Journal of Research in Medical Sciences
Volume:18 Issue: 1, Jan 2013

Human milk (H-M) is a main food for infants, and phospholipids especially long chain polyunsaturated fatty acids (LCPUFA) play an essential role in the growth and brain development. This study was designed to evaluate the fatty acid composition in HM of mothers with preterm and full term newborns and to determine the relationships of dietary intake of docosahexaenoic acid (DHA) and arachidonic acid (A.A) of mothers and the content of these fatty acids in their milks. The A.A and DHA of H-M were determined by gas chromatography at the third day after birth from mothers of 59 term and 58 preterm infants. Mothers were selected from those who delivered in Shahid Beheshti hospital, a referral teaching hospital affiliated to Isfahan University of Medical Sciences, Isfahan, Iran. Dietary fat composition of mothers was examined by a food-frequency questionnaire. Total fat content, DHA and A.A of H-M were compared in both groups. The correlation of dietary DHA and A.A were determined with DHA and A.A of H-M in both groups. We found that maternal age, body mass index (BMI) and self- reported food- frequency questionnaire did not differ in two groups. In preterm and term groups, the mean A.A (0.19 ± 0.10 mg/ml and 0.16 ± 0.09 mg/ml, respectively), DHA (0.10 ± 0.06 mg/ml and 0.08 ± 0.05 mg/ml, respectively), and total fat content (2.58 ± 2.16 g/dl and 2.06 ± 1.22 g/dl respectively) of HM of mothers with preterm neonates were non-significantly higher than in mothers with term neonates. The percentage of DHA in the HM fat of preterm and term groups (0.45 ± 0.16% and 0.45 ± 0.18%, respectively) and the percentage of A.A (0.85 ± 0.26% and 0.84 ± 0.20%, respectively) were comparable with worldwide standards. No correlations were documented between DHA and A.A intake and DHA and A.A content of HM in both groups. Although DHA and A.A content of HM in preterm group were higher than term group, but this differences were not significant. The percentage of DHA and A.A were acceptable in our region in the milk fat of mothers with term and preterm neonates.

This study assessed the effect of lead exposure on the peripheral nervous system in 40 hospitalized patients with lead toxicity [blood lead level (BLL) >70 µg/dl] and compared their electrodiagnostic indices with the results of the control group. We assessed signs and symptoms of neuropathy in patients and conducted nerve conduction velocity (NCV) in patients and control groups, then compared the results between the two groups. Average duration of exposure to lead was 10.85 years. The mean BLL of patients was 100.32 µg/dl (SD= 18.42). The most common symptoms in patients were mood and sleep disturbance (64.1%) and paresthesia (47.5%). Among the patients, all of the NCV indices in median, ulnar, and radial nerves were normal. On comparing the average indices of NCV in lead-exposed men with controls, significant reductions were noted in most of the indices and with prolonged distal motor latency and peak latency. Significant but weak correlations were found between BLL and some of the indices (P-value <0.05, r = 0.33–0.52). Comparing electrophysiological study indicators between case vs controls and considering the symptoms of patients, our study showed that patient may progress to sensory neuropathy.

Gender distribution of acute stroke patients varies considerably among stroke registries throughout the world, but factors responsible for this phenomenon remained vastly unknown. Using data from prospective hospital-based stroke registries in China (n = 752 acute stroke patients), Germany (n = 96054), India (n = 1500), and Iran (n = 1392), this descriptive study explored gender distribution of stroke patients and its determinants. In addition, the proportions of males and females to be expected in fictive study populations were calculated, and differences in gender distribution between stroke databases throughout the world were described. In the German dataset, a maximum male preponderance was found for patients aged between 55 and 64 years (proportion of male patients 0.67 [95% CI: 0.66–0.67]), whereas patients older than 84 years revealed a strong overbalance of females (0.27 [0.26–0.28]). In Germany, age-specific gender distribution of stroke patients is well explained by the numbers of females and males in the general population and by gender-specific stroke incidence rates. Both in China and India, a strong preponderance of male stroke patients was found for the majority of age categories with a maximum proportion of male patients of 0.82 in the 35–44 years age group. In contrast, the Iranian stroke register revealed an overbalance of females (0.13 [0.11–0.14]) in nearly all age categories. Gender distribution of acute stroke patients is highly variable. Gender distribution varied considerably between countries. Apart from demographic factors reflecting gender ratio in the general population and gender-specific stroke incidence rates, sociocultural peculiarities may also play an important role in this context.

Invasive fungal infections cause considerable morbidity and mortality in immunocompromised hosts. Pigeon droppings could especially be a potential carrier in the spread of pathogenic yeasts and mold fungi into the environment. The objective of this study was to isolation of Cryptococcus neoformans and other opportunistic fungi from pigeon droppings. One hundred twenty samples of pigeon droppings were suspended 1:10 in saline solution and then cultured. Identification of C. neoformans was performed on bird seed agar, presence of a capsule on India ink preparation, urease production on urea agar medium and RapID yeast plus system. The identification of candida species was based on micro-morphological analysis on corn meal-Tween 80 agar, RapID yeast plus system and growth in CHROMagar candida. The identification of other fungi was based on macromorphologic, microscopic, biochemical and physiological characteristics. The highest frequency of yeasts and mold fungi were observed in Candida albicans 6.6% and Penicillium spp. 25%. The frequency rate of C. neoformans isolation was 2.5% Several types of fungi are present in pigeon droppings that can spread in environment and transmit to children and elderly as well as immunocompromised patients who are at increased risk of contracting opportunistic diseases.

Although primary spinal cord tumors (PSCTs) comprise a minority of primary central nervous system tumors, they often impose a great deal of morbidity on their victims. Few epidemiologic studies have addressed PSCTs in Iran. We analyzed the demographic/clinical features of all primary intraspinal tumors (with a specific focus on primary intradural spinal cord tumors) identified between 1992 and 2004 in three of the major related hospitals in Isfahan, Iran. We also tracked the malignant cases until 2012. 102 patients with primary intraspinal tumors were found; 82 tumors were intramedullary (36 intramedullary and 46 extramedullary) and 20 extradural. The principal intradural histological subtypes were nerve sheath tumor (33%), ependymoma (22%), astrocytoma (16%), and meningioma (15%). 20 (19%) of the tumors were malignant. Local pain (43%) and motor disabilities (36%) were the most common first-presenting symptoms in the patients. Male-to-female ratio was significant only in ependymoma (male:female ratio = 3.6, P < 0.05). The mean age in meningioma (57 years, standard error [SE]: 15.7) was significantly higher than other types (one-way ANOVA, P < 0.05). our results reflect analogous frequency of distribution for PSCTs compared with most of the previous counterpart studies worldwide. The only notable exception was the comparatively fewer frequencies of spinal cord meningioma in our study.

The objectives of this study were to examine (a) the prevalence of overweight/obesity, and (b) the relationship between body mass index (BMI), body fat percentage (BF) and physical fitness in adolescent and adult female volleyball players. Adolescent (n = 102, aged 15.2 ± 2.0 year) and adult (n = 57, 25.9 ± 5.0 year) players were examined for anthropometric characteristics and body composition, and performed the physical working capacity in heart rate 170 min-1 test, a force-velocity test, the Wingate anaerobic test (WAnT), sit-and-reach test (SAR), handgrip strength test (HST) and countermovement vertical jump (CVJ). Based on international BMI cut-off points, 27.5% (n = 28) of adolescent and 12.3% (n = 7) of adult participants were classified as overweight, with the prevalence of overweight being higher in girls than in women (χ2 = 4.90, P =. 027). BMI was correlated with BF in both age groups (r =. 72, P <. 001 in girls; r =. 75, P <. 001 in women). Normal participants had superior certain physical and physiological characteristics than those who were overweight. For instance, normal girls and women had higher mean power during WAnT than their overweight counterparts (P =. 003 and P =. 009 respectively). Except for flexibility, BMI and BF were inversely related with physical fitness (e.g. BMI vs. HST r = -.39, P <. 001 in girls; BF vs. CVJ r = -.45, P <. 001 in women). The findings confirmed the negative effect of overweight and fatness on selected parameters of physical fitness. The prevalence of overweight in adolescent volleyball players was higher than in general population, which was a novel finding, suggesting that proper exercise interventions should be developed to target the excess of body mass in youth volleyball clubs.

The effect of Human Immunodeficiency Virus (HIV) on the immune system is well documented however; its impact on the nutritional and immunological qualities of the breast milk is scarce. Levels of some essential trace metals, albumin and antioxidant status in the plasma and breast milk of Nigerian HIV-infected lactating mothers were determined. Essential trace metals and total antioxidant potential were measured using spectrophotometric method while albumin was measured using single radial immunodiffusion technique. Only the mean plasma level of albumin in HIV infected lactating mothers (HIM) (9.39 ± 4.46 g/L) was significantly reduced when compared with HIV free lactating mothers (HFM) (26.18± 18.43 g/L, P = 0.000), others had no significant difference. The mean breast milk levels of total antioxidant potential (1776.82 ±564.26 µmolTE/Lvs 2384.67 ± 679.00 µmolTE/L, P = 0.0000), Cu (67.68 ± 5.04 µg/dLvs 71.10 ± 5.45 µg/dL, P = 0.033) and Fe (66.21 ± 6.31 µg/dLvs 71.20 ± 6.48 µg/dL, P = 0.011) were significantly reduced in HIM compared with HFM. No significant differences were observed in other parameters. It could be concluded from this study that hypoalbuminemia is a feature of HIV-infected lactating mothers and that breast milk of HIM has low antioxidant capacity.

The purpose of the present study is to determine the accuracy of magnetic resonance voiding cystourethrography (MRVCUG) for diagnosis of vesicoureteral reflux (VUR) in children and adolescents with recurrent urinary tract infection (UTI). During the cross-sectional study from May 2009 to June 2011, 30 patients'' (60 kidney-ureter units) MRVCUG findings by 1.5 T magnetic resonance imaging (MRI) were compared with voiding cystourethrography (VCUG) findings in patients with urinary tract infection. The sensitivity, specificity, positive and negative predictive values for MRVCUG were calculated. The sensitivity, specificity, positive and negative predictive values and accuracy for MRVCUG for detecting VUR were respectively 92.68% (95% CI: 80.57-97.48%), 68.42% (95% CI: 46.01-84.64%), 86.36% (95% CI:71.95-94.33%), 81.25% (95% CI:53.69-95.02%), and 85% (95% CI: 80.40-89.60%. The level of agreement between MRVCUG and VCUG findings for diagnosis VUR was very good (P < 0.001, according to Cohen’s kappa value = 0.638). Studying correlation of low grade VUR (grade I and II) and high grade VUR (grade III-V) showed a very good agreement between MRVCUG and VCUG findings (P < 0.001, Cohen’s kappa value = 0.754). MRVCUG could accurately reveal the presence and severity of VUR, especially in cases with high-grade (grade III-V) VUR in both children and adolescents.

The effectiveness of a theory-based educational intervention on intension for sexual abstinence among female university students was evaluated. Female students were recruited from humanity sciences department through cluster sampling. Educational intervention was applied for four 90-min sessions and by application of cognitive theories during 4 weeks. One hundred and nine female students with mean age of 20.74 ± 1.57 years took part in the study. Despite the similarity of two groups of intervention (n = 53) and control (n = 59) at baseline, there were significant differences between the two groups in mean scores of the variables, knowledge (4.62 ± 1.38 vs. 3.53 ± 1.61), perceived susceptibility (14.05 ± 1.51 vs. 12.37 ± 2.11), and perceived benefits (28.41 ± 2.14 vs. 27.51±3.05), at follow-up time after 3 months (P < 0.05). Additionally, these variables were observed with improvement over 3 months in the intervention group (P < 0.05). However, this study showed no significant effect on the behavior intention and self-efficacy. This study showed that educational intervention could improve knowledge, perceived benefits, and self-efficacy of the female students regarding HIV/AIDS.

Various findings suggest that uric acid is an inflammatory factor and may have a role in endothelial dysfunction and act as a mediator of diabetic nephropathy. The objective of this study was to evaluate the relationships between serum uric acid level and level of proteinuria in type 2 diabetic (T2D) patients. A cross-sectional analytical study was conducted in 60 patients with T2D without a history of gout. None was treated with allopurinol. Venous blood samples were obtained in fasting state for determinations of serum creatinine, uric acid, and hemoglobin A1c (HbA1c) (reference range 3.8–5.5%); 24-h urine proteinuria was also measured. Mean age of the patients was 57 ± 8.3 years. Mean ± standard error (SE) of serum creatinine was 0.98 ± 0.028 mg/dL, mean ± SE of serum uric acid was 4.5 ± 0.15 mg/dL, and mean ± SE of proteinuria was 388 ± 28.7 mg/day (median = 303.5 mg/day). There was no significant difference in serum uric acid, HbA1c, and creatinine level between males and females (P > 0.05). There was a significant positive association between body mass index (BMI) and serum uric acid levels (r = 0.428, P = 0.001). After adjustment for weight, a significant positive association of serum uric acid with level of proteinuria was seen (r = 0.47, P < 0.001). Serum uric acid had a significant positive association with diabetic nephropathy. It might be hypothesized that serum uric acid plays a role in diabetic nephropathy in T2D.

Some epidemiological and interventional studies have shown the role of vitamin D on insulin secretion and resistance. A previous study in our center showed that intramuscular vitamin D decreases insulin sensitivity in pre-diabetic patients. We investigated the role of oral vitamin D on the insulin sensitivity index and insulin resistance in pre-diabetic patients. In a randomized clinical trial, we divided 45 people with pre-diabetes aged 47.4 ± 6.6 (range 33–61) years into three groups: group A subjects treated with 50,000 IU oral vitamin D and 500 mg calcium carbonate (n = 21), group B subjects treated with a single 300,000 IU intramuscular vitamin D and 500 mg calcium carbonate (n = 9), and group C subjects treated with 500 mg calcium carbonate alone (n = 15). Serum 25-hydroxyvitamin D [25(OH)D] was measured at baseline. If it was less than 75 nmol/l, 50,000 IU vitamin D was given weekly, and if serum 25(OH)D was more than that, vitamin D was administered every 2 weeks. Before and after 12 weeks of treatment, a 75-g glucose tolerance test was performed. We used paired t-test and analysis of variance (ANOVA) to analyze the data. P values less than 0.05 were considered significant. Mean (SD) of serum vitamin D increased from 77.5 ± 39.2 to 118.8 ± 56.3 nmol/l (P = 0.009) in group A and from 80 ± 36 to 102.8 ± 43.3 nmol/l (P = 0.053) in group B, and decreased from 44.8 ± 18.3 to 34.6 ± 13.9 nmol/l (P = 0.06) in group C. Insulin sensitivity index (Matsuda) decreased from 11.4 ± 3 to 9.9 ± 3.2 (P = 0.046) in group A, but in comparison with other groups, it was not significant. Oral vitamin D had no effect on insulin sensitivity in pre-diabetes patients in 12 weeks treatment. A randomized double-blind study with a longer duration of treatment is suggested to investigate the effect of vitamin D on insulin resistance.

Tuberculosis (TB) is one of the main causes of morbidity and mortality in different societies. Understanding factors leading to death following diagnosis of TB is important to predict prognosis in TB patients. The aim of this study was to identify common risk factors associated with death in patients with an in-hospital diagnosis of TB, in a city in Iran with the highest prevalence and incidence of TB in the country. A retrospective study was conducted at a university-affiliated hospital, Zahedan, in the south-east of Iran, which is a referral center for TB. To identify factors leading to death, medical records of 715 patients ³ 15 years old with pulmonary TB from February 2002 to February 2011 have been evaluated. Registered factors included smoking, human immune deficiency virus (HIV) infection, using drugs, lung cancer, drug hepatitis following anti-TB medications, diabetes mellitus, previous TB treatment, anemia; and results of sputum smears. Univariate comparison and multiple logistic regression were performed to identify factors associated with mortality in TB patients. Among 715 registered TB patients, 375 (52.5%) patients were male; among those, 334 (53%) were in the alive group and 41 (54%) in the death group. Seventy-five (10.5%) of the total number of TB patients died during TB treatment. The multivariate model showed that anemia (AOR: 19.8, 95% CI: 5.6-35.5), positive sputum smear (AOR: 13.4, 95% CI: 6.8-33.6), smoking (AOR: 12.9, 95% CI: 3.9-27.3), drug hepatitis (AOR: 12.3, 95% CI: 6.7-24.7), diabetes mellitus (AOR: 9.7, 95% CI: 2.9-32.0), drug use (AOR: 7.8, 95% CI: 2.4-25.5), and history of previous TB (AOR: 6.8, 95% CI: 2.2-21.3) were major risk factors for death in TB patients. Monitoring co-morbid conditions like diabetes mellitus and anemia are important to reduce death rate in TB patients. Preventive measures for smoking and drug addiction also play an important role to decrease mortality. Follow-up of patients with previous TB treatment is recommended.

BK virus (BKV) is ubiquitous in human beings. virus reactivation may occur in immunocompromised settings. The aim of this study was to compare BKV excretion in acquired immunocompromised children (kidney transplant recipients and steroid resistant nephrotic syndrome) with normal population. One hundred and thirty one participants less than 20 years were recruited in the case-control study from June 2009 to December 2010. The participants consisted of 40 patients with steroid resistant nephrotic syndrome (subgroup 1), 39 kidney transplant recipients (subgroup 2) and 52 normal populations as control group. The first morning urine samples were analyzed in duplicate by conventional pcr method for BKV. Nine participants out of 131 had positive results for BKV. Three patients in subgroup 1 (7.5%), two patients in subgroup 2 (5.1%) and six people (11.5%) in the control group had positive PCR results for urinary BKV. no significant difference was noted among groups, P = 0.53. the mean of glomerolar filtration rates in participants with positive and negative results for BKV were 125.5 ± 30.8 ml/min/m² and 132.2 ± 42.5 ml/min/m² respectively, P = 0.8. acquired immunocompromised conditions did not increase the chance of urine BKV excretion in our study.

The chemical contamination of water is a major concern for the environmental and health authorities globally. Some anions present in the water are required for human health, but some of them are harmful. Free cyanide and nitrate are amongst the toxic agents in the aquatic environment. Cyanide is highly toxic for human beings. Industrial plants could be attributed to a major source of these toxic agents. Therefore, cyanide and nitrate concentrations in the drinking and irrigation water wells in the high industrial plants were evaluated. The samples (57) were taken from drinking and irrigation water wells as well as from a wastewater refinery in north of Mashhad in three stages – March 2009, June 2010, and July 2010. Determination of cyanide and nitrate were performed by a spectrophotometer using commercially available kits according to the manufacturer’s protocols. Cyanide and nitrate concentrations in the drinking water samples of the three stages were 0.0050 ± 0.0007, 0.0070 ± 0.0018, 0.0008 ± 0.0014 mg/L and 6.50 ± 2.80, 7.20 ± 1.80, 7.50 ± 1.90 mg/L, respectively. Cyanide mean concentration during March, June, and July was significant (P = 0.001), whereas nitrate mean concentration was not (P = 0.5). Cyanide and nitrate concentrations in the irrigation water samples of the three stages were 0.0140 ± 0.0130, 0.0077 ± 0.0025, 0.0087 ± 0.0047 mg/L and 12.37 ± 8.12, 8.04 ± 3.99, 8.40 ± 2.60 mg/L, respectively. Cyanide (P = 0.754) and nitrate (P = 0.705) concentrations were not significant during three occasions. Cyanide and nitrate concentrations in the wastewaters of the three stages were 0.1020 ± 0.033, 0.1180 ± 0.033, 0.1200 ± 0.035 mg/L and 1633.80 ± 40.74, 279.00 ± 152.17, 298.40 ± 304.74 mg/L, respectively. Cyanide (P = 0.731) and nitrate (P = 0.187) concentration in wastewaters were not significant during different months. Although nitrate and cyanide concentrations in the drinking and irrigation water were within the standard range (0.07 mg/L for cyanide and 50 mg/L for nitrate) and was not a health problem at the time of our study, regular estimation of the toxic chemicals due to the development of industrial plants in this area is recommended.

Juveniles in custody are affected by sexually transmitted infections due to risky behaviors. Therefore, they have a disproportionate burden of hepatitis B virus (HBV) and human immunodeficiency virus (HIV). In this study, the prevalence and associated characteristics of hepatitis B and HIV infections were assessed in young prisoners. In this cross-sectional study, prevalence of HBV and HIV infections was assessed among young prisoners during 2008-2009. A checklist consisting of demographic, social, and risk factors was filled out and blood was drawn for their tests. Sera were analyzed for hepatitis B surface antigen (HBs Ag), hepatitis B surface antibody (HBs Ab), hepatitis B core antibody (HBc Ab) and HIV Ab, and Western blot test was performed on antibody-positive HIV. A total number of 160 young prisoners (147 boys and 13 girls) were evaluated. The mean age of the subjects was 16.59 ± 1.24 year. HBs Ag, HBc Ab, HBs Ab, and HIV Ab were detected in 1 (0.63%), 1 (0.63%), 52 (32.5%), and 1 (0.63%), respectively. with respect to national vaccination program against HBV infection, the juvenile prisoners had low prevalence of HBs Ab.

This is the case report of a pregnant woman who refused pregnancy termination when diagnosed with pulmonary arterial hypertension (PAH) functional class 2–3 at the 24th week of gestation and of her newborn. A pregnant woman with PAH functional class 2–3 was treated with inhaled prostacyclin analog (iloprost), oral sildenafil, oxygen, and low molecular weight heparin. She delivered at 32nd week by Cesarean section. The infant required oxygen up to 36th week postconceptional age and had a short steroid treatment. The mother needed close cardiovascular monitorization, intensive oxygen and pulmonary vasodilator therapy for 2 months and was discharged with oxygen and oral iloprost treatment. A multidisciplinary approach together with pulmonary vasodilator therapy may be succesful in such a high-risk pregnant woman.

We present a rare case of Venous Thrombosis in Subclavian, Axillary, Brachial Veins with extension to Internal Jugular vein, right sigmoid sinus and simultaneous Pulmonary embolism during the treatment with low molecular weight heparin.

When superior vena cava (SVC) compress or obstructed by internal or external pressure, we encounter to SVC syndrome. The cause of this compression is malignant or benign. Although the widespread use of permanent central venous access catheters coupled with the improved success of chemotherapy has increased the incidence of SVC syndrome not caused by direct tumor infiltration (non-malignant SVC syndrome) but SVC syndrome may be a sign of advanced malignancy. In this report, we present a 30-year-old man with lymphoma that present with SVC syndrome at presentation. With chemotherapy, patient was recovered from signs and symptoms.