فهرست مطالب مسیح صدیق رحیم آبادی

Diabetes is a known chronic disease affecting more than 400 million people and causing millions of deaths worldwide annually. The World Health Organization predicts that by 2030, diabetes will become the seventh leading cause of death. In the last decades, numerous chemotherapy approaches have been used. However, herbal remedies have accounted for more than 70 percent of the total administered antidiabetic treatments during the last decade. In this study, we aimed to develop a novel natural antidiabetic therapy with Trigonella foenum-graecum (T. foenum-graecum) L. and Citrullus colocynthis (C. colocynthis) (L.). Based on past studies, using C. colocynthis singly can cause diarrhea, abdominal pain, and heartburn, hence in order to reduce these complications, we applied this plant in combination with T. foenum-graecum based on the recommendations of Persian medicine references.

We admitted 34 diabetics aged 30-65 years old to design a double-blind parallel randomized controlled clinical trial. We prepared therapeutic capsules containing a combination of 40 mg of C. colocynthis and 350 mg of T. foenum-graecum L. We divided participants into an interventional (n=17) and placebo (n=17) groups and measured fasting blood sugar (FBS) levels, lipid profile, and liver function tests initially. After two weeks, all participants returned for a visit, and FBS and blood sugar (BS) were measured. At the end (12th week), all outcomes were measured and analyzed using an independent t-test and Chi-squared (χ2).

The FBS levels decreased significantly in the intervention group compared to that of the control group (171.8±54.9 versus 149.6±46.4, p=0.024), but the improvements in the lipid profile and liver function were not statistically significant.

This study unveiled that combination of T. foenum-graecum L. and C. colocynthis L. at safe levels significantly decreased the FBS levels among T2DM patients. Further studies are needed to provide more efficient antidiabetic effects with the low side effects.

Given the holistic view of Iranian medicine and the importance of planning to reduce the clinical complications of bloating in the military, this study was conducted for the first time to develop and standardize the questionnaire of compliance with the principles of effective Iranian medicine on functional bloating.

Initial questionnaires of 25 questions were extracted from authentic sources of Iranian medicine libraries by extracting the factors affecting functional bloating on lifestyle. Content validity of the questionnaire was calculated by calculating CVI and CVR indices and using the opinions of 25 Iranian medical experts. Exploratory factor analysis was also performed to evaluate the construct validity with 378 individuals enrolled in the study by cluster sampling. Test-retest and Cronbach's alpha coefficient were used to assess the reliability and stability of the questionnaire.

The content validity of the 15-item questionnaire was estimated to be 0.92 by removing 10 questions from the set of questions and reviewing the other 10 questions. Exploratory factor analysis also revealed that the four domains of eating pattern, drinking pattern, sleep pattern and sexual activity were 49.93% of the total variance. Eating pattern was the most important area of ​​the questionnaire because with the highest number of questions, it accounted for 20.85% of the total variance and had the strongest correlation with the total score of the questionnaire. The intra-cluster correlation coefficient of the test in the test-retest test was 0.851 which indicates its stable consistency. Cronbach's alpha coefficient was 0.793 and in the desired range.

The questionnaire of compliance with the principles of Iranian medicine affecting functional bloating has a good reliability and validity and can be used as an appropriate tool to examine aspects of lifestyle affecting functional bloating and gastrointestinal discomfort in the military.

Non-pharmacological approaches such as foot reflexology massage for reducing complications and costs in different patients have been the focus of researchers. This study aimed to investigate the effect of foot reflexology on anxiety and agitation in patients undergoing mechanical ventilation after open heart surgery. This study was a double blind three-group randomized controlled trial. This research was conducted in two hospitals affiliated to Baqiyatallah University of Medical Sciences in Tehran from February 2014 to April 2015. 96 patients were recruited and randomly allocated to the experimental group received 20 minutes foot reflexology (n=34), placebo group simple surface touching (n=30), and the control group (n=32). Foot reflexology massage for 20 minutes was provided to patients in the experimental group on the reflection points in the heart and lungs. The rate of anxiety and agitation based on Faces of Anxiety Scale (FAS) and the Richmond Agitation Scale (RSAS) were recorded in 6 stages. Data from 92 patients (31 in the intervention group and 30 in placebo group and 31 in the control group) were collected. Data from 92 patients, intervention, placebo and control groups (31, 30, and 30, respectively) were collected. Friedman test indicated that there were statistically significant differences between the mean of anxiety and agitation level in groups at different stages of time (P<0.001). The Kruskal-Wallis test indicated that there were not statistically significant differences between the level of anxiety and agitation among the three groups at different stages of time (P>0.05). Foot reflexology massage in reflection points of the heart and lung in patients after surgery did not reduce anxiety and agitation in patients.

In Traditional Iranian Medicine (TIM)، naturally affairs are seven principles which human health and existence are based on them and four elements are at the top of these principles. Although studying the philosophic and scientific subjects of these elements are parts of ancient philosophy knowledge، because of a long time interruption between fellows of Persian Medicine (PM) or TIM and basic science of traditional medicine and dramatically changes in concept and usage of these matters during centuries، surveying the meaning and practical use of such words is a primary step in order to understand PM. In this research، 11 traditional medical texts، 5 philosophic references، 4 dictionaries and some updated resources were surveyed. Results and Upon the results of this research، although four elements (cosmic elements or primordial essences or first principles or elementary principles) are limited to the 4 familiar words; Water، Fire، Air and Earth، their meaning and usage are totally different from the original concept of the modern elements (elements of periodic table) and contemporary meanings of water، fire، air and soil. Perhaps it is more accurate comparing the meaning and characteristics of these particles with fundamental and subatomic particles of modern knowledge

Celiac sprue (gluten sensitive enteropathy) is an autoimmune disease which is hereditary and its pathology mainly bases on immunologic intolerance to gluten. It has a vast variety of signs and symptoms and its clinical features range from a silent disease to a typical gastrointestinal disorder. In this study we reviewed and summarized some other related issues about this disease and its relation with infertility. Case: The case is a 26 years old lady who had referred to a gynecologist because of infertility for 2 years and later it revealed that she has celiac sprue. Screening for its silent or subtle types especially among suspicious cases such as unexplained infertility seems to be a cost effective action. Meanwhile, in time administration of a gluten-free diet can lead to an almost complete cure.

Psychiatric disorders are common in Irritable Bowel Syndrome (IBS) patients. Prevalence of psychiatric disorders is varies in IBS patients in different societies. Objevtive: To determine the prevalence of psychiatric disorders (anxiety-depression) in IBS patients in Rasht. In this cross-sectional study, 256 IBS patients were selected (using criteria of Rome III) and evaluated for psychiatric disorders. In the first phase, subjects were screened by GHQ28. In the second phase, those patients who had scores equal or more than 23 were assessed through semi-structured psychiatric interview. Socio-demographic variables including age, gender, marital status, educational level and occupation, were recorded as well. P-values less than 0.05 were considered statistically significant. Among 256 subjects 30 patients (11.7%) had no significant psychiatric symptoms and 226 subjects (83 male, 143 female) suffered from some degrees of psychiatric problems. After performing semi-structured psychiatric interview; 190 subjects (74.2%) had anxiety-depressive problems [89 patients were suffered from pure anxiety disorders, 41 patients suffered from depressive disorders and 60 patients had co-morbid anxiety-depressive disorders]. In anxiety disorders; generalized anxiety disorder (53.7%) and in depressive disorders; dysthymia (53.5%) had the most frequencies, 53.7% and 53.5% respectively. In comparisone of anxiety-depressive subjects (190 persons) and normal subjects (66 persons), there was a significant statistical differences between the gender (P=0.019), occupation (P=0.002) and intensity of IBS (P<0.001). Although, further studies are needed to determine the relations of demographic variables and types of IBS with psychiatric disorders, it seems to more attention to the psychiatric disorders of some specific patients suffering from IBS is helpful to their treatment.

To assess patient satisfaction with ophthalmologic services at Labbafinejad Medical Center.

The present study was a cross-sectional study conducted during the summer of 2008. Patients with ophthalmic problems were selected by systematic random sampling according to the admission list. A trained investigator interviewed patients in the hospital or clinic. The data collection tool was based on a standard PSQ-18 questionnaire. Primary outcomes were measured as the level of satisfaction domains on a 5-point scale (1 = lowest satisfaction, 5 = greatest).

Of 539 patients (98% response rate) with mean age of 44.7±23 years age, 167 patients (31.2%) were completely satisfied, 215 (39.9%) were satisfied, 95 (17.5%) were partially satisfied, 29 (5.2%) were unsatisfied, and 33 (6.2%) were completely unsatisfied. The mean score and standard deviation of general satisfaction was 4.05±1.1. Mean score in different domains of satisfaction were as follows respectively, interpersonal manner (doctor-patient) 4.6±0.77, financial aspects 4.5±1.1, communication 4.3±0.96, time spent for patient 4.3±0.97, technical quality & professionalism 4.1±0.99, accessibility 3.8±1.1, and convenience 2.6±1.2.

The patients were relatively highly satisfied with the ophthalmologic services overall; however, certain aspects such as accessibility and convenience should be improved.

To report the efficacy of a single intravitreal injection of bevacizumab (IVB) alone or in com-bination with intravitreal triamcinolone acetonide (IVT) versus macular laser photocoagulation (MPC) as primary treatment for diabetic macular edema (DME). This randomized three-arm clinical trial included 103 eyes of 97 patients with clinically significant DME and no previous treatment. The eyes were randomly assigned to one of the three study arms: the IVB group received 1.25 mg IVB (37 eyes), the IVB/IVT group received 1.25 mg IVB together with 2 mg IVT (33 eyes), and the MPC group underwent focal or modified grid laser photocoagulation (33 eyes). Primary outcome measure was change in best-corrected visual acuity (BCVA). Changes in BCVA (logMAR) at 12 weeks were -0.22±0.23, -0.13±0.31 and +0.08±0.31 in the IVB, IVB/IVT and MPC groups, respectively. The marginal regression model based on generalized estimating equation analysis demonstrated that changes in visual acuity was statistically significant in the IVB group at both 6 (P<0.001) and 12 (P=0.024) weeks but only at 6 weeks in the IVB/IVT group. Significant decrease in central macular thickness (CMT) was observed in the IVB and IVB/IVT groups at 6 weeks. Up to 12 weeks, IVB treatment in eyes with DME yielded better visual outcome than laser photocoagulation, although it was not associated with a significant decrease in CMT. IVT seemed to have no further beneficial effect in combination with IVB.

To assess the English language competence of Iranian ophthalmologists and their points of view regarding the need for and importance of holding ophthalmologic congresses in English. A descriptive-analytic, cross sectional study was conducted during the 17th Iranian Ophthal-mology Congress, Tehran. Data collection was performed via a standard self administered question-naire. Five-hundred question forms were distributed among ophthalmologists and answers were graded using an ordinal five-level score. The response rate of this study was 94.6%. The English competence of 200 (42.3%) of the responders was good or perfect. Overall, about 90% of the responders agreed on holding ophthalmo-logic congresses in English; 72 (15.2%) individuals proposed holding speeches in English at all sessions, 189 (40.0%) preferred holding the main hall speeches in English and 162 (34.2%) said that the best way is to have only foreign guests’ speeches in English. Most ophthalmologists implied that holding ophthalmic congresses in English and inviting foreign lecturers is of great importance and the best form of performance is holding all lectures in the main hall in English. It seems that improving the English abilities of ophthalmologist together with holding English congresses and inviting foreign lecturers may help improve international communi-cations and update their knowledge.

To report the visual outcomes and complication of one-stage surgery for management of uveitic cataracts associated with posterior segment disease. In this retrospective interventional case series, 19 eyes of 19 patients with posterior segment involvement due to chronic uveitis underwent sutureless scleral tunnel incision phacoemulsification combined with total vitrectomy using 25-gauge instruments and posterior chamber intraocular lens (PCIOL) implantation. Membrane peeling and endolaser photocoagulation were performed when indicated. Outcome measures were visual acuity, inflammatory activity, macular edema and surgical complications. After a minimum 12-month follow-up, visual acuity was >20/100 in 12 eyes (63.2%) and >20/40 in 6 eyes (31.6%). One grade of decrease in postoperative inflammatory activity was observed in 8 eyes (42.1%). Cystoid macular edema was present in 16 eyes preoperatively and in 12 eyes postoperatively. Early postoperative complications included transient corneal edema in 10 eyes (50.3%), posterior synechia in 9 eyes (47.3%) and fibrin reaction in 3 eyes (15.8%). Glaucoma was the most common late postoperative complication (3 eyes, 18.8%). Nine eyes (47.4%) needed YAG laser capsulotomy during the first year. Combined sutureless 25-gauge vitrectomy, phacoemulsification, and PCIOL implantation may be a well tolerated procedure with an acceptable complication rate for visual restoration in selected uveitic eyes with significant cataract and coexisting posterior segment disease.

To evaluate the incidence of medication error in patients who underwent intraocular surgery based on different methods of drug instruction (hand-written versus orally explained) at Labbafinejad Medical Center.

During a 6-month period, we evaluated 204 postoperative patients who underwent cataract or glaucoma surgery. Patients were randomly assigned to two groups; in group I, patients and their attendants received oral and written instruction in addition to the prescription, while the patients and their attendants in group II only received oral instruction besides the prescription. One to 3 days after the operation, the overall incidence of medication errors was determined and compared between the groups using Fisher’s exact test.

Overall 204 patients including 114 (55.9%) male and 90 (44.1%) female subjects were studied. Mean age of the patients and their attendants was 53.5+22.1 (range 1-90) years and 39.1+12.2 (range 19-79) years, respectively. Actual medication errors occurred in 7 patients including 3 (3%) in the group with written instruction and 4 (3.9%) in the group with oral instruction (P=0.511). Dispensing errors were the cause in 5 (71.4%) patients including 3 in group I and 2 in group II (P=0.491) but the 2 (28.6%) other cases were due to misconsumption (all in group II). Overall, 3 medication errors were detected and corrected (intercepted errors) by the patients or their attendants (all in group I) thus; non-intercepted errors were 4 (all in group II). Cases of actual medication errors were female in 6 (85.7%) and illiterates in 4 (57.1%).

It seems that using a written instruction in addition to the prescription may reduce the incidence of medication errors following ocular surgery.

To compare the visual outcomes of four different therapeutic modalities for central retinal vein occlusion (CRVO) with each other and with the natural course of the disease. This study was conducted on 63 eyes of 63 patients including 13 eyes in the radial optic neurotomy (RON) group, 10 eyes in the combined RON and intraocular triamcinolone injection (RON/ IOT) group, 12 eyes in the combined internal limiting membrane peeling, RON and IOT (ILMP/ RON/IOT) group, 14 eyes in the intravitreal triamcinolone injection (IVT) group and 14 untreated control eyes. All patients were followed for six months. Final best-corrected visual acuity (BCVA) was better in the IVT group as compared to the RON (P=0.037), RON/IOT (P=0.401), ILMP/RON/IOT (P=0.023) and control (P=0.025) groups. However, after adjusting final BCVA for baseline BCVA, only the RON/IOT group showed significant visual improvement after 1 (P= 0.025), 3 (P= 0.023) and 6 (P= 0.054) months as compared to controls. Among the four different approaches evaluated in this study, RON/IOT may entail better visual outcomes in the management of CRVO within six months.

To determine the prevalence and characteristics of retinopathy in diabetic residents of Tehran province, Iran during 2005.

This cross-sectional study was performed on 700 diabetic subjects who were recognized in a sample of 7500 individuals in the "Risk Factor Evaluation for Non-Contagious Diseases" project in I.R. of Iran, 2005. All subjects were recalled to attend a predefined location for the study. All participants underwent systemic examination by an internist and a comprehensive eye examination including dilated funduscopy by a vitreoretinal specialist.

Overall 634 diabetic subjects with mean age of 59.3±12.0 (range 18-78 years) were studied. Retinopathy was detected in 37.9% (95% confidence interval [CI], 34.1%-41.6%) including 72.9% (95%CI, 67.3%-78.5%) non-proliferative and 27.1% (95%CI, 21.5%-32.7%) proliferative diabetic retinopathy. The prevalence of bilateral blindness was 2.1% and 0.8% in diabetic patients with and without retinopathy, respectively (P<0.001). Logistic regression revealed that diabetic retinopathy is associated with male gender (P=0.022), increased disease duration (P<0.001), diabetes control regimen (P<0.001) and presence of diabetic nephropathy (P=0.003).

Regarding the high prevalence of diabetic retinopathy and the associated visual impair-ment, regular screening of diabetic patients for early detection of proliferative retinopathy and timely laser photocoagulation is highly recommended.