anesthesia, the changing trend of BIS reduced until the 30th minute for the BFIT group and until the 45th minute for the B and BFIV groups. Although the BIS scores began to decrease during spinal anesthesia using hyperbaric bupivacaine alone or with intrathecal or intravenous fentanyl for cesarean section, the greatest reduction from baseline BIS values occurred with adding intravenous fentanyl. Moreover, maximum reductions of BIS scores appeared at 30 and 45 minutes after induction of spinal anesthesia.

This study aimed to determine the frequency of nasal carriage and antibiotic susceptibility profile of Staphylococcus aureus (S. aureus) among healthy young adults who referred to premarital screening clinics. A crosssectional study including 158 adults (79 men and 79 women) was conducted at health care centers, Isfahan, Iran, during February- August 2008. Nasal swabs from anterior nares of healthy adults were cultured and tested for S. aureus. Antibiotic susceptibility testing was performed on Muller-Hinton Agar using disc diffusion method according to Clinical Laboratory Standards Institute (CLSI). The prevalence of S. aureus nasal carriage was 26.6%. Resistance to penicillin had the highest rate. The isolates demonstrated higher sensitivity to vancomycin, clindamycin, and rifampicin. In addition, twenty-two S. aureus isolates had intermediate resistance to antibiotics. The importance of implementing strategies to eliminate nasal carriage of S. aureus to prevent the spread of infection is highlighted. Effective strategies in this field are thus strongly recommended.

Hearing impairment screening in newborns is a prompt action to identify those who suffer from deafness or hearing loss disorder. This procedure is aimed at early diagnosis of those cases in which quick intervention could prevent subsequent defects and impairments. Evoked otoacoustic emissions (EOAE) test is a screening test which is used to identify patients with hearing problems. This study was conducted to timely diagnose hearing disorder among newborns in order to prevent their verbal disorder through early interventions. This was a descriptive cross-sectional study which was carried out on 1232 newborns in Baharestan Hospital, Isfahan, in 2009-2010. Newborns were enrolled during their first month and they were evaluated by EOAE test. The prevalence of hearing loss in this study was 4.8 per 1000 newborns. Those newborns whose responses to the test were more than 60 % were accepted in the test. Results of the tests in 50% of newborns who were studied in 2 phases were found negative without risk factors but the rest of 50% had risk factors. According to prevalence of hearing impairment in this study which could affect infant’s verbal skill, hearing screening and efficiency evaluation of hearing screening centers in Iran seems to be necessary.

Cotoneaster discolor and Alhagi pseudalhagi are two important kinds of Iranian manna. They have several therapeutic applications in adults and children. The most important ingredient of Cotoneaster discolor is mannitol. Due to the scarcity of toxicological studies on these compounds, their genotoxicity was evaluated. Comet assay technique using fluorescence microscopy was selected to assess genotoxicity. Tail length, %DNA in tail, and tail moment were measured and DNA damage was evaluated. Our findings showed that A. pseudalhagi, C. discolor, glucose, and mannitol caused DNA damage at concentrations of 5 µg/ml, 100 mg/ml, 25 mg/ml, and 50 mg/ml, respectively. Taking C. discolor and A. pseudalhagi in doses which produce concentrations less than 100 mg/ml and 5 µg/ml, respectively, is safe. The harmful effects of non sugary components might be considered in the toxicity caused by these compounds.

Lung cancer has remained the most prevalent malignancy worldwide. It is the fifth leading cause of cancer death in Iran. Nevertheless, during last few years a gradual permanent increase in its incidence has been reported. Although the crucial role of tobacco smoke in lung cancer initiation has long been established, it is tempting to hypothesize that genetic polymorphisms may contribute to lung cancer predisposition. CYP1A1 gene encodes the main enzyme responsible for metabolic activation of several tobacco carcinogens. CYP1A1 MspI (6235T→C) polymorphism is the most studied variation within the CYP1A1, impacts on the basal levels of metabolism and is believed to be associated with elevated lung cancer risk, mainly in Asian population. We investigated the frequency of this genetic variation in Iranian lung cancer patients through a cross-sectional study. 65 lung cancer cases and 80 healthy controls were recruited. The present findings confirmed the low frequency of the variant CYP1A1*2A allele in the control group. A significant increased risk for lung cancer was observed among those who possessed heterozygous (*1/*2A) genotype (OR = 2.79; 95% CI= 1.01-7.65). Adenocarcinoma was more frequent in non-smoker group (P = 0.00064); however, no significant increased risk obtained for squamous cell carcinoma and small cell carcinoma with respect to smoking. heterozygous (*1/*2A) genotype may increase the risk of lung cancer.

Diabetes is associated with several vascular abnormalities due to abnormal angiogenesis. Vascular endothelial growth factor (VEGF) and nitric oxide (NO) are among the most important angiogenic factors. The aim of this study was to evaluate the effect of L-arginine (L-Arg) and L-NAME on coronary angiogenesis in male diabetic rats. 24 male rats were randomly divided into four groups: (1) control, (2) diabetic, (3) diabetic + L-Arg (50mg/kg/day, ip), (4) diabetic + L-NAME. (10mg/kg/day, ip). After three weeks, blood samples were taken and the apex of the hearts was stained for immunohistochemistry. Coronary angiogenesis expressed as capillary density/mm2 was lower in diabetic group compared to the control group (P 0.05). L-Arg significantly improved capillary density in myocardial tissue in diabetic animals (P 0.05); however, L-NAME did not alter it (P 0.05). It seems that L-Arginine improves coronary angiogenesis in type I diabetic animals through changes of serum angiogenic factors. More studies are needed to clarify the effect of NO agonists in different experimental models of angiogenesis.

Although Health system management is one of the main roles of health care providers, medical sciences students are not properly trained for it. The first national scientific Olympiad for students of medical sciences was designed to motivate students for acquiring managerial knowledge and skills, improve their reasoning and problem solving capabilities and propagate team working in students in an excitingly competitive and joyful atmosphere. Designing a model for the Olympiad included three phases: building up a framework for designing the exam questions and determining the topics, setting the exam questions and administering it, and finally judging. In summer 2009, the first national Olympiad for the students of medical sciences on reasoning and decision making in health system management was held in Isfahan University of Medical Sciences. After 19 months, a framework for the exam questions was built up and the themes of the Olympiad were decided to be health policy and health economics. The exam was run in two phases of individual and group cmpetetion.106 students participated in the event. 88.5% of participants uttered the skills needed for this exam were not taught at the university and 61.6% believed the skills were useful for their professional future. Considering the significance of medical student's awareness about heath system management and the importance of improving reasoning and decision making abilities, holding national festivals like an Olympiad can facilitate the achievement of these objectives.

Schizophrenia requires a large share of medical resources due to its early onset and chronic and severe nature. Compliance therapy is a therapy specifically designed to improve concordance with treatment for those with major mental illnesses. The aim of present study was to determine whether compliance therapy improves drug adherence and consequently makes better global functioning and improves quality of life in schizophrenic patients. This randomized controlled clinical trial study was done in Noor hospital in 2008-2009. Patients were randomly assigned to receive the intervention consisting of 8 sessions of compliance therapy, or the control treatment consisting of an equal number of sessions of supportive counseling. All patients were evaluated by Heinrichs Quality of Life scale, Global Assessment of Functioning (GAF) scale, and Positive and Negative Symptoms Scale (PANSS) at baseline, third month and sixth month follow-up after intervention. 76 schizophrenic patients who met criteria of study were enrolled in the trial. Our data showed a significant main effect for interaction of group and time for GAF scale, Heinrichs Quality of Life scale and PANSS. The findings of our study showed that compliance therapy can improve not only global functioning but also quality of life in schizophrenic patients. In addition, PNASS was improved during the six months follow up in compliance therapy group.

Restless legs syndrome (RLS) is highly frequent among uremic patients; however, little is known about RLS risk factors in these patients. We evaluated the frequency of RLS and associated risk factors in Iranian patients on maintenance hemodialysis (HD) and peritoneal dialysis (PD). Ninety patients on maintenance HD (n=45) and PD (n=45) were included from two medical centers. Diagnosis of RLS was based on the International Restless Legs Syndrome Study Group criteria, confirmed by the validated Cambridge-Hopkins questionnaire. Patients were tested for iron state, folate, vitamin B12, kidney function tests and electrolytes. Patients included 53 males and 37 females with the mean age of 54.2 ± 15.2 years and disease duration of 5.36 ± 4.56 years. RLS was diagnosed in 26.6% of the patients (35.1% in females vs. 20.7% in males, P = 0.019). RLS was more frequent in HD than PD patients (35.5% vs. 17.7%, P = 0.048), and in those with positive family history of RLS (37.5% vs. 4.5%, P < 0.001). Based on multivariate analysis, female gender [odds ratio (OR) = 6.67], being on HD (OR = 15.9), positive family history (OR = 19.1), higher body mass index (OR = 1.19), and higher serum transferrin (OR = 1.04) and lower total iron-binding capacity (OR = 0.96) levels were associated with risk of RLS. RLS was frequent in patients on maintenance dialysis and female gender, family history of RLS, being on HD, body mass index and iron deficiency were associated with the risk of RLS. Further studies are required for better understanding of RLS pathophysiology and possible treatments in uremic patients.

Suicide is a major public health concern. This investigation assessed elderly patients treated for self-intoxication in a poisoning referral center. A retrospective and descriptive study was performed from the point of view of demographic, psychiatric and clinical factors related to the self-poisoning for suicide attempts in subjects aged over 65. The examined population consisted of 43 subjects including 30 males and 13 females with an age of 65 to 83 years (mean age = 72.5 years in male and 73.5 years in female). The majority of subjects were retired (35, 81.4%) and, in many cases lived with their family (39, 90.6%). 27.9% of subjects had been undergoing psychiatric treatment. Depressive disorders (reactive) and endogenic depression (affective) were recognized in 8 subjects (66.7%). 51% suffered from chronic diseases including hypertension (33.3%), coronary artery decease (30.4%), chronic obstructive pulmonary disease (15.9%) and diabetes (10.1%). Two cases had a history of previous suicidal attempt. The most frequently used substances in the attempts were medications (58%), opioids (23.2%), pesticide (11.6%) methanol (4.6%), hair remover (2.3%). The mean duration of hospitalization was 1.3 days. The high rate of depression and chronic diseases in elderly with suicidal attempt necessitates preventive interventions.

Symptoms consistent with irritable bowel syndrome (IBS) are common among patients with inflammatory bowel disease (IBD) in remission phase, and clinicians have difficulties in interpreting such symptoms as an ongoing disease activity or a coexistent IBS. We investigated if the assessment of fecal calprotectin (FC) could be helpful in this regard. The study population consisted of 42 IBD patients in remission that fulfilled the IBS diagnostic criteria (Rome III), 24 IBS patients, and 30 healthy controls. Clinical remission was determined based on physician’s assessments, not using corticosteroids or biological agents within the preceding six months and activity indices. The FC and C-reactive protein (CRP) levels were investigated and compared among the groups. FC levels were significantly higher in patients with IBD (142.9 ± 216.5 µg/g) than those with IBS (24.9 ± 27.8 µg/g) and controls (17.9 ± 14.8 µg/g) (p < 0.001). CRP levels were also higher in IBD than IBS patients [3.9 (SE = 0.5) vs. 2.1 (SE = 0.5), p = 0.030]. However, FC levels were not significantly correlated with CRP levels or with severity of symptoms in IBD and IBS patients (p > 0.05). The presence of IBS-like symptoms in IBD patients in clinical remission may reflect an ongoing activity of IBD, which is undetectable by current activity indices. Serum CRP levels are not specific enough in such situation, and FC is a more accurate and specific test for investigating mucosal inflammation in this regard.

Blood and blood products should be kept in cold temperatures to avoid hemolysis and preserve sterility and functional integrity of blood components. Patients needing massive transfusion require the blood to be warmed at bedside, to avoid cardiac and general hypothermia. Hypothermia due to massive and rapid transfusion in ill and injured patients is associated with adverse side effects which are very difficult to be reversed. Here in, we describe two inventions of portable warming devices for blood and blood products and fluid solutions. These devices have several advantages including reduced contact with blood and blood products, instant preparation of blood for injections, decreased damage to blood and blood products, precise controlling of heating process, avoiding physical and chemical changes in quality of blood and blood products and also avoiding hypersensitivity symptoms due to injections.

Despite using different treatment modalities, treatment of diabetic foot ulcer is still a very important challenge. In this case series, we report successful treatment of 6 patients with resistant diabetic ulcers using topical application of trichloroacetic acid (TCA). Six patients with type 2 diabetes mellitus received standard treatment for 6 weeks. TCA 70% was applied to the periphery of the ulcer while TCA 50% was applied to the center of the ulcer every week until the first significant reepithelialization was observed. All wounds in all 6 treated patients were improved after a mean duration of 7.5 ± 0.83 weeks. In fact, significant reductions were observed in the areas and infection scores of the ulcers. The range of improvement efficacy ranged from 68.6% to 100% with no complications after 1, 2, and 3 months of follow-up. The observed efficacy of TCA on diabetic ulcer healing is due to production of granulation tissue and epithelial cells.

Functional gastrointestinal disorders (FGIDs) are common worldwide and cause considerable social and economic burden. The aims of SEPAHAN project were to 1) assess the prevalence of different FGIDs within an Iranian population, 2) investigate the relationship of FGIDs and their symptoms with lifestyle and nutritional factors, and 3) investigate the relationship of FGIDs and their symptoms with psychological factors. It was a cross-sectional study among staff of Isfahan University of Medical Sciences and Health Sciences (Isfahan, Iran) and consisted of two main phases. In the first phase, a detailed dietary questionnaire was used to assess dietary habits and usual dietary intakes. Other lifestyle factors were investigated using appropriate questionnaires. In the second phase, the epidemiology of different FGIDs was determined using Rome III criteria. In addition, different psychological assessment tools were used to screen for anxiety, depression, psychological distress, coping styles, stressful life events, personality trait, and level of social support. Self-administered questionnaires were used in this study. In the first and second phases of the study 8691 and 6239 adults were recruited, respectively. The complete information of 4763 subjects has been provided after linking the questionnaires from both phases. SEPAHAN project is a novel study that provides the opportunity of investigating epidemiological aspects of FGIDs and their relationship with different lifestyle and psychological factors.

Hypertension is one of the most common chronic medical conditions and to this day has remained one of the important problems of public health. Because of relationship between endothelial dysfunction, atherosclerosis and high blood pressure, returning the endothelium-dependent vasodilatation is known as one of the important goal of treatment for high blood pressure. Drugs should be able to preserve endothelial function and reduce blood pressure. This has caused the most recent treatments and strategies to improve endothelial function. We review the mechanism of these drugs on endothelial function. Most of the drugs have a positive effect on improving endothelial function and the role of dihydropyridine calcium channel inhibitors such as (nifedipine) is obvious. Most studies showed lack of adequate control of blood pressure by monotherapy. A combination of calcium channel blockers and angiotensin converting enzyme has been proposed. The use of new drugs such as antioxidant, aldosterone antagonists and the pro-angiogenic factors with nonpharmacologic and pharmacologic therapy, can reduce blood pressure and has a significant impact on the functioning of epithelial.

Infections are among the most serious complications experienced by intravenous drug abusers. However, there have been rare reports of the cases with acute pericarditis caused by Klebsiella pneumoniae. CASE REPORT: In this study we reported a case of purulent pericarditis caused by Klebsiella pneumoniae in an intravenous drug abuser. The patient was completely treated by adequate surgical drainage and effective intravenous antibiotic therapy. Infections are among the major complications of drug use. Purulent pericarditis usually occurs as a complication of another illness, like surgical wound infection, mediastinal abscess, lung abscess, or severe sepsis. Aggressive surgical and medical treatments would thus be lifesaving.

There are a few case series of giant cell tumor (GCT) in the spine and sacrum. GCT in the thoracic vertebrae is even more exceptional in the medical literature. In this article we report a GCT in a 25-year-old male who presented with progressive back pain and dyspnea. On contrast-enhanced multidetector computer tomography, a large heterogeneously enhancible posterior mediastinal mass was detected with adjacent bony erosion and right main bronchus narrowing. At surgery, resection of large posterior mediastinal mass and curettage of adjacent body vertebrae with stabilization were performed. The final histological examination revealed that these findings were compatible with GCT from thoracic body vertebra.

Pseudohypoaldosteronism type 1 (PHA1) is a rare congenital disease of mineralocorticoid resistance which characterized by neonatal renal salt wasting, vomiting, dehydration and failure to thrive. The clinical presentation of the disease represented mostly during neonatal period with a wide spectrum of symptoms regarding to autosomal recessive (systemic) or dominant (renal) inheritance mode. Biochemically, it is represented by high levels of plasma renin and aldosterone, hyponatremia and hyperkalemia. In this report, we present a case with clinical and biochemical findings of PHA1 and a positive familial history of the disease in her sister. CASE: A 3 months old girl infant was admitted to paediatrics emergency because of poor weight gain. At the time of admission, she was alert but dehydrated without history of vomiting or diarrhea for 1 week which had been deteriorated in last two days. Hyponatremia, hyperkalemia, metabolic acidosis and persistent electrolytes abnormalities were detected with dehydration in spite of adequate treatment, absence of hyperpigmentation, normal 17-OH-P values, high levels of plasma renin and aldosterone. No evidence of adrenal hyperplasia or renal anomalies was seen on ultrasonography. Acceptable response was achieved with high doses of fludrocortisone (0.5mg/day) and oral NaCl. These findings in addition to positive familial history led to the diagnosis of pseudohypoaldosteronism type 1.CONSLUSIONS: In any infant who presents with hyponatremia, hyperkalemia and metabolic acidosis and non-specific symptoms such as growth retardation, some rare diagnosis such as PHA1 should be considered.

thalassemia (Cooley anemia) initially was described by Dr Cooley.[1] It is recognized that various types of thalassemia are inherited anemia caused by mutations at the globin gene, affecting the production of ɑ- or β-globin protein. The anemia interferes with red cell maturation.[2] β-globin gene mutations give rise to β-thalassemia.[3] Patients have abnormal growth, altered pubertal development, and immune function and deficits in bone mineral acquisition.[4] Thalassemia major (TM) refers to a disease requiring more than eight red blood cell transfusions per year. The combination of early diagnosis, improvements in monitoring for organ complications, and advances in supportive care, however, have enabled many patients who have severe thalassemia syndromes to live productive and active lives well into adulthood.[3]...