Journal of Research in Medical Sciences
Volume:16 Issue: 3, Mar 2011

Eicosapentaenoic acid (EPA) is the principal ω-3 fatty acids in marine oils. Fasting blood sugar (FBS), HbA1c and some of the plasma lipids and lipoproteins has been negatively related to the intake of ω-3 fatty acids and ascorbic acid, in some studies. Therefore, the purpose of this study was to assess the effects of EPA and/or vitamin C on glycemic indices, blood pressure, and plasma lipids in type 2 diabetic Iranian males. Sixty five men with type 2 diabetes were enrolled into the study between April 2 and June 27, 2008. Venous blood samples were obtained from all participants after 10 hours of fasting, at the baseline and after the intervention. Subjects received 500 mg EPA and/or 200 mg vitamin C and/or placebo depending on their groups. For eight weeks, 15 participants received EPA supplements with vitamin C (group 1), 16 took EPA supplements and vitamin C placebo (group 2), 17 took EPA placebo and vitamin C (group 3), and 17 received EPA placebo and vitamin C placebo (group 4), daily. There were significant decreases in FBS, HbA1C, LDL-C and TG in groups 1, 2, 3 and 4 (p < 0.01), but significant decreases in TC were shown only in groups 1, 2 and 3 (p < 0.01). There was a significant increase in HDL-C in all groups (p < 0.01). In summary, it is concluded that, eight weeks of taking EPA + vitamin C supplementation improved the plasma levels of cardiovascular markers but didnt reduce BP.

The aim of this study was to evaluate the impact of obesity and overweight on diabetes mellitus (DM) and hypertension (HTN) control in a healthy lifestyle intervention program in Iran. Within the framework of the Isfahan Healthy Heart Program (IHHP), a community trial that was conducted to prevent and control cardiovascular disease and its risk factors, two intervention counties (Isfahan and Najafabad) and one reference county (Arak) were selected. Demographic information, medical history, anti-diabetic and anti-hypertensive medications use were asked by trained interviewers in addition to physical examination and laboratory tests for 12514 adults aged more than 19 years in 2001 and were repeated for 9572 adults in 2007. In women, the frequency of HTN control change significantly neither in normal weight nor in those with high body mass index (BMI), waist circumference (WC) or waist to hip ratio (WHR). In men, the frequency of HTN control was only significant among those with high WHR, whereas the interaction between changes in intervention compared to reference area from 2001 to 2007 was significant in men with normal or high WC or WHR. In intervention area, the number of women with high BMI who controlled their DM increased significantly from 2001 to 2007 (P = 0.008), however, this figure decreased in men. In reference area, obesity indices had no significant association with DM control. The percentage of diabetic subjects with high WC who controlled their DM decreased non-significantly in intervention area compared to reference area in 2007. A non-significant increase in controlled DM among men and women with high WHR was observed between intervention and reference areas. Our lifestyle interventions did not show any improving effect on HTN or DM control among obese subjects based on different obesity indices. Other lifestyle intervention strategies are suggested.

We performed this study to compare the efficacy of oral gabapentin and clonidine premedication for controlling the pressor responses to laryngoscopy and tracheal intubation. In this double-blinded clinical trial ninety-six patients were randomly allocated to one of three groups according to the agents to be used before the induction of anaesthesia: Group P (n = 32) received oral placebo, Group G (n = 32) received 800 mg of gabapentin, and Group C (n = 32) received 0.3 mg of clonidine 90 minutes prior to surgery. Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR) and rate pressure product (RPP) were measured at baseline (3 min before induction), just before laryngoscopy, and postintubation (at 1, 3, 5, 10 and 15 min after start of laryngoscopy). Statistical analysis of data was done with Repeated measure ANOVA and Chi-square test. HR and RPP significantly decreased in Group G and Group C at 5, 10, and 15 minutes after tracheal intubation compared with the just before laryngoscopy (p < 0.05). No significant difference was noted between Group G and Group C considering these variables. SAP, DAP, MAP and RPP at 1, 3, 5, 10, and 15 minutes after intubation were significantly lower in Group G compared with Group P (p < 0.05). There was no significant difference between Group C and Group P in this regard. The present study demonstrated that premedication with oral gabapentin 800 mg or clonidine 0.3 mg similarly blunted the hyperdynamic response after laryngoscopy and intubation.

This trial study aimed to assess the effects of adenoidectomy on the markers of endothelial function and inflammation in normal-weight and overweight prepubescent children with obstructive sleep apnea (OSA). This trial study was conducted in Isfahan, Iran in 2009. The study population was comprised of 90 prepubescent children (45 normal-weight and 45 overweight children), aged between 4-10 years old, who volunteered for adenoidectomy and had OSA documented by validated questionnaire. The assessment included filling questionnaire, physical examination, and laboratory tests; it was conducted before the surgery and was repeated two weeks and six months after the surgery. Out of the 90 children evaluated, 83 completed the 2-week evaluation and 72 patients continued with the study for the 6-month follow up. Markers of endothelial function, i.e., serum adhesion molecules including endothelial-leukocyte adhesion molecule (E-selectin), intercellular cell adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule-1 (sVCAM-1), and the markers of inflammation, i.e., interleukin-6, and high-sensitive C-reactive protein (hs-CRP) decreased significantly in both normal-weight and overweight children after both two weeks and six months. After six months, the total and LDL-cholesterol showed a significant decrease in the overweight children. The findings of the study demonstrated that irrespective of the weight status, children with OSA had increased levels of the endothelial function and inflammation markers, which improved after OSA treatment by adenoidectomy. This might be a form of confirmatory evidence on the onset of atherogenesis from the early stages of the life, and the role of inflammation in the process. The reversibility of endothelial dysfunction after improvement of OSA underscores the importance of primordial and primary prevention of chronic diseases from the early stages of the life.

Increase in intraocular pressure (IOP) following tracheal intubation during general anesthesia can be troublesome. We compared the influence of two muscle relaxants, cisatracurium and atracurium, on IOP in patients undergoing general anesthesia. This randomized, double-blind, comparative trial was conducted on 90 candidates for elective non-ophthalmic surgery under general anesthesia. Patients were 18 to 60 years old with the American Society of Anesthesiologists (ASA) class of I or II. Anesthesia was induced with fentanyl (1.5 mg/kg) and sodium thiopental (5 mg/kg). Patients received atracurium (0.5 mg/kg) or cisatracurium (0.15 mg/kg) two minutes prior to tracheal intubation. IOP, systolic (SBP) and diastolic blood pressure (DBP), and heart rate (HR) were measured at baseline (before medication), after medication (before intubation), and 2, 5, and 10 minutes after intubation. In both groups IOP decreased after administration of muscle relaxants (-3.3 ± 3.6 mmHg), then increased 2 minutes after intubation (5.5 ± 4.4 mmHg), but decreased 5 (-3.3 ± 3.3 mmHg) and 10 (-0.5 ± 2.6 mmHg) minutes after intubation. IOP and SBP were significantly higher in the atracurium compared with the cisatracurium group after 2 (p < 0.001 and 0.002, respectively), 5 (p < 0.001 and 0.012, respectively), and 10 (p = 0.02 and 0.048, respectively) minutes after intubation. Compared with atracurium, administration of cisatracurium can better prevent the increase of IOP following tracheal intubation in general anesthesia. The observed difference might be related to different effects on hemodynamic variables. Application of these results in patients under ophthalmic surgery is warranted.

This study aimed to determine the prevalence of celiac disease in type I diabetic patients and to compare the symptoms and complications of celiac in patients with diabetes and celiac with patients with diabetes only. A total of 241 type I diabetic patients age ≥ 18 who needed insulin intake were recruited from diabetic patients attending the Diabetic Research Center in Kermanshah, Iran. Sample was screened for celiac disease by drawing 5cc blood for complete blood count (CBC), and anti-endomysial antibody test (AEA). Patients then were classified based on immunofluorescent method for the presence of AEA. Those with AEA positive underwent biopsy. The biopsy tissues were classified based on Marsh classification. Twenty one patients tested positive for celiac disease based on AEA test (8.7%) and 20 (8.3%) tested positive based on the biopsy. Prevalence of celiac among diabetic patients in comparison to normal population was 8.3% vs. 0.6%; and 70% were in the stages III and IV. Weight loss was significantly more prevalent among the celiac patients, who were 4 times more likely to lose weight. Other parameters such as anemia, mucocutaneous and cutaneous hemorrhage, milk intolerance, related oral aphthous, diarrhea and steatorrhea, alopecia, dermatitis herpetiform and alopecia were higher in celiac patients but not high enough to be statistically significant. There is a need to improve screening identification and treatment of celiac among all diabetic patients type I, especially in cases with uncontrolled diabetic or weight loss.

Helicobacter pylori (H. Pylori) infection has been associated with atherosclerosis of coronary arteries but there is lack of data regarding possible association between chronic H. Pylori infection and cerebral non-cardioembolic ischemia. We evaluated H. Pylori Serum antibody titers in patients with cerebral non-cardio embolic ischemic stroke. This was a cross-sectional study that was performed in AlZahra hospital, Isfahan, Iran. 96 patients with ischemic stroke were enrolled in this study. Control group were selected from healthy blood donors. IgG and IgA antibodies to H. Pylori were detected using a rapid enzyme linked immunosorbent assay. Quantitative variables and categorical variables were compared using t student and chi-square test. There were 21 cases of hypertension and 5 cases of diabetes mellitus among patients. Patients and controls were similar regarding serum IgA and IgG titers as well as positivity. There were 13 and 15 cases of positive IgA and 44 and 39 cases of positive IgG among patients and controls, respectively. Also, there were 7 and 9 cases of both positive IgA and IgG in among patients and controls, respectively. No differences were found between the two groups in IgA or IgG titers or positivity (p > 0.05). Patients with stroke are not different regarding either H. Pylori IgA or IgG positivity or the antibody titers. Comparing genetic typing of H.Pylori in patients with or without stroke and diagnosis of H. Pylori with more specific and sensitive tests such as stool antigen test are recommended.

Diabetes mellitus has become an international healthcare crisis that requires new approaches to prevent and treat it. The objective of this study was to evaluate the impact of pharmaceutical care on quality of life (QOL) in patients with type 2 diabetes mellitus. A prospective study on impact of pharmaceutical care on QOL in patients with type 2 diabetes mellitus was conducted in a private tertiary care teaching hospital in South India for a period of 8 months. Study was done on 120 eligible patients with type 2 diabetes mellitus enrolled randomly in the intervention group (with pharmaceutical care teachings) or the control (without drug related educations). The intervention group patients received pharmaceutical care through diabetes education, medication counseling, instructions on lifestyle that needed modifications (necessary for better drug function) and dietary regulations regarding their prescribed drugs, whereas the control group patients were deprived of any pharmaceutical care till the end of the study. The “Audit of Diabetes Dependent Quality of Life” standard questionnaire was used to assess the relevant parameters (including: Fasting Blood Glucose, HbA1c, Body Mass Index) and to evaluate the impact of the pharmaceutical care on the subjects. Data were analyzed using t-student test. The intervention group showed an improvement in the quality of life score from -2.156 ± 0.12 at the baseline to -1.41 ± 0.13 at the final interview (p < 0.01). The average HbA1c values decreased from 8.44 ± 0.29% to 6.73 ±0.21% (p < 0.01). There was a significant decrease in the fasting blood glucose from 195.57 ± 10.10 mg/dl to 107.25 ± 3.70 mg/dl between the baseline and the final interview in the intervention group (p < 0.01). The findings in the diabetes treatment satisfaction score also changed in a similar pattern. The pharmaceutical care program was effective in improving the clinical outcome and the patients’ QOL with type 2 diabetes mellitus.

The aim of this study was to investigate the risk factors of low vision in type 2 diabetic patients and the prevalence of ischemic heart diseases and nephropathy for different visual acuities. In this cross-sectional study, data from 738 type 2 diabetic patients including evidences for nephropathy and ischemic heart disease, demographic characteristics, blood pressure and body mass index were collected, and then patients were divided into 3 groups based on their best corrected visual acuity in the better-seeing eye. Analysis of variance was used to compare basic characteristics according to different levels of visual acuity. The prevalence of blindness and low vision was 5.5% and 13.3% respectively, and as age, duration of diabetes, systolic blood pressure and body mass index increased, the visual acuity decreased. The prevalence of hypertension and obesity in patients with visual disabilities was significantly higher than in patients with not impaired visions (p = 0.008 and p = 0.02, respectively). We also found that with greater decline in visual acuity, the prevalence of nephropathy and ischemic heart diseases increased. The factors related to retinopathy play a role in affecting the degree of visual impairment in diabetic patients. Therefore, controlling risk factors can be useful in decreasing impairment of vision and blindness.

To determine the frequency of damage index in patients with systemic lupus erythematosus(SLE) and the association between damage index and disease severity, flare up numbers, disease duration and anti-phospholipid antibodies. Eighty SLE patients were included. The damage was measured using the SLICC (Systemic Lupus International Collaborating Clinics)/ACR damage index (SDI). The disease flare was defined by the increase in the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K). The disease severity surrogates were the presence of class III/IV glomerulonephritis, the presence of severe central nervous system (CNS) involvement and cyclophosphamide administration.Analysis was performed by independent student-t and chi square tests in SPSS16 software was used for the analysis. There were significant association between the damage accrual and the disease severity, flare up and anti-phospholipid antibodies (p = 0.001, p = 0.004, p = 0.05 respectively). The disease severity, frequency of flares and positive anti-phospholipid antibodies are associated with damage accrual.

This study assessed the possible effect of hydrochlorothiazide (HCT) on soothing recurrent abdominal pain (RAP). A hundred girls with RAP and IH were randomly assigned into two groups of experiment (treated with hydrochlorothiazide 1mg/kg/day) and control and all patients were followed for 3 months. In the experiment group, the mean of painful attacks in the first, second and third month were 0.38, 0.4 and 0.26, respectively which were far less than their counterparts in the control group. Single daily dose of HCT is a safe and effective therapeutic option in the treatment of RAP in children with IH.

This study aimed to determine red blood cell (RBC) and serum folate and vitamin B12 levels as well as their intake in schizophrenic patients. The folate and cobalamin status of 60 schizophrenic patients (15-55 years) was compared to 60 matched healthy controls using Radio Isotope Dilution Assay (RIDA). Serum and RBC folate in schizophrenic patients was significantly lower than the control group. Mean serum cobalamin levels in the schizophrenic group were higher than controls. This study showed that folate deficiency is common in schizophrenic patients; therefore, it is important to pay attention to folate levels in these patients.

Neurological manifestation may complicate Takayasu arteritis (TA). A 23-year-old girl with sudden onset of vision loss was admitted to hospital. Her brain MRI showed abnormal T2-signal hyperintensity and visual evoked potential revealed prolonged P100 latency. Consequently, optic neuritis was diagnosed. A review on history of dizziness, falling, and weak pulses of upper extremities led to more investigation. Angiography revealed a total occlusion of right and left carotids, left vertebral arteries, aneurismal dilatation of innominate artery and critical stenosis of right vertebral artery. Following diagnosis of TA, stenting of right vertebral artery was done, but she passed away because of subarachnoid hemorrhage.

Bezoars are concretions of foreign materials that impair gastrointestinal motility or cause intestinal obstruction in the stomach, small intestine or bowel of humans or animals. There are many types of them such as phyto, lacto and trichobezoars. Although bezoars are not rare, multiple giant bezoars which totally fill the stomach lumen and have extension to the small intestine (Rapunzel syndrome) are very rare. This is a case report of a young girl who had a history of trichophagia and presented with partial gastric and intestinal obstructive signs. The patient was healthy, and her physical exam was almost normal and the only positive thing in her past medical history was trichophagia from several years ago. She had a big trapped bobble in her stomach and several air-fluid levels in abdominal radiograph and was investigated with endoscopy which confirmed the diagnosis of a huge gastric trichobezoar.

This report presents a 52-year-old woman who was admitted to nephrology ward with hypernatremia. She shared a persecutory delusion of poisoning with her 22-year-old daughter and did not feed her 8-year-old son due to her delusion.