Journal of Research in Medical Sciences
Volume:17 Issue: 6, Jun 2012

The aim of this study was to evaluate intraocular pressure (IOP) and hemodynamic responses following insertion of laryngeal mask airway (LMA) or endotracheal tube (ETT) after anesthesia induction with propofol and remifentanil in cataract surgery. In a randomized controlled study, 50 adults scheduled for elective cataract extraction procedure under general anesthesia were allocated to LMA insertion (n = 25) or ETT (n = 25) groups. IOP, systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were measured after insertion of the airway device every minute up to 5 min. There were no significant differences between LMA and ETT groups in SBP, DBP, HR, and IOP immediately after airway instrumentation up to 5 min, except in 4th min in DBP, 2nd min in HR, and 5th min in IOP (7.9 } 2.3 mmHg in LMA and 9.4 } 2.5 mmHg in ETT group; P = 0.030). There was good surgeon satisfaction for providing acceptable surgical field in both groups (88% in LMA and 80% in ETT group; P = 0.702). Propofol combined with remifentanil provides good and excellent conditions for insertion ofLMA or ETT with minimal hemodynamic disturbances in cataract surgery. Considering LMA insertion is less traumatic than ETT, using LMA may be better than ETT for airway securing in these patients.

Migraine and allergic rhinitis (AR) are two common causes of headache and facial pain that inflammatory mediators with vasoactive function play important roles in both of them. The aim of this research was to determine the prevalence of migraine in AR patients. In a cross-sectional comparative study performed from June to December 2010 in patients with AR sign and symptoms referred to ear, nose, throat (ENT) clinic of a university hospital in Iran-Rasht, 46 patients with positive skin prick test were compared with 60 subject without AR signs and symptoms and with negative skin test. In both the groups, history of migraine according to IHS (International Headache Society) criteria were investigated. Analysis of data was performed by chi-sqaure and Fisher exact test by using SPSS16. Odds ratio were estimated for determining the chance of migraine in AR. In case group (14 male, 37 female; mean age: 31.17 } 8.31 years) and control group (23 male, 37 female; mean age: 37.58 } 12.6 years), the prevalence of migraine was 37% and 5%, respectively. The differences in prevalence of migraine and migraine without aura between cases and controls were significant (P = 0.001). The chance of migraine in AR was 8.227 folds (95% CI: 2.38-28.42). In subjects older than 40 years old, the difference of prevalence of migraine was significant, contrary to subjects younger than 30 years old and between 30 and 39 years old. There is a correlation between migraine especially without aura and AR and thiscorrelation is more powerful with increasing age.

Context: Cutaneous leishmaniasis (CL) is a public health problem in several endemic countries. Recent studies on mouse model and also a few clinical experiments showed that the type of immune response generated at the site of infection and especially balance between regulatory and effector T-cells determines the outcome of the disease toward self-limiting or long-lasting lesions. The aim of this study was to evaluate the role of natural regulatory T cells (nTregs) in early and late cutaneous lesions of human Leishmania major (L. major) infection. Settings and Design: Skin biopsies were collected from parasitologically proven lesions of 28 CL patients, divided into two groups of early and late lesions. The causative agents were identified to be L. major. Quantitative real-time reverse transcription polymerase chain reaction (PCR)AU: Please define PCR and PBMC at first occurrence. and immunofluorescent staining of biopsies were used to assess the Foxp3 mRNA expression and frequency of nTregs in two groups. Mann-Whitney U test was used to determine the significance of deference between the two groups. Mean relative expressions of Foxp3 mRNA were 0.53 } 0.23 and 1.26 } 0.99 in early and late lesions, respectively, which was significantly upper in chronic lesions (P = 0.007). Parallel results were obtained in tissue staining method. Increased in gene expression and protein staining of nTreg markers in chronic biopsy samples indicates a role for these cells in chronic L. major induced leishmaniasis and supports the effectiveness of regulatory T cell-based immunotherapy for treatment of chronic CL.

Serum low density lipoprotein (LDL) level is an important biomarker for coronary artery disease (CAD). As direct LDL measurement is expensive and not cost effective, especially in a large population, it is estimated by Friedewald formula. Therefore, we decided to compare the direct LDL measurement method with LDL measured by Friedewald formula in a large general population for the first time in Iran. Furthermore, we examined the association of total cholesterol (TCh), triglyceride (TG), and high density lipoprotein (HDL) with LDL. Subjects and This study was conducted on the subjects, aged 11–97 years, in the third phase of Isfahan Healthy Heart Program (IHHP) from three cities: Isfahan, Najafabad, and Arak. A fasting blood sample was taken from all subjects and referred to Isfahan Cardiovascular Research Center (ICRC) laboratory (central laboratory of IHHP) to assess TCh, TG, HDL, and LDL directly. Also, the LDL level was calculated by Friedewald formula, in addition. The mean level of LDL by direct method was lower than that calculated by Friedewald formula. The mean difference between the two methods was significant, which was 6.6 } 15.5 mg/dl difference (t = -42.925, P < 0.0001). Correlation between direct and calculated LDL levels was high, as 80.4% of variation in direct method was predicted with LDL calculated from Friedewald formula. Using regression model, a new formula was found for the estimation of LDL. It is concluded that the Friedewald formula overestimates the LDL level compared to the direct method in general Iranian population. It is suggested that LDL measurement be carried out directly, especially in high-risk people. If necessary to use a formula for LDL estimation it is better to obtain an especial formula for each population.

Maladaptive cognitive schemas can lead to biases during clinical assessment or psychotherapeutic interventions. This study aimed to explore the cognitive schemas among mental health professionals. 100 mental health professionals, of both genders, equally divided between psychiatrists, psychologists, social workers, and psychiatric nurses, were approached and administered the Young Schema Questionnaire - Short Form after written informed consent. Males had higher maladaptive schemas than female respondents across all schema domains, viz., disconnection/rejection, impaired autonomy, impaired limits, other-directedness, and overvigilance (P ≤ 0.05). Psychiatrists had higher maladaptive schemas than psychologists (P ≤ 0.05). Age was weakly but positively corelated with the schemas of self-sacrifice (P = 0.038) and unrelenting standards (P = 0.002). Mental health professionals also may have maladaptive schemas, which needs to be addressed through schema therapy.

Hepatitis-B virus (HBV) infection is a big problem in chronic kidney disease (CKD) population. We attempted to compare the response rate to HB vaccine in CKD stages3-4 patients with that in hemodialysis (CKD stage-5; HD patients) and medical staff. Three hundred and three participants were enrolled into the study to test the seroconversion rate after vaccination. Participants formed three groups: GroupA:HD patients, GroupB: diagnosed with CKD stages34, and GroupC: healthy medical staff. CKD stages34 participants were vaccinated from February to November 2010. HD patients were vaccinated at the time of initial HD and medical staff at the time of being hired. GroupA, GroupB and GroupC received four 40μg(in 0,1,2 and 6 months), three 40μg(0, 1 and 6 months) and three 20μg(0, 1and 6 months) doses of HB vaccine, respectively. Three months after completion of the vaccination schedule, seroconversion and seroprotection rates in each group were investigated. Seroconversion rates were 44.3%, 89.7%, and 96.2% for groups A, B and C, respectively. CKD stages 34 patients showed higher response rate than dialysis patients [χ2(1):30.6, P <0.001]. But a significant difference in the seroconversion rate between CKD stages34 patients and medical staffs was not observed [χ2(1):3.4, P = 0.064]. Multivariate analyses showed patients with more advanced CKD and who were older had less seroconversion rates [odds ratio: 0.09(95%CI: 0.040.25) and [odds ratio: 0.39(95% CI: 0.180.85)], respectively. But sex was not associated with seroconversion (P>0.05). Stages34 patients with higher dosages of routine HB vaccine had higher seroconversion rate than HD patients. Future studies should evaluate the recommended dosage of HB vaccine among these patients.

Melanoma is the most serious skin cancer. There is an established correlation between thickness and aggressiveness of the tumor. Nevertheless, the potential value of vascular endothelial growth factor (VEGF) in correlation with tumor progression remains unresolved. Thirty seven paraffin blocks of cutaneous melanoma were obtained from Pathology department of Al-zahra hospital between 2005 and 2010. The sections were stained with monoclonal mouse antibodies (mAbs) against vascular endothelial growth factor A and evaluated by distribution of expression of VEGF in tumor cells as 0, 0%; 1, 1%--25%; 2, 25%--50%; 3, >50% and the staining intensity from 0 (negative) to 3 (strong). The sum of intensity score and distribution score was then calculated as the VEGF index. The relationship between VEGF expression (distribution, intensity, and index) and tumor progression (vertical and radial growth, Clark’s level, and Breslow’s depth) was studied. SPSS software was used to analyze the data by ANOVA, and chi-square tests. 51.4% of the patients showed vertical growth pattern. Mean Breslow’s depth was 1.84 } 1.79 mm. There was a significant association between growth pattern and VEGF distribution, intensity and index (P = 0.006, P = 0.005, and P = 0.001 respectively). VEGF distribution, intensity, and index all had correlation with Breslow’s depth as well (ANOVA test: P = 0.003, P < 0.001, and P < 0.001 respectively) VEGF index had also correlation with Clark’s level, but this was not seen for VEGF distribution and intensity. VEGF expression (both VEGF distribution and intensity) is associated with progression of malignant melanoma. VEGF index can explain this association better.

Esophageal atresia (EA) is a common congenital anomaly. In this study, we evaluated the mortality and its risk factors in patients born with esophageal atresia. Methods and Materials: A database of 206 consecutive patients treated for EA was developed in ST-Zahra hospital of Isfahan between 1994 and 2004. In this study, 206 patients were evaluated. The most common type of EA was type C (86.4%). Mortality rate was 56%; it was more common in patients with congenital malformation, in late operation and in low birth weight and premature babies. Sepsis was the most common cause of death. For improvement of EA survival, we should improve operation techniques, supportive care, and ICU management. It is also important to operate these patients as soon as possible.

There are many studies indicating the role of psychological factors in the pathogenesis of cardiovascular disorders. Type D as a new personality construct has been proposed by Denollet, characterized by the joint global traits including negative affectivity and social inhibition. The purpose of this study was to examine the link between type D personality and hyperlipidemia in patients with myocardial infarction (MI). One hundred and seventy-six consecutive patients admitted to the cardiac care unit (CCU) wards of nine hospitals in Isfahan, Iran, following MI, were selected based on the inclusive and exclusive criteria. The patients completed demographic questionnaire and Type D Personality Scale (DS14). Their medical data were obtained from medical records. Chi-squared test, Student’s t-test, and multivariate logistic regression were used to analyze the data. Of the 176 subjects, 63 patients (35.8%) were type D. In univariate analysis, hyperlipidemia was the only significant variable (56% vs. 40%, P = 0.041) found to be associated with type D. Also, by multivariable logistic regression analysis, hyperlipidemia [Odds Ratio (OR) 0.374; 95% confidence interval (CI) 0.175–0.796] was the only independently significant variable found to be linked with type D personality. No other statistically significant differences were found between the two groups on demographic and medical factors characteristics. The type D personality was associated with hyperlipidemia. Thus, personality factors may make people vulnerable to metabolic syndromes.

Neurological deterioration in acute spontaneous intra cerebral hemorrhage (ICH) may depend on hematoma volume, electrolyte imbalances, hydration status and other physiological parameters. Plasma osmolality is a marker of hydration. This study has examined the relationship of plasma osmolality with hematoma volume and clinical outcome. This is a prospective observational study included 75 patients with non-traumatic acute spontaneous ICH. Plasma osmolality, hematoma volume and clinical outcome in National Institute Health stroke scale (NIHSS) were measured on admission and on day 7 after treatment. Mean plasma osmolality was compared between those who died before day 7 and those who died after day 7. Plasma osmolality was also compared between patients with NIHSS score >20 and patients with NIHSS score ≤20. Paired t test, Pearson correlation coefficient and independent sample t test were done using SPSS software (version 17 for Windows). There is no significant correlation between hematoma volume and plasma osmolality. Higher admission plasma osmolality was associated with early death [312.0 (±16.0) mOsm/kg for those who died before day 7 versus 297.0 (±14.7) mOsm/kg for those who died after day 7, P value =0.031]. Higher admission plasma osmolality was associated with very severe stroke [311.5 (±14.1) mOsm/Kg for patients with NIHSS score >20 versus 293.6 (±11.3) mOsm/kg for patients with NIHSS score ≤20, P value =0.000). High plasma osmolality is a predictor of early mortality. Hematoma volume is not influenced by plasma osmolality.

Residence characteristics can affect health of residents. This paper reports the development of an instrument assessing these aspects of neighborhoods. Literature search and focus group discussions with residents were carried out and relevant items were extracted. Five experts reviewed and commented on the items. An observation instrument with 54 items was composed and completed by two independent observers in 20 randomly selected locations. Due to lack of acceptable reliability in some items, the checklist was revised. The new 22-items checklist in four categories (general characteristics, public green area characteristics, access to services and undesirable features) was completed by two independent trained observers in 28 randomly selected locations. The items in the final checklist had kappa statistics ranging from 0.63 to 1, with an exception of the item assessing “presence of beggars, homeless or working/street children”, with kappa as low as 0.27 due to variability of their presence in different times. Average Kappa statistics was 0.78 for general characteristics, 0.79 for public green area characteristics, 0.84 for access to services, and 0.54 for undesirable features. Neighborhood and health observation instrument seems to have good reliability in city of Tehran. It can probably be used in other large cities of Iran and similar cities elsewhere.

Sleep problems among university students are common; however, the contributing factors to poor sleep experiences are still unclear. The purpose of this study is to examine the contributing factors to poor sleep experiences in university students. The study was cross-sectional, and the students completed self-report, anonymous questionnaires provided during an in-class survey. This is a single center study. A descriptive survey was conducted randomly on 256 university students in Turkey. The instruments for data collection consisted of the demographic data, and the contributing factors to poor sleep. The most frequent self-reported cause to poor sleep experiences in according to the university students were exposure psychological problems (67.2%), stress (64.8%), exposure to tobacco smoke in the sleeping room (63,7%), pain (62,9%), having family problems (62,5%), being patient (55,1%), air quality of the room (55,1%), strenuous physical activity (53,9%), fatigue (53,5%), sadness (53,1%), noise that caused by other people in the room (52.0%), room scents (sweat, perfume, humidity, naphthalene, etc.) (53.1%), depression (51, 6 %), anxiety, and tension (51, 1%). Students should be encouraged to solve psychological problems, to suitable stress-relieving measures, to follow sleep hygiene practice and adequate time management for academic and social activities.

The major aim of this study is to examine the role of alterations in lipid profile in women developing breast cancer. This study was carried out between May 2009 and December 2010. The relationship between lipids and breast cancer is undistinguished. Until now, conflicting results have been reported on the association between lipids and risk of breast cancer development in women. Plasma lipids (i.e., total cholesterol [TC], high-density lipoprotein [HDL], low-density lipoprotein [LDL], and triglycerides [TG] were analyzed from 60 controls and 120 untreated breast cancer patients with clinical and histopathological evidence, under aseptic conditions. Venous blood was drawn from the cases and controls and estimations of lipid profile were done utilizing the standard procedures. Statistical Analysis Used: Independent sample t-test to compare the mean serum levels of lipid profile and TC/HDL ratio between patients and controls. A significant rise in serum total cholesterol, low-density lipoprotein cholesterol, and ratio of total cholesterol: high density lipoprotein cholesterol values, whereas high density lipoprotein cholesteroland very low density lipoprotein cholesterol were not affected significantly by the breast cancer. The developing breast cancer might be considered as one of the factors in alterations in lipid profile levels.

Commission of crime and hostility and their forensic consequences in a patient with schizophrenia can worsen the patient’s condition and disturb his family, society, and even the psychiatrist. Based on previous research, patients with schizophrenia are at a higher risk for crime. It is not clear whether this is due to the nature of schizophrenia, comorbidity of antisocial personality disorder, or the history of conduct disorder in childhood. In this study, we investigated this hypothesis. In this case–control study, 30 criminal and 30 non-criminal patients with schizophrenia, who had been referred by the court to the Forensic Medicine Center of Isfahan, were evaluated for antisocial personality disorder, history of conduct disorder, and psychopathy checklist-revise (PCL-R) score. Frequency distribution of antisocial personality disorder (73.3%), history of conduct disorder in childhood (86.7%), and score of PCL-R ≥25 (indicating high probability of hostility) in patients (40%) were significantly higher in criminal patients than in non-criminals (10%, 30% and 0%, respectively; P < 0.001). More prevalence of antisocial personality disorder, history of conduct disorder, and high score of PCL-R (≥25) in criminal schizophrenic patients may indicate that in order to control the hostility and for prevention of crime, besides treating acute symptoms of psychosis, patients might receive treatment and rehabilitation for comorbidities too.

To report two patients with recurrent miscarriages and unique reciprocal X-autosomal translocation. Cytogenetic analysis was performed using G-banding and Molecular cytogenetic analysis by Fluorescence in situ hybridization to confirm the breakpoint regions. The chromosomal analysis of the two cases revealed a karyotype of 46,X,t(X;22)(p11.21;q13.3)in the first patient and 46,X,t(X;2)(q22;q13) in second patient. Both the cases were confirmed by using whole chromosome paint probes. This is the rare report of X-autosomal translocations with unique breakpoint regions and their association with recurrent miscarriages. The translocation breakpoint in case 2 on Xq22 and on Xp11.21 in case 1 might be a risk factor for recurrent miscarriages. Here the impact of the X-autosomal translocations is discussed.

Sinonasal teratocarcinosarcoma (SNTCS) is a very rare and aggressive malignant neoplasm histologically characterized by the combination of one or many components of epithelial and mesenchymal elements. Here, we report a SNTCS in a 60-year-old man involving posterior nasal and nasopharyngeal wall extending into left ethmoidal sinus. The patient complained of bleeding from nose, nasal obstruction, and generalized weakness for last two months. Tumor was completely removed by Caldwell-Luc operation and postoperative radiation therapy was given. The follow-up of the patient for two years has shown no evidence of recurrence or metastasis.

Venomous catfish stings are a common environment hazard worldwide. Although these stings are often innocuous, significant morbidity may result from stings, including severe pain, retained foreign bodies, infection, respiratory compromise, arterial hypotension, and cardiac dysrhythmias. Treatment included hot water immersion, analgesia, wound exploration, and prophylactic antibiotics. In this article, two cases of stings by catfish referred to the poison center of Noor Hospital, Isfahan University of Medical Sciences and their treatments have been reported.

The left eye of a 65-year-old male was blind due to optic atrophy and only seeing eye had also dry type age-related macular degeneration. An anterior ischemic optic neuropathy developed in the better seeing eye. Vision recovered in the blind eye in a short time after losing the better eye. Gaining some vision in a blind eye may be an adaptation of visual pathway in such patients.

Paraphenylenediamine is an important constituent of hair dye toxicity of which one could herald fatal complications such as rhabdomyolysis, renal failure, angioneurotic edema, and respiratory failure. We present a case of hair dye poisoning that presented with respiratory distress due to laryngeal edema and later developed trismus, subclinical tetany, apnea, and conduction abnormality on electrocardiogram. This case report highlights the need for a thorough toxicological review of the components of any ingested substance.

Human experimental pain models are essential in understanding the pain mechanisms and appear to be ideally suited to test analgesic compounds. The challenge that confronts both the clinician and the scientist is to match specific treatments to different pain-generating mechanisms and hence reach a pain treatment tailored to each individual patient. Experimental pain models offer the possibility to explore the pain system under controlled settings. Standardized stimuli of different modalities (i.e., mechanical, thermal, electrical, or chemical) can be applied to the skin, muscles, and viscera for a differentiated and comprehensive assessment of various pain pathways and mechanisms. Using a multimodel–multistructure testing, the nociception arising from different body structures can be explored and modulation of specific biomarkers by new and existing analgesic drugs can be profiled. The value of human experimental pain models is to link animal and clinical pain studies, providing new possibilities for designing successful clinical trials. Spontaneous pain, the main compliant of the neuropathic patients, but currently there is no human model available that would mimic chronic pain. Therefore, current human pain models cannot replace patient studies for studying efficacy of analgesic compounds, although being helpful for proof-of-concept studies and dose finding.