Journal of Research in Medical Sciences
Volume:20 Issue: 8, 2015 Aug

Obesity induces endothelial dysfunction even in the pediatric age group. Th e possible protective eff ects of fruits and herbal products on the endothelial dysfunction of obese children remain to be determined. Th is study aims to investigate the eff ects of lemon and sour orange peels on endothelial function of adolescents with excess weight. Th is triple-masked, randomized placebo-controlled trial was conducted for 1-month among 90 overweight and obese participants, aged 6-18 years. Th ey were randomly assigned into three groups of equal number receiving daily oral capsules containing lemon or sour orange powder or placebo. Flow-mediated dilatation (FMD) was compared between three groups by using analysis of covariance. Overall, 30 participants in the lemon group, 27 in the sour orange group and 29 in the control group completed the trial. After the trial, mean FMD was signifi cantly (P < 0.001) higher in the lemon group (11.99 ± 4.05) and in the sour orange group (12.79 ± 5.47) than in the placebo group (6.45 ± 2.79). FMD percent change was 145.02 ± 24.34 in the lemon group, 142.04 ± 16.11 in the sour orange group, and 46.73 ± 5.16 in controls (P < 0.001). Th is trial showed that consumption of extracts of lemon and sour orange peels, which contain plenty amounts of antioxidants, fl avonoids, pectin, and vitamin C, might have signifi cant benefi ts on endothelial function in children and adolescents with excess weight. Trial registry

Th e coexistence primary cancers of the endometrium and ovary are relatively uncommon. Th e purpose of this study was to characterize patients diagnosed primary synchronous endometrial and ovarian cancer (SEOC), endometrial cancer (EC) with ovarian metastasis, and ovarian cancer (OC) with endometrial metastasis and compare clinicopathologic variables and prognosis. All the patients with diagnosis of both endometrium and OC, who hospitalized between 2002 and 2012 in an academic center affi liated to Tehran University of Medical Sciences, were evaluated with respect to diff erent clinicopathologic variables, follow-up times, and outcomes. Fifty-fi ve patients had been diagnosed with both endometrium and OC. 17, 26, and 12 patients were diagnosed as SEOC, EC, and OC, respectively. Th e frequency of abnormal uterine bleeding was signifi cantly lower in OC (16.7%) compared to others (58.8% in SEOC and 53.8% in EC). However, the abdominal/pelvic pain was signifi cantly higher in OC (50%) compared to others (35.3% in SEOC and 34.6% in EC) (P < 0.05). Complex atypical hyperplasia (87.5%), endometriosis (88.8%), and endometrioid carcinoma (54.5%) was observed most in SEOC group. Th e duration of follow-up time was between 3 and 171 months with a mean of 16 months. Th ere was no death in SEOC who followed. Survivals of patients between three group were statistically signifi cant (P = 0.032). Our results showed that overall survival (OS) and progression-free survival (PFS) of SEOC patients is better than those with EC and OC (P = 0.032).

Creatine monohydrate (CrM) has been shown to be benefi cial to health due to its antioxidant potential. Strenuous exercise is associated with oxidative stress, which could lead to apoptosis. We investigated the ability of CrM in amelioration of apoptosis induced by incremental aerobic exercise (AE) to exhaustion in young athletes. In a placebo-controlled, double-blind, randomized, parallel study, 31 young athletes (age 19.52 ± 2.75 years, body mass 79.24 ± 16.13 kg, height 1.73 ± 6.49 m, body fat 16.37% ± 5.92%) were randomly assigned to CrM (4 × 5 g/day, n = 15) or placebo (PL: 4 × 5 g/day of maltodextrine powder; n = 16) to investigate the eff ect of 7 days CrM on serum p53 and insulin-like growth factor-1 (IGF-1) concentration after acute incremental AE test to exhaustion. Subjects performed AE before (test 1) and after 7 days of supplementation (test 2). Before supplementation, AE to exhaustion induced a signifi cant increase in serum p53 and IGF-1 concentrations at both CrM and PL groups (P < 0.05). After supplementation, serum p53 concentrations were signifi cantly lower in CrM than PL at post-AE (P < 0.05). Th ere were no diff erences in IGF-1 concentrations between CrM and PL groups at post-AE (P > 0.05). Our results suggest that supplementation with CrM prevents apoptosis, as measured by decreases in p53 concentration, induced by AE to exhaustion in young athletes. However, CrM had no eff ect on IGF-1 concentration after AE to exhaustion in young athletes.

We aimed to investigate the eff ects of general, spinal and epidural anesthesia on fetal total antioxidant status (TAS) and total oxidant status (TOS), and oxidative stress index (OSI) during elective cesarean section in this study. Forty-seven parturients scheduled for elective cesarean section were randomly allocated into three groups: Group spinal (n = 15), group epidural (n = 17), and group general (n = 15), Th is prospective randomized study was performed in Faculty of Medicine, Turgut Ozal University, Turkey. After the baby was delivered; TAS, TOS levels, and arterial blood gases parameters were analyzed in an umbilical arterial blood sample. OSI values are calculated by a ratio of TOS to the TAS. Th e levels of TAS and TOS in umbilical arterial blood sample were not statistically diff erent among three. However, OSI values were signifi cantly diff erent among the three groups (P = 0.042). Median OSI values is 24 (interquartile range [IQR], 2-37) in group spinal, 19 (IQR, 4-44) in group epidural, and 8 (IQR, 4-36) in group general. Th ere was no signifi cant diff erence in OSI values in the comparison of group spinal with group general and group epidural, but it was signifi cantly lower in group general when compared with group epidural with Bonferroni correction (P = 0.017). Umbilical cord arterial blood gas values (pH, PaCO2, PaO2, SaO2, HCO3, and Ct 2), glucose, lactate, and hemoglobin levels were similar in three groups. General anesthesia may be more favorable than epidural in those undergoing cesarean section when fetal oxidative status gains importance.

Chronic kidney disease is a progressive and irreversible loss of renal function. Anemia is one of the main complications of end-stage renal disease (ESRD) which is linked closely with other complications of the disease. Th e primary therapy for anemia in these patients is erythropoietin (EPO). Th e goal of this study was to fi nd the eff ect of Vitamin D administration in addition to the appropriate dose of EPO in ESRD patients with Vitamin D defi ciency. Th is was a double-blind clinical trial on 64 ESRD patients undergoing hemodialysis in Amin and Noor Hospitals of Isfahan, Iran. Th e patients were divided into two groups of control and intervention. Th e intervention group was given Vitamin D supplements and the control group received placebo. Th e required dose of EPO to reach the target hemoglobin (Hb) was measuredand statistically analyzed. A totalnumber of 32 females and 32 males were included in this study. All the patients in the treatment group were aged between 18 and 76 and the patients in the control group were aged between 21 and 76 years old. Th ere was a signifi cant statistical relationship between Vitamin D administration and the required dose of EPO in both groups (P = 0.013). However, there was no correlation between the concentration of Hb and serum Vitamin D levels. Based on the main fi nding of this study, the relationship between Vitamin D administration and required dose of EPO seems that the predicted dose of Vitamin D prescribing strategy in Kidney Disease Outcomes Quality Initiative guidelines is not adequate to achieve normal serum Vitamin D in ESRD patients.

Esophageal carcinoma is a common malignancy in the North East of Iran. Combined modality treatments have been adopted to improve survival in patients with esophageal carcinoma. In this trial, we evaluated the effi cacy and toxicity of a preoperative concurrent chemoradiotherapy protocol in the patients with locally advanced esophageal carcinoma. Between 2006 and 2011, eligible patients with locally advanced esophageal carcinoma underwent concurrent radiotherapy and chemotherapy and 3-4 weeks later, esophagectomy. Pathologic response, overall survival rate, toxicity, and feasibility were evaluated. One hundred ninety-seven patients with a median age of 59 (range: 27-70) entered the protocol. One hundred ninety-four cases (98.5%) had esophageal squamous cell carcinoma. Grades 3-4 of toxicity in patients undergoing neoadjuvant chemoradotherapy were as follows: Neutropenia in 21% and esophagitis in 2.5% of cases. Th ere were 11 (5.6%) early death probably due to the treatment-related toxicities. One hundred twenty-seven patients underwent surgery with postsurgical mortality of 11%. In these cases, the complete pathological response was shown in 38 cases (29.9%) with a 5-year overall survival rates of 48.2% and median overall survival of 44 months (95% confi dence interval, 24.46-63.54). Th e pathological response rate and the overall survival rate are promising in patients who completed the protocol as receiving at least one cycle of chemotherapy. However, the treatment toxicities were relatively high.

Th is study aimed to determine the relationship between the environmental factor, clinical risk factors, and individual variables with mortality due to acute myocardial infarction (MI) in Isfahan. Th is cross-sectional study was performed between April 2012 and March 2013. Th e data on the patients’ mortality due to MI in Isfahan were obtained from the MI National Registry. Th e international classifi cation system (ICD10: I21-I22) was used to diagnose MI. Th e air quality indicators and environmental variables were used to measure the air pollution. Multilevel logistic regression in the Stata software was used to determine the factors associated with mortality in patients and odds ratios (ORs) were calculated. Six hundred eleven patients with MI were studied during 1-year. 444 (72.2%) patients were male and the rest were female. 4.7% of the patients died due to MI. Th e mean age at MI incidence was 62.2 ± 13 years. Of the air pollution parameters, PM10 had the maximum mean concentration (49.113 ppm), followed by NOX, NO, NO2, CO, SO2, and O3. Th e adjusted OR of mortality was derived 2.07 (95% CI: 1.5-2.85) for right bundle branch block, 1.5 (95% CI: 1.3-1.7) for ST-segment elevation MI, 1.84 (95 CI: 1.13-3) for age, 1.06 (95% CI: 1.01-1.20) for CO, 1.1 (95% CI: 1.03-1.30) for O3, and 1.04 (95% CI: 1.01-1.4) for SO2, all of which were considered as the risk factors of mortality. However, OR of mortality was 0.79 for precipitation (95% CI: 0.74-0.84) and 0.52 for angioplasty (95% CI: 0.4-0.68) were considered as protective factors of mortality. Th e individual characteristics including age, history of MI in the immediate family, hypertension, and diabetes were signifi cantly associated with mortality from MI. Th e indices of air pollution including SO2, CO, O3, and environmental factors such as the precipitation and temperature were the determinants of mortality in patients with MI. With regards to the factors associated with mortality from MI reported in this study, air pollution and environmental factors, in addition to the risk factors and predictive factors, should be particularly addressed to control the mortality from MI.

Multiple factors are involved in the development and progression of type 2 diabetes mellitus (DMII) to DMII with metabolic syndrome (MetS) and cardiovascular complications. To identify some of these factors, we aim to investigate the changes in erythrocyte membrane Na+/K+-ATPase activity, serum glucose, insulin, lipid profi le, hemoglobin A1C (HbA1c), high-sensitivity C-reactive protein (hs-CRP), anthropometric measurements, and blood pressure in DMII with and without MetS. Th is cross-sectional study comprised 155 male subjects distributed into three groups as healthy controls (50 non-DMII volunteers), Group I (50 DMII without MetS), and Group II (55 DMII with MetS). Fasting blood samples were taken for the measurement of glucose, insulin, HbA1c, hs-CRP and lipid profi le. Na+/K+-ATPase activity was determined in erythrocyte ghost. Na+/K+-ATPase activity was signifi cantly decreased in DMII groups compared with controls. No signifi cant diff erence was shown in Na+/K+-ATPase activity between DMII groups. Total ATPase activity, total cholesterol and low-density lipoproteincholesterol levels were similar in the three groups. Levels of insulin, hs-CRP, triacylglycerols, systolic blood pressure, weight, waist and hip circumference, waist/hip ratio, and body mass index were signifi cantly elevated and high-density lipoprotein-cholesterol signifi cantly decreased only in Group II. Signifi cant diff erences in serum glucose and hip circumference were seen between the groups. No signifi cant diff erences in HbA1c levels were observed between DMII groups. Changes in many of the measured risk factors that occurred only in Group II compared with controls and Group I may provide an explanation of how DMII progresses to DMII with MetS and future cardiovascular complications.

Recent evidences have supported migraine headache and neurally mediated syncope as the especial types of endotheliopathies. To determine endothelial function in patients with migraine headache or those with neurally mediated syncope، the present study was conducted. Th is cross-sectional study was performed on 93 consecutive patients aged 5-20 years in four groups; neurally mediated syncope، migraine، both neurally mediated syncope and migraine، and control groups. All subjects were tested for basic biophysical and biochemical features including age، gender، body mass index، systolic، and diastolic blood pressures، intima-media thickness (IMT) and fl ow-mediated dilation (FMD)، blood hemoglobin، fasting blood glucose، lipid profi le، intercellular adhesion molecule (ICAM)، vascular cell adhesion molecule (VCAM)، and E-selectin. Th e mean levels of VCAM and ICAM were signifi cantly higher in all groups when compared to control group (P < 0. 05). FMD was signifi cantly higher in syncope، migraine، and syncope and migraine groups than in the control group (P < 0. 05). Furthermore، mean IMT was signifi cantly lower in migraine and also in syncope and migraine groups than in syncope group and control group (P < 0. 05). Examining the association between IMT and other baseline parameters showed positive association of IMT with systolic and diastolic blood pressures. Endothelial dysfunction is seen in both migraine headache and neurally mediated syncope. Changes in endothelial functional indices are also dependent on the blood pressure.

Hyponatremia has poor outcomes in other cardiopulmonary disorders, but its predictive value in predicting mortality of patients with acute pulmonary embolism is unknown. So, we evaluate the mortality of inpatients diagnosed with pulmonary embolism (PE) who had hyponatremia at the time of admission. By conducting a cohort study in patients with acute pulmonary embolism admitted in Al-Zahra Hospital during the 24 months of the date of March 2012 to March 2014. We evaluated 224 patients admitted with a primary diagnosis of PE. We used logistic regression analysis to evaluate the independent relation among serum sodium levels at the time of presentation and 30 days mortality, with severity of illness and other patient risk factors were adjusted. 109 patients (48.7%) had normal sodium level (serum level >137 mmol/L). 115 patients had sodium level bellow 137 mmol/L. Of these, 56 (25%) had a sodium level 135-137 mmol/L and 59 (26.3%) had a sodium level <135 mmol/L. Patients with a serum sodium of >137, 135-137, and <135 mmol/L had a cumulative 30 day mortality of 14%, 21%, and 42% (P < 0.0001), respectively. Th e mortality of patients with lower serum sodium was signifi cantly increased. When the pulmonary embolism severity index and also its simplifi ed form were replaced in the model and while some confounding variables such patients with a history of cancer, chronic pulmonary disease, heart failure, and chronic renal failure were excluded from statistics, the fi ndings still remained similar. Among patients presenting with PE, hyponatremia is common and is an independent risk factor that increasing short-term mortality. Th is result could be encountered as a variable in determining of PE severity and mortality.

Th is systematic review paper aims to study the experimental and human studies on the relationship between metabolic syndrome (MetS), its component and selenium (Se) concentration. Th e literature was searched in PubMed, Scopus, and Google Scholar databases with no time limitation using MetS X and Se key words in medical subject heading. Th e related papers were selected in three phases. After quality assessment, two reviewers extracted the data, whereas the third reviewer checked their extracted data. All evidence comes from experimental and laboratory studies. Finally, 18 articles were included. While, some studies documented that as an antioxidant agent, Se might be correlated with endothelial function, large controversy exists about the type of correlation including positive, negative, and no correlation between MetS and Se levels in body. Some of the reviewed studies were focused on antioxidant supplementation eff ects on MetS, results also varied in this regard. Th is inconsistency could be because of diversity in study design, population, lack of special focus on Se and MetS, and fi nally the complex nature of MetS.

We are aware of no systematic review or meta-analysis of published fi ndings about the association between Vitamin D status and risk of gastric cancer (GC). We systematically reviewed the current evidence on the association between Vitamin D intake as well as serum 25-hydroxy Vitamin D (25(OH)D) levels and risk of GC. Published evidence in this area was searched to August 2014 through the use of ISI Web of Science, Scopus, PubMed/Medline, Ovid Database, EMBASE, and Google Scholar for relevant articles by cross-referencing. Seven articles had reported odds ratios (ORs) or relative risks (RR) as their eff ect size; four papers had reported the ORs between Vitamin D intake and GC; and three papers had reported the association between serum 25(OH)D and risk of GC. Pooled eff ect size for comparison of highest versus lowest intakes of Vitamin D was 1.09 (95% confi dence interval [CI]: 0.94, 1.25; P = 0.26) indicating no signifi cant association between Vitamin D intake and risk of GC. We failed to fi nd a signifi cant association between serum Vitamin D levels and risk of GC (OR: 0.92; 95% CI: 0.74-1.14; P = 0.429). Among men, the pooled eff ect size or highest versus lowest category of serum Vitamin D levels was 0.92 (95% CI: 0.71, 1.18, P = 0.49). Th e corresponding fi gures in women were 1.04 and 95% CI: 0.74-1. (P = 0.80). We found no evidence for the signifi cant association between Vitamin D status and risk of GC. However, due to limited data in this fi eld, further studies are required to reach a defi nite conclusion.

Recent studies demonstrated that resveratrol has many therapeutic eff ects on liver disorders. Resveratrol signifi cantly increased survival after liver transplantation, decreased fat deposition, necrosis, and apoptosis which induced by ischemia in Wistar rats. It provided liver protection against chemical, cholestatic, and alcohol injury. Resveratrol can improve glucose metabolism and lipid profi le and decrease liver fi brosis and steatosis. Furthermore, it was able to alter hepatic cell fatty acid composition. According to extension of liver disease around the world and necessity of fi nding new threat, this review critically examines the current preclinical in vitro and in vivo studies on the preventive and therapeutic eff ects of resveratrol in liver disorders. A search in PubMed, Google Scholar, and Scopus was undertaken to identify relevant literature using search terms, including “liver,” “hepatic,” and “Resveratrol.” Both in vivo and in vitro studies were included. No time limiting considered for this search. A total of 76 articles were eligible for this review. In these articles, resveratrol shows antioxidative properties in diff erent models of hepatitis resulting in reducing of hepatic fi brosis. Resveratrol could reduce hepatic steatosis through modulating the insulin resistance and lipid profi le in animals. Th ese high quality preclinical studies propose the potential therapeutic implication of resveratrol in liver disorders especially those with hepatic steatosis. Resveratrol can play a pivotal role in prevention and treatment of liver disorders by reducing hepatic fi brosis.

The effects of the vascular endothelial growth factor (VEGF) gene −257 C/A polymorphism on colorectal cancer (CRC) risk have been investigated in some studies; however, the results of these studies were confl icting and ambiguous. Th erefore,we aimed to do a meta-analysis to investigate the association of VEGF −2578C/A polymorphisms with CRC risk from all eligible case-control studies published to date. An electronic search of the PubMed, Embase and Medline was performed. Retrieve terms were utilized as following: (“VEGF a” [MeSH Terms]) and (“polymorphism, genetic” [MeSH Terms]) and (“colorectal neoplasms” [MeSH Terms]). Th e association between VEGF −2578C/A polymorphisms with CRC risk was calculated with odds ratios (ORs) and their corresponding 95% of confi dence intervals (CIs), and stratifi ed analysis was also conducted with respect to ethnicity. A comprehensive meta-analysis of eight studies, including 2312 cases and 2308 controls was performed in this work. Combined analysis revealed that a signifi cant association between the VEGF −2578C/A polymorphism with CRC risk was identifi ed in three comparison models including C allele versus A allele (OR = 0.85, 95% CI 0.75-0.97, P = 0.02), AA versus CA + CC (OR = 1.28, 95% CI 1.09 1.51, P = 0.003), and AA versus CC (OR = 0.77, 95% CI 0.64-0.93, P = 0.006). Moreover, a similar result was obtained in the subgroup analysis that comparison models of C allele versus. A allele (OR = 0.85, 95% CI 0.76-0.95, P = 0.004), AA versus CA + CC (OR = 1.31, 95% CI 1.09-1.57, P = 0.004), and AA versus CC (OR = 0.73, 95% CI 0.59-0.90, P = 0.004) was confi rmed to be associated with CRC risk in Caucasian. It has been proved that the C allele versus A allele, AA versus CA + CC, and AA versus CC comparison models of VEGF −257 C/A polymorphism might be risk factors for CRC, but further studies with larger sample sizes are required to make a better assessment of above association.

Calcium oxalate (CaOx) crystal deposition is a common fi nding immediately after kidney transplantation. However, small depositions of CaOx could be benign while extensive depositions lead to poor graft outcome. Here we report three cases with end-stage renal disease (ESRD), bilateral nephrolithiasis, and unknown diagnosis of primary hyperoxaluria (PH) who underwent a renal transplant and experienced an early-onset graft failure. Although an acute rejection was suspected, renal allograft biopsies and subsequent allograft nephrectomies showed extensive CaOx deposition, which raised a suspicion of PH. Even though increased urinary excretion of CaOx was found in all patients, this diagnosis could be confi rmed with further tests including genetic study and metabolic assay. In conclusion, massive CaOx deposition in kidney allograft is an important cause of poor allograft survival and needs special management. Furthermore, our cases suggest patients with ESRD and a history of nephrolithiasis should be screened for elevated urinary oxalate excretion and rule out of PH.