Journal of Research in Medical Sciences
Volume:18 Issue: 8, Aug 2013

Elective knee surgery for repairing anterior cruciate ligament is usually associated with moderate to severe postoperative pain, and, therefore, selecting appropriate analgesia can considerably facilitate pain control and patient’s discharge.This study was designed to compare the analgesic effectiveness of administration of ropivacaine or ropivacaine plus ketamine on pain control and improvement of muscle weakness after anterior cruciate ligament repair in adults. In this double blind randomized study sixty six patients with American Society of Anesthesiologists health status I to II that underwent elective knee surgery for repairing anterior cruciate ligament under spinal anesthesia were enrolled. Patients were randomly allocated to receive either ropivacaine 0.2% or an equivalent volume of ropivacaine 0.1% plus 1.0 mg/kg ketamine via continuous femoral block with pump infusion. The patients were familiarized with a 10‑point verbal analog scale.Quadriceps muscle weakness and sedation score were assessed based on relevant scales. Parameters assessment were obtained from all patients immediately after PACU entrance, and postoperative assessment was performed at 4, 8, 12, 16, 20, 24, 30, 36, 42, and 48 h after the operation. The data of 31 patients who received ropivacaine and of 33 patients in ketamine‑ropivacaine group were eligible for analysis. Visual analogue scale (VAS) scores differed at various time points after surgery, with higher scores in patients who received concomitant ketamine and ropivacaine (P < 0.05). The degree of quadriceps muscle weakness was similar between the groups at the different time points. Patients in ropivacaine group rated better quality of pain control with appropriate sedation in comparison with the patients in ketamine/ropivacaine group. Our study shows that the addition of a ketamine 1 mg/kg to 0.1% ropivacaine via pump infusion after repairing anterior cruciate ligament could not improve pain control and muscle weakness.

The objective of this study was to investigate whether the sex hormone binding globulin (SHBG) levels before conception are predictive of gestational diabetes mellitus (GDM) in women with polycystic ovarian syndrome (PCOS). A total of 180 women with PCOS were enrolled and followed up during pregnancy. Diagnosis of GDM was based on a 2-hour, 75 g oral glucose tolerance test (GTT) performed at 24-28 weeks of gestational age. SHBG levels were measured from serum samples that had collected before conception. We examined the incidence of GDM and plotted a receiver operating characteristic (ROC) curve to assess discrimination. Of the 180 women, 50 (27.8%) were diagnosed with GDM. Those with lower levels of SHBG before conception were more likely to develop GDM than those with higher SHBG (44.4 ± 14.8 nmol/l vs. 63.5 ± 22.7 nmol/l, P < 0.001). The area under the ROC was 77.0% (95% confidence interval [CI] 71.3-78.8). The optimal cut-off value for detecting GDM was a SHBG ≥62.5 nmol/l. For every 1 nmol/l increase in SHBG value, there was a 7% reduction in the risk for development of GDM (Odds ratio 0.93 [95% CI 0.90-0.96], P < 0.001). In women with PCOS preconception, SHBG levels are strongly associated with development of GDM.

Obesity or being overweight is a major health problem in Iran. Only few studies are available that compare the obesity prevalence by four different available criteria. The aim of this study was to determine the prevalence of overweight and obesity among Isfahani adolescents based on four different definitions. This cross-sectional study was conducted on 3002 Isfahani students (1377 males; 1625 females) aged 11-18 years. Anthropometric measurements including weight and height were measured and body mass index (BMI) was calculated. Sex-specific BMI-for-age reference data of the Iranian national data, Center for Disease Control data (CDC2000), International Obesity taskforce data (IOTF), and recent World Health Organization (WHO) data was used to define overweight and obesity. The mean age of the studied population was 14.8 years and the mean BMI was 20.3 kg/m2. Girls were on an average 1.4 years older and had almost one unit higher BMI than boys. Underweight was prevalent among almost 38.5% and 25.5% of adolescents as per WHO2007 and national Iranian cut-off points, respectively. The prevalence rates reached 39.5% and 45.8% by IOTF and CDC2000 criteria, respectively. The highest prevalence of overweight was obtained by IOTF cut-points (30.5%), while CDC2000 criteria, WHO2007, and national Iranian cut-points gave similar prevalence results (4.7%, 4.0%, and 4.4%); 2.4% of the studied population were found to be obese by WHO2007 definition, while this rate was 0.8%, 0.5%, and 0.8% by IOTF, CDC2000, and national Iranian cut-points. Almost all definitions revealed coexistence of underweight, overweight, and obesity among Isfahani adolescents. Huge differences exist between different criteria for assessing weight status among children. To understand the best appropriate criteria for Iranian adolescents, future studies should focus on the predictability of obesity related co-morbidities by these criteria.

Prostate cancer is one of the most common cancer types both in western and eastern countries, involving mostly elder men. The mechanisms underlying the prostate cancer development remain unclear. Prostate-specific antigen (PSA) is the only well accepted marker for prostate cancer diagnosis and prognosis. The diagnosis and treatment of prostate cancer are facing big challenges.Here, we evaluated the expression of Dipeptidyl peptidase IV (CD26/DPPIV) and C-X-C chemokine receptor type 4 (CXCR4), two known cancer-related molecules but without clear data on prostate cancer population, and their correlation with clinical parameters in prostate cancer tissue array. To explore the correlation of CD26 and CXCR4 expression in prostate carcinoma and their relationship with clinical parameters. We immunohistochemically stained the tissue array containing samples from 36 cases with prostate cancer with CD26 and CXCR4 antibodies. Then we analyzed the expression of CD26 and CXCR4 and its relationship with clinical parameters. We used immunohistochemical staining to evaluate the expression of CD26 and CXCR4 in a set of tissue array containing 36 cases of prostate cancers and eight peritumoral normal prostatic tissues.The data were statistically analyzed with Statistical Package for Social Sciences (SPSS) 16.0 software. The difference between parameters was compared with nonparametric test and correlation analysis was performed with Spearman test.P < 0.05 was considered as significant. We found both CD26 and CXCR4 expression were higher in cancer tissue than in normal tissues. CD26 and CXCR4 levels were correlated with each other. Moreover, CD26 was correlated with PSA level, tumor residue, cancer stage, and tumor size in the studied samples. Our data indicate that CD26 may be a good indicator for cancer behaviors of prostate cancer in clinic.

Although most of the ADHD (Attention Deficit Hyperactivity Disorder) patients respond to stimulant drugs very well,alternative drugs are required for non respondents. It has been revealed that subgroups of patients with ADHD have omega-3 fatty acid deficiency. So, the present study was planned to illustrate the effect of omega‑3 supplementation, as an add‑on to methylphenidate,on ADHD patients. In this double-blind RCT, ADHD children without any co morbidity, who had been diagnosed by a child and adolescent psychiatrist in child and adolescent university clinic, participated and were randomly divided into 2 groups. The experimental group methylphenidate plus omega‑3 capsule (2000mg/d), while control group took methylphenidate plus placebo. Severity of ADHD symptoms were assessed by ADHD rating scale at the baseline and after 2, 4 and 8 weeks of treatment. 69 patients (experimental = 36, control = 33) aged 7 to 15 participated. A significant reduction of both parent’s and teacher’s ADHD rating scale scores in both groups was observed. Bu t it couldn’t show any difference between two groups. Difference score of parent’s at baseline was 1.86± (5/40), Pv 0.262, after 2 weeks -0.70± (4/30), Pv 0.668,4 weeks. 19 ± (5/60), Pv 0.902 and 8 weeks. 30± (4/42), Pv 0.845. Difference score of Teacher’s at baseline was -1.56±(3/45), Pv 0.541, after 2 weeks -0.46± (6/24),Pv 0.888, 4 weeks. 45± (5/41), 0.868 and 8 weeks. 73+‑ (4/18), Pv 0.748. Omega-3 did not enhance the therapeutic results of methylphenidate in ADHD patients.

Regular exercise has been associated with improved quality of life (QoL) in patients with heart failure (HF). However, less is known on the theoretical framework, depicting how educational intervention on psychological, social, and cognitive variables affects physical activity (PA). The purpose of this study is to assess the effectiveness of a social cognitive theory-based (SCT-based) exercise intervention in patients with HF. This is a randomized controlled trial, with measurements at baseline, immediately following the intervention, and at 1, 3, and 6 months follow-up. Sixty patients who are referred to the cardiac rehabilitation (CR) unit and meet the inclusion criteria will be randomly allocated to either an intervention group or a usual-care control group. Data will be collected using various methods (i.e., questionnaires, physical tests, paraclinical tests, patients’ interviews, and focus groups). The patients in the intervention group will receive eight face-to-face counseling sessions, two focus groups, and six educational sessions over a 2-month period. The intervention will include watching videos, using book and pamphlets, and sending short massage services to the participants. The primary outcome measures are PA and QoL. The secondary outcome measures will be the components of SCT, heart rate and blood pressure at rest, body mass index, left ventricular ejection fraction, exercise capacity, and maximum heart rate. The findings of this trial may assist with the development of a theoretical model for exercise intervention in CR. The intervention seems to be promising and has the potential to bridge the gap of the usually limited and incoherent provision of educational care in the CR setting.

Metabolic syndrome (MetS) is a serious public health problem. It is an important risk factor of cardiovascular disease in developed countries. Adipose tissue considered as an organ that releases a variety of molecules referred to adipocytokines such as leptin.Polymorphism of their related genes may play an important role in development of MetS. The aim of this study was to determine the association of leptin gene-2548G/A (LEP-2548G/A) polymorphism with lipid profile in subjects with and without Mets. In this case/control study a frequency of LEP-2548G/A single nucleotide polymorphism was determined between 200 patients (142 women and 58 men) and 200 controls (122 women and 78 men). Both groups were selected randomly from Hamadan city, Iran. Blood samples were collected then followed by routine biochemical analysis,DNA extraction and serum leptin measurements. Polymerase chain reaction-restriction fragment length polymorphism was applied to identify LEP-2548G/A genotypes. Statistical analyses were applied using SPSS software version 10. Continuous variables were presented as means± SD and compared by independent sample t-test. Variables without normal distribution compared through Mann-Whitney U test. In both groups, a significant difference was observed between biochemical factors and leptin concentration. Serum leptin concentration was more in females than males. No statistical significant difference was detected in the frequency of LEP-2548G/A polymorphism between both MetS and healthy groups. In summary, it is concluded that frequency of LEP G-2548A polymorphism in Metabolic syndrome (MetS) and healthy subjects was not significantly different and more research with large sample size is needed in this area.

Hepatitis C virus (HCV) is the main causative agent of post-transfusion hepatitis. The virus is distributed worldwide with varying prevalence in different countries, which could easily lead to chronic infections, cirrhosis, and even hepatocellular carcinoma. The aim of this study was to investigate prevalence of HCV infection and its trend in Iranian blood donors. Literatures on the HCV prevalence among blood donors in Iran were acquired through searching PubMed, Magiran, IranMedex, Scientific Information Databank, and Google databases. All the potentially relevant papers were reviewed independently by two investigators by assessing the eligibility of each paper and abstracting data. Prevalence was calculated using random effects model for meta-analysis. Forty-eight studies with total samples of 10,739,221 persons from 1996 to 2011 were combined and meta-analyzed, the pooled prevalence of HCV infection among blood donors in Iran provinces and cities was 0.5% (95% CI: 0.4-0.6%). Trend of HCV infection was decreasing in recent years. This study provides a comprehensive and reliable data on the prevalence and trend of HCV infection among blood donors and may be helpful in providing insight into disease burden and opportunities for prevention. In comparison with countries in this geographic region, Iran has the lowest rate of HCV infection.

Abnormal weight gain during pregnancy increases the adverse health outcomes during the pregnancy, delivery, and the postpartum period. Most of the pregnant women develop weight gain more than the recommended limits; therefore, interventions to manage such disproportionate weight gain are needed. In this paper, the design of the maternal centered life-style intervention study is described, which focuses on controlling weight gaining during pregnancy for all body mass index (BMI) groups. In our randomized field trial, 160 pregnant women with 6-10 weeks of gestational age who visit one of the participating Isfahan four urban public-health centers and 4 private obstetric offices are included. The maternal centered life-style intervention carried out by trained midwives is standardized in a protocol. All the participants are visited at 6-10, 11-15, 16-20, 21-25, 26-30, 31-34, 35-37, 38, 39, and 40 weeks of pregnancy. The women who are randomized in the intervention group receive maternal centered educational package of prenatal care for the pregnant woman and a log book in the first visit. Counselors accompany the pregnant women to maintain or develop a healthy life-style. Data collection will perform monthly measuring body weight, BMI. Because, we don’t have structured protocol for weight management during pregnancy especially, in private sectors if the maternal centered life-style intervention proves to be effective, it will be suggested to merge this package to routine care. Therewith by empowering women to manage their weight the public-health burden can be reduced. Beside that private obstetricians also have structured protocol for their client management.

Cigarette smoke contains many oxidants and may alter the human reproduction by inducing oxidative stress (OS) in both active and passive smokers. This study was designed to evaluate the effect of environmental tobacco smoke (ETS) exposure on oxidative stress in the follicular follicle and the assisted reproduction outcomes. An observational prospective study was carried out on 236 infertile women, who underwent assisted reproduction cycles. The ETS exposure was assessed using self-reported ETS exposure and the cotinine level in follicular fluid. To evaluate the OS in follicular fluid (FF) malon-di-aldehyde (MDA) and total antioxidant capacity (TAC) were measured. The number of retrieved oocytes, rate of metaphase II stage oocytes, fertilization rate, good cleavage rate, and no-fragmented embryo rate were considered as the assisted reproduction outcomes. The results were adjusted for age, body mass index, duration, and etiology of infertility; P-values less than 0.05 were considered significant. The MDA and TAC levels in FF were not related to the self-report number of the weekly ETS exposure and cotinine levels in FF. Also, the number of retrieved oocytes, MII stage oocytes, fertilization rate, good cleavage rate, and no-fragmented embryo rate were not related to the cotinine level and weekly ETS exposure. However, in women whose cotinine levels in FF were lower and equal/above 3.5 ng/ml, the number of retrieved oocytes was higher (12.63 ± 0.71 vs. 9.28 ± 1.11, P = 0.01). The relationship between the MDA level and cleavage rate (Beta = −18.5, confidence interval-34.9 and-2.1, P < 0.05) was negatively significant and the relationship between the MII stage rate with TAC (Beta = 0.02, confidence interval 0.01 and 0.04, P < 0.05) was positively significant. The ETS exposure may alter the assisted reproduction success by influencing the number of available oocytes. Although, the OS in a follicular environment affect the ability of oocytes to reach the specific cleavage stages at appropriate time intervals, it does not mediate poor-assisted reproduction outcomes due to ETS exposure.

There are different options to manage benign headache in the emergency department. The costs, side effects, and efficacies of the drugs used are significantly different. The aim of this study was to compare intravenous (IV) metoclopramide with subcutaneous (SC) sumatriptan in treatment of migraine headache. In a randomized, double-blinded clinical trial study, patients presenting to the university referral emergency department with acute benign headache were allocated into two groups after obtaining their informed consent. Patients received 20 mg of IV metoclopramide or 6 mg of SC sumatriptan. Pain intensity was assessed with 10-cm visual analog scale at baseline and 60 min after treatment. One hundred and twenty-four subjects participated. The mean age was 34.9 ± 9 years in metoclopramide group and 26.8 ± 4 years in sumatriptan group (P < 0.0001). The baseline pain scores were 6.47 ± 0.84 and 6.12 ± 0.73 in metoclopramide and sumatriptan groups, respectively (P < 0.0001). The mean of pain score decreased to 0.66 ± 0.59 cm (P < 0.0001) in the metoclopramide group and 1.1 ± 0.70 (P < 0.0001) in the sumatriptan group. Comparison of these two groups showed more pain reduction in the metoclopramide group, with a mean difference of 0.55 ± 0.13 between the groups (95% CI: 0.25-0.79 cm) (P < 0.0001). For treatment of migraine headache, IV metoclopramide may be superior to SC sumatriptan in the emergency department.

Congenital hypothyroidism (CH) considered a common endocrine disorder in Iran. We report the epidemiologic findings of CH screening program in Isfahan, seven years after its development, regarding the prevalence of transient CH (TCH) and its screening properties comparing with permanent CH (PCH). In this cross-sectional study, children with primary diagnosis of CH were studied. Considering screening and follow-up lab data and the decision of pediatric endocrinologists,the final diagnosis of TCH was determined. A total of 464,648 neonates were screened. The coverage percent of the CH screening and recall rate was 98.9 and 2.1%, respectively. Out of which, 1,990 neonates were diagnosed with primary CH. TCH was diagnosed in 1,580 neonates. The prevalence of TCH was 1 in 294 live births. 79.4% of patients with primary CH had TCH. Mean of screening (54.7 ± 59.0 in PCH vs 21.8 ± 28.9 in TCH), recall (56.5 ± 58.8 in PCH vs 36.6 ± 45.0 in TCH), and thyroid stimulating hormone (TSH) and mean of TSH before (2.0 ± 2.9 in PCH vs 1.6 ± 1.6 in TCH) and after (37.7 ± 29.5 in PCH vs 4.3 ± 1.9 in TCH) discontinuing treatment at 3 years of age was significantly higher in PCH than TCH (P < 0.0000). The higher rate of CH in Isfahan is mainly due to the transient form of the disease. Further studies for evaluating the role of other environmental, autoimmune and/or genetic factors in the pathophysiology of the disease is warranted.

The objective of this study is to optimize the effective dose of heparin and ligustrazine hydrochloride injection (LHI) for drug combination. The animal clinical study of LHI was performed by the rat’s model of induced arteriovenous shunt thrombosis. Experimental animals were grouped into several groups and separately treated with both LHI (20, 40, 80 mg/kg, i.p.) and heparin (60, 55, and 50 U/kg; 5000 U/ml; Sigma, i.v). The study had used thrombus weight, protein concentration in thrombus homogenate, inhibition rate of thrombosis, and plasma anti-thrombin activity as indications. The group combination (50, 80) got the result of 100% antithrombotic activity with 0 ± 0 mg of thrombus weight, 14 ± 3 μg/ml of protein concentration in thrombus homogenate and 1.5 ± 0.04 U/ml of plasma anti-thrombin activity. Its anti-thrombotic effect was much better than individual groups treated with LHI in a dose of 0 mg/kg and group of combination (0, 80) (P < 0.05) while antithrombotic effect of 55 and 60 U/kg heparin alone was only 37-58%. Therefore, the group of combination (50, 80) was optimal for 100% antithrombotic activity. Optimal combined doses of LHI and heparin preventing blood coagulation were determined and the results were available. It may give some hint for the further clinical application on human.

Prostatic adenocarcinoma is the most prevalent cancer and the second cause of cancer-related death among men. Human Papilloma Virus (HPV) considered as a preventable risk factor for prostatic adenocarcinoma. In this study, we detected the frequency of HPV infection in prostatic adenocarcinoma and benign prostatic hyperplasia (BPH) in Isfahan. In this study, 120 paraffin-embedded blocks (90 and 30 cases with definite diagnosis of BPH and adenocarcinoma, respectively) were selected. Immunohistochemical (IHC) staining was performed for all selected blocks to detect HPV infection. The rate of infection was compared in the two studied groups. Totally, HPV was detected in four blocks. HPV infection was positive in 10% (3/30) of cases with adenocarcinoma and 1.1% (1/90) of cases with BPH (P = 0.04, OR = 9.88, CI 95%). Mean age of patients with positive and negative HPV infection was 61.75 ± 8.3 and 68.51± 11.7 years, respectively. Considering the higher prevalence of HPV infection in prostatic adenocarcinoma, it is suggested that HPV could be probable risk factor for prostatic adenocarcinoma.It is recommended to investigate the prevalence of HPV infection in Iranian men and the outcome of prevention and treatment of HPV infection on prostatic adenocarcinoma.

Fasting during the month of Ramadan is one of the five pillars of Islam. During this month, adult Muslims are obligated to refrain from eating and drinking from dawn to dusk. Although based on Islamic principles patients are exempted from fasting, each year, and many Muslim patients express their willingness to observe the fast in Ramadan month to respect the cultural customs. There are concerns about the impact of fluid restriction and dehydration during Ramadan fasting for patients with renal diseases. In this study, we reviewed the PubMed, Google Scholar, EBSCO, SCIRUS, Embase, and DOAJ data sources to identify the published studies on the impact of Ramadan fasting on patients with renal diseases. Our review on published reports on renal transplant recipients revealed no injurious effect of Ramadan fasting for the renal graft function. Nearly all studies on this topic suggest that Ramadan fasting is safe when the function of the renal graft is acceptable and stable. Regarding the impact of Ramadan fasting on patients with chronic kidney disease, there is concern about the role of renal hypoperfusion in developing tubular cell injury. Finally, there is controversy between studies about the risk of dehydration in Ramadan in developing renal stones. There are uncertainties about the change in the incidence of renal colic in Ramadan month compared with the other periods of the year. Despite such discrepancies, nearly all studies are in agreement on consuming adequate amounts of water from dusk to dawn to reduce the risk of renal stone formation.

Studentship period is a time when most behavioral traits are being created and fixed; this is a special time when students may start smoking. Thus in the present research, prevalence of smoking in university students in Iran has been evaluated. Having extensively explored Iranian and International databases (SID, Iranmedex, Magiran, Medlib,Irandoc, Pubmed, Google Scholar, and WHO) with broad keywords, we looked for relevant papers about the frequency of cigarette smoking among students in Iranian universities in recent years. We recruited only those primary papers with required information and acceptable methodology by reviewing their titles, abstracts, and full-texts. The main data about the prevalence of smoking,age and sex distribution of subjects, sample size, date, and location of studies were extracted from the full-text of eligible papers. A total of 22 valid articles were selected. Among the findings of these studies, the lowest and highest prevalence of smoking among male students was 13.4 and 39.9, respectively, while it was 0.7 and 25.5%, respectively, among female students. Meta-analysis results reveals that smoking frequency among male and female students in Iran’s universities is 19.8% (17.7-21.9) and 2.2% (1.4-3.02), respectively. The variation of smoking in students in different universities shows that the tendency of smoking varies in different locations. Furthermore, compatible with the prevalence of smoking in the general population in Iran, female students smoke much less than male students.

This report describes a 66-year-old male who had a long history of hepatitis B virus (HBV) infection. He was found hepatocellular carcinoma (HCC) 5 months after lamivudine resistance mutation and then received a successful hepatectomy. Three years later, hepatitis B envelope antigen seroconversion was achieved and nucleoside analogs were discontinued. After the withdrawn of antiviral treatment, HBV reactivated and acute-on-chronic liver failure (ACLF) occurred. Anti-HBV treatment improved the patient clinical condition. Three months after the remission of ACLF, the patient was diagnosed as HCC recurrence and received another hepatectomy. This case illustrates indefinite duration antiviral therapy and tight viral control should be performed in patients with HBV-related HCC.