مجله پزشکی بالینی ابن سینا
سال بیست و ششم شماره 1 (پیاپی 91، بهار 1398)

Neuropathic pain is one of the common, important, and irritating complications in diabetes.  Despite the importance of this pain, there is still no effective treatment for that. The aim of this study was to determine the effect of evening primrose oil and gabapentin on neuropathic pain in patients with type 2 diabetes. This triple-blind clinical trial was performed on 70 patients with diabetic neuropathy who obtained score 2 from the Michigan Questionnaire and referred to the Department of Endocrinology at Khayyam clinic affiliated to Hakim Hospital in  Neyshabour from December 2017 to May 2018. The participants were divided into two groups of 35 people. The intervention group was treated with a capsule of evening primrose oil orally  (1000 mg) twice daily for three months and gabapentin (300 mg) daily. On the other hand, the control group was treated with gabapentin (300 mg) and placebo. The neuropathy pain severity was measured before and after the end of three-month intervention using Michigan and McGill Pain Questionnaires. Data analysis was performed in SPSS software (version 21) through Fisher's exact test, ANCOVA, multilevel logistic regression, Mann Whitney U test, Kolmogorov-Smirnov test, and the Chi-square tests. P-value less than 0.05 was considered statistically significant. According to the results obtained from the McGill questionnaire, the mean scores of neuropathy before the intervention were obtained at 10.12±0.57 and 9.85±0.65 in the intervention and control groups, respectively. However,  the mean scores of neuropathy after the intervention were estimated at 6.18±0.48 and 8.31±0.60 in the intervention and control groups, respectively, which was statistically significant (P<0.02). Evening primrose oil is effective in reducing neuropathic pain in type 2 diabetic patients. Therefore, this can be a supplementary treatment for reducing pain associated with diabetic neuropathy.

Prostate cancer is among the five common cancers in males. It is second cancer in terms of the age-standardized rate (ASR) (ASR=16.6) in Iran. The rs2735839 G/A, an intergenic polymorphism is located on chromosome 19q13.33 at 600 base pairs of the KLK3 gene untranslatable region. This gene which codes prostate-specific antigen (PSA) is used in the screening and diagnosis of prostate cancer. The purpose of this study was to evaluate the association between this polymorphism and prostate adenocarcinoma with PSA. This case-control study included 103 and 100 patients with prostate adenocarcinoma and benign prostatic hyperplasia (BPH) as case and control groups, respectively. Tetra-primer amplification refractory mutation system-polymerase chain reaction was used to determine the genotype of each participant regarding rs2735839 polymorphism. There was a significant difference between the adenocarcinoma prostate and BPH groups regarding genotype frequency AG+AA (OR [95% CI]=4.991 [2.475-10.065], P=0.00). According to the results of statistical analysis, a significant difference was observed between the adenocarcinoma and BPH groups in terms of allele frequency (OR [95% CI]=3.927 [2.085-7.397], P=0.00). Moreover, There was a significant difference between rs2735839 and PSA regarding the genotype frequency polymorphism (P=0.011). The results indicate that rs2735839 is associated with an increased risk of prostate cancer in Iranian population. It is worth noting that a significant difference was found between the distribution of allele A and that of allele G with PSA levels of >10.

Thyroid nodules are among the most common clinical problems and the application of an inexpensive and accurate diagnostic method prevents performing inessential surgeries. In this regard, the aim of this study was to compare the cytologic report of fine-needle aspiration (FNA) of thyroid nodules with the results of thyroid surgery. In this cross-sectional study, all the patients who had referred to the clinic of Beheshti Hospital of Hamedan, Iran, due to thyroid nodule in 2017 underwent FNA. The samples were then sent to the pathology laboratory, and the cytology results were recorded in a checklist. Based on the cytology results, a portion of these cases was referred to undergo surgery. Following that, the sensitivity and specificity of cytology results of thyroid nodules were calculated in comparison to pathology results of the surgery sample. Out of 115 studied patients, 18 (15.65%) and 97 (84.35%) subjects were male and female, respectively. The mean age of the subjects was 40.14±12.34 years. Most cases were in the form of the right-side unilateral nodule (46.1%). The number of benign and malignant cases diagnosed by the pathologist was 73 (63.48%) and 42 (36.52%), respectively. The specificity, sensitivity, as well as positive and negative predictive values obtained from the FNA of thyroid nodules by the pathologist, were reported as 82.98%, 95.56%, 89.04, and 92.68%, respectively. It is necessary to mention that the diagnostics accuracy of the pathologist associated with the results of surgery pathology was 90.43%. Performing FNA enjoys a relatively high specificity and sensitivity as an inexpensive, low-risk, and simple method in the differentiation of benign and malignant cases if it is performed precisely from the site of the nodule with adequate biopsy and properly examined pathologically.

Hypothermia induction has been proposed to improve the recovery process of stroke in the last two decades. Therefore, the aim of this study was to investigate the effect of mild hypothermia on the recovery of patients with acute stroke. This single-blind randomized clinical trial was conducted on 60 patients with acute stroke in 2018 in Hamadan, Iran. The patients were selected by available sampling method, and then randomly assigned into two equal-sized groups of intervention and control. Mild hypothermia was induced using a cooling device applied on the patients' head for a period of 72 h. The National Institutes of Health Stroke Scale (NIHSS) was used to collect the data. The results of both groups were compared with each other following the intervention. Finally, the data were analyzed using SPSS software (version 22). The results showed no significant difference between the mean scores obtained before and after the intervention in the control group (P>0.05). In addition, there was no significant difference between the intervention and control groups in terms of the pre-intervention mean scores (P>0.05). However, the results revealed a statistically significant difference in the mean pre- and post-intervention scores of the intervention group (P<0.05). In this regard, the mean score of NIHSS was significantly reduced in the intervention group after the induction of hypothermia. Finally, the results were indicative of a statistically significant difference between the intervention and control groups after the intervention (P<0.05). As the findings of the present study indicated, noninvasively induced hypothermia has a significant clinical effect on acute stroke. Therefore, it can be argued that the use of hypothermia leads to the enhancement of consciousness level and reduction of mortality risk in patients with acute stroke. Consequently, this intervention is suggested to be considered the main therapeutic approach of acute stroke.

Several studies revealed that disgust as an emotional response underlies the contamination fears in Contamination Obsessive Compulsive Disorder (OCD). Other studies supported the role of cognitions related to contagion and disease in contamination OCD. The present study aimed to integrate these two lines of evidence. To this end, regarding the concept of the behavioral immune system, it was investigated whether perceived vulnerability to infectious disease, as a cognitive component of the behavioral immune system, can moderate the relation between disgust, as the emotional component of this system, and symptoms of contamination OCD. This cross-sectional study was conducted on 350 university students in Tehran University through cluster random sampling. The participants were asked to complete the Persian version of the disgust scale, perceived vulnerability to disease questionnaire, and Vancouver contamination subscale. The data were analyzed utilizing hierarchical regression analysis and post hoc tests.  The results revealed that perceived vulnerability to infectious disease moderated the relationship between the feeling of disgust and fear of contamination.  According to the results, perceived infectability subscale which measures perceived weakness of one's immune system with more accuracy, can also exacerbate the relationship between the feeling of disgust and fear of contamination. The results of this study facilitate the understanding of the effect of disgust on fear of contamination, especially the role of cognitions about contagion and disease in potentiating the relation between disgust and contamination OCD. Moreover the obtained results generally provide evidence for the disease-avoidance theory in disgust and support the possible hyperactivity of the behavioral immune system in contamination OCD.

Retinopathy of prematurity (ROP) is an evolutionary disorder in the retina of premature infants. Nowadays, the prevalence rate of retinopathy has increased due to the advancement of medical facilities and the increased survival of preterm infants. The aim of this study was to determine the prevalence rate of ROP and its related risk factors among infants admitted to and examined at neonatal intensive care unit (NICU) affiliated to Fatemieh Hospital in Hamadan. This descriptive cross-sectional study was conducted on all premature infants selected with census sampling methods and with a gestational age of fewer than 34 weeks who were hospitalized in NICU for four weeks or more. The premature infants were investigated regarding the incidence of retinopathy and its risk factors. Out of 80 neonates under study, 24 (30%) cases suffered from ROP, of which 16 and 8 neonates were in stage I and II of ROP, respectively.  Moreover, the mean gestational age of newborns was 29.71±2.16 weeks, and more than 75% of ROP were observed in neonates under 29 weeks' gestational age. In addition, the results revealed that ROP correlated significantly with gestational age, low birth weight, 1st and 5th minute Apgar scores, the need to resuscitation, the use of inotropic drugs, and duration of oxygen therapy. However, there was a significant relationship between low birth weight and retinopathy based on the results obtained from logistic regression. The prevalence rate of ROP stands on average regarding the results obtained from Iranian and foreign published data. Among the independent variables that affect retinopathy, low birth weight was the only significant variable affecting the incidence of retinopathy.

The role of biofilm formation by bacteria has been considered as an important stage in the pathogenesis of Klebsiella pneumoniae. This pathogen is one of the most important opportunistic pathogen agents of nosocomial infections, such as pneumonia, urinary tract infections, invasive infections, and surgical site infections. This study aimed to investigate the biofilm producer strains among different clinical isolates of Klebsiella pneumoniae. This observational study was conducted on 230 clinical samples with bacterial infection. The selective culture media and biochemical tests were used for the identification of Klebsiella pneumoniae isolates. Crystal Violet assay and PCR were also used to characterize biofilm strains. Out of 230 samples collected from different specimens, 100 isolates (43.47%) of Klebsiella pneumoniae were identified by biochemical tests. Of these, 58 (58%) and 42 isolates (42%) were isolated from the male and female individuals, respectively. The phenotypic method showed 2, 27, 41, and 30 isolates as strong biofilm producers, medium biofilm producers, weak biofilm producers, and non-biofilm producers, respectively. The frequency of genes were reported as wzm (47%), markA (69%), pgaAa (65%), and wbbm (47%), respectively. The markA gene plays an important role in biofilm formation and can identify different biofilms in Klebsiella pneumoniae strains. It is also possible to identify bacteria with weak, moderate, and strong biofilms.

Venous thromboembolism is one of the major causes of mortality worldwide. Various environmental and genetic factors are known as risk factors for this disease. Therefore, this study aimed to investigate the frequency of risk factors in patients with venous thromboembolism admitted to Ekbatan and Farshchian hospitals in Hamadan from 2012 to 2017. This cross-sectional descriptive study investigated all patients with venous thromboembolism who had medical records regarding risk factors of venous thromboembolism using census sampling method. The obtained data were analyzed in SPSS software (Version 21). According to the results, out of 226 patients under study, 116 (51.3%) ones were male. Moreover, 103 (45.6%), 76 (33.6%), and 47 (20.8%) patients had deep venous thrombosis, pulmonary embolism, and severe lung embolism with deep venous thrombosis, respectively. The mean±SD age of patients was 59.15±19.85 years. Moreover, the most frequent risk factors associated with venous thromboembolism include the history of hypertension (37.2%), recent hospitalization (29.6%), cardiovascular problems (27.5%), history of recent surgery (16.8%), history of intravenous thromboembolism (8.8% 16%), history of smoking (16.8%), statin use (15.5%), history of hyperlipidemia (13.7%), and catheterization (13.7%). Venous thromboembolism is a multifactorial disease in which some risk factors contribute to the increased risk of it directly and indirectly.