Journal of Research in Medical Sciences
Volume:18 Issue: 4, Apr 2013

Multiple sclerosis (MS) is a common inflammatory - degenerative disease of myelin sheet of central nervous system that affects more young people. These patients show some degrees of cognition problems such as memory and processing disorders. The aim of this study was to evaluate the speed processing ability by word finding assessment in three categories include fruits, animals and objects in MS patients. This study carried out as case-control and descriptive-analytic on 47 MS patients and 29 healthy controls. We measured the reaction time (RT) in three stages. Each stage includes 25 words (animals, fruits and objects words with high familiarity) that were presented randomly. In each stage, the subject should press a key when recognized the target category. Collected data analyzed with repeated measure ANOVA, two-way ANOVA test, and independent-samples t-test. MS patients in comparison to normal healthy subjects show delay in speed of processing in which there was significant difference between MS patients and control subjects in mean reaction time in all three categories (P < 0.001). The speed of processing is impaired in MS patients. Consequently, more evaluation and planning treatment programs based of speed processing for memory in these patients are necessary for them because of the role of memory in daily activities of life.

Thiazolidinediones (TZDs) improves insulin sensitivity by activating the peroxisome proliferator-activated receptor γ (PPAR-g). We aimed to study any association between variation in bone biochemical markers and single nucleotide polymorphism (SNP) in PPAR- γ (Pro12Ala) and investigate if these genetic variants affect bone turnover markers in Iranian diabetic population before and after treatment with pioglitazone. A total of 101 patients (type 2 diabetic (T2D) were treated for 12 weeks with pioglitazone (15 mg/day). Bone Biological markers, osteocalcin, and C-terminal telopeptide of type 1 collagen (CTx) were measured before and after pioglitazone therapy. We genotyped 128 nondiabetic controls and 101 T2D patients as well. Pro12Ala polymorphism in PPAR- γ was done by real-time polymerase chain reaction (RT-PCR) using TaqMan assay. There were statistically significant differences in allele frequencies of Pro12Ala while comparing the controls with T2D subjects. Ala frequency was 7 vs 3%, P = 0.036 and genotypic frequency of Pro/Ala was 5.94 vs 14.06%, P = 0.04. After treatment, the homeostasis model of assessment of insulin resistance (HOMA-IR) as a maker of insulin resistance was significantly decreased (p < 0.001). In respect of bone turnover markers, CTx values decreased and osteocalcin significantly increased. (p < 0.001). Our findings did not reveal a significant association between this polymorphism and bone turnover markers after pioglitazone treatment. The reduced insulin resistance might be the reason that CTx values decreased and osteocalcin increased significantly after short-term pioglitazone treatment. These findings suggest the need for further studies on the possible role of insulin in regulation of bone metabolism.

The aim of this study was to detect prognostic factors in recurrent breast cancer metastasis. Th is retrospective cohort study employed data from 996 breast cancer patients of Isfahan Seyed-o-Shohada research center from 1998 to 2010. Stratifi ed Cox proportional hazards model, marginal approach, was used to evaluate the prognostic value of estrogen receptor, progesterone receptor, tumor protein 53, human epidermal growth factor receptor type 2, diagnosis age,nodal ratio, tumor size, antigen Ki67, and cathepsin D. Survival curves were plotted using Kaplan-Meier method and log-rank test was carried out to compare survival in two categories of nodal ratio (≤0.25 vs. >0.25). In simple Cox regression model, age (P = 0.037), nodal ratio (P < 0.0001), and Ki67 (P = 0.032) were associated with hazard of distant metastasis. Multiple analysis showed that patients with greater nodal ratio had signifi cantly higher adjusted hazard of recurrent metastasis (Hazard ratio: 2.756, 95% Confi dence interval: 1.017-7.467; P = 0.046). Tumor size was not an independent prognostic factor for recurrent metastasis. Comparing survival curves, there was signifi cant diff erence between two categories of nodal ratio in the fi rst (P < 0.0001), second (P < 0.0001) and third (P = 0.024) metastasis; survival was higher in-patients with nodal ratio <0.25. Our findings indicate that tumor size was insignifi cant; this raises the question about conventional premise of being a major prognostic factor for distant metastasis. Furthermore, nodal ratio is suggested to clinicians as a prognostic variable in follow-up of breast cancer patients; patients with higher nodal ratio have greater hazard of distant metastasis.

Growth hormone deficiency (GHD) is associated with an increased cardiovascular mortality.Increased oxidative stress has been associated with development of cardiovascular and cerebrovascular diseases. In the present study, we aimed to evaluate oxidant and antioxidant status in patients with GHD by analyzing serum paraoxonase1 (PON1) activity, and malondialdehyde (MDA) and thiol levels. This study was a case–control study. Thirty patients with GHD were included in the study and compared with 20 healthy controls. Serum PON1 activity, and MDA and thiol levels were measured according to an enzymatic spectrophotometric method. Serum MDA levels (2.8 } 1.3 nmol/mL) were higher in GHD group than the controls (1.7 } 0.5 nmol/mL) (P = 0.001). PON1 activity (149.9 } 77.9 U/L) was lower in GHD group than the controls (286.3 } 126.7 U/L) (P = 0.001). Thiol and high‑density lipoprotein cholesterol (HDL‑cholesterol) levels were lower in GHD group (218.6 } 103.9 μmol/L and 32.6 } 13.4 mg/dL, respectively) than the controls (289.6 } 101.1 μmol/L and 54.3 } 14.9 mg/dL, respectively) (P = 0.021 and P = 0.001, respectively). In GHD patients, serum MDA level was negatively correlated with serum HDL‑cholesterol (r = −0.499, P = 0.001), and serum PON1 activity was positively correlated with serum thiol and HDL‑cholesterol levels (r = 0.306, P = 0.032 and r = 0.303, P = 0.033, respectively). These data support that GHD is characterized by an imbalance between oxidant and antioxidant factors. This abnormality may contribute to the increased atherogenic risk in patients with GHD.

Obesity has been associated with several co‑morbidities such as diabetes and increased mortality. In general, the use of medication promotes only a modest weight loss in the range of 2 to 10 kg, usually most effective during the first 6 months of therapy; however, studies have shown positive effects on other risk factors such as blood pressure and serum glucose levels, but there are fewer studies in patients with diabetes. The aim of this study was to assess the effect of topiramate on weight reduction patients with type 2 diabetes. This was a 32‑week randomized clinical trial study of 69 subjects during 2008‑2010. Patients, in two treatment groups were given topiramate (39 patients) and Placebo (30 patients) and were subjected to participation in a non‑pharmacologic lifestyle intervention program; which were randomly allocated in our two groups. The percentage change in body weight and Body Mass Index (BMI) at the end of the study was the primary efficacy endpoint and secondary indicators were changes in blood pressure (BP), proportion of subjects who achieved 5% or 10% weight loss, changes in lipid profile (total cholesterol, low‑density lipoprotein cholesterol, high‑density lipoprotein cholesterol, triglycerides); and changes in glycosylated hemoglobin (HgA1c). Paired samples and independent samples t‑test was used for statistical analysis. (RCT code: IRCT201112036027N2). All results were extracted on base of 69 (Intended to treat) ITT patients. Mean BMI changes was significantly higher in patients treated with topiramate (‑1.08 1.90 vs. +0.086 ± 1.05 kg/m2, P = 0.006). Mean weight loss percentage was significantly different between active and placebo groups (‑3.02 ± 5.78% vs. +0.32 ± 3.54%, P = 0.005) and systolic blood pressure and HgA1C significantly decreased in patients treated with topiramate (P = 0.021 and P = 0.047, respectively). Topiramate induced weight loss and improved glycemic control in obese, diabetic patients.

Lumbar puncture (LP) is an essential procedure in the diagnosis and treatment of several critical situations. This procedure is routinely performed by palpating external landmarks to fi nd the most appropriate inter-spinous space. In the current study, we compared surface landmark and ultrasound (US) guided LP in different aspects. This clinical trial study was conducted at the emergency department (ED) of a teaching hospital from March 2009 to March 2010. Eighty patients were allocated randomly in two equal groups. In first group, LP was performed by US-guided method and in the control group by palpation of external landmarks of spinal column. Pain score, number of attempts for successful dural penetration, numbers of traumatic LP, and procedure time were compared between two groups. The performance of US-guided LP was assessed with regard to body mass index (BMI) of patients too. The mean of procedure time and pain scores were markedly higher in land mark group in comparison to US group (6.4 ± 1.2 and 7.4 ± 1.1 vs. 3.3 ± 1.2 and 4.4 ± 1.4 respectively).Number of attempts and number of traumatic LPs were significantly lower in US group too. In patients with different subgroups of BMI, US-guided LP showed better results and less complication when compared with surface landmark guided technique. All of these results were statistically significant. This study showed that US was able to find pertinent landmarks to facilitate the LP in patients admitted to ED and resulted in less pain and less time wasting. Moreover, patients who have high BMI may benefi t more than others.

Designing intervention based on health-care settings resources and patient acceptability is potentially important in the prevention of high blood pressure (BP) and other risk factors of cardiovascular disease. To explain a multicenter randomized controlled trial that is designed to examine the effects of the multicomponent lifestyle modification program on BP. The effectiveness of the lifestyle modification program versus usual care in health- care centers is evaluated in a randomized controlled trial. Patients aged 30 years or older having a systolic blood pressure (SBP) of 140-179 mmHg or a diastolic blood pressure (DBP) of 90-109 mmHg or patients taking antihypertensive medications are eligible for the study. The primary outcomes measured are SBP and DBP levels. Mediator outcomes include physical activity level, stress scale, dietary composition, and weight measurements. All measurements will be conducted after the 4 weeks of intervention and also at 6 months. Outcomes of the study will present the effects of implementing multicomponent lifestyle intervention programs to control BP in health-care centers settings.

Previous studies have demonstrated that nuts consumption have beneficial effects on serum lipid profiles in hyperlipidemic or normolipidemic subjects. However, similar studies in diabetes field are quite rare. So, we aimed to investigate the effects of hazelnut consumption on fasting blood sugar (FBS) and lipid profiles in patients with type 2 Diabetes. An 8‑week controlled randomized parallel study in patients with type 2 diabetes. Fifty eligible volunteers were assigned to either the control or intervention groups. 10% of total daily calorie intake was replaced with hazelnuts in intervention group. Blood samples were collected from fasting patients at the start and at the end of the study. After 8 weeks, there were significant differences in high‑density lipoprotein‑cholesterol (HDL‑C) concentrations between two groups, using analyses of covariance (P = 0.009), which was due to the larger HDL‑C reduction in control group (P = 0.003). Although, Hazelnut group achieved greater reduction in triglyceride (TG) concentrations than control group, these changes were not statistically significant. Neither between‑group changes nor within‑group changes were significant for FBS, total cholesterol (TC), TG, and low‑density lipoprotein‑cholesterol (LDL‑C) levels. Results of this study indicated that incorporation of hazelnuts into diet can prevent reduction of HDL‑C concentrations in patients with type 2 diabetes, but had no effect on FBS or other lipid profile indices.

Cardiopulmonary bypass (CPB) during coronary artery bypass grafting is thought to contribute significantly to increased blood glucose level and altered blood electrolytes balance during the operation. In this (CABG) study, blood electrolytes and glucose during CPB in insulin-dependent diabetic and non-diabetic patients were assessed with special emphasis on the trend of the changes. Blood glucose and electrolytes were assessed in 30 insulin-dependent diabetic and 30 non-diabetic patients, classified as class II and III American Society of Anesthesiologist, before, during, and after CPB. Repeated-measures analysis of variance (ANOVA) was used to compare the trend of the changes during CPB for the two groups. The trend in blood glucose level did not show any significant difference between two groups (P = 0.59). For other blood factors, no significant between-group difference was detected except for PaCO2 (P = 0.002). The study suggested that the changes in blood electrolytes and the increase in blood glucose level do not differ between insulin dependent diabetic and non-diabetic patients.

To evaluate the association of apolipoprotein B (apoB), apolipoprotein A (apoA), and apoB/apoA ratio with the body fat indicators in patients with stable angina pectoris (SA). One hundred and twenty two participants aged 40-60 years old, with a mean age of 52.1 ± 7.2 years and SA, were recruited for the present study. Body weight, height, and waist circumference (WC) were measured, and waist to height ratio (WHtR) was calculated. After 12 hours of fasting, a blood sample was obtained and serum levels of apoB and apoA were measured and the apoB/apoA ratio was calculated. These patients underwent an abdominal computerized tomography scan (CTS) to assess visceral and subcutaneous adipose tissue (VAT, SAT). Linear regressions were computed to assess the relation of apoB, apoA, and their ratio with various measurements of adiposity (VAT, SAT, WC, and WHtR), with adjustment for age, sex, and BMI ≥ 25, WC ≥ 80 in women and WC ≥ 90 in men and WHtR ≥ 0.59. From totally 123 patients with SA with a mean age of 52.1 ± 7.2 years, 44.7% male and 55.3% women were entered. Significant positive associations were found between visceral fat area and the apoB/apoA ratio (P = 0.02, β = 0.2), and significant negative correlations were observed between visceral fat area and apoA concentrations (P = 0.04, β = −0.2). As abdominal fat accumulation is associated with other risk factors such as apolipoproteins in ischemic patients, then we most focus on control of these factors.

Date is one of the foodstuff s that are produced in tropical areas and used worldwide. Conventionally, methyl bromide and phosphine are used for date disinfection. The toxic side effects of these usual disinfectants have led food scientists to consider safer agents such as ozone for disinfection, because food safety is a top priority. The present study was performed to investigate the possibility of replacing common conventional disinfectants with ozone for date disinfection and microbial load reduction. In this experimental study, date samples were ozonized for 3 and 5 hours with 5 and 10 g/h concentrations and packed. Ozonized samples were divided into two groups and kept in an incubator which was maintained at 25°C and 40°C for 9 months. During this period, every 3 month, microbial load (bacteria, mould, and yeast) were examined in ozonized and non-ozonized samples. This study showed that ozonization with 5 g/h for 3 hours, 5 g/h for 5 hours, 10 g/h for 3 hours, and 10 g/h for 5 hours leads to about 25%, 25%, 53%, and 46% reduction in date mold and yeast load and about 6%, 9%, 76%, and 74.7% reduction in date bacterial load at baseline phase, respectively. Appropriate concentration and duration of ozonization for microbial load reduction were 10 g/h and 3 hours. Date ozonization is an appropriate method for microbial load reduction and leads to an increase in the shelf life of dates.

Worldwide, cancer of stomach is still the fourth common cancer and the second cause of mortality among all cancers affecting annually 870,000 subjects. This study aims to determine the frequency and the characteristics of gastric cancer in southern Iran. 10,800 of all cancers registered in Fars Hospital-based Cancer Registry were surveyed among which 574 cases were gastric cancer in both genders and all age groups. From January 2002 to December 2007, all hospital-based data were recorded according to International Classification of Disease for Oncology (ICD-O) and registered cases included all invasive cancers in ICD-10 categories of C-00 to C-80 and all duplicate cases were eliminated. Among all registered cancers, there were 574 cases of gastric cancer including 69.3% males. The mean age of patients was 58.1 ± 14.8 years, 25.4% with a history of in their first relatives and most of them were smokers (50.9%) and from low socioeconomic class (45.5%). Metastasis was visible in 182 patients and majority of them underwent surgery (64.3%). The majority of gastric cancer patients were older than 50 years, smokers, low socioeconomic class, and female in favor of adenocarcinoma. Our results showed that in our area, treatment programs and health plans should focus on men, patients older than 50 years and with adenocarcinoma, smokers, and those in a low income level.

Th e eff ects of chronic valproic acid administration on bone health have been a matter of concern and controversy.In this study, the bone status following valproate intake was assessed by using several bone-related biochemical markers. In this case-control study, 62 epileptic patients and 40 age- and gender-matched controls were enrolled. The patients had been under chronic valproate therapy (758 ± 29 mg/day) for at least the past 6 months, without any vitamin D/or calcium supplementation. Serum markers of bone turnover (carboxy-terminal telopeptide of type I collagen (CTX) and bone-specifi c alkaline phosphatase [BALP]), calcium, phosphorus, total alkaline phosphatase, and parathyroid hormone levels were measured in both groups. The markers of bone turnover as well as other measured bone biochemical parameters did not statistically differ between the two groups. Valproate therapy at the mentioned doses does not seem to change bone turnover in adult epileptic patients.

Nutrition for under‑5 children is of great importance as the foundation for life‑time health, strength, and intellectual vitality is laid during this period. Globally, more than one‑third of the child deaths are attributable to under‑nutrition. The discriminatory attitudes against female children vary from being implicit to those that are quite explicit. So, the present cross‑sectional study aims to assess the nutritional status (gender differences) of 146 under‑5 children attending Anganwadis and also to study the bio‑socio‑demographic factors associated with malnutrition attending three Anganwadis of Adopted Urban slum area, involving anthropometric examination using standardized techniques and interview using predesigned semi‑structured questionnaire for the mothers in September‑October 2011. Nutritional status grading was done based on weight for age as per Indian Academy of Pediatrics (IAP) Classification and using height for age as per Vishveshwara Rao’s Classification. 51.4% were males, majority in age group of 2‑3 years. 63% children were malnourished, majority in Grade I malnutrition. Out of the total females, 72% were stunted and 43% were severely malnourished having mid arm circumference <12.5 cm. Birth order (P < 0.05), education status of the mother (P < 0.001), socio‑economic status (P < 0.05) and type of family (P < 0.05) were found to be significantly associated with malnutrition.

Since, the nutritional behavior is a complicated process in which various factors play the role, this study aimed at specifying the effective factors in nutritional behavior of diabetic patients based on Health Promotion Model. This paper reviews the published articles from 2000 to the beginning of 2012, using the various data banks and search engines such as PubMed, ProQuest, Scopus,Elsevier, and the key words” perceived benefits and barriers, perceived self-efficacy, social support, activity related affect, situational influences, commitment to plan of action, immediate competing demands and diabetes, self-caring and diabetes. Unfavorable self-care situation especially, inappropriate nutritional behavior is related to some effective modifiable factors. Perceived benefits and self-efficacy regarding behaviors play a major role in the nutritional behaviors. Social support especially, spouses’ support has a significant role in this regard. Moreover, there is a reverse relationship between perceived barriers and nutritional self-care. In addition, behavioral feelings, situational influences, commitment to plan of action and immediate competing demands and preferences can also impact and overshadow the nutritional self-care. Following the relationship between constructs of Health Promotion Model and nutritional behavior the constructs of this model can be utilized as the basis for educational intervention among diabetes.

Dural arteriovenous fi stula (DAVF) is also known as dural arteriovenous malformation. Two forms of DAVF have been introduced, however, here we present an exceptional case of DAVF with unique origin and drainage. In this study, we present a rare case of multiple DAVFs in a 50 year old man with right parietal intraparenchymal hemorrhage. MRI showed two round right parieto-occipital masses with flow void intensity adjacent to superior sagittal sinus (SSS). Another pathology connected to SSS by an abnormal cortical vein was detected anterior to first lesion. This study showed that both DAVFs were simultaneously drained in SSS in our patient.

Homogeneously staining regions (HSR) or double minute chromosomes (dmin) are autonomously replicating extra-chromosomal elements that are frequently associated with gene amplifi cation in a variety of cancers. The diagnosis of leukemia patients was based on characterization of the leukemic cells obtained from bone marrow cytogenetics. This study report two cases, one with Acute Myeloblastic Leukemia without maturation (AML-M1), aged 23-year-old female, and the other with chronic myelogenous leukemia (CML)-blast crisis, a 28-year-old female associated with double minute chromosomes. Most cases of acute myeloid leukemia with dmin in the literature (including our cases) have been diagnosed as having acute myeloid leukemia.