Journal of Research in Medical Sciences
Volume:20 Issue: 1, 2015 Jan

Contrast induced nephropathy (CIN) is one of the most common complications after radiographic procedures using intravascular radiocontrast media. The aim of the current study was to assess the effect of atorvastatin on prevention of CIN in patients undergoing coronary angiography. In a clinical trial study, 200 patients referred for angiography were randomly divided into two groups of using 80 mg atorvastatin and placebo before the procedure. Furthermore, 100 patients who were under chronic treatment of statins were included as the third group. Serum creatinine (Scr) levels before and after the procedure were evaluated and incidence of CIN (post-procedural Scr of >0.5 mg/dl or 25% from baseline) was assessed. Mean age of the participants was 60.06 ± 0.69 years and 276 (92%) were male. There were no significant differences between group with respect to age and gender. In pre-operation atorvastatin, placebo and long term statin groups, the incidence of CIN was 1%, 2% and 1%, and mean changes of Glomerular filtration rate (GFR) was 3.68 ± 1.32, −0.77 ± 1.21 and 1.37 ± 0.86; and mean changes of creatinine (Cr) was −0.05 ± 0.02, 0.02 ± 0.02 and −0.01 ± 0.01 respectively. respectively (P = 0.776, 0.026 and 0.041 respectively). In pre-operation atorvastatin group, Cr decreased, and GFR increased significantly (P = 0.019 and 0.007 respectively). pre-operation short term high dose atorvastatin use was associated with a significant decrease in serum Cr level and increase in GFR after angiography.

The aim of this study was to investigate clinical applications of mobile C-arms and consequent radiation risk, to increase medical attention on radiation protection, and to provide basic data for safe radiation use in the operating room. In this study, a total of 374 surgical operations, conducted using a portable fluoroscopic X-ray system from January to March of 2013, were analyzed. Dose summaries produced by the General Electric C-arm and data elements in digital imaging and communications in the medicine header of Ziehm C-arm, fluoroscopy time were used to obtain dose-area product (DAP) and effective dose. Corresponding mean and maximum values were calculated, and the resulting data on the frequency of application, fluoroscopy time, DAP, and effective dose were compared and analyzed in terms of surgical specialty and operation types. Orthopedic surgery was the most frequent with 165 cases (44.1%). The highest DAP value and effective dose were found in liver transplant among surgical specialty fields, with mean values of 2.90 ± 3.76 mGy∙m2 and 58 ± 75.2 mSv, respectively (P = 0.0001). The highest DAP value and effective dose were observed in intra operative mesenteric portography among types of surgery, showing mean values of 2.90 ± 3.81 mGy∙m2 and 58.03 ± 76.24 mSv, respectively (P = 0.0001). Because DAP varies significantly across surgical specialties and types of operation, aggressive efforts to understand the effects of radiation dose is critical for radiation protection from intra-operative use of mobile C-arms.

We aimed to evaluate the effects of Pimpinella anisum (anise) from Apiaceae family on relieving the symptoms of postprandial distress syndrome (PDS) in this double-blind randomized clinical trial. Totally, 107 patients attending the gastroenterology clinic, aged 18-65 years, diagnosed with PDS according to ROME III criteria and signed a written consent form were enrolled. They were randomized to receive either anise or placebo,blindly, for 4 weeks. Anise group included 47 patients and received anise powders, 3 g after each meal (3 times/day). Control group involved 60 patients and received placebo powders (corn starch), 3 gafter each meal (3 times/day). The severity of Functional dyspepsia (FD) symptoms was assessed by FD severity scale. Assessments were done at baseline and by the end of weeks 2, 4 and 12. Mean scores of severity of FD symptoms and the frequency distribution of patients across the study period were compared. The age, sex, body mass index, smoking history, and coffee drinking pattern of the intervention and control groups were not significantly different. Mean (standard deviation) total scores of FD severity scale before intervention in the anise and control groups were 10.6 (4.1) and 10.96 (4.1), respectively (P = 0.6). They were 7.04 (4.1) and 12.30 (4.3) by week 2, respectively (P = 0.0001), 2.44 (4.2) and 13.05 (5.2) by week 4, respectively (P = 0.0001), and 1.08 (3.8) and 13.30 (6.2) by week 12, respectively (P = 0.0001). This study showed the effectiveness of anise in relieving the symptoms of postpartum depression. The findings were consistent across the study period at weeks 2, 4 and 12.

On an average 30-50% of patients who undergo incision and drainage (I and D) of anal abscess will develop recurrence or fistula formation. It is claimed that finding the internal orifice of anal abscess to distract the corresponding anal gland duct; will decline the rate of future anal fistula. Surgeons supporting I and D alone claim that finding the internal opening is hazardous. This study is conducted to assess short-term results of optional method to manage patients with anal abscess and fitula-in-ano at the same time. In this cross-sectional descriptive study 49 from 77 patients with anal abscess whose internal orifice was not identified by pressing on the abscess, diluted hydrogen peroxide (2%) and methylene blue was injected into the abscess cavity and the anal canal was inspected to find out the internal opening. Once the opening was distinguished, an incision was given from the anal verge to the internal opening. The internal orifice was identified in 44 out of 49 patients (90%) who underwent this new technique. Up to 18 months during follow-up, only 2.5% of patients with primary fistulotomy developed fistula on the site of a previous abscess. Conventional method to seek the internal orifice of anal abscesses is successful in about one-third of cases. By applying this new technique, surgeons would properly find the internal opening in >90% of patients. Needless to say, safe identification of the anal gland orifice in anal abscess disease best helps surgeons to do primary fistulotomy and in turn it would significantly decrease the rate of recurrence in anal abscess and fistula formation.

Early pleural tuberculosis (TB) diagnosis is particularly difficult. The aim of this study was to investigate the diagnostic accuracy of the Xpert MTB/RIF (Xpert) (Cepheid, Sunnyvale, CA) assay using pleural biopsy and pleural fluid specimens in patients with suspected pleural TB but who had a negative sputum acid-fast bacilli (AFB) smear. In this study, 134 sputum smear-negative suspected pleural TB patients were selected. Paired pleural fluid and pleural biopsy specimens were tested for Mycobacterium tuberculosis by standard smear-microscopy, Lowenstein-Jensen and mycobacterial growth indicator tube (MGIT) culture, and the Xpert assay. Mycobacterial culture from pleural biopsy specimens was used as a reference standard for sensitivity and specificity calculations. Detection of rifampicin resistance was compared with the MGIT method. Of 126 evaluable patients, 55 received a diagnosis of pleural TB. The sensitivity of the Xpert assay using pleural biopsy specimens for the diagnosis of pleural TB was 85.5%, and specificity was 97.2%. The sensitivity and specificity of the Xpert assay in pleural fluid were 43.6% and 98.6%, respectively. The Xpert assay correctly identified 90.0% of phenotypic rifampicin resistant cases and 93.9% of phenotypic rifampicin-susceptible cases. The Xpert assay on pleural biopsy specimens may provide an accurate diagnosis of pleural TB in patients who had a negative AFB smear.

Improvement of endothelial dysfunction could prevent or delay the occurrence of the atherosclerosis process in patients with Kawasaki disease (KD). It is suggested that Vitamin C could improve endothelial dysfunction. In this study, we investigated whether administration of Vitamin C as a water-soluble antioxidant could be effective in this regard among patients with KD. In this case control analytic-experimental study, children aged 3-18 years with KD, and a group of healthy children evaluated. Vitamin C (250 mg/daily) administrated for the two studied groups for 1 month. Endothelial function evaluated by flowmediated dilatation (FMD) and intima-media thickness (IMT) measurement using vascular Doppler ultrasonography, before and after trial. In this study, 16 patients with KD and 19 normal children were studied. At baseline mean of IMT and FMD was not different in the two studied groups (P > 0.05). After Vitamin C administration IMT decreased significantly in two studied groups (from 27.06 ± 6.27 to 21.56 ± 3.77 in KD group and from 27.66 ± 5.66 to 23.33 ± 3.66 in control group [P < 0.05]). FMD increased in two studied groups, but the difference was significant in the control group (from 6.84 ± 2.51 to 7.03 ± 2.87 in KD group and from 6.53 ± 2.36 to 7.82 ± 2.14 in the control group). Vitamin C might improve the endothelial function of patients with KD.

Tissue expanders are devices which are used to create enough skin to form suitable flap in restoration of great skin deficiencies which are not modified initially. The current study aimed at investigating the patients’ satisfaction and the complications such as rupture, hematoma, wound infection, seroma, leakage, chronic pain, and expander expose of internal (implanted under the skin) and external (implanted outside) ports. In a prospective quasiexperimental study conducted at Alzahra and Imam Musa al-Kadhim educational referral hospitals in Isfahan, two matched groups of patients each one contained 38 patients undergone, external and internal ports, were followed-up weekly until the removal of expander and the injection was done weekly through port. The frequency of complications and patients’ satisfaction between two groups were compared. The of age for patients in internal and external groups were 25.5 ± 8.7 and 24.7 ± 9, respectively (P = 0.71). There was significant difference between average of operation time of internal and external group (97.3 vs. 79.6; P < 0.001). The rate of complications suchas infection, hematoma, skin necrosis, and expander expose between two groups was comparable, while significant difference was found between groups in terms of pain intensity in injection [4.92(1.2) vs. 1.53(0.69), P < 0.001]. There was no significant difference between groups in terms of symptom incidence and tissue expander insertion place as well as patients’ satisfaction. Although internal port has favorite appearance; however, some complications such as skin infection due to frequent injection, pain rate are higher than external port lead to its more acceptability by the patients.

The prevalence of type 2 diabetes is increasing in Malaysia, with most patients poorly controlled. Hence, this study aimed to determine nutritional and metabolic status as well as blood pressure of Malaysian patients with type 2 diabetes mellitus and identify associated risk factors for poor glycemic control. A total of 104 type 2 diabetic patients were recruited and completed a questionnaire covering socio-demographic status, 3-day diet records, and physical activity. Anthropometry and glycemic control parameters, lipid profile and blood pressure were also measured. Subjects were on average 56.7±9.9 years old with a mean duration of diabetes of 6.5 ± 5.0 years. The mean hemoglobin A c of the subjects was 7.6% ± 1.4%, with only 20.2% achieving the target goal of <6.5% with no significant differences between genders. The mean body mass index was 26.9 ± 4.7 kg/m2, with 86.5% either were overweight or obese. Only 10.6% of the subjects exercised daily. The proportions of macronutrients relative to total energy intake were consistent with the recommendations of most diabetes associations. The adjusted odds of having poor glycemic control were 3.235 (1.043-10.397) (P < 0.05) higher among those who had high density lipoprotein cholesterol levels below the normal range. Those taking one or two types of oral anti-diabetic drugs had 19.9 (2.959-87.391) (P < 0.01) and 14.3 (2.647-77.500) (P < 0.01) higher odds of poor glycemic control respectively compared to those who were being treated by diet alone. Poor glycemic control was prevalent among Malaysian diabetic patients, and this could be associated with low levels of HDL and being treated with oral anti-diabetes agents.

We are aware of limited data about the effects of purslane on diabetes. Earlier studies have mostly indicated the beneficial effects in animal models. This study aimed to evaluate the effect of purslane seeds on glycemic status and lipid profiles of persons with type 2 diabetes. This cross-over randomized controlled clinical trial was conducted on 48 persons with type 2 diabetes. Participants were randomly assigned to receive either g/day purslane seeds with 240 cc low-fat yogurt (intervention group) or only 240 cc low-fat yogurt (as a control group) for 5 weeks. After a 2-week washout period, subjects were moved to the alternate arm for an additional 5 weeks. At baseline and end of each phase of the study, fasting blood samples were collected to quantify plasma glucose levels, as well as serum insulin and lipid profiles. Within-group and between-group changes in anthropometric measures, as well as biochemical indicators, were compared using a paired-samples t-test. Mean age of study participants was 51.4 ± 6.0 year. We found a significant reduction in weight (−0.5 vs. 0.09 kg, P = 0.003) and body mass index (−0.23 vs. 0.02 kg/m2, P = 0.004) following purslane seeds consumption. Despite a slight reduction in fasting plasma glucose levels (−2.10 vs. −2.77 mg/dL, P = 0.90), we failed to find any significant effect on serum insulin levels and homeostatic model of assessment of insulin resistance score. Furthermore, purslane consumption decreased serum triglyceride levels (−25.5 vs. −1.8 mg/dL, P = 0.04) but could not affect serum high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and total cholesterol levels. We observed a significant reduction in systolic blood pressure (−3.33 vs. 0.5 mmHg, P = 0.01) and a borderline significant decrease in diastolic blood pressure (−3.12 vs. −0.93 mmHg, P = 0.09) after purslane seeds intake. In summary, consumption of purslane seeds for 5 weeks in persons with type 2 diabetes might improve their anthropometric measures, serum triglyceride levels, and blood pressure. Further studies are required to determine the appropriate dosage for these patients.

Lifestyle factors such as weight, salt intake, and physical activity have shown to be important in treating hypertension. The object of this study was to describe feasibility and to assess the effectiveness of a multicomponent lifestyle intervention on high blood pressure (BP) of Iranian women. This randomized controlled trial was conducted in four health centers by recruiting 161 women aged 35-65 years with high BP and randomizing them to a 4-week lifestyle modification (n = 80) or control group (n = 81). BP level and other health behavioral factors were assessed before and after the 4-week intervention and also after 6 months. The mean systolic BP changed from 158.8 (±8.1) mmHg to 153.2 (±6.4) mmHg during 4-week and to 145.5 (±4.6)) mmHg after 6 months in the intervention group (P < 0.001). There was a significant difference between two groups of study after 4-week mean = 5.6 (confidence interval [CI] = 5.1-6.6) and 6 months follow mean (CI = 12.3-14.6).(P < 0.001) A significant correlation was detected between systolic BP (SBP) and diastolic BP (DBP) with weight, body mass index, waist circumference, salt intake, and physical activity level (P < 0.001). Stepwise regression analyses indicated that the weight, dietary salt intake, and physical activity level were significant predictors of SBP and DBP. The results of this study suggest that lifestyle modification program is associated with improvements in BP level in Iranian women.

Considering the effectiveness of craniofacial photographic analysis for diagnosis and management of obstructive sleep apnea-hypopnea syndrome (OSAHS) as well as ethnic differences in indexes measured by this method, this study designed to compare the surface facial dimensions, including nose width, intercanthal width and mandibular width of Iranian patients with mild, moderate and severe OSAHS. In this cross sectional study subjects with mild, moderate and severe OSAHS based on apnea-hypopnea index, were studied. To determine cephalometric measurements, face and neck digital photographs were taken from participants following a standardized procedure. Cephalometric measurements including face, intercanthal and mandibular widths were compared between studied groups. In this study, 100 participants enrolled. From which 20 (20.8%), 35 (36.45%) and 41 (42.7%) of them had mild, moderate and severe OSAHS, respectively. Mean of nose, intercanthal and mandibular width were significantly higher in patients with severe OSAHS than those with mild or moderate OSAHS (P < 0.05).In both genders, mandibular width were higher in severe forms of OSAHS. Disease severity was significantly associated with increased age and mandibular width (P < 0.05). Mandibular width was the most important index, which had a significant association with the disease severity. It seems that our results could be used both for diagnosis and follow-up of OSAHS management. They could be used as baseline information as well as a clinical and research tool in the field of OSAHS.

Child language development and disorder in Iran has been the focus for research by different professions, the most prominent ones among them being psychologists and speech therapists. Epidemiological studies indicate that between 8% and 12% of children show noticeable signs of language impairment in the preschool years; however, research on child language in Iran is not extensive compared to studies in English speaking countries, which are currently the basis of clinical decision making in Iran. Consequently, there is no information about the prevalence of child language disorders in Iranian population. This review summarizes Iranian studies on child language development and disorder in the preschool years and aims to systematically find the most studied topics in the field of normal development, the assessment and diagnosis of language impairments as well as exploring the current gaps within the body of literature. Three main Iranian academic websites of indexed articles along with four other nonIranian databases were scrutinized for all relevant articles according to the inclusion criteria: Iranian studies within the field of Persian language development and disorders in preschool children published up to December 2013. They are classified according to the hierarchy of evidence and weighed against the criteria of critical appraisal of study types. As this is a type of nonintervention systematic review, the preferred reporting items for systematic reviews and meta-analyses is modified to be more compatible to the designs of eligible studies, including descriptive studies, test-developing and/or diagnostic studies. Several limitations made the process of searching and retrieving problematic; e.g., lack of unified keywords and incompatibility of Persian typing structure embedded in Iranian search engines. Overall, eligible studies met the criteria up to the third level of the hierarchy of evidence that shows the necessity of conducting studies with higher levels of design and quality.

Transmission of Mycobacterium tuberculosis (M. tuberculosis) can occur in different ways. Furthermore, drug resistant in M. tuberculosis family is a major problem that creates obstacles in treatment and control of tuberculosis (TB) in the world. One of the most prevalent families of M. tuberculosis is Haarlem, and it is associated with drug resistant. Our objectives of this study were to determine the prevalence and occurrence rate of M. tuberculosis Haarlem family multi drug resistant (MDR) in the worldwide using meta-analysis based on a systematic review that performed on published articles. Data sources of this study were 78 original articles (2002-2012) that were published in the literatures in several databases including PubMed, Science Direct, Google Scholar, Biological abstracts, ISI web of knowledge and IranMedex. The articles were systematically reviewed for prevalence and rate of MDR. Data were analyzed using meta-analysis and random effects models with the software package Meta R, Version 2.13 (P < 0.10). Final analysis included 28601 persons in 78 articles. The highest and lowest occurrence rate of Haarlem family in M. tuberculosis was in Hungary in 2006 (66.20%) with negative MDR-TB and in China in 2010 (0.8%), respectively. From 2002 to 2012, the lowest rate of prevalence was in 2010, and the highest prevalence rate was in 2012. Also 1.076% were positive for MDR and 9.22% were negative (confidence interval: 95%).0020. Many articles and studies are performed in this field globally, and we only chose some of them. Further studies are needed to be done in this field. Our study showed that M. tuberculosis Haarlem family is prevalent in European countries. According to the presence of MDR that was seen in our results, effective control programs are needed to control the spread of drug-resistant strains, especially Haarlem family.

Proper placement of central venous catheter (CVC) tip could reduce early and late catheter-related complications. Although the live fluoroscopy is standard of care for placement of the catheter, it is not available in many centers. Therefore, the present study evaluated the sensitivity and specificity of bedside chest X-ray (CXR) for proper positioning of the catheter tip. A total of 82 adult patients undergoing elective placement of tunneled CVC were enrolled in this study during 2010-2012. The catheter tip position was evaluated by postoperative bedside chest radiographs as well as trans-thoracic echocardiogram as definite diagnostic tool. The catheter position was considered correct if the tip was positioned in the right atrium both in CXR or echocardiography. Finally, CXRs interpreted by expert radiologist. Thus findings were compared by echocardiography. Sensitivity, specificity, accuracy, positive, and negative predictive values were calculated. Data were analyzed using SPSS version 16 (SPSS Inc., Chicago, IL), and P < 0.05 considered as significant. The patients were 57.37 ± 18.91 years of age, weighed 65.79 ± 15.58 kg and were 166.36 ± 9.91 cm tall. Sensitivity and specificity of CXR for proper catheter tip position were 74.3% and 58.3%, respectively. Positive and negative predictive values were 91.2% and 28%. In addition accuracy, positive likelihood ratio, and negative likelihood ratio were 71.9%, 1.78, and 2.27 respectively. Bedside CXR alone does not reliably predict malpositioning after CVC placement.

For the first time we tested an association between the human multidrug resistance gene 1 (MDR1) polymorphisms (SNPs) and idiopathic pulmonary fibrosis (IPF). Several MDR1 polymorphisms are associated with pathologies in which they modify the drug susceptibility and pharmacokinetics. We genotyped three MDR1 polymorphisms of 48 IPF patients and 100 control subjects with Italian origins. No evidence of association was detected. There are 50 known MDR1 SNPs, and their role is explored in terms of the effectiveness of drug therapy. We consider our small-scale preliminary study as a starting point for further research.

Peripherally inserted venous ports fracture with embolization in patients who received chemotherapy is a serious and rare complication, and few cases have been reported in children. We report a successful endovascular technique using a snare for retrieving broken peripherally inserted venous ports in a child for chemotherapy. Catheter fragments may cause complications such as cardiac perforation, arrhythmias, sepsis, and pulmonary embolism. A 12-year-old female received chemotherapy for acute lymphocytic leukemia through a central venous port implanted into her right subclavian area. The patient completed chemotherapy without complications 6 months ago. Venous port wasaccidentally fractured during its removal. Chest radiographs of the patient revealed intracardiac catheter fragment extending from the right subclavian to the right atrium (RA) and looping in the RA. The procedure was performed under ketamine and midazolam anesthesia and fluoroscopic guidance using a percutaneous femoral vein approach. A snare with triple loops (10 mm in diameter) was used to successfully retrieve the catheter fragments without any complication. Percutaneous transcatheter retrieval of catheter fragments is occasionally extremely useful and should be considered by interventional cardiologists for retrieving migrated catheters and can be chosen before resorting to surgery, which has potential risks related to thoracotomy, cardiopulmonary bypass, and general anesthesia.

Symphysis pubis is an uncommon site of tuberculosis and only few cases have been reported in the literature. It is important to distinguish it from the more common entities like Osteitis pubis and Osteomyelitis of pubis symphysis to prevent delay in diagnosis and minimize morbidity and prevent complications. We report a rare case of tuberculosis of symphysis pubis in a 50-year-old Indian female from low socioeconomic status. Diagnosis is not difficult if one is aware of the condition. A high index of suspicion along with radiograph and fine needle aspiration led to the diagnosis. The patient had an excellent outcome following a complete course of anti-tuberculous chemotherapy for tuberculosis.