Journal of Research in Medical Sciences
Volume:16 Issue: 8, Aug 2011

This study aimed to determine the secular trends in the national prevalence of overweight and obesity among 6-year-old Iranian children, and to compare the results in Northern, Central and Southern parts of the country. The data were collected as part of a routine and mandatory national screening program on children entering elementary schools in 2007, 2008 and 2009. The study population comprised 2,600,065 children including 862,433 in 2007, 782,244 in 2008 and 955,388 in 2009. Of total children 12.8%, 13.5% and 10.9% were overweight in 2007, 2008 and 2009, respectively (p > 0.05). The corresponding figures for obesity were 3.4%, 3.5% and 3.4%, respectively (p > 0.05). In all surveys, the prevalence of overweight was higher in Southern region than in the other two regions. P for trend was not significant for prevalence rates of overweight and obesity in any of the regions. To the best of our knowledge, this study is the first of its kind in presenting the nationwide trend of overweight and obesity in young children living in a developing country. It showed a considerably high prevalence of overweight and obesity, but with a constant rate in three years. The higher prevalence of overweight in Southern region than in Central and Northern regions might be related to the lower socioeconomic position of this population. At a very young age, children's lifestyle is more under control of parents. Primordial and primary prevention efforts against the overweight epidemic can be effective and shall be further strengthened.

The studies indicate that psychological factors and extra-intestinal symptoms affect health related quality of life (HRQoL) in patients with irritable bowel syndrome (IBS) more than bowel symptoms themselves do. Type D personality characterized by global traits including negative affectivity and social inhibition has been proposed to be related to HRQoL. The aim of this study was to determine the association between type D personality and HRQoL in patients with IBS. In a cross-sectional study, 194 consecutive patients with IBS referred to two referral gastrointestinal clinics affiliated with Isfahan University of Medical Sciences were selected in respect of inclusive and exclusive criteria. The patients completed type D personality (DS-14), IBS quality of life and the IB severity scoring (IBS-SSS) scales. The patients were divided into two groups with and without type D personality using DS-14. Then, the data was analyzed using ANCOVA and multiple regression. The findings indicated that 40.7% of the patients had type D personality. The results of ANCOVA controlled for the influence of severity of IBS and treatment duration showed significant difference between the two groups in health related quality of life (F = 11.89, p < 0.01). Multiple regression analysis indicated negative affectivity (ß = -0.283, p < 0.010), severity of symptoms (ß = 0.279, p < 0.001) and duration of treatment (ß = -0.189, p < 0.050) as significant predictors for HRQoL in patients with IBS. Type D personality may be an important determinant of individual differences in HRQoL among IBS patients. Negative affectivity as one of type D dimensions may have an adverse effect on HRQoL in patient with IBS. Therefore, additional attention is needed in IBS patients with type D personality.

It is a well known fact that there is increased oxidative stress and decreased serum antioxidant levels in smokers than in non-smokers. In this study, the aim was to compare the malondialdehyde (MDA), a lipid peroxidation product and vitamin C, an antioxidant, between non- smokers (Group A) and chronic smokers (Group B) and also between chronic smokers (Group B) and chronic smokers with acute myocardial infarction (AMI) (Group C). MٍETHODS: Thirty six non-smokers and 36 chronic smokers appropriately matched with AMI patients were selected. Thirty six smokers with AMI were selected from Hanagal Kumareshwara hospital, Bagalkot, Karnataka, India. Fasting blood sample was collected in group A and group B. In AMI patients, blood sample was collected before any intervention. Serum levels of MDA and vitamin C were estimated. Statistical analysis was done by t test using SPSS version 11. p< 0. 05 was considered statistically significant. All the results were expressed as mean ± SD. The MDA and vitamin C were compared between Group A and Group B and also between Group B and Group C. There was a significant rise in MDA (p < 0. 0001) and significant decrease in vitamin C (p < 0. 01) in Group B compared to Group A. There was a significant rise in MDA (p < 0. 0001) and significant decrease in vitamin C (p < 0. 001) in Group C compared to Group B. The increase in serum MDA levels and decrease in vitamin C was found in chronic smokers compared to non-smokers. It was also found that there is increase in serum MDA and decrease in vitamin C in smokers with AMI compared with smokers without MI. The inter-subject variability of MDA and vitamin C levels may be because of gene-environmental factors.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women. Its presentation is that of irregular menstruation associated with ovulation defects. Because of adverse outcomes such as metabolic and cardiovascular disorders, its diagnosis and treatment is very important. Therefore, the diagnostic value of prostate-specific antigen (PSA) in women with polycystic ovary syndrome was evaluated. MٍETHODS: A total of 32 women with PCOS and 32 aged matched healthy females were recruited in this case-control study. The subjects were compared by means of metabolic measures and serum PSA level. The correlations between these markers were evaluated. Sensitivity and specificity values and cut off levels of PSA were established for diagnosis of PCOS. Mean PSA, Ferriman Gallwey score (FGS), luteinizing hormone/follicle stimulating hormone ratio (LH/FSH), testosterone, dehydroepiandrosterone sulfate (DHEAS), 17 hydroxyprogesterone (17HP) levels were significantly higher in PCOS (p < 0. 001 respectively). PSA levels greater than 0. 07 ng/ml yielded a sensitivity of 91% and specificity of 82%, and was helpful as a diagnostic tool for women with PCOS. Circulating androgens and hirsutism were associated with higher levels of PSA in PCOS women. Our results showed direct correlation between PSA, hirsutism and hyperandrogenism state. Therefore, it seems logical to use PSA level for detection of hyperandrogenism state in women.

Recent findings suggest that production of pro-inflammatory cytokines, such as Tumour Necrosis Factor-alpha (TNF- α), is increased in the brain tissue of patients suffering late-onset Alzheimer’s disease (LOAD) and play an important role in the pathogenesis of this disease. Several epidemiological studies also suggest that patients taking anti-inflammatory drugs have a decreased risk of developing AD. TNF- α is an important pro inflammatory cytokine that is unregulated in Alzheimer’s patients. Functional polymorphisms in tumor necrosis factor alpha (TNF-α) can affect immune response, inflammation, tissue injury and possibly the susceptibility to Alzheimer disease (AD). MٍETHODS: We used the polymorphic DNA markers (-308G/A) and (-863C/A) to study the association of TNF-α gene mutations with Late-onset Alzheimer’s disease (LOAD) and the relation between clinical features and genotypes in affected individuals. A total of 160 patient samples and 163 healthy controls from west northern Iran (Eastern Azerbaijan) were genotyped for the two polymorphisms by the PCR-RFLP method and genotype frequencies were statistically determined Our data showed significant difference in TNF-α-308 G/A genotype and pro inflammatory cytokine allele frequencies between the Alzheimer disease patients and healthy subjects. Contrary to that, no significant difference was observed in TNF-α-863 C/A genotype and allele frequencies between these two groups TNF-α-308 G/A gene polymorphism could affect cerebral inflammatory response and the risk of late-onset Alzheimer disease but -863C/A polymorphism does not influence the risk of this disease and this possible association between TNF-α -308G/A and -863C/A gene polymorphisms have to be further elucidated in larger case control studies

The aim of this study was to compare outcomes of open reduction and rigid internal fixation of displaced calcaneal fractures with that of non operative treatment. MٍETHODS: Seventy two consecutive patients with displaced intra-articular calcaneal fractures were selected regarding inclusive and exclusive criteria and then were randomly allocated to surgical and non surgical groups. First group underwent open reduction and internal fixation with reconstruction plate and screws fixation and the other group were treated with closed reduction and cast immobilization. Data were collected by clinical observation and a check list. Data was analyzed by chi-square and t–student test. The results showed significant difference between outcomes of surgical treatment and nonsurgical method (p = 0. 001). There were some differences between two methods in terms of decreasing pain [Odd Ratio (OR): 6. 72, p = 0. 001], swelling (OR: 6. 80, p = 0. 001), increased range of motion of the joints (p = 0. 001), decreased late osteoarthritis (OR: 2. 33, p = 0. 22) in favor of surgical group. Open reduction and internal fixation of displaced calcaneal fractures in absence of open fracture, severe osteoporosis, or comminution, poor general condition may be the preferred method of treatment.

In order to declare the preoperative diagnostic value of brain aneurysms, two radiological modalities, computed tomographic angiography and digital subtraction angiography were compared. In this descriptive analytic study, diagnostic value of computed tomographic angiography (CTA) was compared with digital subtraction angiography (DSA). Sensitivity, specificity, positive and negative predictive values were calculated and compared between the two modalities. All data were analyzed with SPSS software, version 16. Mean age of patients was 49.5 ± 9.13 years. 57.9 % of subjects were female. CTA showed 89% sensitivity and 100% specificity whereas DSA demonstrated 74% sensitivity and 100% specificity. Positive predictive value of both methods was 100%, but negative predictive value of CTA and DSA was 85% and 69%, respectively. Based on our data, CTA is a valuable diagnostic modality for detection of brain aneurysm and subarachnoid hemorrhage.

Relationship between premature menopause and presence, severity and life-threatening events of coronary artery disease (CAD) has been suggested in recent observations. The present study tried to assess relationship between age of menopause and severity of CAD in a sample of women with suspected CAD. MٍETHODS: In a cross-sectional study, we included 189 consecutive women with suspected CAD that were candidate for coronary angiography and admitted to the Shafa hospital in Kerman city. Our final population for analysis included women who underwent natural menopause (n = 148) or premature menopause (n = 41). CAD severity was classified according to the number of coronary artery stenosis ≥ 50% in coronary angiography. Among 189 study patients with suspected CAD, 22. 0% of those with early menopause and 23. 6% of those with normal menopause suffered three coronary vessels involvement, while normal angiography features was shown in 39. 0% and 40. 5%, respectively. Regarding severity of CAD and left main lesions, no significant differences were found between the patients with and without premature menopause. According to the multivariable logistic regression model and with the presence of other patient's variables as cofounders, age of menopause could not predict the presence and severity of CAD in patients with suspected CAD. However, patient's age (OR: 1. 11, p < 0. 001) and family history of CAD (OR: 2. 05, p = 0. 04) were main predictors of the severity of CAD in these patients. Premature menopause does not predict occurrence or severity of CAD in women with suspected CAD, but women age and their family history of CAD are main predictors of the severity of CAD.

In vitro and in vivo antileishmanial activities of crude hydroalcoholic extract of peganum harmala seeds were investigated against Leishmania major. The extract of aerial parts of P harmala was obtained by maceration. The in vitro experiments were per- formed on promastigotes to assess antileishmanial activity of the extract using amphotericin B as a reference. The in vivo studies were carried out on cutaneous leishmaniasis in outbred mice to evaluate the effects of topical application of the ointment-based extract. The in vitro experiments showed a concentration-dependent decrease of parasites number caused by the ex- tract with an IC50 value of 59.4
g/ml. In vivo studies demonstrated a significant post-treatment decrease in the lesion size and parasite count in infected animals, compared to placebo and control groups. High performance liquid chroma- tography (HPLC) of the crude extract demonstrated the existence of harmaline and harmine as beta-carboline alkaloids. P harmala seeds extract showed significant in vitro and in vivo antileishmanial activities. Most biologi- cal activity of the extract could be attributed to its beta-carboline content. However, another alkaloid of P harmala seeds extract, peganine, has also been reported to have antileishmanial activity. These beneficial effects can be attri- buted to the cumulative effects of various biologically active components present in it.

The objective of the present study was to evaluate the effect of the two methods of delivery, “hands-on” vs. “hands poised”, on perineal trauma and delivery outcome in primiparous women referred to Shariati Hospital of Isfahan during 2007-2008. In a clinical trial study, 100 low risk primiparous pregnant women were randomly assigned to two hands-on and hand-poised (hands-off) groups. In the hands-on group, this method was used to control fetal head in the second stage of labor. It means that the fingers of one hand supported fetal occiput and the other hand applied slight pressure on the head to control the delivery of the head during the crowning process. In the hands-poised group, midwife observed the parturient woman and do not touch perineum during the second labor stage while fetal head was delivering. Then, the two groups were compared in terms of perineal trauma, as well as neonatal and delivery outcome. Demographic characteristics of all studied women were similar in two groups. The rate of episiotomy was higher in hands-on group (84% vs. 40%, p = 0.001). The rate of postpartum hemorrhage (4th stage) was higher in hands-on group (12% vs. 4%, p = 0.04). The rate of mild and moderate postpartum pain in hands-on group was higher than hands-off group (70% vs. 58% and 29% vs. 10%, p < 0.001) but sever pain was not different in two groups. It seems that hands-poised method is associated with less perineal trauma, particularly regarding the lower need for episiotomy and postpartum hemorrhage.

Breast cancer is the most common cancer in women. Surgical treatment of breast cancer may cause body image alterations. The purpose of the current study was to examine the effects of cognitive behavioral counseling on body image among Iranian women with primary breast cancer. In this quasi-experimental designed study, 72 patients diagnosed as breast cancer and surgically treated were enrolled in Isfahan, Iran. The patients were entered the study by convenience sampling method and were randomly divided in two groups of intervention (n = 32) and control (n = 40). The intervention group received consultation based on Ellis rational emotive behavior therapy (REBT) method for 6 sessions during 3 weeks. The control group did not receive any consultation. Paired t-test was used to compare the changes in groups and independent t-test was conducted to compare two groups. The average values represented as mean ± standard deviation. Before the study, the body image score was not significantly different between the intervention (16.97 ± 5.44) and control (15.95 ± 4.66) groups (t = 0.86; P = 0.395). The body image score was significantly lower in the intervention group (9.03 ± 6.11) compared to control group (17.18 ± 5.27) after the intervention (t = -6.07; p < 0.001). Since a woman’s body image influences her breast cancer treatment decision, oncology professionals need to recognize the value of a woman's favorite about appearance and body image. This study emphasizes the importance of offering consultation in breast cancer patients.

There are controversial evidences on the association between fingerprint traits and schizophrenia. We compared fingerprint traits of patients with schizophrenia and normal individuals in Iranian population. Fingertip dermal ridge of 290 patients with schizophrenia and 290 normal subjects were studied for four dermal traits. Data was analyzed with Pearson correlation and t-student tests. Fingerprint patterns and secondary creases were not significantly different between the two groups (p > 0.05). Although mean ridge counts of left and right index fingers in the case group were greater than the control group (p < 0.05), the difference was not significant in females. Probably left index ridge counts and fluctuating asymmetry in schizophrenic patients are different from those of the normal population. This difference may serve as a diagnostic biological marker for screening people susceptible to schizophrenia. Further studies are needed to determine the predictive value of fingerprint trait as a schizophrenia biomarker.

The new antiepileptic medications are prescribed for the treatment of patients with seizure disorders since 17 years ago. Gabapentin (GBP) was approved on January 1994 as adjunctive treatment in patients 12 years or older with partial seizures, with or devoid of secondary generalization. GBP, was formerly known as an anticonvulsant γ-aminobutyric acid (GABA) mimetic, is considered as a safe and well-tolerated antiepileptic drug (AED) with promising pharmacokinetic properties and a wide therapeutic index. GBP is useful for the therapy of mixed seizure disorders and refractory partial seizures in children. GBP must be regarded as the first treatment for older patients with recently diagnosed seizures. GBP has a well recognized clinical efficacy in those types of focal epilepsy which were resistant to the traditional AEDs. The main object of this review was to evaluate the efficacy, tolerability, dosing schedules and safety of GBP that have been investigated in peer-reviewed journals.

Applying an effective management system in emergency incidents provides maximum efficiency with using minimum facilities and human resources. Hospital Emergency Incident Command System (HEICS) is one of the most reliable emergency incident command systems to make hospitals more efficient and to increase patient safety. This research was to study requirements, barriers, and strategies of HEICS in hospitals affiliated to Isfahan University of Medical Sciences (IUMS). MٍETHODS: This was a qualitative research carried out in Isfahan Province, Iran during 2008-09. The study population included senior hospital managers of IUMS and key informants in emergency incident management across Isfahan Province. Sampling method was in non-random purposeful form and snowball technique was used. The research instrument for data collection was semi-structured interview; collected data was analyzed by Colaizzi Technique. Findings of study were categorized into three general categories including requirements (organizational and sub-organizational), barriers (internal and external) of HEICS establishment, and providing short, mid and long term strategies. These categories are explained in details in the main text. Regarding the existing barriers in establishment of HEICS, it is recommended that responsible authorities in different levels of health care system prepare necessary conditions for implementing such system as soon as possible via encouraging and supporting systems. This paper may help health policy makers to get reasonable framework and have comprehensive view for establishing HEICS in hospitals. It is necessary to consider requirements and viewpoints of stakeholders before any health policy making or planning.

This report describes a case of classic severe primary hyperparathyroidism (PH) with clinical presentation that is very infrequent nowadays, which was osteitis fibrosa cystica. As bone scintigraphy demonstrated multiple areas of increasing uptake associated with hypercalcemia, a thorough investigation was conducted to exclude the neoplasms which most frequently are responsible for bone secondarisms. A fludeoxyglucose (FDG) positron emission tomography/CT demonstrated diffuse and multiple foci of increased FDG uptake and a focal uptake at the left thyroid region. Parathyroid function was studied, revealing unexpectedly high parathyroid hormone (PTH) levels. Further tests confirmed the diagnosis of PH and localized a parathyroid adenoma in the lower left side.

Systemic lupus erythematosus (SLE), is sometimes complicated by the rare fatal syndrome, Thrombotic thrombocytopenic purpura (TTP), but the occurrence of TTP as the initial manifestation of SLE is very rare. Since they have similarities in some features, the differentiation of TTP from SLE may be missed. SLE patients are also more prone to thrombotic events. Here we report a case with TTP and deep vein thrombosis as the presenting symptoms of SLE.

Perimortem caesarean section is an ethically difficult decision for emergency medicine resuscitation teams. A 34-years-old woman was attacked by her husband with a gunshot. At the time arrival to the emergency room, there was no pulse, no spontaneous breath and blood pressure was unobtainable. Although extensive advanced cardiopulmonary resuscitation was performed for 7 minutes, no cardiac activity was regained. During the cardiopulmonary resuscitation efforts, an abdominal ultrasonography was performed and revealed a fetal heart rate with bradycardia. Low segment caesarean section was performed by the obstetrician in the resuscitation room and a female newborn was delivered within less than one minute of the skin incision. Decision on terminating the CPR efforts should not be made in maternal cardiac arrests older than 28 weeks’ gestational age, unless the viability of the fetus had been evaluated.

Healing a wound, a break in skin which is usually caused by cuts or scraps, is a response of the injury that sets into motion a sequence of events.1-3 Various types of treatment methods have been used to increase the speed of this process. One of the new methods used recently to improve the speed of wound healing is Tropical Negative Pressure Wound Therapy (TNPWT). Although pressure decreases the speed of wound healing in some patients such as spinal cord injury individuals, and those who need to be in bed for a long time,4,5, it can also be used to facilitate the wound healing process, especially in chronic wounds.2,6-9 This method is based on the idea of turning the open wound into a close one and remove the excess fluid from the wound (Figure 1). The new method has been used as a non-pharmacological treatment for chronic and acute wounds such as pressure ulcers, diabetic, abdominal and traumatic wounds 2.

Editor, I read the recent publication on thoracic CT in 2009 H1N1 influenza with a great interest 1. Rostami1 et al. concluded that “The most common thoracic CT findings in pandemic H1N1 were patchy infiltration, lobar consolidation, and interstitial infiltration with airbronchogram and bilateral distribution.1” This is an interesting finding. Indeed, there are some previous reports on thoracic CT and Chest X ray findings in 2009 H1N1 influenza with similar findings.2, 3 However, it was noted that the pattern of thoracic pathological image relates to the severity of the diseases.2 The question on the CT findings that “is there any relationship between detected thoracic CT pattern and severity of the disease?” should be raised. However, based on the present study with few subjects, it might not be concluded. Finally, it seems not clear why thoracic CT was used in the setting of this retrospective study. Thoracic CT is not routinely used in management of influenza. Rationale of this investigation should be further clarified and discussed.

I read the letter from Professor Viroj Wiwanitit1 about our article entitled "Thoracic CT in 2009 H1N1 Influenza”2 with great interest. In response to the question “Is there any relationship between detected thoracic CT pattern and severity of the patients?” we may suggest a comparative study comparing thoracic CT findings in those with and without severe pulmonary symptoms and signs. Using logistic regression analysis and considering abnormal thoracic CT finding as a dependent variable and all severe pulmonary signs and symptoms as independent variables will enable us to find the chance of each variable in predicting abnormal CT findings. On the other hand, although thoracic CT is not routinely used in management of influenza, in our department for the patients with severe pulmonary symptoms and signs3 the thoracic CT was performed. We In addition, the most useful imaging modalities available for the evaluation of patients with suspected pulmonary infection are chest radiography and computed tomography (CT). Imaging examinations should always be interpreted with the knowledge of how symptomatic the patient is, the degree of dyspnoea, and the level of impairment.4