Journal of Research in Medical Sciences
Volume:17 Issue: 7, Jul 2012

To assess the national prevalence of clinical disorders in 6-year-old Iranian children before school entry using a national health assessment survey. In a cross-sectional nationwide survey, all Iranian children entering public and private elementary schools were asked to participate in a mandatory national screening program in Iran in 2009 in two levels of screening and diagnostic levels. The study population consisted of 955388 children (48.5% girls and 76.1% urban). Of the whole children, 3.1% of the 6-year-old children had impaired vision. In addition, 1.2, 1.8, 1.4, 10, 10.9, 56.7, 0.7, 0.8 and 0.6% had color blindness, hearing impaired, speech disorder, height to age retardation, body mass index extremes, decayed teeth, having disease with special needs, spinal disorders, and hypertension, respectively. The distribution of these disorders was unequally distributed across provinces. Our results confirmed that the prevalence of clinical disorders among 6-year-old children across Iranian provinces was not similar. The observed burden of these distributions among young children needs a comprehensive national policy with evidence-based province programs to identify the reason for different distribution among provinces.

Low testosterone, with or without symptoms, reported in diabetic men in some studies. We investigated the prevalence of hypogonadism in Iranian type 2 diabetic men. Total testosterone (TT) and sex hormone binding globulin (SHBG) concentrations were measured in 247 diabetic men >30 years who had symptoms of androgen deficiency, according to ADAMs questionnaire. The correlation between some parameters and total, free and bioavailable testosterone levels was determined using Pearson correlation coefficient. Free and bioavailable testosterone were calculated by electronic calculator. Four patients were excluded because of high testosterone level, due to unreported androgen use. Overt hypogonadism was defined as total testosterone ≤8 nmol/l or calculated bioavailable testosterone (cBT)≤2.5 nmol/l and borderline hypogonadism was considered as TT 8-12 nmol/l or cBT 2.5-4nmol/l. The mean and SD of age was 59 (9.3) years. The mean TT, calculated free testosterone (cFT), and cBT and SHBG levels were 4.81 (1.7) nmol/l, 0.11 (0.06) nmol/l, 2.42 (1.17) nmol/l and 36.15 (18.3) nmol/l, respectively. According to TT and cBT, overt hypogonadism observed in 7.4% and 61.6% of men, respectively, and the prevalence of borderline hypogonadism was 9.9% and 36%, respectively. cFT ≤0.16 nmol/l found in 227 diabetic men (96%). Hypogonadism (TT ≤12 nmol/l) was not correlated with obesity, smoking, age, duration of diabetes, blood pressure, and HbA1c. Hypogonadism is highly prevalent in type 2 diabetes men.

This study aimed to investigate whether magnesium supplementation might affect serum magnesium, high sensitive C-reactive protein (hs-CRP), plasma fibrinogen, and interleukin 6 (IL-6) levels in healthy middle-aged overweight women. The relationships, if any, between serum magnesium and the inflammatory markers were also examined cross-sectionally in the entire participants at the beginning of the study. This double-blinded, placebo-controlled, randomized trial included 74 middle-aged overweight women. Participants were randomly assigned to receive either 250 mg magnesium as magnesium oxide or placebo daily for 8 weeks. Serum magnesium, hs-CRP, fibrinogen and IL-6 concentrations were measured before and after the intervention. Serum magnesium was found to be inversely correlated with hs-CRP (r =−0.22, P=0.05) in the entire participants at baseline. Serum hs-CRP declined significantly in both groups as compared with baseline values (median change=0.8 mg/L; PMagnesium=0.03, P Placebo < 0.001). Plasma fibrinogen decreased significantly, by 9%, in the magnesium group at the end of week 8 compared to baseline (P=0.001). Mean concentration of IL-6 was significantly increased in the magnesium group comparing the baseline value(P=0.001). However hs-CRP, fibrinogen and IL-6 levels at week 8 or any changes during the study were not statistically different between the two groups. Serum magnesium showed no significant changes in any groups. Serum magnesium had a significant inverse correlation with hs-CRP. In the present study, magnesium as magnesium oxide, 250 mg/day, for 8 weeks did not significantly attenuate inflammatory markers in the magnesium group as compared to the placebo.

Obstructive sleep apnea (OSA) syndrome is predisposed to the development of upper airway obstruction during sleep, and it poses considerable problem for anesthetic management. Difficult intubation (DI) is an important problem for management of anesthesia. In this clinical research, we aim to investigate the relationship between DI and prediction criteria of DI in cases with OSA. We studied 40 [OSA (Group O, n = 20) and non-OSA, (Group C, n = 20)] ASA I-II, adult patients scheduled tonsillectomy under general anesthesia. Same anesthetic protocol was used in two groups. Intubation difficulties were assessed by Mallampati grading, Wilson sum score, Laryngoscopic grading (Cormack and Lehane), a line joining the angle of the mouth and tragus of the ear with the horizontal, sternomental distance, and tyromental distance. Demographic properties, time-dependent hemodynamic variables, doses of reversal agent, anesthesia and operation times, and recovery parameters were recorded. Significant difference was detected between groups in terms of BMI, Mallampati grading, Wilson weight scores, Laryngoscopic grading, sternomental distance, tyromental distance, doses of reversal agent, and recovery parameters. OSA patient’s DI ratio is higher than that of non-OSA patients. BMI Mallampati grading, Wilson weight scores, Laryngoscopic grading, sternomental distance, and tyromental distance evaluation might be predictors for DI in patients with OSA.

The aim of this study was to test the potential properties of metformin (MF) to protect the kidney from gentamicin (GM)-induced renal toxicity. In this preclinical study, 50 male Wistar rats were randomly divided into five groups of 10 rats in each. In the first group (group I), they were kept in the same condition as others without receiving drugs for 10 days. In group II, the rats were injected intraperitoneally with 100 mg/kg/day of GM for 10 consecutive days. Group III rats received 100 mg/kg/day MF orally for 10 days. In group IV, the rats received GM (100 mg/kg; intraperitoneally) for 10 days and 100 mg/kg/day MF orally for the next 10 days. In the last group (group V), the rats received a combination of GM 100 mg/kg/day intraperitoneally and MF 100 mg/kg/day orally for 10 days simultaneously. Serum blood urea nitrogen (BUN) and creatinine (Cr) values were measured and renal tissues of the animals were processed for light microscope examination. The levels of BUN in groups II, IV, and V, and also the serum level of Cr in groups II and V were increased significantly after the experiment. Furthermore, post-treatment with MF or co-treatment with MF could prevent the elevation of serum BUN and Cr induced by GM and also attenuates the damage score (P < 0.05). MF may prevent or ameliorate GM-induced acute renal failure, and therefore it might be beneficial in patients under treatment with this medicine.

Cardiovascular disease remains the leading cause of death and disability in industrialized and developing countries. The aim of this research was to determine the effect of rice bran oil, with a low-calorie diet, on lipid profiles, in hyperlipidemic patients. This study was a parallel groups’ randomized clinical trial with a pre- and post-test design. Fifty hyperlipidemic patients of both sexes and age range of 25 – 65 years had participated. The patients received a low-calorie diet based on 1400 kcal energy, 17% protein, 26% fat, and 57% carbohydrate per day for four weeks. The treatment group received a low-calorie diet including rice bran oil (30 g / day). Blood samples were obtained after an overnight (12 hours) fasting period before the study and on the last day of the intervention period. Anthropometric indices and levels of serum triacylglycerol, total cholesterol, low-density lipoprotein, and high-density lipoprotein were measured before and after the intervention. In both groups, weight, body mass index, waist, and hip circumferences were significantly reduced (P < 0.05) after four weeks. In comparison with the control group, the results of treatment with rice bran oil, with a low-calorie diet, showed that at the end of the fourth week, total cholesterol,low-density lipoprotein, and atherogenic ratio of total cholesterol / high-density lipoprotein were significantly decreased (P < 0.05). The results confirm that rice bran oil, when consumed as part of a healthy diet, is effective in improving risk factors for cardiovascular disease.

To determine whether the phosphodiesterase type 5 inhibitor, Sildenafil citrate, affects uteroplacental perfusion. Based on a randomized double-blinded and placebo-controlled trial, forty one pregnant women with documented intrauterine growth retardation at 24-37 weeks of gestation were evaluated for the effect of a single dose of Sildenafil citrate on uteroplacental circulation as determined by Doppler ultrasound study of the umbilical and middle cerebral arteries. Statistical analysis included χ2test to compare proportions, and independent-samples t-test and paired student’s t-test to compare continuous variables. Sildenafil group fetuses demonstrated a significant decrease in systolic/diastolic ratios (0.60 [SD 0.40] [95% Cl 0.37-0.84], P=0.000), and pulsatility index (0.12 [SD 0.15] [95% Cl 0.02-0.22], P=0.019) for the umbilical artery and a significant increase in middle cerebral artery pulsatility index (MCA PI) (0.51 [SD 0.60] [95% Cl 0.16-0.85], P=0.008). Doppler velocimetry index values reflect decreased placental bed vascular resistance after Sildenafil. Sildenafil citrate can improve fetoplacental perfusion in pregnancies complicated by intrauterine growth restriction. It could be a potential therapeutic strategy to improve uteroplacental blood flow in pregnancies with fetal growth restriction (FGR).

Athletes use flavonoids as antioxidant to enhance endurance and physical performance. In vitro data indicate flavonoids have antioxidative and antiinflammatory functions but data in human studies are limited. The aim of this study was to determine the effects of a 2-month flavonoid quercetin supplementation on oxidative stress and inflammatory biomarkers in nonprofessional athletes with regular exercise. The randomized double-blind clinical trial was done among subjects with systematic and regular exercise for 8 weeks in four groups, each containing 15 individuals: 500 mg quercetin + 250 mg vitamin C as pro-oxidant (Q+C), 500 mg of quercetin alone (Q), 250 mg of vitamin C alone (C), and placebo (Control). IL-6, CRP, E-selectin and F2-isoprostane were measured before and after intervention. In 60 participants with mean (±SD) age of 21.0 ± 1.6 years, statistically significant within group differences were observed in IL-6 (P<0.1), CRP (P<0.01) and F2-isoprostane for group 1 and pre- and postchanges in E-selectin was marginally significant for all study groups (P<0.1). Group 1 had marginally smaller F2-isoprostane (P<0.1) and interleukin 6 than control group (P<0.05) and there were marginally differences in CRP between respondents in group 1 and 2 with the control group (P<0.1). Eight-week supplementation with quercein-vitamin C was effective in reducing oxidative stress and reducing inflammatory biomarkers including CRP and IL-6 with little effect on E-selectin in healthy subjects.

Type II diabetes mellitus (DM) increases the risk of cardiovascular disease. Treatment with insulin substantially reduces C - reactive protein (CRP) because of its anti-atherosclerotic action. This study was designed to explore and compare the cardio protective role of regular human insulin (RHI), aspart and lispro insulin in type II DM. A randomized, open, parallel group, comparative clinical study was conducted on 90 patients of type II DM. After baseline clinical assessment and investigations, RHI was prescribed to 30 patients, aspart insulin to 30 patients and lispro insulin to another 30 patients for 12 weeks. The efficacy variables were change in blood pressure, glycemic control, lipid profile, serum potassium, high-sensitivity CRP (hsCRP) and UKPDS 10-year CHD risk scoring over 12 weeks. At the end of the study, the patients were followed up and changes in variables from baseline were analyzed by statistical tools. Systolic blood pressure decreased significantly in aspart group (P = 0.008) whereas diastolic blood pressure was decreased significantly both in aspart (P < 0.001) and lispro group (P = 0.01). Fasting, postprandial blood glucose and HbA1c were decreased in all three groups significantly but change in aspart group was superior (P = 0.01). Triglyceride was significantly better controlled by lispro (P < 0.01) whereas aspart insulin was superior to decrease total cholesterol and LDL (P < 0.05). The extent of potassium loss was significantly more with RHI (P = 0.004) than others. CRP-lowering effect (P = 0.017) and decrease in UKPDS risk scoring (P = 0.019) in aspart and lispro group was superior to RHI group. Short acting insulin analogues, especially aspart insulin have been found to havea better cardio protective role than RHI in type II DM.

Context: participation in regular intensive exercise is associated with a modest increase in left ventricular wall thickness and cavity size. The magnitude of improvement depends on frequency, intensity, type, and duration of exercise program. to determine the effect of sports training on LV morphology and function, lung function, and to know the intensity of the exercise program enough for these changes. Settings and design: this was a longitudinal study (20 weeks duration) done on the medical college students. three groups, doing exercise at different intensities, high intensity group (HG) [74.9±3.9 %HRmax], low intensity group (LG) [59.46±4.1%HRmax] and no exercise group (NG) were made, and their assessments were done using the echocardiography and pulmonary function test three times, first before start of the exercise program, second at the end of 10th week, and then at the end of the 20th week. Statistical analysis used: 3 × 3 Anova test and Bonferroni’s post-test using Graph pad prism5 software. significant improvement was seen in HG in majority of cardio respiratory parameters (VO2max, heart rate, LVIDD, LVIDS, EDV, MVV, PEFR, FVC) as compared to the LG (VO2max, heart rate, MVV, PEFR) and this improvement was specially seen at the end of the twentieth week. twenty weeks of training is helpful in improving aerobic power, MVV, and PEFR even the exercise is of moderate (LG) to high intensity (HG) but for overall cardio respiratory development physical training must be associated with very hard intensity if duration of the exercise program is short.

Accidental exposure to blood and body secretions is frequent among health care workers (HCWs). They are at risk of acquiring blood-borne diseases. In this study, we have investigated the prevalence and risk factors of occupational exposure among the HCWs of the Emergency Departments (ED) at three teaching hospitals in Tehran. We conducted this observational, descriptive, cross-sectional study using a self-reporting 25-question survey, related to occupational exposures, in February 2010. It was carried out among 200 HCWs (specialist physicians, residents, medical interns, nurses, laboratory personnel, housekeepers, cleaners, and others), who were working in the EDs of the three teaching hospitals of the Tehran University of Medical Sciences. The age, sex, and job category of the HCWs suffering from the injury were determined, as also the risk factors responsible for the exposure of the HCWs. One hundred and fifteen (57.5%) of the 200 HCWs had had at least one episode of blood or body fluid exposure in their professional life. Hollow-bore needles accounted for the highest amount of injuries, with 41.5%, followed by suture needles (18.5%). The most prevalent procedures associated with injuries were suturing (17.5%) and recapping used syringes (16.5%), respectively. All the specialist doctors in this study reported at least one exposure. The percentage of exposure in the other participants of our study was 74.3% for ED residents, 61.1% for laboratory technicians, 51.9% for nurses, and 51% for medical interns. Binary logistic regression analysis revealed that male gender, recapping needles, and job profession were independently associated with exposure to blood or body fluids. High prevalence of occupational exposure in this study emphasized the importance of promoting awareness, training, and education for the HCWs, for preventive strategies, and also reporting of occupational exposure to blood and body secretions.

Distraction during painful interventions may reduce pain perception, but results in the literature are inconsistent. The aim of the study was to test the effectiveness of a musical mobile as a distraction tool on pain reduction in infants during a vaccine injection. The study based on a quasi-experimental model involving a test group and a control group was performed on 120 healthy infants, who were presented to the primary healthcare center for their first DaPT-IPV-Hib combined vaccination. The study was conducted in a room furnished with or without a musical mobile fixed to the head of the examination table, suspended at a distance of 20 – 25 cm from the infant’s face. A question form was used to determine the infants’ characteristics, and the Face, Legs, Activity, Cry, Consolability (FLACC) Pain Scale was used to assess their levels of pain. Data were collected between January 1 and May 15, 2008. The pain scores of the infants in the test group (during the procedure 5.13 ± 2.11 and after the procedure 1.26 ± 2.01) were lower than the scores of the infants in the control group (during the procedure 6.65 ± 2.69 and after the procedure 3.61 ± 2.27). The crying duration was also shorter among infants in the test group than among infants in the control group (23.53 ± 18.38 vs. 30.88 ± 22.78 seconds) during the vaccination injection. A lower pain score and shorter crying duration in response to vaccination in a room furnished with a musical mobile indicates that distracting attention via a musical mobile is a practical way to reduce pain during routine medical interventions in infants.

Primary dysmenorrhea is defined as painful cramps during menstruation with no pelvic pathology. Due to the adverse effects of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are considered as the most common pharmacological treatment for this disorder. The present study was conducted to assess the impact of Shirazi Thymus Vulgaris compared to that of Ibuprofen on primary dysmenorrhea. A randomized, single-blind clinical trial was conducted amongst 120 female students ofIlam University of Medical Sciences, aged 18-25 years who suffered from primary dysmenorrhea. The participants were randomly divided into two groups; one received the herbal and the other classical treatments. The herbal group received 5 ml of the Shirazi Thymus Vulgaris medication that commercially called BronchoT.D, orally four times a day. The classic group received Ibuprofen orally three times a day. A visual analogue scale (VAS) was used to record pain severity. Pain severity was reduced in both herbal and classic groups with no significant differences. Pain duration at the first and second month of treatment was also similar between two groups. Shirazi Thymus Vulgaris decreased dysmenorrhea symptoms, which might be attributed to its antispasmodic effects. The herbal Shirazi Thymus Vulgaris can be recommended as an effective medication fortreatment of the primary dysmenorrhea disorder.

Sepsis is a systemic inflammatory response associated with high mortality rates in the clinical setting. A multiplex end point PCR based assay for rapid detection Enterobacteriaceae involvement in septicemia, which included Internal Control and16S rDNA is present. To develop a panel of primers and evaluate analytical sensitivity and specificity for DNA fragments of 16S rDNA, Enterobacteriaceae and internal control. Primers for amplification of Enterobacteriacea IC and16S rDNA were designed, and then PCR was performed. Minimal analytical sensitivity was determined by Cloning and colony PCR and specificity tested on the basis of their respective standard strains. This study is a cross-sectional kind. Our results showed the rpoB gene as the most promising target for detection of Enterobacteriaceae by PCR amplification. Specificity and sensitivity of end point PCR were 100%, 100% and 100%, 10, 1 and 100 copies/reaction for Enterobacteriaceae, IC and 16S rDNA in analytical step by standard strains, respectively. The molecular panel of presented offers the advantage of an easy, reliable and cost-effective system when compared to other molecular detection methods. However, further evaluation is needed, our assay holds promising for more rapid pathogens related in clinical sepsis.

The aim of this study is to access which modifiable, non-modifiable and socioeconomic factors are a good predictor for lipid profiles and fasting blood sugar (FBS) in healthy over weight and obese women. This clinical cross-sectional study is done with 811 overweight and obese women in the age group of 20-60 years of the Islamic Republic of Iran. In this study, the dependent variables were FBS, lipids profile and the independent variables were educational level, waist-to-hip ratio (WHR), body mass index (BMI), waist circumference (WC), age, fasting glycemia and diabetes. Significant factors associated with FBS were age, BMI, education and WHR, but the effect of age was stronger than others. For TC, only glycemia had significant effect (P=0.004, OR 1.9) vs. other independent variables odds ratios. Having diabetes, BMI ≥30 mg/dl and education ≤12 years were significant factors associated with TG but the effect of diabetes was stronger than others (OR: 2.7, 2.2, 1.9 for Diabetes, BMI, and education respectively). The effect of age was stronger than other independent factors with LDL-C. Logistic regression model had not shown any significant association between independent variables with HDL-C. based on obtained results, for healthy overweight and obese women, age, glycemia, and having diabetes can be considered for predicting FBS and LDL-C, TC, and TG respectively.

Human growth hormone (hGH) is a single-chain polypeptide that participates in a wide range of biological functions such as metabolism of proteins, carbohydrates and lipids as well as in growth, development and immunity. Growth hormone deficiency in human occurs both in children and adults. The routine treatment for this condition is administration of recombinant human growth hormone (rhGH) made by prokaryotes. Since nonglycosylated human growth hormone is a biologically active protein, prokaryotic expression systems are preferred for its production. Different strains of E.coli were transformed by plasmid containing human growth hormone gene and cultured in different conditions. After induction by IPTG, recombinant human growth hormone production was assessed using ELISA, dot blotting and western blotting techniques. High levels of rhGH were produced using E.coli prokaryotic protein production system. This simple and cost effective production process could be recruited for large scale production of rhGH.

Estimation of energy intake is required for understanding of growth and disease of young students. This study was conducted to estimate energy intake of young students and compare with their energy requirements. In cross-sectional study, using simple random sampling, 400 students, aged 14-18 years were selected in 2010. Hariss-Benedict equations were used to estimate energy requirement of each groups. Mean and standard error of energy intake and requirements of male was 2155±30, 1670±18 and 2700±21, 2300±4 Kcal for females. Differences of means, energy intake and requirement in both sex were significant (P<0.001). Because of being in 14-18 years, which is called growth age, energy intake was lower than their needs.

Bulimia nervosa (BN) is a type of feeding disorder that starts in adolescence and presents a variety of symptoms, recurrent vomiting in the oral cavity that may reach down to the larynx – similarly to gastro-esophageal reflux, causing laryngeal and voice disorder alterations. These studies aimed at surveying the literature and investigate the studies that considered BN a risk factor for voice disorders and its epidemiology, complications, diagnostic criteria, and management. A review of the literature was done based on a survey of BIOMED CENTRAL and COCHRANE @ OVID databases, which are linked to the IMU ezproxy virtual library (http://ezp.imu.edu.my/menu). The keywords “bulimia nervosa”, “teenage complications” and “voice changes” were used. Citations with summaries were chosen to limit the topic, for the period between 2000 and 2010, in English. Of the ninety three papers we found, twenty three were used as a basis for this review. Among them, only three discuss BN as an etiology factor associated with voice changes in adult women, and we did not find any paper associating this with bulimic teenagers. It is necessary to observe laryngeal and vocal signs and symptoms associated with BN, especially in teenagers whose voices are going through a period of change. The contribution of this type of investigation, which should begin with a clinical history, is essential for minimizing the complications of bulimia nervosa. Thus, adolescents and adults with voice disorders should be investigated in greater detail.

To investigate the role of dietary patterns in prevention and management of type 2 diabetes mellitus. A systematic review of databases which were published in ISI, Cochrane Central Register of Controlled Trials databases, PubMed, Iran Medex, and MagIran was performed. “Diabetes” and “dietary pattern” were used as the keywords. A total of 58 studies which aimed to focus on diabetes mellitus, insulin resistance, metabolic syndrome, dietary pattern, and other related key words were reviewed. More than 47,447 articles were found and 46,709 entries of the extracted studies were excluded on the basis of the title and abstracts. The major dietary patterns were: “Healthy,” “Western,” “Traditional,” “Prudent,” “Unhealthy,” “Mediterranean,” “Modern,” and “Dietary Approach to Stop Hypertension” (DASH) diets. Comparison of the effects of different diets revealed that dietary patterns containing fiber-rich foods have a protective role in managing diabetes mellitus. “Healthy,” “Mediterranean,” “Prudent,” and “DASH” dietary patterns were associated with lower risk of hyperglycemia. The adherence to the “Mediterranean,” “Prudent,” or “DASH” diets could control hyperglycemia. The higher intake of vegetables, fruits, nuts, whole grains, and lower intake of red meat could reduce the risk of type 2 diabetes mellitus.

Although nursing education in Iran has a positive trend in growth; it is still facing with multifaceted challenges. This study aims to explore the challenges for effective evaluation of nursing education perceived by academic managers. A qualitative study was performed by using 21 face-to-face, in-depth interviews with academic managers in medical universities and at the Ministry of Health and Medical Education in Iran. All interviews were recorded digitally, transcribed verbatim, and analyzed by qualitative content analysis. The main challenges could be categorized under 3 themes, each included 3 subthemes: managerial issues (inefficacy of management, inadequacy of policies and strategies, ineffective evaluation planning);administrative issues (inefficient and affected evaluators, inappropriate implementation, and inefficacy of approaches and tools); and structural issues (inappropriate culture, clinical education complexity, lack of alumni follow-up system). The results emphasize the need for educational evaluation development in nursing, including systematic and regular educational evaluation planning focusing on efficient feedback system and regard to excellence models. The comprehensive educational evaluation requires participation, involvement, and collaboration among the Nursing Board, Nursing ministerial office, faculties of nursing, and Nursing Organization. Thus, it is necessary to better designate current educational evaluation systems, policies, approaches, methods, and procedures.