Journal of Research in Medical Sciences
Volume:17 Issue: 12, Dec 2012

To determine disparity in mortality-related factors in 1- 59 months children across Iran using hospital records of emergency units. After designing and validating a national questionnaire for mortality data collection of children 1-59 months, all 40 medical universities has been asked to fill in the questionnaires and return to the main researcher in the Ministry of Health and Medical Education. Age and sex of deceased children, the type of health center, staying more than 2 h in emergency unit, the reason of prolonged stay in emergency, having emergency (risk) signs, vaccination, need to blood transfusion, need to electroshock and so on have also been collected across the country. There was also a comparison of children based on their BMI. Chi-square test has been applied for nominal and ordinal variables. ANOVA and t-student test have been used for measuring the difference of continuous variables among groups. Mortality in 1-59 months children was unequally distributed across Iran. The average month of entrance to hospital was June, the average day was 16th of month, and the average hour of entrance to hospital was 14:00. The average of month, day and hour for discharge was July, 16, and 14:00, respectively. The hour of discharge was statistically significant between children with and without risk signs. More than half (54%) of patients had referred to educational hospital emergency units. There were no statistically significant differences between children with and without emergency signs. There were statistically significant differences between children with and without emergency signs in age less than 24 months (0.034), nutrition situation (P=0.031), recommendation for referring (P=0.013), access to electroshock facilities (P=0.026), and having successful cardiopulmonary resuscitation (P=0.01). This study is one of the first to show the distribution of the disparity of early childhood mortality-related factors within a developing country. Our results suggest that disparity in 1-59 months mortality based on hospital records in emergency units needs more attention by policy-makers. It is advisable to conduct provincially representative surveys to provide recent estimates of hospital access disparities in emergency units and to allow monitoring over time.

Some studies have demonstrated the role of calcium in reducing body mass index (BMI) or fat mass. Though, BMI does not provide very valid information about changes in body fat mass, Fat Mass Index (FMI) relates body fat mass to height and allows comparing body fat mass of individuals at different heights. This study investigated the possible association between dietary calcium intake (CI) and other nutritional factors and weight status of girls aged 8-10 years. In this case-control study, 110 girls aged 8-10 with FMI at or above 7.2 kg/m2 as cases and 307 girls with FMI less than7.2 kg/m2 as controls were recruited through multistage cluster random sampling. FMI at or above 7.2 kg/m2 was considered as the cutoff point for obesity. Body fat mass was assessed by a stand on bio impedance analyzer. In order to assess CI, participants were asked to complete a validated food frequency questionnaire. Mean and standard deviation of CI in the case group was significantly lower than the control group 649 ± 103 and 951 ± 152 mg/d, respectively (P < 0.01). After Adjustment for total energy intake, the percentage of energy from fat, carbohydrate and protein in quartiles of physical activity, inverse association between CI and obesity was significant and in the highest quartile of physical activity the association was weaker. By further adjustment for the effect of fruits and vegetable intake inverse association between CI and obesity became weaker but yet was significant. The inverse relationship between CI and FMI remained significant even after controlling for confounding factors. FMI may be more accurate, compared to BMI, in showing the association between CI and obesity.

Heat exposure among construction workers in the Persian Gulf region is a serious hazard for health. The aim of this study was to evaluate the performance of wet bulb globe temperature (WBGT) Index for estimation of heat strain in hot/humid conditions by the use of Physiological Strain Index (PSI) as the gold standard. This cross-sectional study was carried out on 71 workers of two Petrochemical Companies in South of Iran in 2010 summer. The WBGT index, heart rate, and aural temperature were measured by Heat Stress Monitor (Casella Microtherm WBGT), Heart Rate Monitor (Polar RS100), and Personal Heat Strain Monitor (Questemp II), respectively. The obtained data were analyzed with descriptive statistics and Pearson correlation analysis. The mean (SD) of WBGT values was 33.1 (2.7). The WBGT values exceed from ACGIH standard (30°C) in 96% work stations, whereas the PSI values were more than 5.0 (moderate strain) in 11% of workstations. The correlation between WBGT and PSI values was 0.61 (P = 0.001). When WBGT values were less and more than 34°C, the mean of PSI was 2.6 (low strain) and 5.2 (moderate strain), respectively. In the Persian Gulf weather, especially hot and humid in the summer months, due to the WBGT values exceeding 30°C (in 96% of cases) and weak correlation between WBGT and PSI, the work/rest cycles of WBGT Index is not suitable for heat stress management. Therefore, in Persian Gulf weather, heat stress evaluation based on physiologic variables may have higher validity than WBGT index.

Ketogenic enteral nutrition (KEN) is a modification of the protein sparing modified fast in which a protein solution is introduced with a continuous infusion through a nasogastric tube over 10-day cycles. The aim of the study was to perform a retrospective analysis of the safety, compliance, weight loss and body composition changes after 3 sequential 10-day cycles of KEN therapy. From a large number of patients who underwent KEN therapy in our department over a 5-year period, we selected 188 patients who participated in 3 KEN cycles with 10-13 days of break between them. Before and after the treatment cycles, body composition was analyzed by bioelectric impedance; a final assessment was made 10 days after the end of last cycle. During each rest period all the patients were on a low-carbohydrate, normal caloric diet. Most patients (97%) successfully tolerated the nasogastric treatment and lost an average of 14.4 kg of body weight, 10.6 kg of fat mass and 3.4 kg of body cell mass. Adverse effects were recorded as mild gastric hypersecretion (2%) and constipation (5%). Patients continued to lose fat during the 10-day follow up period after the end of each KEN Cycle. This effect may be explained by abnormality of water distribution during the rapid weight loss inducing the observed change to fat mass. Ten-day KEN treatment cycles can induce rapid weight loss and reduction to fat mass in obese patients. Furthermore, preservation of lean mass can be achieved by infusing 1.9 g of protein/kg of BCM.

The aim of this study was to simultaneously measure the concentrations of vascular endothelial growth factor (VEGF) and soluble VEGF receptor-1 (sVEGFR-1, also known as sFlt-1) in the aqueous humor of patients with non-proliferative diabetic retinopathy (NPDR) and to investigate whether aqueous levels of vascular endothelial growth factor (VEGF) and VEGFR-1 are related to diabetic macular edema. Aqueous humor was collected from 27 diabetic patients and 33 age- and sex-matched normoglycemic controls and analyzed for pro-angiogenic VEGF and angiogenic inhibitor VEGFR-1 by enzyme-linked immunosorbent assay (ELISA). The mean foveal thickness was measured by optical coherence tomography (OCT). There was no significant difference in the aqueous levels of VEGF in patients with NPDR compared with control subjects (P > 0.05), while the NPDR patients had significantly lower sVEGFR-1 in their aqueous humor. Furthermore, a significant (P < 0.01) positive correlation was observed between sVEGFR-1 concentration and the mean foveal thickness measured on OCT. The results suggest that decreased chelating effect of sVEGFR-1 may be the preliminary event allowing VEGF to activate the proangiogenic endothelial cell state and to induce permeability. The imbalance between angiogenic agent (VEGF) and the antiangiogenic factors (sFlt-1), which is disturbed in the diabetic state, may determine the fate of diabetic macular edema.

According to transtheoretical model (TTM), Stage matched interventions are more effective in quitting. The objective of current study was to investigate the effect of individual counselling, line follow-up, and free nicotine replacement therapy (NRT) on smoking cessation in smokers who are in preparation stage of smoking. In a randomized clinical trial design, through sending the short message system, potential participants in preparation stage of smoking were recruited and divided into control (n = 60)and treatment (n = 50)groups. The treatment group received an in-person counselling, line follow-up, and free NRT. TTM variables trend; prosand cons of smoking, behavioural and experiential processes, temptation, were assessed at baseline, 3 and 6 months follow-up along with point prevalence and continuous abstinence. Continuous abstinence at 6-month follow-up were 3.3%(n = 2) in control group and 46%(n = 23) in the treatment group (x2 = 34.041, P< 0.001). Time× group analyses indicated that except cons of smoking(P> 0.05), all TTM constructs had significantly changed; temptation (F= 36.864, P< 0.001), pros (F = 12.172, P< 0.001), experiential processes (F = 3.377, P< 0.001),and behavioural processes(F = 11.131, P< 0.001). Interventions based on TTM variables increased the quite rate in prepared and motivated people. Our findings suggest that interventions through individual counselling along with free NRT and line follow-up in people who prepare for quitting are beneficial for our country.

Recently, omega-3 fatty acids are in the center of attention for their potent anti-inflammatory effects. Osteoporosis as a chronic senile disease is associated with inflammation, and the role of inflammatory mediators has been demonstrated in the recent years. The beneficial effects of n-3 fatty acids on bone were proven in many animal studies, while to date, no conclusive data is available in human. The aim of this study was to evaluate the impact of n-3 fatty acids on bone biomarkers in osteoporotic women. Forty osteoporotic post-menopausal women were recruited in the study and randomized in receiving either 40 g canola oil or the same amount sunflower oil per day as their dietary oil for 3 months. Serum levels of osteocalcin, bone alkaline phosphatase (BALP), N telo peptide collagen (NTX) and 25- hydroxy vitamin D3 were measured at baseline and at the end of the third month in both groups. In the canola oil group, BALP and NTX were increased after 3 months while osteocalcin decreased in both groups slightly; however, none of these changes were significant. In both groups, serum vitamin D3 was increased significantly; however, this change between groups was not significant. Canola oil did not affect bone formation and resorption significantly after 3 months consumption. Further investigations with longer follow up are recommended.

self care empowers individuals to self manage their minor ailments, chronic conditions, and to exert more control over their lives. Self care includes activities such as influencing prevention, health maintenance, and treatment of illness by individuals, this study was conducted to assess views about self care among the general population living in south of Tehran. This survey was cross-sectional study by using of two-stage random cluster sampling, 1200 individuals aged 17 years and over was surveyed regarding self care. A structured closed validated questionnaire was used to collect data. Data were finally analyzed by Kruskal-Wallis, Pearson Chi-square, Fisher exact test and linear by linear association. Questionnaire has totally five parts including knowledge, attitude, performance toward self care, views regarding general health and demographic characteristics as well. Furthermore; project number is 4276-62-02-85. The mean age of subjects was 27.9 years (SD = 5.2); 50.2% (n = 603) were female; 54% (n = 643) were married (deleted), (55%, n = 658) reported that they were not knowledgeable about self care and (82%, n = 986) were interested in self care. Only 4% (n = 53) of subjects indicated they drank ≥7 glasses of water daily; fewer reported they consumed at least five portions of fruits/vegetables daily (3%, n = 31; and (4%, n = 51) engaged in physical activity more than 3 h weekly. There were statistically significant relationships between knowledge and interest (P < 0.01), knowledge and practice (P < 0.001), and interest and practice regarding self care (P < 0.001). The vast majority of subjects approximately two third felt satisfied with their health, most of subjects reported “feeling healthy” despite engaging in unhealthy life styles, it is revealed that more educated people, and likely those with more income, were interested in and knowledgeable regarding self care and were actually active in healthy life styles. In brief; this study suggests that physicians could support self care through their consultations with patients.

Myocardial infarction (MI) is the acute condition of necrosis in myocardium which occurs as a result of imbalance between coronary blood supply and myocardial demand. The resultant oxidative stress excess leads to worsen the condition. The aim of this study was to investigate the effect of mebudipine, a new dihydropyridine calcium channel blocker, on lipid peroxidation and antioxidant enzymes in myocardial ischemia-reperfusion injury. Male Wistar rats (250-300g) were randomly divided to Control-ischemic, mebudipine-ischemic and vehicle (ethanol-ischemic) groups. The hearts of anaesthetized rats were removed and mounted on Langendorff apparatus and perfused by Krebs-Henseleit solution under constant pressure of 75mmHg at 37°C. Ischemic groups were received 30 min global ischemia and 120min reperfusion and the mebudipine and vehicle groups received mebudipine (0.1nM) or ethanol (0.01%)-enriched solution 25min before global ischemia. Malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GPX) and catalase levels of heart tissue samples were determined by commercial specific Kits. Mebudipine significantly reduced the MDA level (2.3±0.07 nmol/mg protein) as the biochemical indicator of oxidative damage and lipid peroxidation product as compared with those of vehicle (4.6± 0.01 nmol/mg protein) and control groups (4.8 ± 0.09 nmol/mg protein). Furthermore, antioxidant enzymes SOD (0.1±0.006 in drug vs. 0.037±0.009 U/mg Protein in control), GPX (16±0.009 in drug vs. 0.068±0.01 U/mg Protein in control) and catalase activities (0.075±0.006 in drug vs. 0.028±0.002 U/mg Protein in control), activities of myocardium were significantly increased by mebudipine (P<0.01). Our results showed that mebudipine may have antioxidant activity against myocardial ischemia-reperfusion injury, since it decreased oxidative stress by enhancing the enzymatic antioxidant defense and inhibiting the lipid peroxidation. Thus, this drug can reduce the intensity of cardiac ischemic insults.

This study aims to assess the cerebral vessels flow in brain death patients with different causes, including focal and diffuse lesions and comparison of flows according to the underlying causes. Two groups of 15 brain-dead patients one with focal and the other with diffuse brain lesions were compared according to their cerebral blood flow pattern 48 h passed brain death certification. Bilateral absence of flow in middle cerebral artery (MCA) was found in 54.5% of brain-dead patients with diffuse lesion and 50.33% of those with focal lesions. Systolic spike pattern in MCA flow was found in 46.2% of patients with focal lesion and 16.65% of patients with diffuse lesion. Diastole–systole separation pattern in MCA was seen in 16.65% of patients with the diffuse lesions. This pattern in MCA was not seen in patients with the focal lesion group. In carotid arteries, we did not find the absence of flow in any cases. Thirty percent of all patients in both groups had a normal flow pattern (36.6% of patients with focal lesions and 23.3% of patients with diffuse lesion). Patients with focal lesion had 33.3% systolic spike pattern flow and had 23.35% diastole–systole separation flow pattern. In intra-cranial vessels, systolic spike pattern was more common among patients with focal lesions than patients with diffuse lesion, however, this difference was not statistically significant (46.2% of patients with focal lesion and 16.65% of patients with diffuse lesion) (P value = 0.244-0.09(. Diastole–systole separation flow was more common in patients with diffuse lesions than those with the focal lesions although this could not reach the significant level as the previous pattern (20% of patients with diffuse lesion versus no case in patients with focal lesion) (P value = 0.181). Absence of flow was the most common brain flow pattern in the focal and diffuse group lesions. There is no difference in flow pattern between the focal and diffuse brain lesions groups in brain-dead patients.

Nearly 50% of older adults have insomnia, with difficulty getting to sleep, early awakening or feeling un-refreshed on waking. With aging, several changes occur that can place one at risk for insomnia including age-related changes in various circadian rhythms, environmental and lifestyle changes and decreased nutrients intake, absorption, retention and utilization. The natural NMDA antagonist and GABA agonist, Mg2+ seams to play a key role in the regulation of sleep. The objective of this study was to determine the efficacy of magnesium supplementation to improve insomnia in elderly. A double blind randomized clinical trial was conducted in 46 elderly subjects, randomly allocated into the magnesium or the placebo group and received 500 mg magnesium or placebo daily for 8 weeks. Questionnaires of insomnia severity index, physical activity, and sleep-log were completed at baseline and after the intervention period. Anthropometric confounding factors, daily intake of magnesium, calcium, potassium, caffeine, calories form carbohydrates and total calorie intake, were obtained using 24-hrs recall for 3-days. Blood samples were taken at baseline and after the intervention period for analysis of serum magnesium, renin, melatonin and cortisol. Statistical analyses were performed using SPSS19 and P-values < 0.05 were considered as statistically significant. No significant differences were observed in assessed variables between the two groups at the baseline. As compared to the placebo group, in the experimental group, dietary magnesium supplementation brought about statistically significant increases in sleep time (P = 0.002), sleep efficiency (P = 0.03), concentration of serum renin (P < 0.001) and melatonin (P = 0.007), also resulted in significant decrease of ISI score (P = 0.006), sleep onset latency (P = 0.02) and serum cortisol concentration (P = 0.008). Supplementation also resulted in marginally between-group significant reduction in early morning awakening (P = 0.08) and serum magnesium concentration (P = 0.06). Although total sleep time (P = 0.37) did not show any significant between-group differences. Supplementation of magnesium appears to improve subjective measures of insomnia such as ISI score, sleep efficiency, sleep time and sleep onset latency, early morning awakening and likewise insomnia objective measures as concentration of serum renin, melatonin and serum cortisol, in elderly people.

Clinical reasoning is one of the most important competencies that a physician should achieve. Many medical schools and licensing bodies try to predict it based on some general measures such as critical thinking, personality, and emotional intelligence. This study aimed at providing a model to design the relationship between the constructs. Sixty-nine medical students participated in this study. A battery test devised that consist four parts: Clinical reasoning measures, personality NEO inventory, Bar-On EQ inventory, and California critical thinking questionnaire. All participants completed the tests. Correlation and multiple regression analysis consumed for data analysis. There is low to moderate correlations between clinical reasoning and other variables. Emotional intelligence is the only variable that contributes clinical reasoning construct (R2chnage =.46, P Value=.000). Although, clinical reasoning can be considered as a kind of thinking, no significant correlation detected between it and other constructs. Emotional intelligence (and its subscales) is the only variable that can be used for clinical reasoning prediction.

The conjunctiva is a thin and flexible mucus membrane that provides a protective barrier to the eye. Very few histopathologic studies have been conducted on conjunctival biopsies in eastern India. 120 conjunctival biopsies from 117 patients (76 males, 41 females) received during 8 years (January 2003–December 2010) were included in this study. Histologic diagnoses were: degenerative lesions in 38 cases (31.66%), benign epithelial lesions in 23 cases (19.16%), premalignant and malignant epithelial lesions in 27 cases (22.5%), melanocytic lesions in 10 cases (8.33%), lymphoid in 7 cases (5.83%), and miscellaneous in 15 cases (12.5%). Squamous papilloma was the commonest benign tumor, whereas the commonest malignant tumor was squamous cell carcinoma. Melanocytic lesions were less prevalent compared to other/western studies.

Cystoid macular edema (CME) is a relatively common painless condition usually accompanied by blurred vision. The prevalence of CME varied from 5% to 47% depending on cause of pathology. There are several treatments available for ME including intravitreal use of bevacizumab that has been used in different doses in few studies. However, there is still scarcity of data available on the use of bevacizumab for the treatment of ME. A systematic review is needed to provide a foundational base to discuss and synthesize the available information on the effectiveness and safety of intravitreal bevacizumab in macular edema, so that recommendations and policies can be built regarding controversial use of bevacizumab in macular edema. We have planned to perform a systematic review with an objective to compare the effects of a single injection of 1.25 mg intravitreal bevacizumab (avastin) in the improvement of visual acuity, macular edema, and thickness with other interventions/controls for the treatment of macular edema at 3 and 6 months interval using randomized controlled trials. This is only a protocol of the review and we will soon be conducting a full length review, addressing the issue shortly.

Primary breast lymphoma (PBL) of the breast is a rare type of localized non-Hodgkin lymphoma, which is usually of the B-cell. The majority of breast lymphoma present as a unilateral painless breast masses in an older woman, average age at diagnosis 55-60. A less common but distinctive presentation is a young woman of childbearing age who presents during or immediately after pregnancy. We present a 23-year-old postpartum woman with bilateral breast swelling. After surgical drainage and debridement and pathologic examination, the diagnosis of breast Burkitt lymphoma (BL) was confirmed. Chemotherapy was immediately started for her and the patient showed a good response with complete remission.

Aneurysmal bone cyst (ABC) of the talus is an extremely rare lesion; less than 20 cases have been reported in PubMed till 2012. We report a primary ABC of the talus in a 20-year-old male that was managed by extended intralesional curettage with phenol as an adjuvant and autologous cancellous iliac crest bone grafting. The patient had excellent functional outcome and there was no recurrence at 2 years of follow-up.