Journal of Research in Medical Sciences
Volume:19 Issue: 11, Nov 2014

No-reflow phenomenon after percutaneous coronary intervention (PCI) in patients with acute ST-segment-elevation myocardial infarction (STEMI) is relatively common and has therapeutic and prognostic implications. On the other hand cigarette smoking is known to be deleterious in patients with coronary artery disease, but the effect of smoking on no-reflow phenomenon is less investigated. The aim of our study was to assess the impact of smoking on no-reflow phenomenon after PCI in STEMI patients. A total number of 141 patients who were admitted to Chamran Hospital (Isfahan, Iran) between March and September, 2012 with diagnosis of STEMI, enrolled into our Cohort study. Patients were divided into current smoker and non-smoker groups (based on patient’s information). All patients underwent primary PCI or rescue PCI Within the first 12 hours of chest pain. No-reflow phenomenon, thrombolysis in myocardial infarction (TIMI) flow and 24-hour complications were assessed in both groups. 47 current smoker cases (32.9%) and 94 (65.7%) nonsmoker cases were evaluated. Smokers in comparison to non-smokers were younger (53.47 ± 10.59 versus 61.46 ± 10.55, P-value <0.001) and they were less likely to be hypertensive (15.2% versus 44.7%, P-value< 0.001), diabetic (17% versus 36.2%, P-value <0.05), and female gender (4.3% versus 25.5%, P-value <0.01). Angiographic and procedural characteristics of both groups were similar. 9 patients died during the first 24 hours after PCI (4.3% of smokers and 6.4% of non-smokers, P-value: 0.72). No-reflow phenomenon was observed in 29.8% of current smokers and 31.5% of non-smokers (P-value = 0.77). Smoking status and no-reflow phenomenon were not significantly correlated even after adjustments for age, gender, history of diabetes, hypertension, history of CAD and the extent of stenosis (OR = 1.68; 95% CI 0.68-4.10, P-value = 0.25). According to the present study, no-reflow phenomenon or short-term complications were not significantly lower in smokers. So better results in previous studies may be explained by differences in baseline characteristics and not by smoking status itself. Current smokers developed STEMI about 8 years earlier than non-smokers with similar age and sex-adjusted risk of no-reflow phenomenon and 24 hour mortality. These results emphasize role of efforts to encourage smoking cessation as prevention of myocardial infarction.

The renin angiotensin aldosterone system (RAAS) plays a vital role in regulating glucose metabolism and blood pressure, electrolyte and fluid homeostasis. The aim of this systematic review is to assess the association of the RAAS genes with diabetes mellitus (DM) and its complications of retinopathy, neuropathy and cardiovascular disease (CVD). The relevant English-language studies were identified using the key words of DM, type 1 diabetes mellitus (T1DM), T2DM, rennin angiotensin aldosterone polymorphisms or genotypes and RAAS from the search engines of MEDLINE/PubMed, and Scopus from January 1, 1995 to July 30, 2014. Inclusion criteria for selecting relevant studies were reporting the role of RAAS gene variants in the pathogenesis of T1DM or T2DM, diabetic retinopathy (DR), diabetic neuropathy and cardiovascular complication of DM. The reviewers identified 204 studies of which 73 were eligible for inclusion in the present systematic review. The review indicates the angiotensinogen (AGT) M235T polymorphism might not affect the risk of DM. The role of angiotensin converting enzyme insertion/deletion (ACE I/D) and angiotensin II type 1 receptor gene (AT1R) A1166C polymorphisms in the pathogenesis of DM could not be established. Studies indicate the absence of an association between three polymorphisms of AGT M235T, ACE I/D and AT1R A1166C and DR in DM patients. A protective role for ACE II genotype against diabetic peripheral neuropathy has been suggested.Also, the ACE I/D polymorphism might be associated with the risk of CVD in DM patients. More studies with adequate sample size that investigate the influence of all RAAS gene variants together on the risk of DM and its complications are necessary to provide a more clear picture of the RAAS genes polymorphisms involvement in the pathogenesis of DM and its complications.

Isolated torsion of a fallopian tube in the third trimester of pregnancy is an uncommon event. Its common symptoms are lower abdominal pain, vomiting, and nausea. Because these symptoms are nonspecific, isolated torsion of a fallopian tube may be misdiagnosed, delaying treatment and the opportunity to preserve the tube. This is a case report of a primipara in her third trimester, who was misdiagnosed as having acute appendicitis and ovarian cyst torsion. The ultrasound-assisted examination was useful, but the specific diagnosis was made after laparotomy and histopathology. The patient was managed by simultaneous salpingectomy and cesarean section. This surgical intervention prevented adverse obstetric sequelae. We summarize our experience, provide our conclusions, and review 17 relevant studies from the literature to aid clinicians in understanding, diagnosing, and managing this condition in a timely fashion.

The people with prediabetes have insulin resistance (IR). IR may affect thyroid function, size and nodules. We investigated the effects of metformin on the thyroid gland in prediabetic people. In a randomized,double-blind placebo-control clinical trial, 89 people with prediabetes, aged 18-65 years were studied for 3 months. They were divided into two, metformin (n = 43) and placebo (n = 46) treated groups. Serum thyroid stimulating hormone (TSH) was measured and thyroid nodules and volume was studied by ultrasonography. The data were compared between and within groups, before and after the study. Mean of the baseline characteristics in metformin and placebo-treated groups had no statistically significant difference. At the end of the study, serum TSH was not significantly different between the two groups. However, if the TSH range was divided into two low normal (0.3-2.5? U/ml) and high-normal (2.6-5.5? U/ml) ranges,significant decrease was observed in metformin-treated group with a high-normal basal serum TSH (P = 0.01). Thyroid volume did not change in metformin-treated group. However, in placebo-treated group, the thyroid was enlarged (P = 0.03). In 53.9% of participants, thyroid nodule was observed. There was just a decrease in the volume of small solid (not mixed) nodules from median of 0.07 ml to 0.04 ml in metformin-treated group (P = 0.01). In prediabetic people, metformin decreases serum TSH, only, in those people with TSH >2.5? U/ml and reduces the size of small solid thyroid nodules. It also prevents an increase in the thyroid volume.

Gastro-esophageal reflux disease (GERD) is prevalent and related to more severe disease in patients with respiratory problems. We evaluated the effects of antireflux therapy in warfare victims of exposure to Mustard gas with chronic cough. This randomized, double-blind, placebo-controlled, cross-over study was conducted on 45 cases of sulfur mustard injury with chronic cough (?8 weeks) and GERD. Patients were randomized into two groups, receiving either 20 mg twice daily omeprazole-placebo (OP) or matching placebo (placebo-omeprazole [PO]) for 4 months, followed by a 1-month washout period and the alternative treatment for 4 months. Assessments included GERD and cough, quality of life, and pulmonary function using spirometry. Leicester Cough Questionnaire and SF-36 were used for measuring quality of life. Patients in the OP group experienced a more decrease than those in the PO group in severity of Leicester cough scores during the first 4-month of trial. After crossing the groups, the OP group experienced an increase (P = 0.036) and the PO group experienced a nonsignificant decrease (P = 0.104) in the severity of scores. The OP group also experienced improvement in GERD symptoms and quality of life at the end of the trial, but changes in the PO group was not significant. There was no significant change in respiratory function indices in any groups. Long-term treatment with high-dose omeprazole improved GERD as well as cough, and quality of life,but not changed respiratory function indices in sulfur mustard injured cases with respiratory symptoms.

The mechanism underlying Buerger’s disease (BD) is still unknown. Recently, thrombophilic conditions predisposing to a hypercoagulable state have been hypothesized as triggers for BD. The aim of the study is to evaluate the prevalence of the hyperhomocysteinemia and level of the anticardiolipin antibodies, and the role of folic acid on the hyperhomocysteinemia and on the rate of the amputations in the patients with BD. In an experimental placebo-controlled double-blinded study, between 2004 and 2010, thirty patients with BD were randomly assigned into two groups (14 patients in a drug group and 16 patients in the placebo group). Drug or placebo was administered, and they were followed in 2 and 6 months for homocysteine, Anticardiolipin antibodies and the risk of amputations. At the beginning of the study homocysteine level was higher than normal in 19 patients (63%). There was a significant decrease in homocysteine level during 6 months in folic acid group (P < 0.001), but there was no change in the placebo group. None of our patients had elevated Anticardiolipin antibodies, and there was no change in the level of Anticardiolipin antibody during study. High level of homocysteine did not associate with more amputations during 6 months of study (P > 0.05). This study shows the hyperhomocysteinemia in BD, and the benefit of folic acid treatment in homocysteine lowering, but folic acid doesn’t inhibit the risk of major and minor amputation during 6 months of follow-up. Longer follow-up may reveal the role of folic acid in these patients.

High concentrations of triglyceride-rich lipoproteins, and apolipoprotein B in newborns with low gestational age may increase the risk of cardiovascular diseases in the future. We investigated the lipid profile in term, late preterm and preterm Iranian infants. A total number of 99 term (gestational age? 37 weeks), preterm (gestational age <34 weeks), and late preterm (34? gestational age <37 weeks) newborns were studied. Total cholesterol, low-density lipoprotein-cholesterol (LDL-C),high-density lipoprotein-cholesterol (HDL-C), and triglycerides, as well as apolipoproteins A and B were analyzed using auto analyzer. Significant differences existed between cord blood concentrations of triglycerides, total cholesterol, and LDL-C in the term,late preterm and preterm infants (P < 0.05). The highest (61.69 mg/dl) and lowest (47.03 mg/dl) concentrations of triglycerides were documented in term and preterm newborns, respectively. Late preterm infants had the highest concentration of cord blood cholesterol. The lowest amount of cholesterol was found in term newborns (72.51 mg/dl). No significant difference existed in the mean of HDL-C and apolipoproteins in the studied groups (P > 0.05). In this study, the cord blood concentrations of cholesterol, triglycerides, and LDL-C were lower in term than in preterm and late preterm infants. This finding should be considered in infant nutrition and preventive measures.

Evidences have shown that migraine with aura (MA) is associated with elevated homocysteine levels but, few studies have evaluated the relationship between homocysteine levels and characteristics of migraine attacks such as severity, frequency, duration and headache diary result (HDR). Thus, in this study, we investigated the association between homocysteine levels and characteristics of migraine attacks in patients with MA. This cross-sectional study was carried out in Isfahan city, Iran, in February 2013. Fasting serum levels of homocysteine were measured in 130 MA patients (31 males and 99 females) aged 15-60 years. Severity, frequency and duration of migraine attacks, as well as HDR, were determined in each patient according to international headache society criteria by a neurologist. Linear and ordinal logistic regression tests were used to evaluate the relationship between serum homocysteine levels and characteristics of migraine attacks. There is no significant association between serum levels of homocysteine with severity, frequency, duration and HDR. This association was not significant after adjustment of confounding variables such as age, body mass index (BMI) and family history of migraine. However, serum homocysteine levels were significantly associated with HDR among males after adjustment for age, BMI and family history of migraine (P = 0.01). Significant relationship between homocysteine levels and characteristics of migraine attacks such as severity, frequency, duration and HDR were not found. However, after adjustment of confounding variables, we found a significant positive relationship between homocysteine levels and HDR among men.

Failure to thrive (FTT) is a common problem of children especially in underdeveloped countries. In addition to its short-term adverse health effects, it is associated with long-term behavioral and cognitive defects. One of the recommended treatment modalities for FTT is synbiotics. Due to high prevalence of FTT with undefined organic causes and failure of most medications on treatment of this type of FTT, we decided to search the effect of synbiotics on these patients. A randomized,triple-blinded, placebo-controlled trial study was done from 2011 to 2012. A number of 84 patients were randomly assigned to intervention and control groups. The synbiotics sachets administered to study group for 6 months. The growth indices were measured at the beginning of the trial after 3 and 6 months and compared with control. Variance analysis of observations showed improvement of growth indices in both groups. The increase in weight was significantly higher in synbiotics group than in controls (P < 0.05). The corresponding figure was not significant for height and head circumference (P > 0.05). The values of mean weights were 10.25 ± 0.20 kg and 10.750 ± 0.160 kg in intervention and control groups, respectively, at the beginning of the study. Meanwhile,the mean weights of two groups became 12.280 ± 0.190 and 11.760 ± 0.17 kg in intervention and control groups, respectively, after 6 months. This result has confirmed that the effect of synbiotics is significant on weight gain of our patients. Our findings support beneficial effects of synbiotics in weight gain of children with FTT.

In recent years, hemoglobin A1c (HbA1c) is accepted among the algorithms used for making diagnosis for diabetes and prediabetes since it does not require subjects to be prepared for giving a blood sample. The aim of this study is to assess the performance of HbA1c against fasting plasma glucose (FPG) and oral glucose tolerance test (OGTT) in detecting prediabetes and diabetes. A total of 315 subjects were included in this study. The success of HbA1c in distinguishing the three diagnostic classes was examined by three-way receiver operating characteristic (ROC) analysis. The best cut-off points for HbA1c were found for discriminating the three disease status. The performance of HbA1c, measured by the volume under the ROC surface (VUS), is found to be statistically significant (VUS = 0.535, P < 0.001). The best cut-off points for discriminating between normal and prediabetes groups and between prediabetes and diabetes groups are c1 = 5.2% and c2 = 6.4% respectively. The performance of HbA1c in distinguishing between the prediabetes and diabetes groups was higher than its ability in distinguishing between healthy and prediabetes groups. This study provides enough information to understand what proportion of diabetes patients were skipped with the HbA1c especially when the test result is healthy or prediabetes. If a subject was diagnosed as healthy or prediabetes by HbA1c, it would be beneficial to verify the status of that subject by the gold standard test (OGTT and FPG).

Nonalcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease. It is generally accepted that insulin resistance is a pathopysiological factor in the development of NAFLD. In the present study, the aim was to determine the relationship between resistin and ghrelin levels, which were found to be closely related to insulin resistance, and fibrosis scores in NAFLD. 40 (21M,19 F) NAFLD patients whose diagnosis was confirmed with biopsy and 40 (18M, 22 F) healthy controls were included in the study In the comparison of resistin and ghrelin levels, only resistin values were found to be significantly higher in NAFLD group whilst there was no significant difference in ghrelin values (respectively p<0.05; p=0.078). In according to the fibrosis groups there was no difference with regard to fasting plasma glucose, insulin values, HOMA-IR measurements and also resistin and ghrelin levels. It has been understood that insulin resistance plays an important part in NAFLD. Larger studies are required that investigate the gene expression of hormones influencing insulin resistance, particularly resistin and ghrelin in order to determine their role in NAFLD.

The success of treatment of chronic hepatitis C (CHC) with pegylated interferon-? (PEG-IFN-?) and ribavirin (RBV) is affected by several host, viral, and treatment factors. This study was designed to describe the association of interleukin (IL) 28B genotypes for rs12979860 with sustained virologic response (SVR) in patients with genotype 1 CHC infection treated with PEG-IFN? -2 and RBV. Methods and Interleukin-28B genotype in 100 studied patients was detected by tagman real-time polymerase chain reaction. Before treatment blood samples were obtained, then patients were treated for 48-week with a combination therapy using of the PEG-IFN? -2 and RBV. SVR evaluated 6 months after stopping therapy, and was defined as undetectable plasma hepatitis C virus-RNA. Among studied patients, 65% were IL-28B CT, 27% CC, and 8% TT. In all studied patients, SVR was 58.3%, relapse 15.6%, and null virological response 26.1%. SVR rates were 76.9% in IL-28B-CC, 56.4% in IL-28B-CT, and 12.5% in IL-28B-TT patients. Relapse rates were 7.7% in IL-28B-CC, 12.9% in IL-28B-CT, and 62.5% in IL-28B-TT patients. There was a significant difference between response to treatment in patients IL-28B-CC, CT, and TT (P = 0.003). IL-28B genotype CC, (odds ratio = 0.053, 95% confidence interval; 0.005-0.54, P = 0.03), was the independent predicting factor. Interleukin-28B was an important predictor of CHC treatment outcome with Peg-IFN-? and RBV. IL-28B-CC seems to be more important than IL-28B-CT/TT in predicting positive treatment response.

Although, patent ductus arteriosus (PDA) is associated with significant morbidity due to hemodynamic instability in preterm infants, the effect of ductus closure on mortality and morbidity is a controversial issue. The aim is to evaluate the efficacy of oral and intravenous (IV) ibuprofen treatment on ductal closure and effects on mortality and bronchoplumonary dysplasia. The medical records of 292 premature infants treated at Ege University Neonatal Intensive Care Unit were retrospectively evaluated. Patients were classified into 3 groups as; No PDA, hemodynamically insignificant PDA (hiPDA) and hemodynamically significant PDA (hsPDA) according to the presence and hemodynamical significance of PDA by echocardiography. hsPDA group was treated with IV or oral ibuprofen. Patent ductus arteriosus was diagnosed by routine echocardiography in 145 patients, of whom 78 (53.7%) had hsPDA. All 65 infants with hiPDA had spontaneous PDA closure. Echocardiographic measurements were similar to those patients treated with oral or IV ibuprofen, as in the response rate to treatment without serious adverse effects. The presence of respiratory distress syndrome, surfactant therapy, late sepsis, bronchopulmonary dysplasia (BPD) and mortality rates were significantly higher in patients with hsPDA. However, with stepwise logistic regression; 5th min Apgar score (odds ratio [OR], 1.321, 95% confidence interval [CI], 1.063-1.641,P = 0.012) and gestational age (OR, 1.422, 95% CI, 1.212-1.662, P < 0.001) were the only significant variables associated with mortality.Gestational age (OR, 0.680, 95% CI, 0.531-0.871, P = 0.002) was the only significant variable associated with BPD shown with logistic regression. Ibuprofen treatment is effective for hsPDA closure with minimal side effects. HiPDA can close spontaneously;therefore treatment decision should be individualized. However, medical treatment of PDA does not reduce mortality and BPD.

Blunt abdominal injury is a leading cause of death in trauma patients. A reliable test predicting intra-abdominal hemorrhage would be a novel method. The study objective was to assess the diagnostic accuracy of plasma ammonia in detection of intra-abdominal bleeding in patients with blunt abdominal trauma (BAT). In this observational study, all patients suffering from BAT, referred to our university teaching hospital included. The levels of ammonia were measured at the time of emergency department admission and 1 h after initial treatment. Demographic data, vital signs, and venous blood gas reports were recorded. Findings of contrast-enhanced abdominopelvic computed tomography scan and laparotomy were assumed as a gold standard for abdominal injuries. A total of 104 patients was enrolled in the study. 15 patients (14.4%) had intra-abdominal hemorrhage and the mean plasma ammonia level in this group was significantly higher than the other patients on admission time (101.73 ± 5.41? g/dL vs. 47.36 ± 26.31? g/dL, P < 0.001). On receiver-operator characteristic curve analysis, in cutoff point of 89? g/dL, the sensitivity, specificity, positive and negative likelihood ratios were 100% (95% confidence interval [CI], 79.6-100), 93.26% (95%CI, 86-96.8), 14.83 (95% CI, 6.84-32.12), and 0, respectively. The study findings suggest the measurement of ammonia level at the time of admission in the patients with BAT would be a useful test predicting intra-abdominal hemorrhage. Furthermore,decrease in the ammonia level could be a useful marker for monitoring response to treatment in these patients.

In obstructive uropathy, despite a severe increase in the serum creatinine (Cr) levels, only a mild cystatin C (CysC) increase was previously reported. Therefore, we aimed to determine the availability of serum Cr/CysC ratio in predicting postrenal acute kidney injury (AKI). This was a cross-sectional study involving 61-adult patients with heterogeneous AKI cases. Patients with bilateral pelvicalyceal dilatation in renal sonography were considered as postrenal AKI group (n = 15) and others were intrinsic AKI group (n = 46). Venous blood sampling for blood urea nitrogen, Cr and CysC measurements were performed on admission. The mean age of study population was 66.3 ± 15.5 years; 38 (62%) of which were male. Two groups were similar regarding age, gender, and comorbidities. Cr/CysC ratio was significantly higher in postrenal AKI group (6.9 ± 3.1 vs. 4.4 ± 2.1, P =0.007). We suggest that serum Cr/CysC ratio seems to be a useful diagnostic tool for detection of postrenal AKI cases,especially for the cases without definite hydronephrosis.

Parathyroid glands produce parathyroid hormone (PTH). PTH has a main role in bone formation. Hyperparathyroidism (HPT) is explained as primary, secondary and tertiary types defined as overproduction of PTH. The brown tumor or osteitis fibrosa cystica is a benign bone lesion that is caused by HPT. This complication has been decreased by diagnosis and successful treatment of secondary hyperparathyroidism. Pelvis, ribs, clavicle, mandible and the extremities are most commonly affected bone in brown tumor, whereas maxillary involvement is rare. The present article report a 29-year-old man with chief complaints of bone pain, swelling cheeks and teeth displacement with secondary HPT. Parathyroidectomy was done due to bone disorder. It is important for dentists and endocrinologists to understand maxillofacial manifestation of secondary HPT to prevent its complication.

Molybdenum cofactor (MC) deficiency is defined as a progressive neurodegenerative and neurometabolic disease, characterized by convulsions, severe mental and motor retardation resistant to the treatment. Patients with MC deficiency usually need at least sedation for even minor interventions such as dental examination or treatment. Sedation or general anesthesia for these patients may be complicated due to accompanying disorders. However, we were unable to find any reports on anesthetic management of patients with MC deficiency in the literature. In this article, we intend to share our experience of a patient with MC deficiency, who had undergone dental treatment under deep sedation.