مجله پزشکی بالینی ابن سینا
سال بیست و پنجم شماره 3 (پیاپی 89، پاییز 1397)

  Vitiligo is a depigmantation disorder that depends on genetic and non-genetic factors and results from skin melanocytes malfunction. The aim of this study was to compare the effectiveness of narrow band Ultraviolet B (NBUVB) therapy combined with 0.1% topical tacrolimus and NBUVB monotherapy in vitiligo treatment. In this double-blind clinical trial study, 30 patients with vitiligo who had at least two symmetrical lesions were selected (60 lesions in total). The patients were randomly divided into intervention and control groups. Phototherapy with 0.1% tacrolimus ointment and with eucerin ointment (placebo) was administered to the intervention and control groups, respectively. The size of the lesions and the degree of repigmentation were evaluated with photogram and Visual Approach Slope Indicator (VASI) scoring system, respectively, at the beginning of the treatment, 1.5 and three months after the treatment. The results were then recorded in checklists and the data were analyzed in SPSS software (version 16.0). The results of the study showed that the mean age of patients was 31.60 years with the prevalence of females (n=18, 60%). The mean and standard deviation of the size of vitiligo lesion in the intervention and control groups at the beginning of the treatment were 5.41 cm ±2.81 and 5.40 cm ±2.82, respectively. Moreover, the mean size of vitiligo lesion 1.5 and three months after the treatment lesion in the intervention and control groups were 4.96 cm ±2.84, 4.59 cm ±2.77, 3.85 cm ±2.35, and 4.66 cm ±2.80, respectively (P>0.05). The mean score of VASI in the intervention and control groups were 0.50 ±0.51 and 0.53 ±0.51 at the beginning of the treatment and 1.46 ± 1.44 and 1.13±1.01 after 1.5 months treatment and 2.18±1.57 and 1.52±1.21 after three months of treatment, respectively (P>0.05). Furthermore, the percentages of repigmentation in the intervention and control groups after 1.5 months were 18.25% and 14.12%, and three months were 30.63% and 19%, respectively. The percentage of vitiligo recession in the combined treatment group was higher than that of monotherapy; however, no significant statistical difference was observed regarding the two therapeutic methods

  Diabetes mellitus is one of the most commonly reported diseases that is associated with insulin resistance and increased blood glucose levels. The aim of this study was to determine the probable anti-inflammatory effects of sitagliptin and vitamin D3 (VitD3) on pro-inflammatory IL-6 and TNF-α in patients with type 2 diabetes mellitus (T2DM). In this case-control study, 20 blood samples of patients with T2DM and healthy controls (HCs) were collected (n=20). Peripheral blood mononuclear cells (PBMCs) were isolated using the Ficoll-Paque method and cultured with Phytohemagglutinin (PHA) in the presence or absence of sitagliptin and VitD3 for 4 days. The enzyme-linked immunosorbent assay was used to analyze the levels of IL-6 and TNF-α produced by PBMCs. After PHA stimulation, the production of IL-6 was increased significantly in T2DM patients compared to HCs (P=0.03) . Compared to PHA cultures, sitagliptin and VitD3 resulted in the reduction of IL-6 production in patients (P≤0.001, P≤0.001), and HCs (P=0.03, P=0.02), respectively. Moreover, with regard to the cultures with sitagliptin or VitD3, sitagliptin with VitD3 reduced the level of IL-6 in both groups of patients (P=0.02, P=0.002) and HCs (P=0.002, P=0.03). There was a significant reduction in the level of TNF-α by sitagliptin with VitD3 in patients (P=0.04, P=0.002) and HCs (P=0.04, P=0.03) , compared to cultures with sitagliptin or VitD3. According to the results, it can be concluded that the combined use of sitagliptin and VitD3 is more influential regarding the anti-inflammatory effects on patients. In addition, the reduction of sitagliptin dose may result in decreasing its possible side effects

Attention deficit/hyperactivity disorder (ADHD) is one of the most common psychiatric disorders that causes educational, social, and family problems. The main aim of present study
was to compare the efficacy of of neurofeedback and neurofeedback
plus Barkly’s parental training on auditory attention dimensions and comprehension among ADHD Children. This research was a clinical trial study with two experiment and one sham control groups in three stages of pre-test, post-test, and ten weeks follow-up test. A total number of 42 elementary ADHD boys along with their mothers were selected using purposive sampling technique in 2017. The partcipants were assigned to two experimental and one control groups randomly. Those in the experimental group received neurofeedback training in 30 sessions (i.e., 30-min sessions 3 days a week). Parents of the compound group received nine sessions of training based on Barkley’s model for an hour. Students in the control group had neurofeedback only with random rewards without any definite setting. All the participants were assessed in three stages by Integrated Visual and Auditory Continues Performance Test. Data were analyzed using SPSS software (version 23) through repeated measure ANOVA. The obtained results of post-test and follow-up revealled a significant increase in auditory vigilance (P≤0.005), focus (P≤0.001), speed (P≤0.012), and auditory comprehension (P≤0.003), as well as a significant decrease in ADHD symptoms, compared to the results of the control group. However, the difference between the two experimental groups was not significant. Neurofeedback training and neurofeed plus Barkly’s parental training equally increase auditory attention dimension and comprehension among ADHD children.

  Mortality of hemodialysis patients is still high, which can be estimated using the Charlson Comorbidity Index (CCI) and serum albumin. This prospective cohort study was conducted on adult chronic hemodialysis patients (n=532) from 9 hemodialysis (HD) facilities in September 2012. The obtained data included demographic factors and laboratory data, which consisted of serum albumin and patients’ comorbidities at the beginning of study, as well as the causes of mortality, hospitalization, and termination of hemodialysis in a 28-month follow-up period. Furthermore, one- and two-year survival of patients was evaluated by CCI and the age of patients was estimated by serum albumin≥ 3.5 g/dL and serum albumin< 3.5 g/dL. The mean age of patients was 56±15.4 years. The participants consisted of 57% men, 41% diabetes, and 43% ischemic heart disease. The mean of dialysis vintage was 44.6±49.1 months. The mean values were 10.6±1.50 g/dl, 3.90±0.35 g/dl, and 1.31±0.21 for serum hemoglobin, serum albumin, and dialysis treatment adequacy (Kt/V; i.e., K=Clearance Dialyzer, T=Time, V=Volume of Distribution of Urea), respectively. A total of 161 (30%) patients passed away (17 per 100 patient a year), and the most common causes of mortality were cardiovascular diseases (42%) and infections (25%). In Cox proportional hazard model, hazard ratio (HR) of death was 1.03 year (95% CI: 1.01-1.05; P=0.007), for serum albumin (g/dL) was 0.21 (95% CI: 0.11-0.40; P<0.001), and for CCI was 1.75 (95% CI: 1.59-1.94; P<0.001). One-year survival probability for patients in the group A (serum albumin≥ 3.5 g/dL) with CCI scores 2-3, 4-5, 6-7, and ≥ 8 were 96%, 92%, 81%, and 64%, respectively. However, these numbers for patients in group B (serum albumin< 3.5 g/dL) were 86%, 75%, 60%, and 42%, respectively. Two-year survival probability for patients in group A with CCI scores 2-3, 4-5, 6-7, and ≥ 8 were 94%, 89%, 73%, and 36%, respectively. Furthermore, the obtained results for patients in group B were 86%, 45%, 39% and 22%, respectively. Charlson Comorbidity Index along with serum albumin and age are appropriate variables to predict one- and two-year survival of HD patients. Therefore, there is a need to take appropriate measures for high risk patients to improve their health status

Vulvovaginal Candidiasis (VVC) affect millions of women annually. Candida albicans is the most common cause of VVC. Secreted aspartyl proteinases (SAPs) are among the most important virulence factors in Candida species. The SAP3 enzyme is effective in the initial development of VVC infection due to its role in the adhesion of Candida albicans. The aim of this study was to determine the presence of SAP3 gene in Candida albicans strains isolated from patients with Vulvovaginal Candidiasis. In this cross-sectional study, vaginal secretion samples were collected from 268 vaginitis patients referred to Amiralmomenin Hospital of Gerash city, Fars province, Iran from March to August 2018. After direct microscopic examination, all samples were cultured on sabouraud dextrose agar medium with chloramphenicol (50mg/L). Candida strains were identified using standard phenotypic and sugar assimilation tests (API20C). Genomic DNA extraction and the presence of SAP3 gene were performed using chloroform-phenol-isoamyl alcohol and polymerase chain reaction (PCR) methods, respectively. Out of 268 samples, 79 (29.47%) cases were positive for Candida species under direct microscopy and culture results. 48 (60.75%) and 31(39.24%) Candida albicans strains and Non-albicans candida species were isolated, respectively. The results of PCR showed the presence of SAP3 gene in 47 (97.91%) Candida albicans strains. It can be concluded that Candida albicans were more likely to cause Vulvovaginal than other Candida species. The explanation for this is the presence of the SAP3 gene in most Candida albicans strains.

Ocular biometry refers to the measurement of the axial length of the eye and thickness of the intraocular structures. This process is routinely performed for all patients before cataract surgery. The accuracy of the biometric data is directly associated with the refractive status after cataract surgery. Currently, two methods of biometry, namely ultrasound and optical biometry, are used to calculate the intraocular lens power. The purpose of this study was to compare the Lenstar and ultrasound biometry methods in determining the axis length and refractive error after cataract surgery. This descriptive cross-sectional study was conducted on 372 patients with cataract. The study population was randomly divided into two groups of Lenstar and ultrasound based on the biometry methods they received. A total of 17 patients were excluded from the study due to having mature and dense cataract. Therefore, the study was continued with 355 patients, 186 and 169 cases of whom were managed with ultrasound and Lenstar biometry methods, respectively. Postoperative refractive errors were evaluated in each patient 4-6 weeks after the surgery. The two groups were compared in terms of the mean absolute refractive error using paired sample t-test. The mean absolute refractive errors before the surgery were obtained as 2.38±3.93 and 2.19±2.68 diopter in the ultrasound and Lenstar groups, respectively, which were not significantly different between the two groups (P=0.2). The mean axial lengths of the eye were 23.10±1.19 and 23.34±1.17 mm in the ultrasound and Lenstar groups, respectively. The two groups showed no significant difference in this regard (P=0.96). After the operation, the mean absolute refractive errors in the ultrasound and Lenstar groups were 0.56±0.45 and 0.51±0.38 diopter, respectively. This variable was not significantly different between the two groups after the surgery (P=0.11). The findings of this study revealed no significant difference between the ultrasound and Lenstar biometry methods in terms of determining the axis length and mean absolute refractive error after cataract surgery.

Chronic obstructive pulmonary disease (COPD) is a worldwide health problem with increasing prevalence. It is often associated with negative health outcomes, including depression. Therefore, the aim of this study was to determine the prevalence of depression in patients with COPD. This cross-sectional study with a descriptive-analytic design was conducted on 103 patients referring to the respiratory disease clinic and admitted to the pulmonary disease department of Shahid Beheshti teaching Hospital, Hamadan, Iran from April to September 2018. The inclusion criteria were the diagnosis of severe and very severe COPD according to the medical history, physical examination, and standard spirometric methods. The patients with lack of bereavement, trauma, and the use of antidepressant drugs were excluded from the study. Depression levels were measured using 21-items Beck II depression questionnaire. The results of the study showed that 57 patients (55.3%) were males and 46 cases (44.7%) were females. The majority of the subjects (33%) were in the age group of 50-59 years old. According to the results, the prevalence of depression in the study population was 66%. There was a significant relationship between spirometric parameters of forced expiratory flow at 25-75% of the pulmonary volume, forced expiratory volume at 1 second and COPD severity (P=0.024, P=0.003). With regard to the high prevalence of depression among people with severe and very severe COPD, it is necessary to consider psychological counseling for patients

  The prevalence of metabolic syndrome is on a growing trend. Weight and age are among the most important factors affecting this condition. Evidence is indicative of a relationship between coronary heart diseases and metabolic syndrome. The present study was conducted to determine the prevalence of metabolic syndrome among patients admitted to the Cardiology Department of Farshchian Hospital in Hamadan city, Iran. The present descriptive cross-sectional study was conducted on 390 patients admitted to the Cardiology Ward of Farshchian Hospital in 2015. The diagnosis of metabolic syndrome was accomplished according to the Adult Treatment Panel III criteria. The data were analyzed in SPSS software (version 16) using descriptive statistics, Chi-square test, and Student’s t-test. Metabolic syndrome was observed in 53.3% of the patients. This condition was mostly associated with ischemic heart disease (62.5%) and hypertension (50%). Abdominal obesity, high systolic and diastolic blood pressures, high fasting blood sugar, low high-density lipoprotein (HDL), and high triglyceride were significantly more frequent in patients with metabolic syndrome than in those without such condition. The results revealed no significant relationship between body mass index (BMI) and metabolic syndrome. Metabolic syndrome is highly prevalent among the patients with ischemic heart disease. Abdominal obesity, low HDL, high triglyceride, and elevated systolic blood pressure are among the proper predictive factors of metabolic syndrome. However, BMI cannot properly predict this condition.