Journal of Research in Medical Sciences
Volume:18 Issue: 3, Mar 2013

The purpose of the present study was to determine the post-operative analgesic effects of preemptive intravenous (iv) paracetamol and the amount of reduction in tramadol (Contramal®) consumption. Following local research ethics committee approval, ASAI-II, 300 patients were assigned in a randomized manner into three groups: Group I (preemptive) received iv paracetamol 1 g/100 mL 10 min before skin inscision and 100 mL of saline solution at the end of the operation, Group II (post-operative) received 100 mL of saline solution 10 min before skin inscision and iv paracetamol 1 g/100 mL at the end of the operation and Group III (placebo) received 100 mL of saline solution 10 min before skin insicision and 100 mL of saline solution at the end of the operation as well. The time to first analgesic requirement use and 24 h total analgesic consumption were recorded. Visual analog scale (VAS) pain scores were obtained from all patients at 15, 30, min 1, 2, 4, 6, 8, 12 and 24 h after the end of the operation. Time to first analgesic requirement was significantly longer in Group I and Group II, compared to Group III (P < 0.05). Time to first analgesic requirement was significantly longer in Group I compared to Group II (P < 0.05). Total analgesic consumption and postoperative VAS pain scores recorded were significantly lower in Group I and II, compared to Group III. Total analgesic consumption and postoperative VAS pain scores recorded were significantly lower in Group I compared to Group II (P < 0.05). In conclusion, preemptive iv paracetamol provided effective and reliable pain control after cholecystectomy surgeries and reduced post-operative pain scores, the need for and use of supplementary opioids and the time to first request of analgesics.

Obesity in accordance with metabolic syndrome (MetS) confronts populations at the higher risk of morbidity and mortality of chronic diseases including, chronic kidney diseases (CKD). The renal complication of obesity and MetS has been less debated in young adolescents. the objective of this study was to assess the kidney function in obese adolescents with or without MetS. The data used in this study were collected as part of a national study entitled childhood and adolescence surveillance and prevention of adult non-communicable disease study. The present study was conducted on a sub-sample of 113 obese adolescents (body mass index >95th percentile) aged between 10 years and 16 years selected by convenient sampling from the whole population studied. Anthropometric indexes and blood pressure were examined. A 12-h fasting serum was obtained for each participant to measure blood glucose, lipid profile, quantitative CRP(HS-CRP), cystatin-c, urea, and creatinine. Fasting spot urine was collected to determine microalbumin and creatinine. Based on the study findings, participants were assigned into two groups with and without MetS. The mean of microalbuminuria was in similar ranges in two groups and while the mean glomerular filtration rate (GFR) calculated by Bokenkamp’s, updated and combined Schwartz’s formulas were significantly lower in MetS + obese group in comparison with obese group. The similar result was not achieved by filler’s formula. Among MetS components, waist circumference had a correlation with HS-CRP(p = 0.04; r = 0.15). GFR was calculated based on the Schwartz formula and cystatin-c formulas had no significant correlation with any MetS components. Our findings suggest that MetS can increase the risk of kidney dysfunction in obese adolescents. More studies are suggested in this regard in the pediatric population.

High level of semen reactive oxygen species is considered as an important factor in male infertility. Sesame has antioxidant properties, which could be effective on improvement of semen parameters. This study was designed to determine the effects of sesame on sperm quality. Twenty‑five infertile men entered this clinical trial. They were treated with a 3‑months course of taking 0.5 mg/kg sesame. The pre intervention sperm analysis (sperm count, motile sperm percentage and normal morphology sperm percentage) was compared with post treatment sperm analysis. Based on the post intervention seamen analysis, patients were advised to undergo either IVF or ICSI to assess their fertility status. There was significant improvement in the sperm count (10.56 ± 5.25 vs. 22.71 ± 30.14 million per ml) and motility (15.32 ± 13.58 vs 23.32 ± 20.61 percent) after treatment with sesame (P value: 0.04 and <0.0001 respectively), but there was no significant improvement in sperm morphology after the treatment (10.72 ± 6.66 vs. 13.20 ± 11.14 percent, P value: 0.10). Three patients (12%) underwent IUI, which resulted in 1 successful pregnancy. Two patients (8%) underwent ICSI, which was not successful; however 2 (8%) patients had spontaneous pregnancy. Fortunately, all pregnancies led to live birth. Except 1 case of diarrhea, no other major side effect was reported. Sesame improved sperm count and motility, and can be prescribed as an effective and safe method for male factor infertility.

The H-reflex is a useful electrophysiological procedure for evaluating the status of the peripheral nervous system, especially at the proximal segment of the peripheral nerve. The purpose of this study is to investigate the relation between triceps surae H-reflex and M- response latencies and thigh length in normal population, in order to determine if there is any regression equation between them. After screening 75 volunteers by considering inclusion and exclusion criteria, 72 of them were selected to enroll into our study (34 men and 38 women with the mean age of 36.04 ± 7.7 years). In all of the subjects H-reflex and M-response latencies were recorded by standard electrophysiological techniques and thigh length was measured. Finally, our data was analyzed for its relations with respect to ages in both sexes by appropriate statistical and mathematical methods. Mean ± SD for H-reflex latency was 27.94 ± 1.6 ms. We found a significant correlation between H-reflex latency and M-latency (r = 0.28), no significant correlation was found between H-reflex latency and thigh length (r = -0.051). Finally based on our findings we introduce a new formula in this paper. We found a significant correlation among of M-response latency and other variables (H-reflex latency and thigh length). Despite this it was eliminated from our formula. The relationship between H-reflex latency and age was significant. Further studies are required to delineate the clinical usage and interpretation of the formula, which we found in this study.

The relation between vitamin D deficiency with depressive and fatigue symptoms in both Multiple sclerosis (MS) patients and healthy population have been reported. To represent our regional achievement in this field we investigated the relation between Vitamin D status with fatigue and depressive symptoms in MS patients. In two hundred MS patients, depressive symptoms and fatigue were measured using Beck PC (BDI-PC) and FFS scale, respectively. Venous blood sample was obtained from all participants and serum 25-hydroxy vitamin D was measured by radioimmunoassay (RIA) method. Mean score of FSS,BDI-PC and EDSS were compared in patients with normal and low level of vitamin D. The relation between FSS, BDI-PC score, EDSS and low vitamin D status was determined. There was a moderate significant correlation between MS disability evaluated by EDSS and fatigue (r=0.37, P<0.001) and depression (r=0.26, P<0.001).The prevalence of low vitamin D status was 48.5%. Low vitamin D status was inversely associated with depressive symptoms of patients with MS (P=0.02 rs=-0.16), but there was not significant correlation between vitamin D and fatigue symptoms (P=0.2). More interventional studies for determining the role of vitamin D supplements in this regard is recommended.

Blacks have a higher incidence of diabetes and its related complications. Self-rated health (SRH) and perceived stress indicators are associated with chronic diseases. The aim of this study was to examine the associations between SRH, perceived stress and diabetes status among two Black ethnicities. The cross-sectional study included 258 Haitian Americans and 249 African Americans with (n = 240) and without type 2 diabetes (n = 267) (N = 507). Recruitment was performed by community outreach. Haitian-Americans were less likely to report ‘fair to poor’ health as compared to African Americans [OR=0.58 (95% CI: 0.35, 0.95), P = 0.032]; yet, Haitian Americans had greater perceived stress than African Americans (P = 0.002). Having diabetes was associated with ‘fair to poor’ SRH [OR=3.14 (95% CI: 2.09, 4.72), P < 0.001] but not perceived stress (P = 0.072). Haitian-Americans (P = 0.023), females (P = 0.003) and those participants having ‘poor or fair’ SRH (P < 0.001) were positively associated with perceived stress (Nagelkerke R2=0.151). Perceived stress associated with ‘poor or fair’ SRH suggests that screening for perceived stress should be considered part of routine medical care; albeit, further studies are required to confirm our results. The findings support the need for treatment plans that are patient-centered and culturally relevant and that address psychosocial issues.

Contrast induced kidney injury is an acute renal dysfunction that is secondary to the administration of radio contrast media. The purpose of this study was to evaluate the levels of urotensin-II (UT-II) and endothelin-I (ET-I) after contrast media administration in patients undergoing percutaneous coronary interventions. In this prospective cohort study, we evaluated 78 patients with coronary artery disease who were scheduled for and ultimately underwent percutaneous coronary interventions. As a contrast material, nonionic contrast media was used in various amounts (70-480 mL). Blood and urine samples were obtained to measure U-II, ET-I just before and at the twenty-fourth hour of percutaneous coronary interventions. Compared to baseline, twenty-fourth hour creatinine levels were significantly increased (P < 0.001). The twenty-fourth hour serum and urine levels of both UT-II and ET-I were also significantly increased compared to baseline (P < 0.001 for all) and 24th hour serum and urine UT-II (r = 0.322, P = 0.004; r = 0.302, P = 0.007 respectively), ET-I (r = 0.511, P < 0.001; r = 0.266, P = 0.019 respectively) levels were significantly correlated with the amount of contrast media. Our study indicates that; increased UT-II and ET-I levels seem to be a consequence of hazardous effects of contrast media on blood vessels and the kidney.

Cadmium and lead compounds are classified as human carcinogens by several regulatory agencies. Twenty five percent of all cancer-related deaths are attributed to gastrointestinal cancers (GI Ca). We investigated the levels of 2 different heavy metals (Cd and Pb) in the soils of the Lenjanat region, Isfahan province, Central Iran where intensive agriculture is surrounded by different industries like steel and cement-making factories and mining and gastrointestinal cancers are very common in this province. Two hundred topsoil samples (0-20 cm depth) were collected from agricultural and non-agricultural soils of the region and were analyzed for heavy metals. The metal contents were determined by flame atomic absorption spectrometry. The findings of this study showed that frequency of gastrointestinal cancers in the study area have been increased in the recent years. Results of soil samples in this region showed that the mean concentration of Pb and Cd were more than 16 and 1 mg kg−1, respectively. The total Cd concentration in most of the samples exceeded the suggested Swiss thresholds (0.8 mg kg−1) but the mean value of Pb concentration in soil was less than the threshold of 50 mg kg−1 set by Swiss Federal Office of Environmental, Forest and Landscape. Compared to the threshold values for heavy metals (Cd and Pb) in soils, data showed that the studied fields were contaminated especially by Cd. High heavy metals content in the soils seems to play an important etiological role in the carcinogenesis. Excessive accumulation of heavy metals in agricultural soils may not only result in soil contamination, but also lead to elevated heavy metal uptake by crops, and thus affect food quality and safety. Thus, analyzing heavy metals content in crops, water and dust could provide us a better insight to solve the problem.

From the thousands of years, metal compounds have been used in medicine for treatment of various diseases including various types of cancers. Ruthenium was seen as a promising metal due to its similar kinetics to platinum and its lower toxicity. Therefore, we aimed to evaluate the newer mononuclear ruthenium (II) compounds for antinociceptive and antitumor activities. Ruthenium (II) compounds were evaluated for antinociceptive and antitumor activity using the various in vitro and in vivo models. The compounds were injected to mice at concentrations of 1 and 2 mg kg-1 intraperitoneally and were screened for antinociceptive activity, and the antiproliferative effect was evaluated against murine leukemia cells (L1210), human T-lymphocyte cells (CEM) and human cervix carcinoma cells (HeLa) using MTT assay. The results for antitumor activity clearly indicated that compound R1 was potent cytotoxic agent than R2 with IC50 values ranging from 4-6 µM for R1, whereas IC50 values for compound R2 ranging from 65-103 µM. The compounds have shown a significant anti-inflammatory effect in carrageenan and dextran models but do not having the central analgesic activity, this indicating that the antinociceptive activity is related to the peripheral nervous system. The results for 5-Lipoxygenase (5-LOX) activity showed that both R1and R2 compounds were found to be significant 5-LOX inhibitory activity with IC50 values of 14.35 µg.ml-1 and 29.24 µg.ml-1 respectively. These findings concluded that the new ruthenium compounds might be the promising antiproliferative agents as these compounds showing significant 5-LOX inhibitory activity and potential agents in the management of pain related disorders.

We aimed to compare peak systolic velocity of central retinal artery (PSV.CRA) and peak systolic velocity of ophthalmic artery (PSV.OA) between patients with retinal detachment who were treated with segmental scleral bucking and scleral buckling with encircling procedure. This study was a descriptive-analytic cross sectional study that was performed in Isfahan university referral centers since April 2010 to April 2011. Of the patients who have undergone scleral buckling surgery, 20 patients belonging to two groups were randomly selected to enroll in the study. Study groups were, patients who have undergone segmental scleral buckling and the other group were patients who have undergone scleral buckling with encircling procedure. Patients were invited to perform color Doppler imaging. PSV-RA and PSV-OA were measured and documented in both operated and unoperated eyes. All of the Doppler’s performed at least three months after ophthalmic surgery. We found significant decrease in PSV.CRA among patients in both groups. In patients who had undergone scleral buckling with encircling procedure PSV.CRA was 11.03 ± 3.04 (cm/sec) and 14.83 ± 4.80 in operated and unoperated eye respectively (P = 0.03). In other hand, who treated with segmental scleral buckling these parameters were 11.02 ± 2.48 and 14.45 ± 4.69 (P = 0.03). PSV.OA did not change significantly in each method. The difference between mean PSV.CRA and PSV.OA in operated eye between two study groups was not significant. PSV.CRA reduced significantly in both surgery methods and PSV.OA changes was not significant. However, the mean PSV.CRA and PSV.OA changes did not show statistically significant difference between surgery methods.

Gastric carcinoma is the second most common cause of cancer-related death in Iran. It is well-known that atrophic gastritis is a major risk factor for gastric cancer, which leads to variations in the serum levels of gastrin 17 (G-17), pepsinogen I (P-I), and pepsinogen II (P-II). The aim of this study was to investigate the diagnostic accuracy of these serum biomarkers in the early detection of atrophic gastritis. A total of 132 dyspeptic patients underwent upper endoscopy and biopsies were taken. The biopsy specimens were evaluated as the gold standard according to operative link for gastritis assessment staging system. Serum levels of G-17, P-I, and P-II were investigated using enzyme-linked immunosorbent assay. Receiver operating characteristic (ROC) analysis was used to calculate the diagnostic indices and optimal cut-off values using Statistical Package for the Social Sciences SPSS statistical software. A total of 67 men and 65 women were analyzed, among which 48 (36.4%) had atrophic gastritis. The mean age was 45.8 (±15.8) years. ROC curve analysis demonstrated that the biomarkers (including pepsinogen I/II [P-I/II] ratio), except for P-I, are diagnostically significant in detecting gastric atrophy. The area under the curve (95% confidence interval [CI]) for G-17, P-I, P-II, and P-I/II ratio were 0.65 (0.55-0.76), 0.42 (0.32-0.53), 0.62 (0.52-0.72), and 0.61 (0.50-0.72), respectively. However, the diagnostic indices were low (sensitivity <50%, specificity <90%). The prevalence of Helicobacter pylori infection was significantly higher in patients with atrophy against those without atrophy (75.0% vs. 57.4%, P value < 0.0001). In the studied population, the serum biomarkers of atrophic gastritis are not useful screening tests due to their low sensitivity.

Prolonged fasting may precipitate or exacerbate gastrointestinal complaints. The aim of this study was to evaluate the relation between Ramadan fasting and acute upper gastrointestinal bleeding (AUGIB), and to assess characteristics of those occurred in the holly month. Retrospective analysis was conducted for all patients, who underwent endoscopy for AUGIB in Ramadan (R) and the month before Ramadan (BR). Epidemiological, clinical and etiological characteristics and outcome of patients having AUGIB were compared between the two periods from 2001 to 2010. Two hundred and ninety-one patients had endoscopy for AUGIB during the two periods study. There was an increasing trend in the overall number of patients in Ramadan period (n = 132, 45.4% versus n = 159, 54.6%), especially with duodenal ulcer (n = 48, 37.2% versus n = 81, 62.8%). The most frequent etiology was peptic ulcer but it was more observed in group R than in group BR (46.2% versus 57.9%, P = 0.04), especially duodenal ulcer (36.4% versus 50.3%, P = 0.01); this finding persisted in multivariable modeling (adjusted odds ratio: 1.67; 95% confidence interval, 1.03-–2.69, P = 0.03). In contrast, there was a decreasing trend in rate of variceal bleeding from BR period (26.5%) to R period (18.9%; P = 0.11). Regarding the outcome, there were no significant differences between the two periods of the study: Recurrent bleeding (10.6% versus 7.5%, P = 0.36) and mortality rate (5.3% versus 4.4%, P = 0.7). The most frequent etiology of AUGIB was peptic ulcer during Ramadan. However, Ramadan fasting did not influence the outcome of the patients. Prophylactic measures should be taken for people with risk factors for peptic ulcer disease.

To determine the prevalence of cryoglobulins in Iranian patients with systemic lupus erythematosus (SLE) and evaluate the correlation of cryoglobulins with disease activity in these patients. In a cross-sectional study, we investigated 80 consecutive women who fulfilled the 1982 revised criteria of the American College of Rheumatology for the classification of SLE. All the patients had undergone a medical interview and general physical examination by a rheumatologist for clinical and serologic characteristics of SLE. For the determination of cryoglobulins, sera were collected by a standard protocol at 37 °C, and after incubation at 4 °C for seven days, the level of cryoglobulins was estimated for each patient. Cryoglobulins were detected in the sera of 39 (48.8%) patients. All of these patients had cryocrit over 5%. Disease was active in 30 patients [SLEDAI ≥6 (DAI: disease activity index)] and inactive in 50 (SLEDAI <6). There was no significant difference between active and inactive patients for the presence of serum cryoglobulins (r =0.086, p =0.56). A significant positive correlation was observed between antinuclear antibody (ANA), anti-dsDNA (dsDNA: double-stranded Deoxyribonucleic acid), CH50 (CH50: total hemolytic complement assay), and C-reactive protein (CRP) (r =0.21, p =0.004, r =0.65, p =0.001, r =0.45, p =0.023, r =0.38, p =0.036, respectively). Hepatitis C virus (HCV) infection was not detected in any of the SLE patients. Although the presence of cryoglobulins in the SLE patients correlated with positive anti-ds DNA and low CH50, it could not be predict activity of the disease.

More than 100,000 Iranian veterans and civilians still suffer from various long-term complications due to their exposure to sulfur mustard (SM) during the Iran–Iraq war in 1983–88. The aim of the study was to investigate DNA damage of SM in veterans who were exposed to SM, 23–27 years prior to this study. Blood samples were obtained from the veterans and healthy volunteers as negative controls. Lymphocytes were isolated from blood samples and DNA breaks were measured using single-cell microgel electrophoresis technique under alkaline conditions (comet assay). Single cells were analyzed with “Tri Tek Comet Score version 1.5” software and DNA break was measured based on the percentage of tail DNA alone, or in the presence of H2O2 (25 μM) as a positive control. A total of 25 SM exposed male veterans and 25 male healthy volunteers with similar ages (44.66 ± 6.2 and 42.12 ± 5.75 years, respectively) were studied. Percentage of the lymphocyte DNA damage was significantly (p < 0.01) higher in the SM-exposed individuals than in the controls (6.47 ± 0.52 and 1.31 ± 0.35, respectively). Percentages of DNA damage in the different age groups of 35–39, 40–44, 45–49, and 50–54 years in SM-exposed veterans (5.48 ± 0.17, 6.7 3 ± 1.58, 6.42 ± 0.22, and 7.27 ± 0.38, respectively) were all significantly (p < 0.05) higher than the controls (1.18 ± 0.25, 1.53 ± 0.22, 1.27 ± 0.20, and 1.42 ± 0.10, respectively). The lymphocytes incubated with H2O2 had much higher DNA damage as expected. The average of tail DNA is 42.12 ± 2.75% for control cells + H2O2 and 18.48 ± 2.14% for patients cells + H2O2; P < 0.001. SM exposure of the veterans revealed DNA damage as judged by the comet assay.

The respiratory module at Shifa College of Medicine (SCM) is delivered in third year with emphasis on respiratory pathophysiology and respiratory medicine. Smoking as a topic was introduced to emphasize the preventive aspects of respiratory illnesses. An innovative approach to involve students in their learning was developed. To determine whether this innovation would be well received and effective for students’ learning about smoking, we carried out this study. This is a one group post-test quasi-experiment. Two days were assigned for a smoking seminar. The class of 106 students was divided into 10 batches, and each batch was assigned a theme related to smoking. These themes were developed by the faculty, and each theme was related to a different perspective on smoking. A post-test questionnaire was distributed at the end of the seminar for feedback to see what aspects of students’ learning were highlighted and what needed to be improved upon. Questions related to the usefulness of the activity were incorporated into the questionnaire and the students were asked to agree or disagree on a five-point Likert scale. Most (68.3%) students agreed that this activity improved their knowledge regarding smoking, and 54.8% agreed that it also helped in application of this knowledge. Improvement in presentation and counseling skills (59.8%), evidence-based medicine (47.6%), and softer skills, such as teamwork (72%) and creativity (63.4%), were also reported to be enhanced. Seminars led by the students have shown to be effective in breaking the monotony and generating an interest of the topic. Such an activity serves as a small step to make our graduates more empathic, humane, competent, and skilful.

In some studies, the level of adenosine deaminase (ADA) in sputum and effusion liquids was used for the diagnosis of tuberculosis (TB). But it is not always possible to access these materials. The goal of this study is to assess the diagnostic value of serum ADA levels in pulmonary TB patients. In this study, 40 sputum smear-positive TB patients who were hospitalized and 40 non-TB patients who referred for surgeries were selected. A serum sample was collected and serum ADA level was measured by ADA kit. The average (SD) of serum ADA in TB and non-TB patients were 20.88 (±5.97) and 10.69 (±2.98) U/L, respectively (P value < 0.05). The best cut-off point was 14 U/L. The calculated area under the receiver operating characteristic (ROC) curve was 0.955 (95% CI, 0.914-0.995); sensitivity was 92.7% (95% CI, 84.7-100) and specificity was 88.1% (95% CI, 78.3-97.8) (P < 0.001). Serum ADA level may be proposed as a proper index for TB diagnosis.

Pulmonary thromboembolism (PTE) in pregnancy as a common cause of maternal death has been a challenge for both clinicians and radiologists. Choosing the appropriate modality in each case has been under question and there are also related imaging pitfalls and hesitancy about radiation exposure and using contrast media for a pregnant mother. The aim of this article is to review the imaging modalities used to investigate PTE in pregnancy, related pitfalls, and recommendations for optimizing them.

The usage of Implantable Cardiac Defibrillator (ICD) since 1980s is becoming more popular these days. The rate of both, endocarditis and constrictive pericarditis are low but it still needs attention. We are reporting a rare case of ICD endocarditis as a result of toe infection in a diabetic patient. This was followed by infectious pericarditis after device removal by open heart surgery and then delayed constrictive pericarditis.

Osteoid osteomata are rarely found in the distal phalanges of the hand. The usual presenting features are chronic pain, nail enlargement and increase in size of the terminal part of the digit. Diagnosis is difficult but surgical excision is effective for treating the patients’pain. We reported this tumor in distal phalanx of the middle finger.