Journal of Research in Medical Sciences
Volume:17 Issue: 3, Feb 2012

There have been few studies to specifically examine the efficacy of selective serotonin reuptake inhibitors (SSRIs) for the symptoms of depression in schizophrenia. This study aimed to determine the efficacy of sertraline as a treatment for depressive symptoms in patients with stable schizophrenia. A 12-week randomized, double-blind, placebo-controlled clinical trial was designed in 2010 with an active medication (sertraline) and a matching placebo. Sertraline was administrated 50-200 mg/daily. A total number of 60 patients were randomized into two groups in a 1:1 fashion. Calgary Depression Scale for Schizophrenia (CDSS) was used as the primary measure and Global Assessment of Functioning (GAF) scale was used as the secondary measure. The data was analyzed by repeated measures analysis of variance (ANOVA) model to determine the effectiveness of sertraline. RSULTS: After 12 weeks, sertraline was significantly more effective than placebo in improving depressive symptoms in stable schizophrenia (p = 0.003). The mean score of GAF did not differ significantly in the sample population as a whole (p = 0.093). The difference between the two groups was not significant, either (p = 0.453). In addition, the rate of side effects was little but it was significantly more in the sertraline group (p < 0.001). The results of this study suggested sertraline to be useful as a treatment for depressive symptoms in patients with stable schizophrenia.

The aim of the study was to evaluate the efficacy and safety of intravenous patient-controlled analgesia (PCA) morphine versus intravenous PCA with methadone for postoperative pain management. In a randomized controlled clinical trial, 400 patients were randomly allocated to receive either morphine or methadone delivered via intravenous PCA after surgery. Patients were followed for 24 hours after surgery. Pain and patient satisfaction was assessed via numeric rating scale as well as sedation score. Data on the incidence of nausea and vomiting, severe sedation and pruritus were also collected. Pain scores at 1 and 3 hours postoperatively in the morphine group was significantly higher than methadone group (p < 0.05), but the trend of pain score, sedation score and the incidence of nausea and vomiting during the 24 hours follow-up were not significantly different between groups. Patients in the methadone group had higher ratings of satisfaction than the morphine group (p = 0.001). Incidence of pruritus in morphine group were higher than the methadone group (P-value = 0.006). PCA with methadone might be more effective than PCA with morphine in reducing postoperative pain during the first hours after surgery with less frequency of pruritus.

Melatonin, a hormone secreted by the pineal gland, has multiple effects on circadian physiology, blood pressure, and coronary blood flow. It has also free radical scavenger and anti-oxidative activity. This study was planned to evaluate the effects of melatonin on left ventricular function of patients with heart failure. In this randomized double-blind clinical trial, 60 patients with heart failure (based on clinical and echocardiography findings) admitted to Shahid Chamran and Khorshid Hospitals in Isfahan, Iran in 2010 received 3 mg melatonin or placebo for 2 months. New York Heart Association (NYHA) functional class and left ventricular ejection fraction (LVEF) in each group, before and after the study were compared. Comparisons were also made between the two groups each step. The data was analyzed by appropriate statistical methods. Overall, 60 patients (41 males and 19 females) participated in this study. LVEF increased from 31.7 to 37.6 in the case group (p < 0.001) and from 34.1 to 35.2 in the control group (p = 0.42). NYHA functional class improved only in the case group (p = 0.014 versus 0.317). This study revealed that melatonin may have beneficial effects on patients with heart failure. However, larger studies may help to define its role in heart failure management.

Vitiligo is an acquired, autoimmune melanocytic disorder characterized by circumscribed depigmented macules and patches. It affects approximately 0.5-2% of the general population worldwide. Many medical treatments have been attempted with partial success, but there has been no previous trial on the combination of topical 5-fluorouracil (5FU) 5% and clobetasol. The aim of this study was to evaluate and compare the therapeutic efficacy of topical clobetasol (as a standard method for treatment of vitiligo) versus a combination of topical clobetasol + 5FU. In this double-blind clinical trial study, 45 patients who had at least two vitiligo patches were treated with topical clobetasol on one side of the body, and with a combination of clobetasol and 5FU on the other side. Treatment was repeated every other day, once a day, for three months. At the end of the treatment, patients were visited again to be evaluated for the therapeutic efficacy of the drugs. Paired t-test revealed a significant improvement in both sides (the right side which was treated with 5-FU+clobetasol and the left side which was treated with clobetasol alone). Therefore, both drugs seem to have been effective in the improvement of vitiligo (p < 0.0001). Comparing the percentage of improvement in the lesion size, there was a statistical difference between the two groups (right side = 38.1 ± 4.3% and left side =24.2 ± 3.3%; p < 0.0001). Adding topical 5FU to clobetasol increases its efficacy in treatment of vitiligo without significant side effects.

Traumatic brain injury (TBI) is known as one of the most important causes of mortality in middle-aged population. The aim of this study was to evaluate the effects of gabapentin in improvement of consciousness level in these patients. This randomized clinical trial was performed in March 2008 to September 2009. A total number of 60 patients from neurology clinics of Kashani Hospital (Isfahan, Iran) were randomly divided into two groups of 30 subjects as the case and control groups. The groups were respectively treated with 300 mg gabapentin and placebo twice a day for two weeks. The electroencephalogram (EEG), Glasgow Outcome Scale (GOS), and Glasgow Coma Scale (GCS) findings were evaluated in all patients before and one week after the intervention. The mean values of GCS and GOS before and after the treatment were not significantly different between the groups. This study showed significant changes in EEG patterns after treatment with gabapentin. Gabapentin might not be suggested for management of unconsciousness due to TBI.

Supervised exercise-based cardiac rehabilitation programs (CRP) have been suggested to all patients, especially after myocardial infarction. However, the effects of cardiac rehabilitation on systolic function are controversial. The aim of this study was to examine the effects of an 8-week cardiac rehabilitation on left ventricular systolic function and left ventricular mass in patients with myocardial infarction (MI) and revascularization. This study included 29 men with MI after reperfusion therapy, i.e. coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). The patients were randomized into a training group (n = 15, mean age: 54.2 ± 9.04 years) and a control group (n = 14, mean age: 51.71 ± 6.98 years). The training group performed 8 weeks of CRP with an intensity of 60-85% of maximum heart rate, 3 times a week. Each session lasted for 60 minutes. Before and at the end of the study, all patients underwent 2-dimentional echocardiography for left ventricular systolic function and left ventricular mass to be assessed. After 8 weeks of CRP, left ventricular ejection fraction (LVEF) increased significantly in the training group (48.53 ± 10.41 vs. 59.13 ± 5.9; p < 0.001). Moreover, the difference in LVEF between the training and control groups were significant after the course (59.13 ± 5.9 vs. 55.9 ± 9.6; p < 0.001). In addition, stroke volume increased significantly (57.22 ± 7.84 ml vs. 64.03 ± 12.8 ml; p < 0.001) while left ventricular systolic volume decreased significantly (42.89 ± 17.32 ml vs. 31 ± 8.34 ml; p < 0.001) in the training group. CRP decreased left ventricular mass in the training group (229 ± 42 vs. 196 ± 34; p < 0.05). A 2-month CRP in post-MI patients led to improvements in systolic function and reductions in left ventricular mass and thus cardiomegaly.

Previous reports have suggested acute phase proteins, such as albumin, to alter in hemodialysis (HD) patients. Intravenous L-carnitine supplementation is expected to improve the level of plasma albumin in HD patients. This study was performed to evaluate the effects of oral L-carnitine supplementation on hemoglobin, lipid profile, and albumin in HD patients. In a double-blind, placebo-controlled study during October 2008 to April 2010, 54 HD patients were randomly assigned into 3 groups to receive 750 mg/day oral L-carnitine (17 patients), placebo (19 patients), or nothing (control group, 18 patients) for 6 months. Eligible patients for the study were above 21 years old, had no carnitine during the previous month, and had signed the informed consent to enter the study. The primary outcome was plasma albumin level. The secondary outcomes were hemoglobin level, erythropoietin (EPO) doses, lipid profile [high-density lipoprotein (HDL), low-density lipoprotein (LDL), cholesterol, and triglyceride), and side effects of L-carnitine. Patients were followed for side effects. The results were analyzed by SPSS17. Before administration of L-carnitine, the mean levels of hemoglobin were 10.81 ± 1.20 mg/dl in the L-carnitine group, and 9.85 ± 1.13 mg/dl in the placebo group. At the end of the study, hemoglobin level was 11.6 ± 1.05 mg/dl in the L-carnitine group and 10.33 ± 1.08 mg/dl in the placebo group. Therefore, hemoglobin levels rose significantly in the L-carnitine group (p = 0.04) but not in the placebo group (p > 0.05). HDL decreased in the placebo group but had no changes in the L-carnitine group. Cholesterol, triglyceride, and LDL did not change during 6 months (p > 0.05). Side effects did not increase in the L-carnitine group. Administration of 750 mg/day oral L-carnitine for 6 months had beneficial effects on hemoglobin and HDL, but not on albumin and the required EPO. Studies with higher doses of oral L-carnitine or in peritoneal dialysis patients are suggested.

• Eicosapentaenoic acid (EPA) is the principal ω-3 fatty acid in marine oils. Significant differences have been reported in the serum levels of inflammatory biomarkers, malondialdehyde (MDA), and antioxidant enzymes activity between diabetic patients and controls after supplementation with ω3 fatty acids and antioxidants. Therefore, the aim of this study was to determine the effects of EPA and/or vitamin C, as an antioxidant, on serum levels of interleukin (IL)-6, tumor necrosis factor alpha (TNF-α), MDA, and glutathione reductase activity in type 2 diabetic Iranian males. • This study was performed on 65 men with type 2 diabetes who aged 33-63 years. Venous blood samples were obtained from all participants at 8:00-9:00 a.m. after 10 hours of fasting, at the baseline and after the intervention. Subjects received 500 mg EPA and/or 200 mg vitamin C 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 supplement placebo and vitamin C (Group 3), and 17 received EPA supplement placebo and vitamin C placebo (Group 4), daily. • There were significant falls in TNF-α levels in Groups 1 and 2 (p < 0.05) and in MDA in Group 3 (p < 0.05). On the other hand, a significant increase was observed in MDA in Group 2 (p < 0.01) and in glutathione reductase activity in Groups 1 and 3 (p < 0.05). Moreover, according to Tukey's test, there were significant differences in IL-6 (p < 0.01) and glutathione reductase activity (p < 0.05) between Group 4 and other groups. Meanwhile, Tukey's test showed that TNF-α was significantly different between Group 1 and other groups (p < 0.01), Groups 2 and 3 (p < 0.05), and Groups 2 and 4 (p < 0.05). Finally, there were significant differences in MDA levels between Groups 1 and 2 (p < 0.01), Groups 1 and 4 (p < 0.05), Groups 2 and 3 (p < 0.05), Groups 2 and 4 (p < 0.05), and Groups 3 and 4 (p < 0.05) after 8 weeks of intervention. • In summary, it is concluded that eight weeks of EPA + vitamin C supplementation improved inflammation and antioxidant status in male type-2 diabetic patients.•KEYWORDS:

Nocturnal snoring is a common complication. In addition to the harassment of the people around, it can lead to cardiovascular diseases, reduced awareness of the environment, and higher statistics of accidents. The treatment of this disorder is mostly by surgical approach. It is also common to use other techniques such as radiofrequency (RF). The purpose of this study was to compare the effects of simultaneous uvulopalatopharyngoplasty (UPPP) and RF treatment with surgery alone for reducing the upper airway obstruction as well as decreasing or eliminating snoring in affected patients. This clinical trial was conducted in Isfahan, Iran during 2009-10. A total number of 46 patients were consecutively assigned into two groups. The first group underwent UPPP whereas the second group received RF in addition to UPPP. The severity of snoring and sleepiness in patients were recorded before and after the surgery using a checklist. The obtained results were then compared. A visual analogue scale (VAS) was used to assess snoring status based on the patient's idea. The Epworth Sleepiness Scale (ESS) was also used to evaluate sleepiness. In the UPPP group, the mean score of nocturnal snoring decreased from 80 ± 23.3 to 23.9 ± 28.4 (p < 0.001). In the group of UPPP with RF, the mean intensity of snoring decreased from 86.5 ± 24.4 to 31.7 ± 27.7 (p < 0.001). The snoring score reduction was not significantly different between the UPPP and UPPP and RF groups (56.1 ± 34.5 vs. 58.8 ± 38.6; p = 0.47). Considering the findings of this study and previous research, it can be suggested that RF may have a complimentary effect in treating simple snoring and obstructive sleep apnea syndrome (OSAS). When indicated, RF can result in more favorable medical improvement in a shorter period of time than UPPP alone.

Cisplatin is a chemotherapeutic agent with a wide range of anticancer effects. Two main toxicities of this drug are nephrotoxicity and myelosuppression. These toxic effects are related to free radical damage, reduction in antioxidant levels and oxidant stress. In this study, 22 patients received 400 IU vitamin E and 200 µg selenium daily and 24 patients received placebo. The primary outcome was nephrotoxicity and the secondary outcome was bone marrow suppression. Glomerular filtration rate (GFR) and complete blood count with differential (CBC/diff) including of white blood cell (WBC) count, hemoglobin (Hb), and platelet counts were determined at the start of chemotherapy and before each cycle as well as one month after cessation of chemotherapy in both groups. Significant differences in GFR were observed between the two groups after the third cycle and one month after the end of chemotherapy (p < 0.05). WBC, Hb, and platelet counts showed significant differences between the study groups after the second and third cycles (p < 0.05). While after one month WBC and platelet counts demonstrated significant differences (p < 0.05), Hb changed insignificantly (p > 0.05). According to our findings, vitamin E and selenium can be used to reduce cisplatin-induced nephrotoxicity and bone marrow suppression.

The usefulness of electroconvulsive therapy (ECT) in the management of mood disorders would be improved if its related cognitive impairment is attenuated properly. In this study we investigated the effects of using a combination of Crocus sativus (CS), Cyperus rotundus (CR), and honey in the treatment of ECT-induced memory impairment. In this randomized double-blind clinical trial, patients with mood disorders who were candidates for ECT were selected by random sampling method. They were then randomized into 2 groups of intervention and placebo. The two groups received 9 grams of an herbal combination of CS, CR, and honey or identical placebo twice daily for 40 days from the ECT initiation time. ECT was performed 3 times a week. Cognitive status was examined using Addenbrooke's Cognitive Examination-Revised (ACE-R) test. Patients were examined on 5 occasions, i.e. before ECT, after the fourth and the last session, and one and two months after the last session. Mean scores of ACE-R were compared between the two studied groups and between the studied occasions using repeated measures analysis of covariance (ANCOVA). Overall, 84 patients were randomized into two groups of intervention and placebo. Mean scores of ACE-R were not different between the two studied groups in the studied occasions (p > 0.05). However, ACE-R scores increased significantly in the intervention group after one or two months after the last ECT session (p < 0.05). Time and interaction effects were significant but the intervention effect was not. Our findings confirmed the memory improving effects of CR, CS, and honey. However, achieving more conclusive results requires larger sample size and longer duration of study.

Few studies have evaluated the effects of soy milk replacement in the diet on inflammatory markers among non-menopausal overweight and obese female adults. We evaluated the effects of soy milk compared to cow's milk on inflammation and lipid profiles among non-menopausal overweight and obese female adults. This cross-over randomized clinical trial was conducted on 24 overweight or obese women. There were two 4-week trial periods (soy milk period and cow's milk period). In the soy milk period, only one glass of soy milk (240 cc) was replaced instead of one glass of cow's milk (240 cc). Fat contents in soy milk and cow's milk were 1 g per 100 ml and 1.5 g per 100 ml, respectively. Serum low density lipoprotein (LDL) level reduced significantly following soy milk period (mean percent change in soy milk period vs. cow's milk period: -11.22 ± 3.85% vs. -1.18 ± 2.82%; p = 0.01). Inflammatory factors and other lipid profiles did not change significantly after the soy milk period compared to the cow's milk period. In addition, soy milk could not reduce the weight of non-menopausal overweight and obese female adults. Soy milk replacement had beneficial effects on LDL levels in a short term trial among overweight and obese women. However, it had no significant effects on inflammatory markers and other lipid profiles among these non-menopausal overweight and obese adults.

Thalassemia is an inherited disorder in which repeated blood transfusion is needed. This causes accumulation of iron in various organs. Silymarin is a natural medicinal plant that has been used for centuries in the treatment of liver depositions. In this study, magnetic resonance imaging (MRI) of liver, which has high accuracy in measuring liver iron concentration (LIC), was used to evaluate the effects of silymarin (Legalon) as an iron-chelating agent. In this double-blind randomized clinical-trial study, 48 thalassemic patients were enrolled during a period of 6 months. In order to evaluate the efficacy of Legalon on LIC, the control group was treated with deferoxamine and placebo tablets while the case group received a combination of deferoxamine and silymarin. MRI was performed for all patients before and after the intervention to determine liver iron using Gandon's protocol. Overall, 37 patients, including 22 controls and 15 cases, completed the study. The mean concentrations of liver iron at baseline were 290 ± 62 µmol/g and 328 ± 27.8 µmol/g in the control and case groups, respectively. The mean liver iron concentrations after 6 months of intervention were 290.4 ± 65.4 µmol/g and 334.6 ± 27.9 µmol/g in the control and case groups, respectively. No group experienced a significant difference in LIC change before and after the 6-month trial (p = 0.43). Administration of silymarin did not cause significant changes in liver iron concentration. Evaluating a longer course of treatment with this drug is thus suggested.

Diabetic macular edema (DME) is the most common cause of reduced vision in diabetic patients. With regards to its prevalence and its severe morbidity, attention to new methods of treatment like anti-vascular endothelial growth factor (VEGF) therapy is of great importance. Therefore, this study aimed to evaluate the efficacy of intravitreal injection of bevacizumab (Avastin) in the treatment of diabetic macular edema. This prospective clinical trial was conducted on patients with DME who referred to Feiz Hospital, Isfahan, Iran, during 2007-8. The subjects were selected using simple sampling method. Eligible patients underwent a complete ophthalmic examination including optical coherence tomography (OCT) before injection. The treatment was performed through 3 intravitreal injections of 1.25 mg Avastin. There was a 1-month interval between very two injections. A second OCT was obtained 4 weeks after the last injection and the changes in macular thickness were compared using statistical analyses. This study was conducted on 52 eyes of 28 patients (17 men and 11 women) with the mean age of 62.60 ± 7.80 years (range: 45-80 years). The mean macular thickness increased from 259.19 ± 75.9 microns before injections to 265.94 ± 109.40 after 3 injections (p = 0.48). In case to case comparisons, macular thickness reductions were observed in 31 cases from 2 to 74 microns (mean: 24.60 ± 20.85). In 21 cases on the other hand, macular thickness increased from 1 to 324 microns (mean: 52 ± 88.20). Macular thickness before injection was 261.22 ± 77.79 microns in men and 255.95 ± 74.67 in women (p = 0.81). After injections, the values changed to 276.44 ± 122.79 microns in men and 249.15 ± 83.94 in women (p = 0.34). Intravitreal Avastin is not effective in reducing macular thickness after 4 weeks of injection. In contrast, according to other studies, it seems to be temporarily effective. Therefore, it is better to be combined with other routes of therapy, e.g. laser and intravitreal steroid, in the management of DME.

Adhesions, as abnormal scared tissue, are common following gynecological operations and can cause chronic pelvic pain, infertility, poor outcomes of future surgeries, and intestinal obstruction. Oxygen free radicals are known as one of the main causes of adhesion formation. This study is to evaluate the effect of vitamin E on decreasing post operative adhesion in uterine horn of rats. This experimental study was performed on 45 non-pregnant female rats randomly placed into 3 equal groups. In all groups after general anesthesia and sterile exploration, anti-mesenteric surface of the left uterine horn of the rats was traumatized using a single-polar couther. The right side was traumatized by a scalpel. Intra-peritoneal and intra-muscular vitamin E were administrated in the 1st and 2nd groups, respectively, while in the control group only normal saline solution was poured onto the horns. Following 4 weeks recovery, second laparotomy was performed to grade the adhesions, if any. The dose of vitamin E for each rat was 10 IU (50u/kg). Vitamin E had no effect on preventing adhesion formation in the right uterine horn traumatized by scalpel. However, vitamin E administration in the left side (both intra-peritoneal and intra-muscular) traumatized by cautery, had a significantly preventive effect against adhesion formation. In comparison with intra-peritoneal administration, intra-muscular vitamin E had a greater protective effect. Considering vitamin E availability, cost-efficacy and safety, injected intra-muscularly before operations can prevent adhesion formation.

Work-related stress has increased during recent years throughout the world as well as in developing countries. Studies demonstrate that Work-related stress can have a negative effect on the quality of life, productivity, and as a result lead to considerable socioeconomic consequences. The purpose of the current study was to examine the effects of a brief stress management intervention on work-related stress in employees of Isfahan Steel Company in Iran. A quasi-experimental design was used to compare the intervention group with the control group. Eighty-eight employees of Blast Furnaces were randomly allocated to intervention (n = 44) and control groups (n = 44) and completed Occupational Role Questionnaire before and after A brief three-session CB (Cognitive behavioral) stress management. After the intervention significant differences were detected between the control and intervention groups in role overloud, role insufficiency, role boundary, and responsibility but not in role ambiguity and physical environment Results suggest that the brief stress management intervention can be considered as a preliminary education for employees to develop skills to cope with role overloud, role insufficiency, role boundary, and responsibility, which are some of the factors of work-related stress.

This study was designed to compare the effectiveness of oral gabapentin and locally injected depomedrol in trigger points (TrPts) of the head of patients suffering from chronic tension type headaches (CTTH). In this study patients with a diagnosis of CTTH who had at least one active trigger point in their scalp were recruited. Patients were randomly divided into two groups: one receiving depomedrol and the other receiving gabapentin. Depomedrol was injected 10 mg per each TrPt up to a total dose of 40 mg in each patient. Gabapentin was initiated with 200 mg/day and was gradually increased to 300-600 mg daily depending on the therapeutic response. Patients were followed for two months and during the study patients were given a headache diary to record the number, duration and intensity of their headaches, these records were compared at baseline one month and two months after the initiation of therapy. Headache Intensity × Duration index showed a significant decrease in both groups. It was however, significantly lower in depomedrol receiving patients at the end of the first 4 weeks (368.13 ± 195.75 Vs. 467.73 ± 203.09, p < 0.05), and the second 4 weeks (165.44 ± 62.75 Vs. 238.68 ± 81.39, p < 0.05). Similar superiority was detectable for intensity, duration and frequency of headaches (p < 0.05). We found trigger point injection with depomedrol to be a more potent prophylactic agent in comparison to daily oral gabapentin.

Pentavalent antimonial drugs have been the first line of therapy in cutaneous leishmaniasis for many years. However the cure rate of these agents is still not favorable. This study was carried out to compare the effect of 50% topical trichloroacetic acid in combination with non-ablative radiofrequency heat therapy and intralesional glucantime on cutaneous leishmaniasis. A total of 76 lesions in 60 patients were studied and randomly divided into 2 groups. A total of 30 patients with 38 lesions were treated with intralesional injection of meglumine antimoniate (Glucantime) (Sanofi-Aventis, France) as group-1 and the 38 lesions in the remaining 30 patients were treated with a combination of non-ablative radiofrequency and 50% topical trichloroacetic acid as group-2. Complete cure rate besides the lesion’s changes in size and size of scars were assessed and compared between groups especially according to the gender and location of initial lesions. complete cure of after 4 months of treatment was achieved significantly more in group-1 than group-2 (p = 0.01). However, the complete cure rate at month 6 of treatment was not significantly different between groups (p = 0.06). Score II-III of the lesions’ reduction size (more than 50% reduction in size) was achieved significantly more in group-1 (p = 0.004). There was no significant cure rate difference between the two groups according to the location of lesions (head and upper extremities vs. lower extremities) or the patient’s sex. Moreover, there was no significant scar size difference between groups according to the location of lesions. The study showed that intralesional glucantime has a significantly higher cure rate of cutaneous leishmaniasis in a shorter time than 50% trichloroacetic acid in combination with non-ablative radiofrequency. Furthermore, it could significantly induced efficient reduction size of more than 50% in most lesions. The analysis reveals that intralesional glucantime still has the superiority to be the first line of therapy in cutaneous leishmaniasis.

The second most common vaginal infection is candida vaginitis. The use of anti-fungal traditional medicine and herbal therapies has been increased in recent years. The anti-fungal effect of E.platyloba DC extract on candida has been shown in the in vitro studies. The purpose of this study was to investigate this effect in women with candida vaginitis by in vivo study. A randomized double blind clinical trial was done on 60 married women with candida albicans vaginitis referred to Obstetrics and Gynecology clinic. Patients were randomly divided into two groups. The first group received Echino cream plus fluconazole and the second group received fluconazole alone. Patients were evaluated by the second questionnaire and laboratory studies on vaginal specimens two weeks and 6 months later for recurrence. 14 days after treatment the positive culture of vaginal discharge were observed in 13 cases of (43.3%) the group treated with fluconazole, and 6 cases (20%) treated with fluconazole and Echino cream (p < 0.5). The rate of recurrent candida vaginitis was 17 cases (56.7%) in the group treated with fluconazole, and 8 cases (26.7%) in the second group (p < 0.5). E. platyloba DC extract was effective in women with candida vaginitis. More multicentral studies are needed to evaluate the effects in more details.

Recently autologous fat tissue transfer has gained much popularity. On the other hand, applying the transferring methods with a higher survival rate is still controversial. The aim of this study is to compare dermis-fat graft and dermal-fascia-fat graft. This animal study was conducted in 2008-2009. 12 dogs underwent fat graft transfer in forms of free fat, dermis-fat and dermal-fascia-fat. Two months post operation the grafts were removed and analyzed microscopically and macroscopically. The most significant weight loss was observed in circular free fat while, dermal-fascia-fat graft had the least. According to microscopical analysis the most considerable angiogenesis was improved in dermal-fascia-fat graft. Dermis-fat graft had a higher survival rate than free fat graft. Considering the higher angiogenesis and collagen synthesis used in the dermal-fascia-fat group, it seems that fat graft has more maintenance in the presence of fascia. To determine the influences of fascia further studies are recommended.

Coronary artery bypass graft is commonly associated with post cardiac surgery delirium. Proinflammatory processes play an important role in the pathogenesis of postoperative delirium. Therefore, dexamethasone might have a beneficial effect on the reduction of this complication. This randomized clinical trial was conducted with the objective of the evaluation of dexamethasone effects on postoperative delirium and complications after cardiac surgery. The eligible patients were divided into 2 groups of dexamethasone with 43 patients and placebo with 50 patients. The dexamethasone group took 8mg dexamethasone before induction of anesthesia followed by 8mg every 8 hour for 3 days and the other group received placebo in the same way. all patients were assessed by a mini mental status questionnaire and psychiatric interviewing with the aim of diagnosing delirium. Extubation time of the dexamethasone group was significantly reduced. Our results showed that in the first postoperative day delirium, extubation time, and intensive care unit length of stay significantly decreased in the dexamethasone group without increasing serious complications such as infectious diseases. After administration of dexamethasone only hyperglycemia as an adverse event was increased in the dexamethasone group. Other complications of renal, cardiac, cerebrovascular and respiratory system did not show any significant differences between the two groups. postoperative delirium is in correlation with costly adverse events after cardiac surgery. Our data suggested that preoperative administration of dexamethasone might safely protect the brain of patients who undergone cardiac surgery against postoperative delirium.

One of the materials, which have been used to strengthen the graft in tympanoplasty, is cartilage. This clinical trial aimed to assess the anatomic and functional results of homograft cartilage tympanoplasty. This clinical trial study was conducted on 40 patients who underwent homograft cartilage tympanoplasty between 2008 and 2011 in Al-Zahra Hospital, Isfahan, Iran. All patients were followed up one month after surgery for recurrent retraction pocket cholesteatoma and re-perforation of the tympanic membrane. Periodic follow up visits were done every 3 months and all patients were followed up at least six months after the surgery. The results of the surgery were determined by otoscopic examinations and audiometric tests. One month after the surgery, there were no cases of retraction pocket, adhesive otitis, recurrent cholesteatoma, membrane re-perforation and cartilage atrophy. 6 months after surgery 20 patients (50%) had a normal tympanic membrane, 15 patients (37.5%) had some degrees of cartilage atrophy that was not associated with pathologic changes, and 5 patients (12.5%) had retraction pocket. Re-perforation, recurrent cholesteatoma and adhesive otitis were not observed in any of the cases. The findings of this study demonstrated that homograft cartilage tympanoplasty is an effective technique for tympanic membrane closure and prevention of retraction pocket cholesteatoma with acceptable hearing results.

Epidemic levels of obesity and overweight in today's world are leading to a higher number of mortality and morbidity, especially due to cardiovascular diseases (CVDs). Body fat distribution contributes a great amount to atherosclerosis formation and therefore increased CVD incidence. The present study used the autopsy of 40 healthy-appearing adults who died due to non-cardiac causes to explore the association between atherosclerosis and body fat distribution indices including abdominal fat, visceral fat, subcutaneous fat, and pericardial fat. This cross-sectional study examined the autopsy of 40 individuals of 20 to 50 years old who died due to non-cardiac causes, mostly car accidents, and were sent to the forensic center. Measurement of abdominal fat, visceral fat, subcutaneous fat and heart weight/height ratio as a pericardial fat index in the cadavers was followed by atherosclerosis assessment in the carotid artery, left and right internal and external carotid arteries, as well as right coronary artery (RCA), left anterior descending (LAD) and left circumflex (LCX) coronary arteries based on American Heart Association (AHA) criteria. In order to evaluate the relation between atherosclerosis development and body fat distribution indices, SPSS version 19 was used for multinomial logistic regression analysis in the crude and adjusted models (for age, smoking, LDL-c, HDL-c, HBA1c, and CVD history). The effectiveness of body fat distribution variables along with age, smoking, LDL-c, HDL-c, HBA1c, and CVD history on atherosclerosis was also determined by stepwise forward regression analysis. The average age of the subjects was 29.97 ± 9.84 years. Among 40 performed autopsies only 3 were women. Coronary and carotid atherosclerosis were observed in 50% and 85% of the cadavers, respectively. Logistic regression analysis revealed no link between carotid atherosclerosis and body fat distribution indices. Although, the correlation found between heart weight/height ratio and atherosclerosis in the crude model did not remain significant after the adjustment of other indices, stepwise forward regression analysis resulted in OR = 9.461 and confidence interval = 1.199-74.650. Our results indicated a link between coronary atherosclerosis and heart weight/height ratio. Since coronary and carotid atherosclerosis were not found to be correlated with subcutaneous and visceral fat, further investigation is suggested.

Vitiligo as a common pigmentary disorder affects up to 2% of the general population. There are several treatment modalities in the literature but photo therapy is one of the best known with an improving effect. The goal of this study was to compare the efficacy of NB-UVB alone with adjunction of NB-UVB with needling procedure in inducing of regimentation. This was a randomized clinical trial which was done on 41 vitiligenous patches of patients with non responding vitiligo. The selected patches of the body were treated 3times a week with NB-UVB therapy either with or without the needling approach for three month. The pigmentation score and the photographs of before and after the therapy were compared to evaluate the response rate. The pigmentation scare and improvement of the lesions differed statistically in the combined needling side in comparison with the NB-UVB alone side in favor of the combined treatment (p 0.05). The response rate was higher in trunkal lesions than lesions on the extremities (p 0.05). The needling procedure can increase the response rate of photo therapy and it accelerates the improvement process and therefore, reduces the side effects.

Recently elective inductions of labor at term have increased dramatically which may be in part due to the patient and clinicians desire to arrange a convenient time for delivery. Termination of pregnancy before emerging labor pain is an important concern. Because induction of labor is one of the most commonly performed obstetrical procedures clinicians all over the world investigate to find a safe technique for mother and neonate. Labor induction with PGE1 is one of the selections. Our objective was to compare vaginal delivery, maternal, fetal, and neonatal complications in the induction of labor with oxytocin and misoprostol. we selected one hundred and eight cases with term pregnancy, not in active labor, singleton pregnancy, vertex presentation, normal fetal heart rate reactivity and Bishop Score of < 6, who consented to participate in the study. Fifty-four of the cases were included in misoprostol group and a 100 µg misoprostol tablet was placed in the posterior vaginal fornix. Another 54 cases were included in the oxytocin group. Labor characteristics, maternal and neonatal outcome were analyzed. The mean duration of induction to true labor pains (p = 0.001) and induction to labor (p < 0.001) in the misoprostol group was significantly shorter than the oxytocin group. Rate of cesarean section and maternal and neonatal complications were equal between the two groups. It is effective, safe, and economic to use 100µg misoprostol vaginally in term pregnancy with low Bishop Scores.

Many patients using warfarin may be at risk of international normalized ratio fluctuations. This may cause severe massive gastrointestinal or cerebral bleeding. Subclinical hypothyroidism in our population is highly prevalent (range from 3.1% to 8.4% for males and females respectively). Overt hypothyroidism diminishes the effect of warfarin but there is a lack of results on the effects of subclinical hypothyroidism on warfarin dosage. In this clinical trial, 102 patients using warfarin were checked for TSH, and if the result was abnormal, Serum TSH, T4, T3, and T3RU concentration were assayed again. Mean weekly dosage of warfarin and frequency of its fluctuations were compared 2 months before, 2 months after and also during the treatment period of hypothyroidism. The INR is obtained weekly, to verify dosing within range by stability of the INR. Duration of hypothyroidism treatment was about 3 months. Seventeen (16.6%) patients had thyroid diseases, 15 patients of them (88%) had subclinical hypothyroidism. Weekly dosage of warfarin for the subclinical hypothyroidism state was 33 ± 15 mg (mean ± SD). The weekly dosage of warfarin during the treatment period of hypothyroidism was 30 ± 13 mg. Mean warfarin dosage 2 months after treatment was 29 ± 11 mg. There was a significant difference between warfarin dosage before and after hypothyroid treatment (p < 0.05). There was a significant decrease in INR fluctuation after treatment of hypothyroidism (p < 0.05). Since fluctuations of INR may be very harmful especially in the elderly population, carefully selected patients using warfarin with labile INR, can gain from concomitant therapy for subclinical hypothyroidism.

Constipation is one of the common problems in childhood and consists of 3% of referrals to pediatricians and 25% of pediatric gastroenterologists. Aperients are common alternatives for treating chronic constipation. The present study aimed to compare the efficacy of three laxatives [polyethylene glycol (PEG), magnesium hydroxide, and lactulose]. In this randomized clinical trial, 1 to 6 year old children with functional chronic constipation (the patients had functional chronic constipation based on ROME III criteria) were studied. 75 patients were divided into three 25 member groups through randomization method. The patients of each group received either of the polyethylene glycol, magnesium hydroxide, or lactulose medications in a standard dosage. After a month, the results were assessed and analyzed through statistical tests. Comparing the frequency of increased defecation in patients of the three groups also found no significant difference among them; however, mean increase of defecation frequency was higher in the magnesium hydroxide group. Compared to patients who had more than three times of defecation per week, PEG group was significantly higher than the other two groups (p < 0.05). Comparing the side effects showed that the prevalence of side effects was lower in the polyethylene glycol group than the other two groups. The patients had a significantly higher satisfaction from the taste of polyethylene glycol and lactulose (p < 0.01). Although the total mean of increase in defecation frequency after the treatment was higher in the magnesium hydroxide group, the indicator of defecation frequency greater than three times per week was higher in the polyethylene glycol group which indicated the success of treatment in this group. In total, comparing the therapeutic results and satisfaction of the patients, it can be concluded that polyethylene glycol can be used as one of the best alternatives to treat constipation.

During Ramadan, the 9th month in the Hijri lunar calendar, healthy adult Muslims are obliged to fast from sunrise to sunset. The fast of Ramadan has significant health effects and is the most commonly researched religious fasting. In this study, we will investigate available findings on the effects of Ramadan fasting on gastrointestinal (GI) signs, symptoms, and diseases. We searched PubMed, Google Scholar, Iran Medex, and Scientific Information Database (SID) for related articles in English or Farsi. Editorial articles and case reports were excluded. Of 2312 articles found, 23 articles fulfilled our inclusion criteria and were included. Ramadan fasting seems to increase peptic ulcer complications (peptic ulcer perforation and bleeding) and have a deteriorating effect on patients with chronic peptic ulcer diseases on drug therapy, but not on duodenal ulcer patients under treatment. Healthy individuals might experience minor GI symptoms but no serious complications have been reported. Studies regarding the incidence of acute appendicitis and peptic ulcer diseases are not in agreement, but acute mesenteric ischemia, hyperemesis gravidarum and primary small bowel volvolus seem to be increased during Ramadan. No increase in idiopathic intussusception is observed during Ramadan and fasting does not appear to impose serious risks on patients with an inflammatory bowel. Fasting is generally safe for healthy individuals, but might be hazardous to patients with various GI diseases and may increase the risk of complications in this group.

Surgicel (oxidized regenerated absorbable cellulose) is used topically for homeostasis in surgery. Complicated obstetric vaginal laceration after vaginal delivery can be difficult to manage using traditional techniques.In February 2012, a 32-year-old primipara referred to our center (Shahid Beheshti Hospital, Isfahan, Iran) 10 days after vaginal delivery with moderate to severe vaginal bleeding. She had a large laceration in vagina. Due to underlying inflammation, the edges of the wound were quite fragile and direct homeostasis with suturing was impassible. Therefore, we used a new technique, i.e. a Gavage syringe (Ethicon) covered by a 10*20 cm Surgicel, for appropriate and effective vaginal packing to control hemorrhage. Although previous research has employed Surgicel for neovaginoplasty in patients with vaginal aplasia,1,2 to the best of our knowledge, we were the first to use this method to manage postpartum bleeding due to vaginal laceration. After 24 hours of using this device, bleeding completely stopped and the syringe was removed while the Surgicel was still attached to the side wall of vagina.The patient used sit bath 3 times every day for a week.Gavage syringe covered by Surgicel may be useful for homeostasis in complicated obstetric vaginal lacerations when wounds are quite fragile and direct homeostasis with suturing is impassible.