Journal of Research in Medical Sciences
Volume:20 Issue: 9, 2015 Sep

Primary cutaneous lymphomas (PCLs) represent a heterogeneous group of T- and B-cell lymphomas that present in the skin with no evidence of extracutaneous disease at the time of diagnosis. The aim of this study was to assess and report the epidemiological characteristics of PCLs in Isfahan, Isfahan Province, Iran — as a main province of Iran. A total of 99 patients were recruited over a recent 10-year period (2003-2013) with diagnosis of PCLs; the patients were classified according to the The World Health Organization/European Organization for Research and Treatment of Cancer (WHO-EORTC) criteria. Mean and standard deviations (SDs) were used to describe continuous data, numbers, and percentages for categorical data. Statistical significance was defined as P < 0.05. The patients comprised 45 men and 54 women aged 5-80 years (median 36) at diagnosis. The male-to-female ratio was 1:1.2. Histological examination showed features of primary cutaneous B-cell lymphomas (PCBCLs) in four cases. The mean ± SD age in primary cutaneous T-cell lymphomas (PCTCLs) and PCBCLs was 37.9 ± 16.5 years and 39.7 ± 9.1 years, respectively (P = 0.72). The mean ± SD latent period between the time of diagnosis and initiation of skin lesions in men and women was 2.3 ± 4.1 years and 5.9 ± 10.1 years,respectively (P = 0.02). The most frequent subtypes were mycosis fungoides (MFs) (86.9%) followed by Sézary syndrome (SS)(4%). Five patients died from PCL related deaths. The distinguishing epidemiologic characteristics of PCL in Iran are the absence of a male predominance and a lower age of diagnosis. The study highlights the ethnic or regional variations in the clinicoepidemiological characteristics of PCLs.

Insulin receptor substrate (IRS) Type 1 is a main substrate for the insulin receptor, controls insulin signaling in skeletal muscle, adipose tissue, and the vascular, so it is an important candidate gene for insulin resistance (IR). We aimed to compare the effects of the Dietary Approaches to Stop Hypertension (DASH) and Usual Dietary Advices (UDA) on IRS1 gene expression in women at risk for cardiovascular disease. A randomized controlled clinical trial was performed in 44 women at risk for cardiovascular disease. Participants were randomly assigned to a UDA diet or the DASH diet. The DASH diet was rich in fruits, vegetables, whole grains, and low-fat dairy products and low in saturated fat, total fat, cholesterol, refined grains, and sweets,with a total of 2400 mg/day sodium. The UDA diet was a regular diet with healthy dietary advice. Gene expression was assessed by the real-time polymerase chain reaction at the first of study and after 12 weeks. Independent sample t-test and paired-samples t-test were used to compare means of all variables within and between two groups respectively. IRS1 gene expression was increased in DASH group compared with UDA diet (P = 0.00). Weight and waist circumference decreased in DASH group significantly compared to the UDA group (P < 0.05) but the results between the two groups showed no significant difference. DASH diet increased IRS1 gene expression and probably has beneficial effects on IR risks.Key words: Diet, Dietary Approaches to Stop Hypertension diet, insulin receptor substrate 1gene expression, insulin resistance Insulin receptor substrate (IRS) Type 1 is a main substrate for the insulin receptor, controls insulin signaling in skeletal muscle, adipose tissue, and the vascular, so it is an important candidate gene for insulin resistance (IR). We aimed to compare the effects of the Dietary Approaches to Stop Hypertension (DASH) and Usual Dietary Advices (UDA) on IRS1 gene expression in women at risk for cardiovascular disease. A randomized controlled clinical trial was performed in 44 women at risk for cardiovascular disease. Participants were randomly assigned to a UDA diet or the DASH diet. The DASH diet was rich in fruits, vegetables, whole grains, and low-fat dairy products and low in saturated fat, total fat, cholesterol, refined grains, and sweets,with a total of 2400 mg/day sodium. The UDA diet was a regular diet with healthy dietary advice. Gene expression was assessed by the real-time polymerase chain reaction at the first of study and after 12 weeks. Independent sample t-test and paired-samples t-test were used to compare means of all variables within and between two groups respectively. IRS1 gene expression was increased in DASH group compared with UDA diet (P = 0.00). Weight and waist circumference decreased in DASH group significantly compared to the UDA group (P < 0.05) but the results between the two groups showed no significant difference. DASH diet increased IRS1 gene expression and probably has beneficial effects on IR risks.

Pancreatitis is a serious complication of endoscopic retrograde cholangiopancreatography (ERCP) and may cause significant morbidity and even death. There is no effective prophylactic intervention for patients with average risk yet. This study aims to investigate preventive effect of aggressive hydration for post-ERCP pancreatitis. In a double-blind controlled setting, 150 patient were randomly assigned to receive either aggressive hydration with lactated Ringer’s solution (3 mL/ kg/h during ERCP, followed by a 20 mL/kg bolus and 3 mL/kg/h for 8 h after the procedure, n = 75) or standard amount of hydration (1.5 mL/kg/h during and for 8 h after ERCP, n = 75). Patients were observed for volume overload as well as pancreatic pain and serum levels of amylase at baseline and 2, 8, and 24 h after ERCP. Post-ERCP pancreatitis was defined as hyperamylasemia (level of amylase >300) and pancreatic pain during the 24 h follow-up. Hyperamylasemia and pancreatic pain were the secondary end points. Mean age of the patients was 50.8 ± 13.5 years. Most of the patients were female (66%). Pancreatitis developed in 21 patients, including 22.7% of patients receiving standard hydration and 5.3% patients receiving aggressive hydration (P 0.002).Hyperamylasemia was detected in 44.0% of patients receiving standard hydration and 22.7% of patients aggressive hydration (P =0.006). The pancreatic pain was reported by 5.3% of patients receiving aggressive hydration and 37.3% of patients receiving standard hydration (P? 0.005). Aggressive hydration with lactated Ringer’s solution may effectively prevent post-ERCP pancreatitis as well as hyperamylasemia and pancreatic pain in patients with average risk.

Restless and violent behaviors are common in Emergency Departments (EDs), which need therapeutic interventions in most of the times. The first-generation anti-psychotic drugs are one of the most applicable therapeutic agents in the management of such patients, but their use has some limitations. Some studies suggest midazolam as an alternative medicine. Therefore, this study was performed with the aim of comparison of the efficacy and safety of haloperidol and midazolam in the restless management of referring patients to EDs. The present double-blinded trial was done on patients needed sedation and referred to the ED of Alzahra Hospital, Isfahan, Iran, in 2014. The patients were categorized into two random groups of haloperidol (5 mg) and midazolam receivers (2.5 mg for those weighing <50 kg and 5 mg in >50 kg), as intramuscular administration. The time to achieve sedation, need for rescue dose, need to resedation within the first 60 min, and adverse effects of drugs were compared among the groups. Forty-eight patients were entered to the study. The mean age in the haloperidol and midazolam groups was 44.8 ± 4.1 years and 45.5 ± 4.7 years, respectively (P = 0.91). The mean time of sedation in the haloperidol and midazolam groups was 5.6 ± 0.3 min and 5.2 ± 0.1 min, respectively (P = 0.31). The mean time of full consciousness after sedation was 36.2 ± 4.5 min and 38.2 ± 3.4 min in the haloperidol and midazolam groups, respectively (P = 0.72). On average, time to arousal in the midazolam group was 10.33 min more than the haloperidol group, but it was not statistically significant. The results of the present study show that administration of midazolam and haloperidol have similar efficacy in the treatment of restless symptoms with the same recovery time from drug effects for referring patients to the ED. In addition, none of the adverse effects were observed in this study.

ackground: The most common complication of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) is acute pancreatitis. A number of therapeutic trials have been studied due to reduce the occurrence of postendoscopic retrograde cholangiopancreatography pancreatitis (PEP) but many of them were unsuccessful. Periampullary corticosteroid injection was proposed to use as prophylactic agents for PEP because of its anti-inflammatory property with relative low systemic side effects. By conducting a double blinded clinical trial study in a single center university hospital, all patients undergoing therapeutic or diagnostic ERCP in our gastrointestinal endoscopy ward, enrolled the study. During ERCP, we randomly assigned the patients in blocks of 40 to undergo a locally injection of methylprednisolone acetate (corticosteroid group) or saline (control group) on the major papilla and prospectively evaluated the occurrence of PEP pancreatitis in each groups. Clinical and laboratory findings of acute pancreatitis were collected by means of a validated questionnaire during the procedure and before discharge. At baseline and end of the study, were compared pancreatitis prevalence and also its severity by using Chi-square and t-test statistics. The frequency of moderate to severe PEP pain was not significantly between the placebo and corticosteroid receiving group (13.7% ± 3.2% vs. 9.3% ± 2.1%, respectively; P = 0.8). There is no significant difference in the mean concentration of lipase and amylase between corticosteroid receiving group and placebo receiving group at the first, second, and third time. In the corticosteroid receiving group, 3 patients (10.3%) while in the control group, 11 patients (11.3%) developed pancreatitis. We found no significant difference in PEP rates and also severity between the corticosteroid and placebo groups. The mean increase in serum amylase and amylase level in pancreatitis patients and the frequency of abdominal pain were not significantly higher in the placebo group. Besides, there were no cases of severe PEP pancreatitis in either group.

Evidence has shown a link between allergic disease and inflammatory bowel diseases (IBDs). We investigated food allergy in Iranian pediatric IBD patients. A cross-sectional study was conducted on a consecutive sample of children with newly diagnosed IBD referring to Mofid Children’s University Hospital in Tehran (Iran) between November 2013 and March 2015.Data on age, gender, history of cow’s milk allergy (CMA), IBD type, routine laboratory tests, and colonoscopic and histopathological findings were gathered. Food allergy was assessed with the skin prick test (SPT). A total of 28 patients including 19 ulcerative colitis (UC), 7 Cronh’s disease (CD), and two with unclassified colitis with a mean age of 8.3 ± 4.4 years. (57.1% females, 42.9% were studied. History of CMA was present in eight patients (28.6%). Seventeen patients (60.7%) had at least one food allergy (68.4% of UC vs. 42.9% of CD, P = 0.230). Ten patients (35.7%) had multiple food allergies (36.8% of UC vs. 42.9% of CD, P > 0.999). Common allergic foods were cow’s milk (28.6%), beef, seafood, albumen, wheat, and walnuts (each 10.7%), and peanuts and chestnuts (each 7.1%). The SPT showed CMA in 68.4% (8/17) of UC but none of the CD patients (P=0.077). Food allergy is frequent in Iranian pediatric IBD patients with CMA being the most common observed allergy. The CMA seems to be more frequent in UC than in CD patients.

A suitable sedative status during gastro-enteric endoscopies results in better physicians’ approach and more stable view of internal organs. Therefore, we evaluated the effect of ketamine for sedation in endoscopic procedures of adult patients. Patients who were candidates for gastro-enteric endoscopy during the years 2014-2015 were included into the study and divided into two groups of case (administered 5 mg/kg of oral ketamine half an hour before initiation of the procedure and control (administered placebo in a same pattern). After endoscopy, patients and physicians’ satisfaction of sedation was assessed.SPSS-22 was used for data analysis. Eighty-six patients participated into the study of which divided into each groups. The pain and discomfort scores were 2.4 ± 1.8 and 5.81 ± 1.48 in case and control groups, respectively, (P < 0.001). Mann-Whitney test revealed statistical difference among groups about physician’s satisfaction of sedation during endoscopy (P < 0.001). Patients who received ketamine had better sedative status (P < 0.001). None of the patients in the case group was completely awake but all of the patients in the control group were awake. The number of retching during endoscopy showed that individuals in the control group had more frequent retching episodes (P = 0.04). Low dose oral administration of ketamine could make a satisfied sedation for gastro-enteric endoscopy.

The mean platelet volume (MPV) is the most commonly used measure of platelet size and is a potential marker of platelet reactivity. In this study, we aimed to explore the relationship between hepatic histopathology in viral hepatitis and MPV levels,which are associated with platelet count and activity. We performed a retrospective case-control study of baseline histological and clinical parameters in chronic hepatitis B and C patients in our tertiary reference center between January 2005 and January 2011. Two hundred and five chronic hepatitis B patients and 133 chronic hepatitis C patients who underwent liver biopsy were included in the study. The patients were divided into two groups: Chronic hepatitis B and chronic hepatitis C and were additionally divided into groups of two according to histological activity index (HAI) and fibrosis scores obtained by liver biopsy results (according to the Ishak scoring system). The clinical characteristics of chronic viral hepatitis patients, including demographics,laboratory (especially MPV), and liver biopsy findings, were reviewed. One hundred and forty-three patients were male (69.1%), and the mean age was 41.9 ± 12.75 with an age range of 18-71 years in hepatitis B patients. In the classification made according to HAI, 181 patients were in the low activity group (88.3%) and 24 in the high activity group (11.7%). In the evaluation made according to fibrosis score, 169 patients were found to have early fibrosis (82.4%) and 36 were found to have advanced fibrosis (17.6%). In patients with hepatitis B, there was no statistically significant difference in terms of their MPV values between the two groups, separated according to their degree of activity and fibrosis. Sixty-three patients were male (47.3%), and the mean age was 50.03 ± 12.75 with an age range of 19-75 years. In the classification made according to HAI, 109 patients were in low activity group (81.9%) and 24 in high activity group (18.1%). In the evaluation made according to fibrosis score, 101 patients were found to have early fibrosis (75.9%) and 32 have advanced fibrosis (24.1%). There was a statistically significant difference between the activity and fibrosis groups of the hepatitis C patients (P = 0.04 and P = 0.02, respectively). MPV values are more reliable in hepatitis C patients than hepatitis B for predicting the advanced damage in liver histology. This finding might be useful for the detection of early fibrosis and also starting early treatment, which is important in hepatitis C.

Nowadays, application of nuclear technology in different industries has largely expanded worldwide. Proportionately,the risk of nuclear incidents and the resulting injuries have, therefore, increased in recent years. Preparedness is an important part of the crisis management cycle; therefore efficient preplanning seems crucial to any crisis management plan. Equipped with facilities and experienced personnel, hospitals naturally engage with the response to disasters. The main purpose of our study was to present a practical management pattern for hospitals and medical centers in case they encounter a nuclear emergency.In this descriptive qualitative study, data were collected through experimental observations, sources like Safety manuals released by the International Atomic Energy Agency and interviews with experts to gather their ideas along with Delphi method for polling, and brainstorming. In addition, the 45 experts were interviewed on three targeted using brainstorming and Delphi method. We finally proposed a management plan along with a set of practicality standards for hospitals and medical centers to optimally respond to nuclear medical emergencies when a radiation incident happens nearby. With respect to the great importance of preparedness against nuclear incidents adoption and regular practice of nuclear crisis management codes for hospitals and medical centers seems quite necessary.

In this study, we aimed to investigate the ability of transvaginal Doppler ultrasonography in predicting in vitro fertilization (IVF) outcome in women undergoing this procedure. In this prospective observational study, 65 infertile women underwent IVF procedure in Isfahan, during 2013-2014, were studied. The pulsatility index (PI), resistive index (RI) and peak systolic velocity (PSV) of the uterine arteries and arcuate arteries were measured in all selected women using transvaginal color and pulsed Doppler measurements on the day of human chorionic gonadotrophin injection. The women followed up for the primary endpoint which was a successful pregnancy. The mean of PI, RI, and PSV were compared in groups of women who had successful IVF and not. The receiver operating characteristic (ROC) curve was used to determine the predictive value of studied indices. In this study, from 65 women, 32 (49.2%) and 33 (50.8%) have successful and unsuccessful IVF outcome, respectively. The mean of PI and RI of both uterine and arcuate arteries were significantly lower in pregnant women than non-pregnant ones (P < 0.001). The area under the ROC curve of PI (84.7%) and RI (84.4%) for uterine arteries was higher than other indices. The most accurate indices for predicting the outcome of IVF was RI of uterine arteries with an accuracy of 81.5%. The findings of this study indicated that PI and RI assessments of uterine arteries could be used as a routine non-invasive factor, before hCG stimulation, for predicting the outcome of IVF.

Gastroesophageal reflux (GER) is one of the most common causes of chronic cough, and chronic cough due to GER represents a subtype of GER-related diseases. Gastroesophageal reflux-induced chronic cough (GERC) can be divided into two subgroups based on the pH of the GER. Nonacid GERC is less common than acid GERC, and its diagnosis and treatment strategy have not been standardized.However, nonacid GERC usually presents with its unique set of characteristics and features upon diagnosis and treatment in the clinic.Although the underlying molecular mechanism of nonacid GERC is not fully understood, it is considered to be associated with reflux theory, reflex theory and airway hypersensitivity. Multi-channel intraluminal impedance combined with pH monitoring is a promising new technique that can detect both acid and nonacid reflux, and our findings as well as those of others have shown its usefulness in diagnosing nonacid GERC. Development of new diagnostic techniques has led to an increased rate of nonacid GERC diagnosis. We summarize our experience in the diagnosis and treatment of nonacid GERC and provide a guide for future therapeutic approaches.

Although several in vitro and animal studies have suggested that isoflavones might exert inhibitory effects on gastric carcinogenesis, epidemiologic studies have reported inconclusive results in this field. The aim of this brief review was to investigate whether such an association exists among dietary isoflavones and gastric cancer incidence, prevention, and mortality in epidemiologic studies. We conducted a search of PubMed, Google Scholar, Cochrane, Science direct, and Iranian Scientific Databases including Scientific Information Database and IranMedex Database (up to November 2014) using common keywords for studies that focused on dietary isoflavones and gastric cancer risk. A total of nine epidemiologic studies consisting of five case-controls, three prospective cohorts, and one ecologic study were included in this review. An inverse association between dietary isoflavones and gastric cancer was shown in only one case-control and one ecologic study. In summary, whether anticarcinogenic properties of isoflavones are established, research found no substantial correlation in this field. There are insufficient studies to draw any firm conclusions about the relationship between isoflavones intake and the risk of gastric cancer. Hence, further evidence from cohort and trial studies are needed.

To conduct a systematic review and meta-analysis on controlled treatment trials of meta-cognitive therapy for anxiety disorders. Studies were included if they employed controlled methodology and treated people above 18 years with anxiety disorders. Case studies (with less than 4 cases) and single case designed studies were excluded. A comprehensive literature search identified 15 trials for systematic review. All included studies showed better treatment results in the MCT arms compared to the control groups. We also statistically pooled the results across studies (when possible). The meta-analyses also showed that MCT had statistically significant better results compared to the control groups in GAD (both immediately post-treatment and 12 months post-therapy results), OCD, and PTSD (p-values ranged <0.0001-0.025). Based on the results of our systematic review,MCT seems to be an effective treatment for anxiety disorders and can effectively control their psychological problems.

Improvement in complications of antitumor agents and surgery is important to enhance life quality and survival among patients with colon and colorectal cancer. It has been reported that some dietary components such as glutamine (Gln) have beneficial effects on these complications of cancer therapies. However, the results of studies are inconsistent in this area. We performed a review on randomized controlled trials (RCTs) evaluating the effects of Gln intake on complications related to therapeutic strategies of the colon and colorectal cancer. A systematic search was conducted in PubMed, Google Scholar, Cochrane Library, and SID databases to find the relevant literature, published before July 2015. Nine RCTs of 217 screened articleswere included in this systematic review. The results of the present review suggested that Gln intake among colon and colorectal cancer patients could reduce some complications induced by chemotherapy such as gut mucositis and diarrhea and improve nitrogen balance, immune system and wound healing after surgery, whereas benefits role of Gln on radiochemotherapy side effects were not provided. The role of Gln intake on some improvement of complications induced by cancer therapeutic methods and shorten the length of hospital stay may be promising and one that is worthy of further exploration.