Journal of Research in Medical Sciences
Volume:18 Issue: 11, Nov 2013

Routine protocol of asthma treatment has been focused on symptom suppression but severity of inflammation and spirometry findings may be neglected. We investigated the efficacy of full dose treatment protocol on patients with mild asthma symptoms with normal spirometry. A before-after clinical trial study was conducted on patients with asthma symptoms (dyspnea, cough, and wheezing), while they had a near to normal pulmonary function test. Full dose treatment protocol (prednisolone 1 mg/kg for 5 days then fluticasone spray 250 mg four puffs daily plus salmeterol spray 25 mg four puffs daily), which was routinely used for severe asthma, was administrated and patients were followed up for 2 months. Sixty-eight patients (mean age (±SD) = 43.77 ± 10.70 years, female/male ratio; 47/53%) finally finished the study. At the baseline, mean forced expiratory volume in first second (FEV1) and forced vital capacity (FVC) were 91 ± 12% and 87 ± 11% of the predicted value, respectively. Two months after treatment, the mean FEV1 and FVC were 105 ± 14% and 97 ± 10%, respectively, which both improved compared with the baseline, significantly (P < 0.001). Frequencies of cough and dyspnea were significantly decreased (P = 0.041 and 0.034, respectively). Our result declared that full dose treatment can improve spirometry amounts and frequency of symptoms in patients with near to normal spirometry and obvious asthmatic symptoms. Routine treatment protocol of mild asthma recommends sole short-acting b2 receptor agonist, but it seems that pulmonary function and volume can be increased with more aggressive treatment.

Along with conventional electrodiagnostic studies, several other indexes including residual latency (RL) were introduced in patients with different types of peripheral neuropathies. RL is the time difference between measured and predicted distal conduction times. This study was performed to determine the values of the median nerve RL and to investigate its sensitivity and specificity in the diagnosis of carpal tunnel syndrome (CTS). The study was carried out among 100 hands of 75 healthy volunteers and 64 patients who had a positive history of pain or paresthesia in upper extremities and 2 of 3 signs suggesting CTS. Information including age, gender and results of sensory and motor nerve conduction velocity, compound motor action potential of proximal and distal stimulation and RL were recorded for analysis. Normal range of the median nerve RL was found to be 1.03- 2.65 (mean = 1.84 ± 0.41). The cut-off point of median RL was 2.37 for CTS diagnosis with sensitivity of 85.9% (95% of confidence interval [CI]: 84.4-87.5%) and specificity of 91.1% (95% CI: 87.8-92.2%). In mild cases of CTS, which conventional nerve conduction studies (NCSs) shows abnormalities only in sensory studies, RL may better demonstrate the effect on the median nerve motor fibers. We conclude that RL measurement of the median nerve may raise the sensitivity of NCSs for the diagnosis of CTS.

The reciprocal interaction between adipocytes and angiogenesis is considered as an essential component in the development and expansion of adipose tissue. The aim of this study was to evaluate the effect of ghrelin on angiogenic response using in vivo angiogenesis assay of matrigel plug and its correlation with serum leptin levels in normal and diet-induced obese mice. This experimental study has been done on 24 male C5 BL/6 mice which were randomly divided into four groups: Normal diet (ND) or control, ND + ghrelin, high-fat-diet (HFD) or obese and HFD + ghrelin (n = 6/group). Obese and control groups received HFD or standard diet for 14 weeks. Then, growth factor reduced matrigel plug (500 μl) containing bFGF (basic fibroblast growth factor; 100 ng) with or without ghrelin (100 μg/kg) was injected subcutaneously in the mid-ventral abdominal region of each mice. After 10 days, blood samples were taken and matrigel plugs were removed under anesthesia and angiogenic response was assessed by immunohisochemical staining. HFD significantly increased angiogenesis in matrigel plug as expressed as the number of CD31-positive cells than standard diet (43 ± 5 vs. 13 ± 2.5 CD31+ cells/field). Ghrelin did not alter angiogenesis in matrigel plug in both obese and control groups. There was a strong positive correlation between the number of CD31-positive cells and serum leptin concentration (r = 0.91). Leptin as an angiogenic factor has a positive correlation with angiogenesis in matrigel plug model of angiogenesis and ghrelin could not alter angiogenesis.

The cesarean section (C-section) has higher risk compared to normal vaginal delivery (NVD). The aim of this populationbased study was to evaluate the frequency of mothers’ tendency toward the mode of delivery and the factors that can affect this inclination. This cross-sectional study was conducted from August 2011 to June 2012 in Fars Province, Iran, and comprised mothers in their 20th to 30th weeks of pregnancy. A questionnaire was designed to include, sociodemographic information, maternal knowledge, main sources of knowledge, attitude of the mother, husband, parents, close friends, and gynecologist, regarding the route of delivery, convenience factors, and barriers to choosing NVD, and mother’s preference for the route of delivery. Of 6921 participants, 2197 (31.7%) preferred C-section and 4308 62.2%) favored NVD while 416 (6%) had no idea regarding the preferred route of delivery. Score of knowledge in 904 (13.1%) participants was zero, and 1261 women (18.2%) achieved an acceptable level of knowledge. Using binary logistic regression, positive history of previous abortion and/or infertility, higher education level of mother and husband, mother’s unacceptable level of knowledge regarding complications of C-section, and mother’s and husband’s positive attitude toward C-section were determinant factors in choosing C-section as a preferred route of delivery. Appropriate measures should be taken to raise awareness and knowledge of mothers and all families about complications of the C-section. Establishment of clinics for painless NVD and assuring mothers of benefits and lower complications of NVD can reduce the tendency for C-sections.

Osteoporosis is one of the most common bone diseases that is characterized by a generalized reduction of the bone mass. Osteoporotic fractures are associated with morbidity, but can be a predictable condition if early diagnosis is made.The diagnosis is based on the World Health Organization’s (WHO) T-score criteria. Panoramic images have been also used to predict low bone mineral density. The aim of the study was to evaluate the prediction of lumbar spine bone mineral density (BMD) from the mandibular cortical width in postmenopausal women. On the panoramic radiographic images, the mandibular cortical width (MCW) was measured by drawing a line parallel to the long axis of the mandible and another line tangential to the inferior border of mandible and a constructed line perpendicular to the tangent intersecting inferior border of mental foramen and analyzed the correlation of recorded MCW with BMD and T-score by using SPSS software and linear regression and bivariate correlation tests. Bivariate correlation showed a significant correlation between BMD and MCW (r = 0.945) (P = 0. 000). There was also a significant correlation between T-score and MCW(r = 0.835) (P = 0. 000). To detect the accurate association between the BMD and MCW and also T-score and MCW, linear regression analyses tests showed two associations to predict the BMD and T-score from MCW with confidence interval of 95%. These associations were as follows: T-score= −7.087 + 1.497 × MCW BMD= 0.334 + 0.163 × MCW. The MCW is a good index to help the dentists to predict the osteoporosis by panoramic radiographs and have a significant role in patient screening and early diagnosis of osteoporosis.

Vast majority of cardiac patients who refer to cardiac rehabilitation program (CRP) are obese and obesity is associated with coronary heart disease (CHD). So, the aim of this study is to investigate the effects of CRP on obesity indexes, lipid profiles, and functional capacity (FC) in obese men with CHD and to explore whether significant weight reduction affected these risk factors and FC or not. In an observational study, we evaluated 536 patients, including 464 non-obese men and 72 obese men. All participants completed CRP for 2 months; then, obese patients weredivided into two groups: patients with weight reduction ≥ 5% and patients who didn’t have significant weight reduction. Data were analyzed with SPSS software version 15. For comparing the mean of outcomes independent t-tests and paired t-tests were used. Results showed following CRP, nonobese men had significant improvement in obesity indexes (P = 0.00), lipid profiles (P < 0.05), and FC (P = 0.00) and in obese men, favorable improvement were seen in obesity indexes (P = 0.00), FC (P = 0.00), and total cholesterol (P = 0.02). Comparing two groups revealed that there were significant differences in obesity indexes, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio. In addition, comparing subgroup of obese patients revealed that there were significant differences in FC (P = 0.00) and low-density lipoprotein cholesterol/ high density lipoprotein cholesterol ratio (P = 0.04). CRP has more advantage in management of obesity, FC, and lipid profiles in both obese and non-obese patients. Also, weight reduction may cause greater improvement in FC and fitness levels in obese men with CHD.

The study was carried out with the aim of determining the factors affecting and to evaluate anxiety situations and self-esteem of children with and without mentally retarded siblings. The sampling included 227 healthy children: 108 of them have mental retarded sibling and 119 of them do not have mental retarded sibling. The context of this study consisted of 15-18 year of age healthy children with mentally retarded siblings and 15-18 year of aged healthy children having at least one sibling between the dates February 15st and June 26st 2010. Personal Information Form, Rosenberg Self-Esteem Scale and Trait Anxiety Scale were used. It was found out that trait anxiety of 17-18 aged of children with mental retarded sibling (47.04 ± 7.3) was higher than that of the children without mental retarded siblings 44.05 ± 11.23) (P < 0.05). It was observed that self-esteem of children with mentally retarded sibling was not affected from the handicap of their siblings (P > 0.05). Trait anxiety score averages of children with mentally retarded sibling and experience some difficulties due to his or her siblings’s handicap (47.00 ± 7.76) were found higher than those of those of the children without any problem with the environment (42.61 ± 7.48) (P < 0.05). Although the average score of trait anxiety and self-esteem in both groups were not significant different, score of trait anxiety for children with mentally disabled siblings was higher in comparison. It was concluded that anxiety of children with and without mentally retarded siblings increased as self-esteem of these children decreased.

Pemphigus is a group of autoimmune blistering diseases of the skin and mucous membranes caused by the presence of antibodies against adhesion molecules on the cell surface of keratinocytes. The possible role of herpes simplex virus infection in the pathogenesis of pemphigus vulgaris (PV) has been suggested. In this study, we evaluated the impact of a course of acyclovir in improvement of the pemphigus patients and reduction of the hospitalization duration. A total of 30 patients with definitive diagnosis of PV were recruited in study. They were randomized in two groups. One group received routine treatment and another received the routine plus 2 week course of oral acyclovir (1200 mg/day). The improvement was defined as a more than 50% change in baseline severity score of the disease. All data was registered at the checklists and after follow-up period, the statistical analyses were performed by aid of t-test and Fisher’s exact test. There was no statistically significant difference in mean severity score and improvement rates between two groups at the end of study (P > 0.05). Meanwhile, there was no statistical difference in duration of hospitalization in two groups (P > 0.05) though the severity score and hospitalization duration were apparently less in acyclovir-group than control group. Neither of the patients (in acyclovir group) showed any side effect. We did not observe any difference between response to treatment and hospitalization period in the group that was treated with acyclovir as compared with control group. However, the partial and complete remissions were higher in patients on acyclovir therapy compared to controls. In those pemphigus patients who do not respond to sufficient immunosuppressive regimen or show a sudden relapse after reaching partial or complete clinical remission, a trial of oral acyclovir therapy may have promising result.

Studies have shown the association of mood disorders and endothelial dysfunction, and increased risk of cardiovascular disease; however, mediatory mechanisms are not entirely clarified in this regard. We investigated the relationship between depression/anxiety symptoms with systemic inflammation and endothelial function. This cross-sectional study was performed in 2011 on employees of an oil company located in the Isfahan city (central Iran). Participants were selected with clustered random sampling. Anxiety and depression were evaluated by Hospital Anxiety Depression Scale (HADS). Systemic inflammatory status was evaluated by measuring sensitive C-reactive protein (high sensitive-CRP). To evaluate the endothelial function flow-mediated dilation (FMD) was measured. During the study period, 254 participants (mean age = 51.4 ± 6.1 years) were evaluated. No significant relationship was found between high sensitive CRP or FMD and any of the variables of anxiety or depression. In multivariate analysis, by controlling the possible confounding factors, no association was found between anxiety score, depression, or the overall score of HADS with high sensitive-CRP or FMD. After the separate analysis of patients with and without diabetes, depression score was correlated inversely with FMD among patients with diabetes (r = 0.525, P = 0.021). According to the results, in the studied population, there was no relationship between anxiety/depression with systemic inflammation or endothelial dysfunction, while in individuals with diabetes, depression was associated with endothelial dysfunction. In this regard more cohort studies are recommended.

This study evaluates the evidence-based administration of risperidone and paliperidone for the treating children and adolescents with conduct disorder (CD). A review of the current literature from clinical trials that investigated the efficacy of risperidone and paliperidone on CD considering the inclusion criteria and search strategies was performed by a search of PubMed and Google Scholar databases. Out of 53 titles, 31 were irrelevant. The abstract of 22 potentially related articles were studied. Only six articles reported the results of clinical trial. However, one of them reported the effect of risperidone on conduct behaviors in autistic disorders. One study was a re-analysis of two previous studies, one study reported the effects of maintenance versus withdrawal of risperidone treatment and two studies included children with sub average intelligence. Headache, somnolence and increased appetite are among the most common reported adverse effects. No study examined the effect of paliperidone on CD was found. Current literature suggests that risperidone could be effective for treating some conduct behaviors in children and adolescents. The effect of risperidone on CD is not a well-researched area. There is no well-controlled evidence based reports about the safety and efficacy of risperidone for the treatment of CD. Further trials should examine the efficacy of these medications on CD rather than conduct behaviors or disruptive behavior disorders.

Harlequin fetus is a rare and the most severe form of the congenital ichthyosis with an autosomal recessive inheritance. Incidence of the disease is nearly 1 in 3,00,000 live births. The disease might be lethal at birth and the affected babies are often premature. Harlequin ichthyosis (HI) is marked by severe keratinized and alligator-like horned skin. The present study reports a new case with HI and adds to the collective knowledge of this rare skin disorder. HI has been linked to mutation in the ABCA12 gene; therefore, genetic counseling and mutation screening of this gene should be considered.

Zolpidem, a nonbenzodiazepine hypnotic, binds to the benzodiazepine binding site on the gamma-aminobutyric acid type A (GABA-A) receptors. Many studies have reported efficacy and safety of zolpidem in treatment of insomnia, low abuse, and dependence capability. However, many cases of zolpidem abuse and dependence were reported around the world. This case showed that zolpidem can exert abuse capability, euphoric mood, tolerance, and withdrawal syndrome.