Journal of Kerman University of Medical Sciences
Volume:28 Issue: 2, Mar-Apr 2021

Coronary Artery Disease (CAD) as a complex process will be the most common cause of death in the world by 2020. One of the relatively new factors associated with CAD is the plasma level of melatonin. This study aimed to determine the effect of plasma melatonin level on the occurrence and severity of CAD.

This cross-sectional study was conducted from August to December 2018 in Kerman, Iran. Eighty-seven adolescents with suspected CAD were selected via the convenience sampling method. Severity of CAD was evaluated by a cardiologist for each patient using Gensini score. The anxiety, depression, and sleep disturbance of participants were examined by HADS and PSIQ questionnaires, respectively. The blood sample of patients was taken at 3:30 a.m. and it was immediately transferred to the laboratory for serum separation. A two-part model was used for data analysis using STATA software.

The mean age (±SD) of the participants was 54.0 (±10.83) years. Less than half of the patients experienced anxiety and depression symptoms during last month (33% and 42%, respectively). Results showed that more than half of the patients (n=51, 57.5%) were diagnosed as CAD patients. According to multivariate regression models, melatonin (AOR=0.96, 95% CI: 0.94, 0.98) and depression (β: 0.79, 95% CI: 0.06, 1.52) were determined as predictors for CAD occurrence and severity, respectively.

Melatonin as a protective factor has an effect on the occurrence and severity of CAD, but the existence of some diseases like mental disorders can lead to a decrease in the plasma concentration of melatonin. By treating depression and improving melatonin synthesis and secretion cycle, the occurrence and severity of CAD may be decreased.

The worldwide prevalence of diabetes is increasing. Diabetes is a complex disease that results from impaired secretion of insulin or insulin resistance. In adipose tissue, insulin increases glucose uptake by stimulating the transfer of glucose transporter type 4 (GLUT-4) to the plasma membrane. In this study, the effect of IRAK inhibitor (IRAKi) and pioglitazone on genes expression in adipose tissue of insulin resistant mice was evaluated. Mice were randomly divided into 6 groups (n= 8 each), five groups of which were fed a high-fat diet and one group received a normal diet for 12 weeks. The treatment with pioglitazone and IRAKi was performed for 2 weeks. At the end of the study, the animals were sacrificed and the adipose tissue and blood samples were collected. The expression of GLUT4, TNF-α, peroxisome proliferator-activated receptor gamma (PPARγ), and Lepin were determined by real-time PCR in the adipose tissue. The malondialdehyde (MDA) level and total antioxidant capacity (TAC) in serum were measured. Results were analyzed by SPSS 22. The data showed that the combination of IRAKi and pioglitazone increased PPARγ expression, leptin and TAC levels in serum, and reduced TNF-α expression and MDA levels. The GLUT4 expression in adipose tissue was not significant between studied groups. Pioglitazone and IRAKi improved insulin function by inhibiting inflammation signaling. According to the results of this study, IRAKi may be an appropriate target for inhibiting inflammation and related disorders, including insulin resistance.

Warfarin is the most widely used oral anticoagulant for the prevention and treatment of thromboembolic disorders. Because of narrow therapeutic index and various genetic and non-genetic factors that influence the disposition of the drug, its dose undergoes a great variability. The aim of this study was to determine the allelic variants of CYP2C9 and VKORC1 genes in Iraqi patients, and to investigate the contribution of genetic on warfarin dose requirements.

A cross sectional study was carried out on a sample of Iraqi patients from Baghdad city who were admitted to Ibn AL-Bitar Specialized Center for cardiac surgery. Blood samples of all patients were collected for both hematological and genetic analysis utilizing standard techniques.

The frequency of CYP2C9*3 allele was 9.4% whereas that of CYP2C9*2 allele was 13.7%. The frequency of (VKORC1-1639G) allele was 58.75% and the frequency of (VKORC1-1639A) allele was 41.25%. Patients’ daily warfarin doses were administered according to their genotype.

It can be concluded that CYP2C9*3 and VKORC1 had significant effect on warfarin dose. New warfarin-dosing algorithm was developed based on CYP2C9*3 and VKORC1genotypes for predicting the required dose of warfarin.

Cardiovascular diseases are still among the most important causes of death in different countries. There are several risk factors for the onset of this disease. The rating of these risk factors is very important for informing the community and planning for the future.
Linear regression is one of the classic statistical methods that has many applications in medical sciences. When dealing with fuzzy data, it is not possible to use linear regression. The use of angiography to estimate the extent of congestion is associated with an estimate of more or less stenosis and the increase of atherosclerosis. Hence, this variable has been considered as a fuzzy variable. Fuzzy linear regression (FLR) was used to rank and compare the known risk factors for coronary artery occlusion.
After analyzing the data by least squares FLR, the most important risk factors included Family history, history of diabetes, age, history of hypercholesterolemia, history of cigarette smoking, Body Mass Index and history of hypertension respectively.
When it is not possible to calculate the response variable or one of the independent variables examined in the model accurately, FLR, or to be more precise, regression in fuzzy environment can be a good alternative for conventional regression analysis.

We sought to determine whether there is a linear trend between different levels of depression and different food security/insecurity situations in patients with diabetes mellitus.

Two hundred women with diabetes mellitus referred to the diabetic clinic of Shaheed Bahonar, Kerman/ Iran and aged 35-75 years were enrolled randomly in a descriptive-analytic cross-sectional study. The patients completed Beck Depression Inventory-II (BDI-II) and Food Security Questionnaire (HFIAS). Pearson's Chi-Square test was carried out to assess whether depressive disorders and household food security/insecurity were related.

There was a significant association between the four-level variable of depressive disorders and the four-level variable of food security/insecurity (X2 ≥ 29.545, p=0.001). There was a significant association between the two-level variable of depressive disorders and the four-level variable of food security/insecurity (X2 ≥ 9.878, p=0.020). There was also a significant association between the two-level variable of depressive disorders (normal and depressive diabetic patients) and the two-level variable of food security/insecurity (food secure and insecure diabetic patients) (X2 ≥ 6.073, p=0.014). About half (47%) of the patients with mild to extreme depression had mild to severe food insecurity. However, two-thirds of the patients in the normal situation were food secure (p=0.014).

We found enough evidence to suggest a significant association between household food security/insecurity and depressive disorders. The value of the linear by linear association test for trend was shown to be significant and indicated that household food insecurity trends to rise with values of depressive disorders. Therefore, the more severe the depression, the greater the food insecurity.

Olfactory and gustatory dysfunctions can be considered as important symptoms to screen for the mild cases of the COVID-19 disease. However, there are limited studies on the specificity of olfactory and gustatory changes in patients with COVID-19, and it is unclear to what extent the changes may be unique to the disease. This study aimed to evaluate the duration and outcome of olfactory and gustatory disorders in patients with COVID-19.

The study population was patients with COVID-19 at Afzalipour Hospital whose disease was confirmed by nasopharyngeal polymerase chain reaction (PCR) test. 20 patients with olfactory and gustatory dysfunctions were studied. Data were collected using two forms, which were completed at the time of diagnosis and two weeks after the onset of the disease.

In 20% of the patients, olfactory and gustatory dysfunctions were among the early symptoms. In 85% of the cases, these dysfunctions were permanent during the disease. 30% of the cases had a chronic underlying disease such as sinusitis, nasal polyps, and allergy. In follow-up, 13 patients (60%) reported that their olfactory dysfunctions had completely improved.

The patients whose only symptom is the sudden olfactory or gustatory dysfunction or the dysfunctions are among their early symptoms, should be screened for COVID-19. Most of the patients will recover over the time.

Previous studies have showed that psoriatic arthritis increases the risk of cardiovascular disease and atherosclerosis. On the other hand, an increased carotid intima-media thickness can be associated with atherosclerosis. The present study aimed to evaluate the association between psoriatic arthritis and carotid intima-media thickness.
In this case-control study performed during 2018, 22 patients with psoriatic arthritis and 22 healthy controls matched for age and sex were participated. In all subjects, the carotid intima-media thickness was measured by ultrasonography. Systemic inflammatory markers, including C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were assessed in psoriatic arthritis patients.
The mean carotid intima-media thickness was 56±0.10 mm in the psoriatic arthritis patients and 54±0.07 mm in the control group with no significant difference (p=0.358). According to the regression analysis, carotid intima-media thickness had no positive correlation with age, sex and body mass index. The carotid intima-media thickness increased in psoriatic arthritis patients with increasing the duration of arthritis, disease activity (DAS-28), CRP, and ESR, but the correlations were not statistically significant.
The study findings do not support the previous reports that claimed a potential correlation between mean carotid intima-media thickness and psoriatic arthritis.

Trichomonas vaginalis is an anaerobic flagellated protozoan which is responsible for human urogenital infections. Several zymodemes of T. vaginalis have been reported from various parts of the worlds on the basis of isoenzyme patterns. This study was conducted to characterize the isolated organisms of T. vaginalis from HIV patients using isoenzyme electrophoresis in Fars and Kerman provinces, southeast Iran.
Eighteen mass cultivated isolates of T. vaginalis in the modified TYI-S-33 medium were analyzed using isoenzyme electrophoresis. Polyacrylamide gel electrophoresis (PAGE) of five different enzyme systems were used to characterize T. vaginalis isolates: (i) Glucose-6-phosphate dehydrogenase (G6PD), (ii) Glucose phosphate isomerase (GPI), (iii) Malate dehydrogenase (MDH), (iv) Malic enzyme (ME), and (v) Phosphoglucomutase (PGM). 
MDH, GPI, PGM, and ME enzyme systems showed a homogeneity and detected an identical enzyme pattern in all isolates. Meanwhile, G6PD revealed two different enzyme patterns. The isoenzyme electrophoretic profiles divided 18 T. vaginalis isolates into two zymodemes. Zymodeme 1 contained Shiraz isolates and zymodeme 2 contained Kerman isolates.
The polymorphism of Iranian human isolates of T. vaginalis could be assessed by biochemical study using appropriate enzyme systems. Isoenzyme analysis is a promising method for the characterization of T. vaginalis. New molecular studies with increased number of enzyme loci and genetic markers are suggested to classify more zymodemes of Trichomonas in Iran.

Coronavirus disease 2019 (COVID–19), reported pandemic in March 2020, is the current health problem with no definite prevention or treatment. As a newly emerging disease, new cases are reported each day to add to the physician’s knowledge about the best clinical approach. One of the controversies in this regard is the gold standard diagnostic method. Evidence suggests that polymerase chain reaction (RT–PCR) for Coronavirus nucleic acid has a low sensitivity and computed tomography (CT) has been suggested for more accurate diagnosis. Yet, CT has the disadvantage of radiation and is not safe in all patients. Here, we present a case series of 23 patients who underwent both RT–PCR and CT and report the outcome.

A 24 old man sustained an injury to his right hand when playing soccer as goalkeeper, most probably from a direct strike for the ball or offender foot. On physical examination the injury was limited to the right middle finger, which was swollen, tender an essentially no active motion could be observed in none of the interphalangeal joints. The injury was a close one and no wound or nerve injury was present. No evidence of compartment syndrome was observed. The neurovascular examination was normal. Radiograms were taken immediately which revealed double dislocation of both interphalangeal joints in the right fifth finger. Closed reduction under general anaesthesia was performed and early active and passive range of motion was began as soon as possible. In follow up full range of motion of the joints was retained. The case emphasizes the necessity of whole finger radiologic examination in distal interphalangeal dislocations in the hand.

Hiccup has a wide variety of etiologies irritating the hiccup reflex arc. It is usually benign and self-limited but can be an alarm sign for serious underlying conditions. Hiccup has been rarely reported in patients with infective endocarditis as a result of splenic involvement and phrenic nerve irritation. Herein, we report a 72-year-old man with the chief complaint of long-lasting hiccups (for a 1-month duration) who was diagnosed with infective endocarditis; however, his spleen was grossly intact. The bouts of hiccups repeated 2-3 times a day and lasted for 10-20 minutes. After the initiation of antibiotics, his symptoms waned for a while and appeared again, and then, the hiccups were eliminated. Long-lasting hiccups can be a presentation of serious medical conditions such as infective endocarditis, with or without splenic involvement. Hence, it is important to keep in mind these conditions to perform proper diagnostic and therapeutic workups.

Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are two accessible indices for liver evaluation. Upper limit of normal (ULN) of these tests are important for starting further investigations for persons with high values. In recent years, cut off points for ULN of these tests have been disputed. This study aimed to determine the ULN of ALT and AST in a population-based study.

This cross-sectional study was performed on a randomized clustered sample of people of Kerman city. Demographic, anthropometric, and laboratory data were collected and analyzed. After excluding the recognized risk factors for liver function tests in another group (group 2), data were analyzed in this subgroup.

Of 2748 subjects included in this study, 1172 (42.4%) were men, with an age range of 15-85 years. The mean (± SE), median, mode, and 95th percentile were 23.74 ± 0.18, 22, 19, and 37 for AST and 22.37 ± 0.27, 18, 15, and 46 for ALT, respectively. The levels of AST and ALT were higher in men and middle age group (P<0.0001). Similar results were obtained for gender but the association of AST and ALT with age was disappeared in another group.

According to the results of the present study, it is recommended to measure the ULN of AST and ALT periodically in different regions concerning age and gender.

Genetic and environmental factors influence serum adiponectin and may contribute to the risk of metabolic syndrome and type 2 diabetes (T2D). There are many studies conducted to investigate the association between different polymorphisms of the ADI POQ geneand T2D risk in all around the world. Therefore, the present study was conducted to investigate the association between adiponectin gene (ADIPOQ) polymorphism (rs822396) and the risk of T2D, which has not been studied yet in the Iranian patients.

Selected SNP was genotyped in 40 T2D patients and 40 controls by PCR amplification and direct Sanger sequencing. Fisher's exact test and Chi2 test were used to estimate the risk of T2D associated with the selected SNP, and genotypic and allelic distributions were compared between the case and control groups.

It was revealed that there were no significant differences in the distribution of genotypes and allele frequencies of rs822396 between Iranian patients with T2D and controls.

According to the results, -3971 A/G polymorphism is unlikely to be involved in the susceptibility to or the severity of T2D in Iranian patients. Further large prospective studies are required to confirm these findings.