Journal of Research in Medical Sciences
Volume:18 Issue: 2, Feb 2013

Functional constipation is one of the most prevalent childhood gastrointestinal disorders. We evaluated effects of adding a probiotic to mineral oil in the treatment of functional constipation in children. This controlled trial was conducted on 60 children (2 to 14 years old) with functional constipation (Rome III criteria). Children were allocated to receive the synbiotic (Lactol®, composed of Lactobacillus Sporogenes, 1 Tab/20kg/d) plus mineral oil (Paraffin 1 ml/kg/d) or the mineral oil alone for two months. Symptoms of constipation including defecation frequency, stool form, strain and pain at defecation, incomplete evacuation and soiling were assessed and compared before and after the intervention. After the treatment period, the two groups were also compared with regards to subjective global improvement. After the treatment, stool frequency increased in both groups (P < 0.001), with greater increase in synbiotic + mineral oil group (P = 0.001). Frequency of hard/very hard stool and frequency of painful defecation decreased similarly in both groups (P < 0.001). Straining at defecation, incomplete evacuation, and soiling decreased in both groups (P < 0.001), but more decrease was seen in the synbiotic + mineral oil group (P < 0.05). Finally, there was a better global improvement in the synbiotic + mineral oil group (P < 0.05). No severe side effects were observed in any group. Adding the synbiotic Lactol® (containing Lactobacillus Sporogenes) to mineral oil can increase the improvement in children constipation symptoms without specific side effects.

Acne vulgaris is considered one of the most common disorders for which patients seek dermatologic care. In the current study, we evaluated efficacy of the 5% nicotinamide gel versus 2% clindamycin gel in the treatment of the mild-moderate acne vulgaris. This was a randomized, controlled clinical trial that was performed in 2009-2010. Sixty female patients with mild or moderate acne vulgaris were recurited to be treated either with 5% nicotinamide or 2% clindamycin gel for 8 weeks. Acne severity index (ASI) was used to evaluate response to treatment and SPSS software was used to analyze the data. The mean of ASI at the baseline was 16.85 ± 8.5 and 18.2 ± 12.27 in nicotinamide gel and clindamycin gel, respectively (P > 0.05). The mean of ASI was significantly decreased compared with baseline ASI during the time in both groups (P < 0.0001). However, there was not a significant difference regarding reduction of ASI between the nicotinamide and clindamycin gel (P = 0.583). Five percent nicotinamide gel is as effective as 2% clindamycin gel for treatment of mild to moderate acne vulgaris. No side effect was observed during the treatment.

Oxidative stress (OS) generated by hyperglycemia, is one of the major focuses of recent research related to diabetes mellitus. Studying associations between hyperglycemia, OS and atherogenic dyslipidemia (AD) is therefore important. Plasma was obtained form a total of 52 subjects with newly diagnosed Type 2 diabetes mellitus (T2DM) and 52 healthy controls to study associations between hyperglycemia, lipid risk factors for atherogenicity and malondialdehyde (MDA), a lipid peroxidation product. Ferric reducing ability of plasma (FRAP) was evaluated as a measure of total antioxidant capacity (TAC). Diabetic patients had significantly higher (P < 0.05) plasma triglycerides (TG)), very-low-density lipoprotein cholesterol (VLDL-C), TG to high-density lipoprotein cholesterol ratio (TG/HDL-C), atherogenic index (AI), and MDA. Whereas FRAP levels were depleted significantly in the patients compared to that of controls (P = 0.000). Pearson correlation analyses showed MDA correlates significantly with FBS (r = 0.39, P = 0.004), TG/HDL-C (r = 0.45, P = 0.001), and AI (r = 0.40, P = 0.003), and a significant negative correlation with LDL-C (r = -0.33, P = 0.019) which was lost upon nullifying the effect of FBS by partial correlation analysis (r = -0.28, P = 0.050). Receiver operating curve (ROC) analysis showed high AUC for TG/HDL-C and AI (0.62; P = 0.03). Hyperglycemia of diabetes is associated with elevated levels of plasma MDA. This study suggests that TG/HDL-C and AI may be particularly useful as atherogenic risk predictors in newly diagnosed patients with T2DM.

This randomized clinical trial compared rates of stroke or transient ischemic attack recurrence or death in patients with cryptogenic stroke and patent foramen ovale (PFO) who received medical treatment with aspirin or warfarin. Forty-four Iranian patients with cryptogenic stroke and patent foramen ovale participated in this randomized, single-blind trial between July 2007 and June 2010. All patients underwent transesophageal echocardiography and contrast-transcranial Doppler sonography to confirm the presence of patent foramen ovale. The patients were randomly assigned to receive aspirin or warfarin and were followed for 18 months for the recurrence of ischemic events or death. The principal investigator was blind to the group assignment. This trial is registered under number IRCT138805192323N1. Five (11.4%) patients had a stroke, 2 (4.5%) had a transient ischemic attack and 2 (4.5%) died. There was no difference in the rate of ischemic events or death between the aspirin- and warfarin-treated groups (hazard ratio: 0.45; 95% CI: 0.1-1.8; P = 0.259). There was no difference in ischemic event recurrence, death rates or side-effects between patients with cryptogenic stroke and patent foramen ovale who were treated with aspirin vs. warfarin.

Considering the presence of squamous epithelial cells and fibroblasts in the tympanic membrane (TM), topical estrogen application may influence the repair of TM perforations. Therefore, this study was designed to investigate the healing effect of topical estrogen on chronic TM perforations and improvement in hearing threshold. Sixty patients were enrolled in a randomized clinical trial. Thirty patients were treated with paper patch and 30 with estrogen-impinged paper patch. Complete closure of the TM perforation and hearing threshold were evaluated in both groups. Chronic unilateral perforations of the TM involving less than 40% of the total area of the TM without active disease in the middle ear were selected. The margin of the perforation was chemically trimmed using 15% trichloroacetic acid and patching performed under an operating microscope. Microscopic examination was performed after 14 days and repeated after 30 days. Complete closure of the TM perforation was considered as successful repair. Hearing threshold was determined before the start of the trial and 30 days after treatment. No significant difference was found between the two groups after 14 days in complete closure of the perforation (P = 0.310). After 30 days, patients treated with estrogen-impinged paper patch showed a significantly higher rate of closure of the perforation (63.4%) and improvement in hearing threshold (P = 0.017). Topical estrogen may have a healing effect on chronic TM perforations and improvement in hearing threshold.

Bacground: The aim of this study was to investigate bladder wall thickness (BWT) and ultrasound estimated bladder weight (UEBW) values in healthy population with a portative ultrasound device and their relationship with demographic parameters. The study was carried out in Neurorehabilitation Clinic of Ege University Hospital. Ninety-five subjects (48 women and 47 men) aged between 18 and 56 were included in the study. BWT and UEBW were determined non-invasively with a portative ultrasound device; BladderScan BVM 6500 at a frequency of 3.7 MHz at functional bladder capacity. These values were compared by gender, and their relation was assessed with age, body mass index (BMI) and parity. Mean BWT was 2.0 ± 0.4 mm and UEBW was 44.6 ± 8.3 g at a mean volume of 338.0 ± 82.1 ml. Although higher results were obtained in men at higher bladder volumes, the results did not differ significantly by gender. Correlation analyses revealed statistically significant correlation between UEBW and age (r = 0.32). BWT was negatively correlated with volume (r = –0.50) and bladder surface area (r = –0.57). Also, statistically significant correlations were observed between UEBW and volume (r = 0.36), bladder surface area (r = 0.48) and BWT (r = 0.25). Determined values of BWT and UEBW in healthy population are estimated with portative ultrasound devices, which are future promising, for their convenient, easy, non-invasive, time-efficient hand-held use for screening.

The aim of the study is to compare the effects of remifentanil/dexmedetomidine and remifentanil/midazolam combinations in monitored anesthesia care (MAC) during cystoscopies. Forty patients who received remifentanil infusion of 0.05 mg kg-1 min-1 for cytoscopy procedure were randomized into two groups: Either dexmedetomidine 1 mg kg-1 (Group D) or midazolam 0.2 mg kg-1 h-1 (Group M) was administered intravenously for the first 10 min. Subsequently, anesthesia was maintained by using the bispectral index as a continuous infusion of dexmedetomidine (0.2-0.7 mg kg-1 h-1) or midazolam (0.05-0.15 mg kg-1 h-1). Heart rate, mean arterial pressure, mini-mental state examination findings, levels of sedation andanalgesia, and the patient’s and surgeon’s satisfaction were recorded. Successful sedation and analgesia were achieved in all the patients. We were able to reach the target sedation level faster in Group D (P<0.0001). In Group D, the cognitive functions were less affected than in Group M (P<0.0001). Patient’s and surgeon’s satisfaction were significantly higher in Group D. The targeted sedation levels were achieved in a shorter period with dexmedetomidine-remifentanil compared to midazolam-remifentanil. The dexmedetomidine-remifentanil combination was observed to affect the cognitive functions less than midazolam-remifentanil did with shorter recovery times. Besides, patient’s and surgeon’s satisfaction rates were superior with dexmedetomidine-remifentanil. It was concluded that dexmedetomidine-remifentanil may be a combination of choice for monitored anesthesia care applications in outpatient surgical procedures of short duration.

Acceptance-based behavior therapy (ABBT) was developed based on the theory that generalized anxiety disorder (GAD) is maintained through a reactive and fused relationship with internal experiences and a tendency toward experiential avoidance and behavioral restriction. ABBT specifically targets these elements. Here, we aimed to compare ABBT to the applied relaxation (AR), which is the most utilized psychological therapy for GAD. This study was a randomized clinical trial study. The sample included 18 GAD patients who were referred by an expert psychiatrist to Psychosomatic Research Center of Isfahan University of Medical Sciences. Patients were assigned into two groups (ABBT and AR group). Both groups received routine drug therapies by psychiatrists. The ABBT and AR were applied in 12 weekly sessions. The instruments used in the study included Valued Living Questionnaire, Action, and Acceptance Questionnaire, and Short-Form Health Survey-12 revised Version (SF-12V2). The data were analyzed using the multivariate analysis of variance. No significant differences were found between ABBT and AR groups in their acceptance of internal experiences, engagement in meaningful activities and quality of life (P > 0.05). The current study compared ABBT to the most utilized psychological therapy for GAD; i.e., AR. ABBT and AR have similar efficacy on acceptance of internal experiences, valued actions and quality of life.

Taste abnormalities are common among cancer patients after starting radiotherapy or chemotherapy. Considering the role of zinc and reports on its beneficial effects in taste perception, we evaluated the preventive effects of zinc sulfate on radiation-induced taste alterations. In a randomized, placebo-controlled trial, adult patients with head and neck cancers who were on schedule for radiotherapy, with or without chemotherapy, were allocated to receive zinc sulfate (50 mg, three times a day) or placebo; started with beginning of radiotherapy and continued for one month later. Taste acuity was determined by measuring detection and recognition thresholds for four taste qualities at baseline, at the end of radiotherapy, and a month later using the Henkin method. Thirty-five patients (mean age = 59.2 ± 16.5, 60% male) completed the trial. The two groups were similar at baseline. After radiotherapy, and one month later, there was a significant increase in taste perception threshold for bitter, salty, sweet, and sour tastes in the placebo group (P = 0.001). In those who received zinc, there was only slight increase in threshold for perception of the salty taste (P = 0.046). No relevant side effects due to zinc sulfate were reported. Zinc supplementation in head/neck cancer patients under radiotherapy can prevent radiation-induced taste alterations. Further studies with longer follow-ups and with different doses of zinc supplementation are warranted in this regard.

Ramadan fasting and its associated lifestyle changes have been linked to changes in sleep and daytime sleepiness. This study was designed to assess the effects of Ramadan fasting on patterns of sleep and daytime sleepiness. The SenseWear Pro Armband™ was used to assess the duration and distribution of sleep in eight Muslim and eight non-Muslim volunteers during the last week of Shaaban [baseline (BL) and the first (R1) and second (R2) weeks of Ramadan (1430 H)]. OPTALERT™was used to assess daytime drowsiness objectively using the John Drowsiness Scale (JDS) to assess sleepiness, and a visual reaction time test was used to assess mean reaction time (MRT). The mean ages of Muslims and non-Muslims were 36.25±4.46 and 34.75±3.33 years, respectively. Although the start of work was delayed for Muslims from 0730 to 1000 hours, there was no change in working hours for non-Muslims. During Ramadan, bedtime and wake-up time were delayed, and there was a significant reduction in total sleep time for Muslims (5.91±1.36 hours, 4.95±1.46 hours, and 4.78±1.36 hours during BL, R1, and R2, respectively, p <0.001), but not for non-Muslims. JDS values in both Muslims and non-Muslims were normal at BL (1.70±1.16 and 1.68±1.07, respectively), and no changes occurred during Ramadan (R1 orR2), indicating no increase in daytime sleepiness. There were no significant changes in MRT during R1 and R2 from BL in either group. Although the sleep cycle of the studied sample shifted during Ramadan among fast observers, there was no objective evidence for increased sleepiness during fasting.

Diabetes mellitus (DM) is a common metabolic disorder that can cause various complications including, peripheral neuropathy (PNP). Some possible risk-factors such as blood glucose level, hyperglycemia, duration of diabetes, and lipid profiles are assumed to be important in diabetic PNP incidence. The aim of this study is to evaluate the prevalence and possible risk-factors of PNP in children with insulin dependent DM. Among diabetic children, 146 patients (up to 18-years old) were evaluated in this cross-sectional study. All patients were examined for signs and symptoms of neuropathy and nerve conduction studies were performed. Blood level of glucose and lipid profiles were also tested. The relation between variables was compared by independent t-test and logistic regression test. The mean age of diabetic children was 11.9 ± 3.3 years whereas mean diabetes duration was 3.8 ± 2.9 years. PNP was detected in 40 patients (27.4%) that 62.5% of them have subclinical and 37.5% have clinical neuropathy. According to logistic regression analysis, duration of diabetes was the most important factor in prevalence of PNP (5.7 ± 3.5 and 3.1 ± 2.5 years in patients with and without neuropathy respectively, P < 0.001, 95% confidence interval [1.15-1.54]). As most of the patients had subclinical PN, neurological assessment is recommended to detect subclinical neuropathy in asymptomatic type 1 diabetic children and it seems that the best way to prevent this complication is still rigid blood glucose control and periodic evaluations.

Coronary artery bypass graft is one of common cardiac surgeries which unfortunately accompany with some adverse events such as delirium. Proinflammatory processes play an important role in pathogenesis of post-operative delirium. Therefore, the effect of dexamethasone (DEX) on post-operative delirium after cardiac surgery was evaluated. This randomized clinical trial study was conducted with objective of evaluation of DEX effects on post-operative deliriums and complications after cardiac surgery. Ninety three eligible patients who undergone coronary arteries bypass graft was divided into two groups of DEX with 43 patients and placebo (PCB) with 50 patients. DEX group taken 8 mg DEX intra-venous before induction of anesthesia followed by 8 mg every 8 h for 3 day and other group received PCB in same way. all patients assessed by Mini-mental status questionnaire and psychiatric interviewing with aim of diagnosing delirium. Extubation time of DEX group was significantly reduced. The first post-operative day deliriums, extubation time, hospital, and intensive-care unit length of stay significantly reduced in DEX group without increasing serious complications such as infectious disease. After administration of DEX only hyperglycemia as an adverse event was increased in DEX group. Other complications of renal, cardiac, cerebrovascular and respiratory system did not show any significant differences between groups. Pre-operative administration of DEX might safely protect brain of the patients who undergone cardiac surgery against post-operative delirium.

Since its first discovery in an Iranian male in 1961, zinc(Zn) deficiency in humans is now known to be an important malnutrition problem world-wide. It is more prevalent in areas of high cereal and low animal food consumption. The diet may not necessarily be low in zinc, but its bio-availability plays a major role in its absorption. Phytic acid is the main known inhibitor of zinc. Compared to adults, infants, children, adolescents, pregnant, and lactating women have increased requirements for zinc and thus, are at increased risk of zinc depletion. Zinc deficiency during growth periods results in growth failure. Epidermal, gastrointestinal, central nervous, immune, skeletal, and reproductive systems are the organs most affected clinically by zinc deficiency. Clinical diagnosis of marginal Zn deficiency in humans remains problematic. So far, blood plasma/serum zinc concentration, dietary intake, and stunting prevalence are the best known indicators of zinc deficiency. Four main intervention strategies for combating zinc deficiency include dietary modification/diversification, supplementation, fortification, and bio-fortification. The choice of each method depends on the availability of resources, technical feasibility, target group, and social acceptance. In this paper, we provide a review on zinc biochemical and physiological functions, metabolism including, absorption, excretion, and homeostasis, zinc bio-availability (inhibitors and enhancers), human requirement, groups at high-risk, consequences and causes of zinc deficiency, evaluation of zinc status, and prevention strategies of zinc deficiency.

Microteaching, a teacher training technique currently practiced worldwide, provides teachers an opportunity to perk up their teaching skills by improving the various simple tasks called teaching skills. With the proven success among the novice and seniors, microteaching helps to promote real-time teaching experiences. The core skills of microteaching such as presentation and reinforcement skills help the novice teachers to learn the art of teaching at ease and to the maximum extent. The impact of this technique has been widely seen in various forms of education such as health sciences, life sciences, and other areas. The emerging changes in medical curricula by the Medical Council of India and the role of medical teachers envisage the need of this special training of teachers and monitoring of their skills for their continued efficient performance at any age. The alleged limitations of microteaching can be minimized by implementing this at the departmental level in several sequences. The author made literature search of research and review articles in various educational databases, journals, and books. From the reference list of published articles, books were also reviewed. This paper presents an outline of the various phases of microteaching, core teaching skills, implementation aspects, and the impact of microteaching on medical education.

Carotid body tumor (CBT) is paraganglioma and mainly found in the carotid bifurcation. The manifestations of the tumor are variable; in most cases, it presents as a non-symptomatic slow-growing mass, rarely compression of carotid body induces bradycardia and hypotension and repeated syncope, prolonged syncope can cause convulsion. Convulsive syncope occurred in 0.03% of patients with syncope. In this paper, we report three cases with CBT and convulsive syncope for which surgery was done and patients did not experience syncope again.