Journal of Research in Medical Sciences
Volume:24 Issue: 4, Apr 2019

Among patients with diabetic polyneuropathy, the status of folic acid, homocysteine, and nerve conduction studies (NCS) variations has been associated with methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms. The objective of the present study is to assess B9 vitamin supplementation associated with MTHRF C677T polymorphism can be effective on NCS variations in patients. This study is a randomized, double‑blind, placebo‑controlled study. Patients were randomly allocated to either intervention (1 mg of folic acid, n = 40) or placebo (n = 40) groups based on parallel group design. Blood samples were taken to determine the serum levels of folic acid and homocysteine. The NCS data were collected for the assessment of diabetic neuropathy. Genotyping was performed for C677T polymorphism of the MTHFR gene. Four months after intervention, patients significantly observed change of serum folic acid and homocysteine levels based on C677T genotypes in the MTHFR gene. The amplitude of sensory peroneal nerve between intervention and placebo groups with CC genotype was significantly different (2.8 ± 1.6 vs. 1.9 ± 1.1). However, peak latency and amplitude of sensory sural nerve between CC (3.8 ± 1.8 vs. 4.0 ± 1.5 for peak latency and 3.5 ± 1.0 vs. 2.5 ± 1.0 for amplitude; and CT + TT genotypes (3.7 ± 1.7 vs. 3.9 ± 1.3 for peak latency and 3.2 ± 1.0 vs. 2.3 ± 1.1 for amplitude) were significant. Furthermore, significant difference for variables of motor tibial nerve and motor peroneal nerve amplitude was observed in different groups of MTHFR C677T genotypes (5.4 ± 2.9 vs. 4.6 ± 3.2 for onset‑latency of tibial nerve between CC genotype; 4.8 ± 2.8 vs. 4.6 ± 3.2 for onset‑latency of tibial nerve between CT + TT genotype; 0.6 ± 0.2 vs. 0.3 ± 0.1 for amplitude of tibial nerve between CC genotype; 0.5 ± 0.3 vs. 0.3 ± 0.2 for amplitude of tibial nerve between CT + TT genotype; 26.0 ± 13.3 vs. 23.2 ± 13.4 for velocity of tibial nerve between CC genotype; 26.0 ± 13.7 vs. 23.1 ± 9.6 for velocity of tibial nerve between CT + TT genotype; 1.6 ± 1.0 vs. 0.9 ± 0.7 for amplitude of peroneal nerve between CC genotype; 1.4 ± 0.7 vs. 0.9 ± 0.5 for amplitude of peroneal nerve between CT + TT genotype). The study determined that MTHFR C677T polymorphism effects the efficacy of folic acid supplementation on serum folic acid, homocysteine levels and some NCS parameters in diabetic polyneuropathy patients.

Antiretroviral (ARV) therapy extends life for persons living with HIV. Antiretroviral treatment (ART) has been rapidly expanding coverage around the world, including in Iran. However, ART drug resistance also rapidly develops with expanding use and limits effectiveness and treatment options. The aim of this study was to monitor the appearance of new mutations conferring HIV pretreatment drug resistance in the treatment of naïve patients with HIV in Iran. Blood samples were obtained from ARV treatment‑naïve patients from 8 different provinces in Iran in 2016 for genotyping for drug resistance mutations. Sequences were successfully obtained from 90 specimens. Of these, 2 (2%) mutations conferring resistance to protease inhibitors, 2 (3%) conferring resistance to nucleoside reverse transcriptase inhibitors (NRTIs), and 9 (13%) conferring resistance to non‑NRTI (NNRTI) were detected. Any ARV‑resistant drug mutation was found in 11 patients (12%). Nearly one in 8 ARV‑naïve patients had mutations associated with NNRTI resistance in diverse areas of Iran in 2016. Iranian ARV therapy guideline for HIV could consider non‑NNRTI‑based first‑line therapies and expand routine drug resistance testing before treatment initiation as according to HIV drug resistance recommendations of the World Health Organization.

Physical training signals cardiac hypertrophy through PI3K as an upstream and Hand2 gene as a downstream agent. The present study aimed to find the role of PI3K and Hand2 gene in myocardial hypertrophy following interval and endurance training (ET). Twenty‑four adult Wistar male rats (210–250 g) randomly divided into control, sham, high‑intensity interval training (HIIT), and ET group. Swimming time in ET increased incrementally 30–75 min, whereas in HIIT, load/body weight, and time/rest ratio increased within 12 weeks. Heart morphometry, including left ventricle end systolic (LVESV) and Diastolic (LVEDV) volume, LV posterior wall (LVPW), stroke volume (SV), ejection fraction (EF), fraction shortening (%FS), pure heart weight (HW) and left ventricle weight (LVW), and PI3K and Hand2 gene expression were measured. HW and LVW were significantly more than control after ET (P < 0.05) and HIIT (P < 0.05). Both of the training groups demonstrated significantly thicker LVPW (P < 0.05), SV (P < 0.05), and %FS (P < 0.05). Furthermore, PI3K concentration and Hand2 expression significantly increased in ET (P < 0.001; P < 0.001, respectively) and HIIT (P < 0.05; P < 0.001, respectively) compared to control. It can be concluded that this training protocol caused physiological hypertrophy in both of ET and HIIT groups, whereas HIIT can be more beneficial because of shorter training time.

Breast cancer is the most common diagnosed female cancer. Breast cancer is also the leading cause of cancer death in females accounting for 13.7% of female cancer‑related mortality globally. Variable known prognostic factors such as histological tumor type, tumor size, nodal status, grade, age, and estrogen receptor (ER) status and the proliferation marker – Ki‑67 influence the type of treatment decision. The purpose of this present study is to investigate the association between Ki‑67 expression with several clinicopathological variables and patients’ outcome. This is a retrospective cohort study from September 2008 to March 2017; 165 newly diagnosed breast cancer patients were enrolled in the study. Ki67 levels were measured using immunohistochemistry and compared with clinicopathological variables. The relation of Ki67 expression with disease‑free survival (DFS) and overall survival (OS) was also analyzed. The result of this study revealed that age, tumor size, menopausal status, and human epidermal growth factor receptor 2 (HER2) status had no effect on the patients’ outcome. Patients with ER‑positive, progesterone receptor (PR)‑positive, and HER2‑negative tumors expressed a higher rate of Ki‑67 (>10%) than patients with ER‑negative, PR‑negative, and HER2‑positive tumors, respectively. However, we found that Ki‑67 levels were not significantly increased statistically with ER, PR, and HER2 statuses. There was a statistically significant correlation between Ki‑67 expression and with higher stages of the disease. Multivariate analysis showed that Ki‑67 expression could not to be an independent prognostic factor for 5‑year OS and DFS. Furthermore, p53 status was only prognostic factor for 5‑year OS whereas higher stages of disease and p53 status were prognostic factors for 5‑year DFS. Ki67 could not be an independent variable for prediction of breast cancer outcome.

The aim of the present study was to evaluate the effect of natural antioxidant formula (blend of herbs: ginger root, cinnamon bark and raw almond fruit powder, rosemary leaf powder, and honey) on oxidative status, antioxidant enzyme activity, and relative heat shock protein (HSP‑70) expression in recreational female athletes. Eighteen female participants trained for 4 weeks and randomly received either antioxidant formula (FormEX) (n = 8) or placebo (PlcEX) (n = 10) in a randomized controlled trial. Blood samples were obtained 1‑h before, 1 h and 24 h postexercise to measure malondialdehyde (MDA), total antioxidant capacity (TAC), superoxide dismutase (SOD), glutathione peroxidases (GPx), and HSP70 mRNA expression. Data analysis was performed using 2 (treatment = grouping factor) ×6 (time = within‑factor) repeated measurements analysis of variance or generalized estimating equations (GEE) test. We used the independent t‑test to evaluate any significant differences for real‑time polymerase chain reaction data. Antioxidant formula increased the relative HSP‑70 mRNA expression more than Plc‑EX group in all time points (P = 0.001). The time main effect was significant with regard to TAC and SOD concentrations (P = 0.001 and 0.002, respectively). However, there were no statistically significant differences between groups for TAC, SOD, and MDA (P = 0.25, 0.06, and 0.38, respectively). Neither the time main effect for MDA nor time and intervention interaction was not statistically significant for MDA, TAC, and SOD (P = 0.19, 0.13, and 0.10, respectively). GEE results for GPx showed that there were no significant differences between the groups (P = 0.11). The results presented herein revealed that natural antioxidant rich formula had variable effects on oxidative status. However, in contrast to many antioxidant supplements, this formulation increases the HSP‑70 mRNA expression which might improve the antioxidant ability of cells in the long‑term period and exercise‑induced adaptation.

The present study was conducted to determine antimicotic susceptibility of Candida species (sp.) from patients with symptomatic candiduria. Identification of Candida sp. and determination of efficacy of most routine antifungals were done using polymerase chain reaction‑restriction fragment length polymorphism method and E‑test, respectively. The results from susceptibility test reveal that caspofungin and amphotericin B have high antifungal activity against both albicans (100% and 96%, respectively) and nonalbicans (95.11% and 72.72%, respectively) isolates. The present study suggests that caspofungin and amphotericin B have the excellent ability to eradicate both Candida groups that showed decreased susceptibility to other compounds.

There is a belief that in patients with acromegaly, first‑generation somatostatin analogs (SSAs) might improve cardiovascular (CV) structure and function. However, most published clinical trials involved only a few patients and their results are rather variable. We aimed to conduct a systematic review on available studies on the impact of these drugs on CV parameters. A literature search was conducted in MEDLINE (OVID), EMBase, Cochrane, and ISI Web of Science for citations published until April 30 2018 to identify studies on our objective that considered changes in CV parameters. For this search, we established a Boolean search strategy using keywords related to “acromegaly,” “Somatostatin analog,” and “cardiovascular diseases and parameters.” All study types except for case reports or conference abstracts were included. Twenty‑four studies (n = 558) fulfilled the inclusion criteria and were selected for final analysis. In 12 studies (n = 350), decrease in heart rate (HR) and in 4 studies (n = 128), decrease in blood pressure (BP) was significant. In 15 studies (n = 320), left ventricular mass index (LVMi) changes were significant. In 9 studies (n = 202), the early diastole to peak velocity flow in late diastole (E/A ratio) was evaluated, and in 5 of them (n = 141), the improvement was significant. Eighteen studies (n = 366) examined changes in left ventricular ejection fraction (LVEF), 5 of which (n = 171) reported that these changes were significant. Decrease of left ventricular end‑diastolic diameter was reported in only 2 studies (n = 27). We found that first‑generation SSAs have a beneficial effect on cardiac parameters such as HR and LVMi. For other parameters such as LVEF, BP, LV diameter, and E/A ratio, we were not able to draw a firm conclusion.

Medical imaging modalities are used for different types of cancer detection and diagnosis. Recently, there have been a lot of studies on developing novel nanoparticles as new medical imaging contrast agents for the early detection of cancer. The aim of this review article is to categorize the medical imaging modalities accompanying with using nanoparticles to improve potential imaging for cancer detection and hence valuable therapy in the future. Nowadays, nanoparticles are becoming potentially transformative tools for cancer detection for a wide range of imaging modalities, including computed tomography (CT), magnetic resonance imaging, single photon emission CT, positron emission tomography, ultrasound, and optical imaging. The study results seen in the recent literature provided and discussed the diagnostic performance of imaging modalities for cancer detections and their future directions. With knowledge of the correlation between the application of nanoparticles and medical imaging modalities and with the development of targeted contrast agents or nanoprobes, they may provide better cancer diagnosis in the future.

Strategies for teaching in clinical rounds are dispersed. There is a need to comprehensively collate bedside strategies to enhance teaching and learning and make clinical rounds more effective. A systematic review of English articles using Web of Science, PubMed, Embase, Scopus, and Cochrane library was conducted. Relevant keywords for teaching rounds/medical teachers/medical students/strategies and their synonyms were used accordingly. Additional studies were identified by searching reference lists of retrieved articles. All searches were conducted within a 10‑day period from May 25, 2017, to June 3, 2017. In this systematic review, studies with any design on the subject of strategies for clinical rounds from clinical teachers’ and medical students’ perspectives were identified. Our search strategy yielded 524 articles. After removing duplicates, 337 articles remained. Based on the title and abstract review, 37 articles were obtained for further review and finally 18 entered the study. Data were extracted from the included studies. Two authors independently screened and scored the studies. We used inductive content analysis, and categories of strategies were derived from the data. Content analysis yielded identification of strategies for clinical rounds in nine categories named: system issues, advance planning, a preround huddle, patient issues, teachable moments, teacher issues, student issues, atmosphere issues, and a postround huddle. These were classified as “before rounds,” “during rounds,” and “after rounds” activities. Quality assessment scores for the research studies ranged from 5 to 14 (possible range, 1–16). Fourteen (77.8%) studies received quality scores at or above 10, and 4 (22.2%) studies received quality scores below 10. Due to the importance of clinical rounds in students’ learning, medical teachers should divide their teaching session into activities before, during, and after rounds. These strategies on rounding practices can improve teaching and learning.