Journal of Research in Medical Sciences
Volume:18 Issue: 5, May 2013

Cisplatin (cis-diamminedichloroplatinum II; CP) is used widely as an antitumor drug in clinics, but is accompanied with renal toxicity. Cisplatin induced nephrotoxicity consists of change in kidney weight, histological changes in kidney and increase in serum creatinine (Cr) and blood urea nitrogen (BUN). This study was designed to find out a model for prediction of cisplatin induced nephrotoxicity. Pathological damage score, kidney weight, BUN, and Cr of 227 rats that were involved in different projects were determined. A total of 187 rats were treated with 7 mg/kg cisplatin and sacrificed 1 week later. There was a good significant correlation between normalized kidney weight and logarithmic scale of BUN and Cr. Relationship between BUN, Cr or normalized kidney weight and pathology damage score was significant. Normalized kidney weight and pathology damage score is a good predictor of renal function in cisplatin induced nephrotoxicity in experimental rats.

Nowadays Vitamin D deficiency is a notable medical condition world-wide and also in Iran. Since, vitamin D can have reoprotective effect by inhibiting the renin-angiotensin system; it appears that low vitamin D level can worsen the renal injury in diabetic patients. This study demonstrates the effect of vitamin D3 therapy on reducing proteinuria in diabetic patients with concomitant diabetic nephropathy and vitamin D deficiency after controlling hypertension and use of angiotensin converting enzyme inhibitors (ACEIs) or angiotensin II type receptor blockers (ARBs). In this randomized double blinded parallel groups clinical trial, 51 diabetic patients with proven nephropathy and vitamin D deficiency/insufficiency and stable hypertension,dyslipidemia, and hyperglycemic treatment were enrolled. Th e patients were divided randomly into two groups (treatment and placebo group). Patients received oral vitamin D3 (pearl 50000 IU) or placebo one pearl every week for 12 weeks. Patients were assessed at baseline and 12 weeks after intervention from the point of 25(OH) D level, and urine albumin/creatinine ration (UACR). Mean serum 25(OH) D concentrations were 14.06 ng/ml and 16.05 ng/ml before treatment. Furthermore, after intervention, its levels were risen to71.23 and 17.63 in drug and placebo groups, respectively. Whereas, UACR as the main variable did not change significantly after intervention in both groups (P = 0.919). According to our finding, there was not a decrease in proteinuria in diabetic patients who received vitamin D for a period of 3 months.

It was aimed to compare the efficacy and adverse effects of levobupivacaine alone and in combination with fentanyl and sufentanil during transurethral resection of the prostate (TURP) under spinal anesthesia. In this prospective, randomized, double-blind trial, 60 patients undergoing elective TURP under spinal anesthesia were randomized into three groups. Ten milligrams of 0.5% levobupivacaine in Group-I, 7.5 mg 0.5% levobupivacaine combined with 25 µg fentanyl in Group-II and 7.5 mg 0.5% levobupivacaine with 2.5 µg sufentanil in Group-III were administered intrathecally. The time for sensorial block to reach level T10 was 10.2 ± 2.0, 6.9 ± 1.7 and 7.0 ± 1.4 min in Group-I, II and III, respectively (P <0.001). The maximum sensorial block level was T8 in all groups. The frequency of a complete motor block was higher in Group-I. The mean duration of motor block was shorter in Group-II and III than in Group-I (P <0.001). There were no differences between groups regarding side effects (P >0.05). The time for first analgesic request was shorter in Group-I than in the other two groups (P <0.05). During the first postoperative 24-h period, 11 (58%) patients in Group-I, 9 (48%) patients in Group II and 9 (45%) patients in Group-III required an analgesic drug (P> 0.05). This study showed that combining lower dose levobupivacaine with fentanyl and sufentanil provides faster onset ofsensorial block, lower frequency and shorter duration of motor block, and longer analgesia time in TURP under spinal anesthesia.

Long-term tunneled catheters are used for the hemodialysis or chemotherapy in many patients. Proper placement of the catheter tip could reduce early and late catheter related complications. Aim of the present study was to evaluate a new formula for proper placement of tunneled hemodialysis or infusion port device by using an external anatomic landmark. A total of 64 adult patients undergoing elective placement of tunneled Central Venous Catheter (CVC) requiring hemodialysis or chemotherapy were enrolled in this prospective study during 2011-2012 in the university hospital. The catheter length to be inserted in the right internal jugular vein (IJV) was calculated by adding two measurements (the shortest straight length between the insertion point of the needle and the suprasternal notch plus and half of sternal length). The catheter position was considered correct if the tip was positioned in the right atrium (RA) or Superior vena cava (SVC)-RA junction. The patients were 55.28 ± 19.85 years of age, weighed 5.78 ± 16.62 kg and were 166.07 ± 10.27 cm tall. Catheters were inserted successfully in 88% of patients (n = 56). Catheter tip positions in the failures were SVC (n = 5), tricuspid valve (n = 2), and right ventricle (n = 1) in our patients. Long-term hemodialysis or port CVC could easily insert in the right IJV by using half of the sternal length as an external land marks among adult patients.

The serum prostate specific antigen (PSA) levels are used for prostate cancer screening. Some conditions such as prostatitis, manipulation, and prostate cancer could influence on serum PSA. The impact of ejaculation on serum PSA is controversial. The aim of our study was to evaluate the relation of ejaculation and the levels of serum PSA. In this cross-sectional study, 60 healthy voluntary men below and over 50 years during the year 2009-2011 were participated. After history taking, physical examination, and identical lower urinary tract symptoms score (American Urologic Association Score = AUA); three blood samples were taken before, 1 and 24 h after ejaculation. Patients categorized into a non-screening group (age less than 50 years, n = 25), and screening group (age ≥ 50 years, n = 35). Our data showed significant PSA rising in both groups 1 h after ejaculation (P value < 0.05); however, comparison of PSA levels in both groups, before and 24 h after ejaculation showed no significant differences. Spearman coefficient of correlation was showed a positive correlation between PSA in all stage and AUA score in the second group, but there were no such correlation in the first group. There was a significant relationship between ejaculation and the levels of serum PSA in screening and non-screening patients. However, in non-screening men significant rising of PSA after 1 h of ejaculation was not important clinically (not achieve to greater than 4 ng/ml). Taking a history of ejaculation in men older 50 years especially with high AUA score could prevent false positive results and subsequent un-necessary work-ups.

High prevalence of obesity and the importance of this issue as a risk factor for chronic diseases such as severe cardiovascular diseases, diabetes, and cancer necessitate the need for treatment. The aim of this study was the evaluation of acarbose effect on the weight loss in non-diabetic overweight or obese patients in Kerman. A double-blind randomized controlled clinical trial was performed on 66 patients with the body mass index (BMI) between 25 and 35 kg/m2. Patients were divided in treatment and control groups using the randomization. Th e treatment group took 100 mg acarbose 3 times a day for 20 weeks in combination with the low-calorie diet and exercise. Control group was given placebo, low-calorie diet, and exercise. BMI was measured after 20 weeks. The analyses were carried out using t-test and repeated measured ANOVA. Patients in acarbose and placebo group had a non-significant difference in BMI at baseline. Reducing in weight was considered in every month in both groups, but this reduction was higher in the treatment group. At the 5th month, the difference of BMI in the treatment group was significantly lower than the placebo group (2.31 } 0.6 vs. 0.76 } 0.6 kg/m2, P < 0.001). Acarbose, especially in combination with the low-calorie diet and exercise, seems to lose weight effectively in obese and overweight patients in communities that have a high carbohydrate intake (like Persian diet).

Back ground: Considering the high prevalence of congenital hypothyroidism (CH) in Isfahan, the intelligence quotient (IQ) of children with CH and the effect of diagnostic and treatment variables on it were investigated during the CH screening program. A total of 120 children in three studied groups were studied in this comparative study the IQ score, in three subsets of verbal IQ, performance IQ and full scale IQ, of children diagnosed with transient congenital hypothyroidism (TCH) and permanent congenital hypothyroidism (PCH) was measured using revised Wechsler pre-school and primary scale of intelligence and compared with the control group. The relation between IQ score with time of treatment initiation and screening thyroid stimulating hormone (TSH) level was evaluated in all studied groups. Mean of verbal IQ, performance IQ, and full scale IQ score was significantly higher in the control group than CH patients (both permanent and transient) In PCH patients though it was not significant, there was a negative relationship between verbal IQ, performance IQ and full scale IQ and screening TSH and age of treatment initiation. In TCH patients, there was negative and significant relationship between verbal IQ (r = −0.40) and full scale IQ (r = −0.38) and age of treatment initiation (r = −0.46). Mean IQ score in both PCH and TCH patients were lower than the control group, which correlates negatively with treatment initiation time. Though CH screening and early treatment has improved the prognosis of patients, but early and high dose of treatment in children with CH is recommended.

Botulinum toxin A (BTA) is a promising therapeutic option in the treatment of allergic rhinitis (AR). Although recent studies have introduced BTA septal injection as an alternative method, the conventional localization for the injection of BTA in patients with AR is still the nasal turbinates. This study was designed to compare the effectiveness and safety of septal BTA injection with turbinal BTA injection in patients with AR. This open-label study was performed on 50 patients with AR who were randomly allocated to septal and turbinal BTA injection groups. All patients received an injection of 40 U of BTA (Dysport®, Ipsen Ltd, Maidenhead, UK) in each side of the nose and were followed for 8 weeks. Prior to the intervention and 8 weeks later, symptom severity and quality of life scores were calculated using the AR symptom severity and Rhinasthma questionnaires respectively. Comparison of pre- and post-treatment symptom severity scores within each group showed a significant reduction of total symptom severity score and severity of sneezing, rhinorrhea, and congestion in both groups (P < 0.05). However, post-treatment symptom severity scores were not significantly different between two groups (P > 0.05). Both methods have improved the quality of life of subjects significantly (P < 0.05). Significantly more patients in the turbinal injection group reported adverse effects (four patient’s vs. one, P < 0.05). Although both septal and turbinal BTA injections are effective on patients with AR, septal administration of BTA could be safer and easier method. However, further investigations are required to achieve more accurate results.

This study was designed to investigate the effect of vitiligo on the retinal nerve fiber layer (RNFL) thickness. This prospective study was conducted in the Department of Ophthalmology at Kırıkkale University during 2010 and 2011.Sixty eight eyes of 34 vitiligo patients were included in the study. Eighty four eyes were served as control. RNFL thickness was measured by scanning laser polarimetry (Nerve Fiber Analyzer, GDx VCC: 5.3.3; Laser Diagnostic Technologies, San Diego, CA, USA). The mean duration of vitiligo was found to be 9.8 } 2.3 years. The mean average RNFL thickness outside the disc margin was significantly lower in the right eyes of vitiligo group in comparison to the controls (P = 0.02). The mean average thickness of RNFL beneath the measuring ellipse in the superior sector of both eyes were significantly lower than the controls (P = 0.004, P = 0.008, respectively). The topographical distributions of RNFL thickness in superior, inferior, nasal and temporal quadrants were similar for two groups. RNFL thickness seems to be unaffected in vitiligo patients.

Arsenic (As), one of the most significant hazards in the environment affecting millions of people around the world is associated with several diseases including cancers, Diabetes Mellitus (DM) and Hypertension (Htn). Drinking water contaminated with inorganic arsenic (iAs) is the primary route of exposure. This study was conducted to determine the difference in the prevalence of DM and Htn in areas with different levels of water contamination of As. In this analytic ecologic study, after measurement of As level in drinking water in all urban regions of Qazvin Province (Islamic Republic of Iran), two cities with As level of 20-30 μg/L and two with the As level <5 μg/L were selected as exposed and unexposed groups, respectively. Measuring the prevalence of above-mentioned diseases in the 30-60 year-old population of the said regions as total sampling, the results were statistically analyzed and compared. The mean prevalence of Htn in exposed and unexposed areas were 7.09% and 3.73%, respectively and for DM were 4.53% and 1.99% in the said groups, respectively. There was a positive correlation between As level and Htn (P < 0.001) and between As level and DM (P < 0.001). High level of as in drinking water, even in the range of 20-30 μg/L has a relationship with increased prevalence of DM and Htn.

Breast cancer is the most common type of cancer among women, and the second cause of cancer mortality after pulmonary cancer in this gender. Radiotherapy is one of the major treatments, which locally controls the disease and prohibits in recurrency. Radiation pneumonitis is one of the radiotherapy complications, which usually occurs within 1.5-3 months after radiotherapy. As there is no precise estimation concerning this complication in Isfahan, partial frequency of radiation pneumonitis and its association with the energy and treatment technique in patients with breast cancer were evaluated. This was an analytic cross-sectional study performed in 2010 in university referral center. A total of 382 patients with breast cancer, undergone surgery and referred for radiotherapy entered the study. A posterior and anterior and lateral X-Rays were taken as control images before starting radiotherapy and all X-Rays were repeated after 3-4 months post radiotherapy. The occurrence of radiotherapy pneumonitis was evaluated by the same radiologist. Data were analyzed through SPSS version 20. Out of 382 patients undergone breast conservative surgery (BCS) or modified radical mastectomy (MRM), and radiotherapy, 60 patients had pneumonitis of whom 6 patients underwent BCS and were treated by tangential field (three cases by Co 60 and three cases by PH 9). The rest of radiotherapy pneumonitis patients (n = 54) underwent MRM of whom, 42 cases were treated by one-field and 12 by two-field treatment techniques. Incidence of radiotherapy pneumonitis was different with respect to the adopted technique (one-field, two-field and tangential) (P = 0.023), with the highest association with two-field radiotherapy.

Assessing educational environment is vital in determining the success or failure of any institute. A positive environment leads to achievements of students in learning while a negative one would hinder their accomplishments. The aim of this study was to evaluate the medical students’ perceptions of their educational environment and to identify any differences related to gender and colleges affiliated with the University. This cross-sectional study involved all medical colleges affiliated with Dow University of Health Sciences from September to November 2011. DREEM questionnaire was administered to undergraduate medical students of the colleges. Mean and standard deviation of total DREEM score and five subscales were reported. The internal consistency coefficient (Cronbach’s alpha) was calculated. Student’s t test and one-way ANOVA were used for statistical analysis. Total respondents were 586 students (response rate = 90.1%), 463 (79.0%) were female. Total DREEM mean score was 114.4/200 (57.2%). Highest score was found in the domain of student’s academic self-perceptions (58.7%) and lowest in domain of student’s perception of learning (53.7%). The inventory was found to have good reliability, with an alpha-coefficient of 0.89. There was significant difference of total DREEM score, student’s perception of learning, teachers, and atmosphere between different colleges. Females perceived their educational environment to be more positive compared to male students. The undergraduate educational environment of the university is more positive than negative. Highest score was found in domain of student’s academic self-perceptions and lowest in domain of student’s perception of learning.

Placental abruption is one of the most common causes of bleeding during pregnancy. Multiple factors are known to be associated with increase of risk of placental abruption such as alcohol, cocaine use and cigarette smoking. The objective of this study was to identify risk factors for placental abruption in an Iranian women population. In a retrospective case –control study birth records included 78 cases with placental abruption and 780 randomly selected controls were investigated. Statistical analysis for comparing the studied risk factors between groups was performed using pearson,s Chi – square test along with presenting relevant odds ratio(OR). From 7301 deliveries included in the study, 78 (1%) was complicated placental abruption. Women aged 35 or more likely for experiencing (OR = 3.650,95% confidence interval [CL] = 1.57-6.83) and those who had a previous cesarean section (OR = 2.65,95% CL = 3.91- 33.41) were in higher risk for placental abruption([50 cases] 64%vs. [28 cases] 36% P< 0.01). The results indicate that among the placental abruption is one of the most common causes of bleeding during The pregnancy and one of the major obstetrical emergency.

This study was aimed to evaluate protective and therapeutic effects of a specific mixture, containing vitamin C, lysine, proline, epigallocatechin gallate and zinc, as well as alpha-1-antitrypsin protein on lung tumorigenesis induced by benzo(a) pyrene (B (a) P) in mice. Swiss albino mice were divided into two main experiments, experiment (1) the mice were injected with 100 mg/kg b (a) P and lasted for 28 weeks, while experiment (2) the mice were injected with 8 doses each of 50 mg/kg b (a) P and lasted for 16 weeks. Each experiment divided into fi ve groups, group (I) received vehicle, group (II) received the protector mixture, group (III) received the carcinogen, group (IV) received the protector together with the carcinogen (simultaneously) and group (V) received the carcinogen then the protector (consecutively). Total sialic acid, thiobarbituric acid reactive substances, vascular epithelial growth factor, hydroxyproline levels, as well as elastase and gelatinase activities showed significant elevation in group (III) in the two experiments comparing to control group (P < 0.001). These biochemical alterations were associated with histopathological changes. Administration of the protector in group IV and group V causes significant decrease in such parameters when compared with group III in the two experiments (P < 0.001). Th e present protector mixture has the ability to suppress neoplastic alteration and restore the biochemical and histopathological parameters towards normal on lung carcinogenesis induced by benzo(a) pyrene in mice. Furthermore, the present mixture have more protective rather than therapeutic action.

Acute kidney injury (AKI) is commonly occurred in intensive care unit (ICU) patients. The aim of the study was a comparison of RIFLE (Risk of renal injury/Injury to the kidney/Failure of kidney function/Loss of kidney function/End stage disease) classification with other scoring systems in the evaluation of AKI in ICUs. We performed a retrospective study on 409 ICU patients who were admitted during the 5 years period. At the 1st day of admission and time of discharge, the total and non-renal Acute Physiology and Chronic Health Evaluation II and sequential organ failure assessment scores were compared to max RIFLE criteria. In this assessment, there was concordance among the results (P < 0.05). The RIFLE classification can be used for detection of AKI in ICU patients.

Various forms of neuropathy are seen diabetic patients; chronic inflammatory demyelinating polyneuropathy (CIDP) seems not to be infrequent neuropathy in patients suffering from diabetes and it seems to be more common than in the general population; on the contrary, some authorities do not support pathogenesis association between diabetes mellitus (DM) and CIDP. Also, there are some controversies on the subject of CIDP treatment in diabetic patients. Some studies showed that patients with CIDP-DM considerably had recovered following treatment with immunotherapeutic modalities like (Intravenous immunoglobulin) IVIG and conversely, some else have argued against the prescription of IVIG in this group and recommend treatment with corticosteroids and provided that resistant, rituximab may be beneficial. The main limitation in most studies is the inadequate number of cases and as a result, problematic decision making in treatment. This article represents an inclusive review of diabetic CIDP presentation and treatment.

Pharmacists as one of health-care providers face ethical issues in terms of pharmaceutical care, relationship with patients and cooperation with the health-care team. Other than pharmacy, there are pharmaceutical companies in various fields of manufacturing, importing or distributing that have their own ethical issues. Therefore, pharmacy practice is vulnerable to ethical challenges and needs special code of conducts. On feeling the need, based on a shared project between experts of the ethics from relevant research centers, all the needs were fully recognized and then specified code of conduct for each was written. The code of conducts was subject to comments of all experts involved in the pharmaceutical sector and thus criticized in several meetings. The prepared code of conducts is comprised of professional code of ethics for pharmacists, ethics guideline for pharmaceutical manufacturers, ethics guideline for pharmaceutical importers, ethics guideline for pharmaceutical distributors, and ethics guideline for policy makers. The document was compiled based on the principles of bioethics and professionalism. The compiling the code of ethics for the national pharmaceutical system is the first step in implementing ethics in pharmacy practice and further attempts into teaching the professionalism and the ethical code as the necessary and complementary effort are highly recommended.

Inadvertantly or purposely, an oral intake of corrosive substances may cause life-threatening problems. Early admission to the hospital, clinical and endoscopic evaluation, and early surgery when required, may reduce morbidity and mortality. We report the case of a 49-year-old male patient, who had attempted suicide, by drinking about 800 mL of 25% hydrochloric acid, and who had severe intraabdominal damage. The aim of this report is to state the fact that a good outcome is possible in severe burns caused by oral intake of corrosive substances, when fast, multidisciplinary, and appropriate management is provided on time.

Laryngocele is an air-filled, abnormal dilation of the laryngeal saccule that extends upward within the false vocal fold, in communication with the laryngeal lumen. A case of 43-year-old male with bilateral internal laryngoceles, who has been treated as asthma for 4 years, is presented. The patient had dyspnea, cough, and excessive phlegm for a month and a late onset stridor. Flexible nasopharyngolaryngoscopy showed bilateral cystic enlargements of the false vocal folds and true vocal folds could not be visualized. Laryngeal CT without contrast enhancement showed bilateral internal laryngoceles. Submucosal total excision of bilateral cystic masses including parts of false vocal folds was performed. The symptoms resolved immediately after surgery. Although the incidence of internal laryngocele is rare, it should be remembered in the differential diagnosis of upper airway problems and diagnostic flexible nasopharnygolaryngoscopy is routinely indicated for airway evaluation in at-risk patients.