Journal of Research in Medical Sciences
Volume:19 Issue: 7, Jul 2014

Posttraumatic stress disorder (PTSD) tends to follow a chronic and treatment resistant course. Avoidance and numbing are symptoms associated with chronicity and impaired life quality. As D-cycloserine (DCS) can facilitate extinction of conditioned fear, we aimed to investigate the effi cacy and tolerability of DCS for the treatment of numbing and avoidance in chronic PTSD. Th is was an 11-week, double-blind, cross-over trial conducted in 2012 and 2013, in out-patient University psychiatry clinics. Th e studied population was selected randomly among outpatients with chronic combat-related PTSD (based on DSM-IV-TR criteria for chronic PTSD), who were males over 18 and <65 years of age (n = 319). Seventy six eligible patients were randomly assigned to two groups. Patients entered a 1-week run-in period. Th e groups received either an add-on treatment of DCS (50 mg daily), or placebo (4-week). After a 2-week washout, the groups received cross-over treatments (4-week). Clinical, paraclinical assessments, and clinician administered PTSD scale (CAPS) were performed at baseline, and at the end of the 1st, 5th, and 11th week. Side-eff ects were also evaluated. Th e overall number of avoidance and numbing symptoms, symptom frequency, and symptom intensity were measured separately. Neither frequency nor number of symptoms was signifi cantly infl uenced. However, DCS treatment demonstrates a signifi cant decrease in intensity of avoidance/numbing symptoms, and improvement in function (mean [standard error] = −4.2 [1.5], P = 0.008). Side-eff ects were not statistically remarkable. D-cycloserine can help as an adjunctive treatment to alleviate numbing and avoidance in combat related chronic PTSD.

Low urine pH is related to obesity and insulin resistance, which are components of metabolic syndrome (MS). Th e aim of this study was to identify the relation between a low urine pH and MS after controlled for other covariates including demographic and lifestyle factors in adult Korean population. We analyzed data from the 2010 Korea National Health and Nutrition Examination Survey, a cross-sectional and nationally representative survey and 1960 men and 2702 women were included in this study. Study subjects were divided into the group with urine pH <5.5 and the group with urine pH ≥5.5 refer to literature. We then evaluated the association between low urine pH and MS. After adjusting for age, sex, smoking status, drinking status, regular exercise, and blood urea nitrogen level, the odds ratio (OR) for the presence of MS in the group with urine pH <5.5 was 1.350 (95% confi dence interval [95% CI]: 1.158 1.573) using the American Heart Association/ National Heart, Lung, and Blood Institute criteria or 1.304 (95% CI: 1.082-1.572) using the International Diabetes Federation criteria. Among MS components, elevated fasting glucose (OR: 1.231, 95% CI: 1.058 1.433, P = 0.007) and elevated triglyceride (TG) (OR: 1.389, 95% CI: 1.189-1.623, P < 0.001) showed a signifi cantly high OR. Th e fi ndings confi rmed that low urine pH is associated with MS in the Korean population. Among MS components, elevated fasting glucose and elevated TG showed a signifi cantly high OR.

Pulmonary impairment in patients suff ering ulcerative colitis (UC) has been suggested by several investigators using standard pulmonary function tests (PFTs). Th is changes in pulmonary function associated with minimal respiratory symptoms have been documented, especially in patients with active disease. Th e aim of this prospective study was to determine airway resistance and lung volumes in patients with UC who have no respiratory symptoms in comparisons to a healthy control group. We evaluated a total of 30 patients with UC by means of spirometry, body plethysmography, and impulse oscillometry. Th e patients were not complaining of any pulmonary symptoms and did not present any history of previous respiratory diseases. As controls we examined 30 healthy subjects matched for gender, age, and smoking status. Th e relationship between PFT, lung volume, and airway resistance; and the activity, localization, and duration of the UC disease were analyzed. Th ere was a signifi cant diff erence between airway resistances (kPa/L/s) measured by body plethysmography in patients with UC and those of the controls (R5hz; 0.60 ± 0.44 vs. 0.39 ± 0.13; P < 0.001) and R20hz (0.37 ± 0.19 vs. 0.29 ± 0.1, P = 0.02). Th ere were no correlation between PFT, airway resistance and site and scoring activity (P > 0.05). Despite the lack of pulmonary symptoms, increased airway resistance was found in UC patients. We also have not found correlation between PFT, lung volume and airway resistance values and scoring of UC activity.

Obesity is a major health problem worldwide for which conventional therapy effi cacy is limited. Traditional Chinese medicine, particularly body acupoint stimulation, provides an alternative, eff ective, and safe therapy for this medical challenge. Th e present study was designed to compare the eff ects of distinct methods to stimulate the same set of acupoints, on anthropometric and biochemical parameters in obese women. Ninety-nine obese women were randomly assigned to six groups of treatment: Acupuncture with moxibustion, long needle acupuncture with moxibustion, electroacupuncture (EA), EA with moxibustion, embedded catgut with moxibustion (CGM) and sham acupuncture as control. Obesity-related parameters, including body weight, body mass index (BMI), waist and hip circumferences, waist/hip ratio, biochemical parameters (triglycerides, cholesterol, glucose, insulin) and homeostasis model of assessment - insulin resistance (HOMA-IR) index, were determined before and after each treatment. Body weight and BMI were signifi cantly reduced in response to all treatments. Interestingly, acupoint catgut embedding therapy combined with moxibustion was the only treatment that produced a signifi cant reduction in body weight (3.1 ± 0.2 kg, P < 0.001), BMI (1.3 ± 0.1 kg/m2, P < 0.001), insulin (3.5 ± 0.8 mcU/ml, P < 0.1) and HOMA-IR (1.4 ± 0.2 units, P < 0.01) in comparison with sham group. Furthermore, this treatment was able to bring back obese women to a state of insulin sensitivity, indicating that acupoint catgut embedding therapy combined with moxibustion could beuseful as a complementary therapy to reduce the risk of diabetes associated to obesity in women. Overall, our results confi rmed the eff ectiveness of acupoints stimulation to assist in the control of body weight in women. Th ey also highlighted the more favorable eff ects of embedded catgutmoxibustion combination that may be due to the extended and consistent stimulation of acupoints.

Iron defi ciency anemia (IDA) in children with chronic kidney disease (CKD) is common and associated with higher risk of death. Neutrophil geletinase-associated lipocalin (NGAL) is a small 25 kDa glycoprotein, a member of lipocalin superfamily that released at the response of cellular stress from diff erent cells. In addition, NGAL was studied as an iron regulatory glycoprotein andregulator of iron related gene. Th e aim of the current study was to determine any association between serum NGAL and body iron status markers in children on chronic dialysis. Th is correlation study was carried out between May 2012 and May 2013 and evaluated all dialysis patients less than 19 years in pediatric dialysis centers in Isfahan that didn’t have exclusion criteria. Th ey were 40 children, including 23 persons on hemodialysis (HD) and 17 persons dialyzed by peritoneal dialysis (PD). Furthermore, we selected 40 children as healthy controls. We examined the relationship between plasma NGAL levels and indices of anemia such as ferritin, transferrin saturation (TSAT) and serum iron (SI) in dialysis children. Serum NGAL level in children on chronic dialysis (group including both PD and HD patients) was signifi cantly higher than healthy controls (P = 0.008). Furthermore, in this group Serum NGAL level had inverse correlation with TSAT (P = 0., r = −0.22), SI (P = 0.04, r = −0.2), white blood cells (P = 0.045, r = −0.26) and serum ferritin (P = 0.006, r = −0.3). In addition, HD patients had higher serum NGAL level than PD patients (P = 0.048). High serum NGAL level in low TSAT group demonstrated that NGAL probably has an important role in IDA in children on chronic dialysis; therefore, it can be a new marker for diagnosis of IDA in CKD.

Nipple fi ssure is a common disorder during breastfeeding. With high prevalence of nipple fi ssures and its impacts on breastfeeding, as well as the existence of evidence in favor of the application of peppermint as an antiinfl ammatory and antiinfection herb, the purpose of this study is to determine the eff ect of Menthol essence on improving nipple fi ssures in the primiparous breastfeeding women. Th is study was conducted using a clinical trial method. Samples were divided randomly into two groups of 55 women. Th e women in the peppermint group applied four drops of Menthol essence on their nipple and areola after each feeding. Th e control group applied four drops of their own milk on the nipple and areola after each feeding. Th en, the two groups were studied on days 10 and 14 postpartum. For intensity of pain, the visual analog scale (0-10 cm) and to measure the severity of damage, Amir scale (1-10 cm) were applied and the existence or lack of nipple discharge was also recorded. Th e data were analyzed using SPSS 17 software. Th e mean intensity of pain and nipple fi ssure before treatment (8.55 ± 1.74) and day 10 after delivery (4.26 ± 1.57) and before treatment and day 14 after delivery in the case group (1.32 ± 1.02) had a signifi cant diff erence (P < 0.001). Nipple discharge between the two groups, before treatment (75.2) and day 10 after delivery (%31.6) and before treatment and day 14 after delivery (%15.7), the case group had a signifi cant diff erence (P < 0.001). Menthol essence can improve nipple fi ssures in the primiparous breastfeeding women.

Hypermobile joints are joints with beyond normal range of motion and may be associated with joint derangements. Th is study aimed to evaluate the prevalence of benign joint hypermobility syndrome (BJHS) among soldiers and eff ect of training courses on related joint instabilities. In a prospective cohort study on 721 soldiers of Iran Army in Isfahan in 2013 the prevalence of joint hypermobility was obtained by using Beighton criteria. Soldiers divided in two groups of healthy and suff ered based on their scores. Th e prevalence of ankle sprain, shoulder and temporomandibular joint (TMJ) dislocations identifi ed before beginning service by history-taking and reviewing paraclinical documents. After 3 months of military training, a recent occurrence of mentioned diseases was revaluated in two groups. Th e collected data were analyzed using SPSS-20 software using Independent-T and Chi-square tests. Th e frequency of BJHS before military training was 29.4%. After passing military training period, the incidence of ankle sprain was signifi cantly higher in suff ered group achieving the minimum Beighton score (BS) of 4 (4.3%, P = 0.03), 5 (5.5%, P = 0.005) and also 6 out of 9 (6.5%, P = 0.01). Th e incidence of TMJ dislocation was not signifi cantly diff erent based on a minimum score of 4, while it was higher in suff ered group when considering the score of 5 (2.1%) and 6 2.6%) for discrimination of two groups (P = 0.03). Th ere was no signifi cant diff erence between two groups in case of shoulder dislocation anyway. Military training can increase the incidence of ankle sprains and TMJ dislocations in hypermobility persons with higher BS in comparison with healthy people. Th erefore, screening of joint hypermobility may be useful in identifying individuals at increased risk for joint instabilities.

Amyloid A (AA) amyloidosis is a multisystem, progressive and fatal disease. Renal involvement occurs early in the course of AA. We aimed to investigate the etiology, clinical and laboratory features, and outcome of patients with biopsy-proven renal AA amyloidosis. A total of 121 patients (male/female: 84/37, mean age 42.6 ± 14.4 years) were analyzed retrospectively between January of 2001 and May of 2013. Demographic, clinical and laboratory features and outcomes data were obtained from follow-up charts. Familial Mediterranean fever (37.2%) and tuberculosis (24.8%) were the most frequent causes of amyloidosis. Mean serum creatinine and proteinuria at diagnosis were 2.3 ± 2.1 mg/dL and 6.7 ± 5.3 g/day, respectively. Sixty-eight (56.2%) patients were started dialysis treatment during the follow-up period. Mean duration of renal survival was 64.7 ± 6.3 months. Age, serum creatinine and albumin levels were found as predictors of end-stage renal disease. Fifty patients (%41.3) died during the follow-up period. Th e mean survival of patients was 88.7 ± 7.8 months (median: 63 ± 13.9). 1, 2 and 5 years survival rates of patients were 80.7%, 68.2% and 51.3%, respectively. Older age, male gender, lower levels of body mass index, estimated glomerular fi ltration rate, serum albumin, calcium, and higher levels of phosphor, intact parathyroid hormone and proteinuria were associated with a higher mortality. Higher serum creatinine, lower albumin, dialysis requirement and short time to dialysis were predictors of mortality. Th e outcome of patients with AA amyloidosis and renal involvement is poor, particularly in those who had massive proteinuria, severe hypoalbuminemia and dialysis requirement at the outset.

Non-contrast computed tomography (NCCT) is the diagnostic choice for renal stone disease. Knowing the composition of a stone before passage can help to choose a better management. We sought to determine whether the Hounsfi eld unit (HU) measured by NCCT can predict the composition. 180 urinary stones from patients seen at Shariati, Kashani and Alzahra CT centers, were submitted to stone analysis, 2012. All scans had been interpreted for HU. Primitive statistical fi ndings showed an eff ect of size on the HU. To avoid confounding bias, Hounsfi eld Density (HD: HU/largest transverse diameter) was calculated. Statistical comparisons were performed between composition with HU and HD. Calcium stones had specifi c ranges for HD and HU. No non-calcium stone had HU more than 448 and HD greater than 50 HU/mm. NCCT can diff erentiate just Calcium from non-calcium stones.

Ramadan fasting represents one of the fi ve pillars of the Islam creed according to the Sunnah and the second practice of faith for the Shiaa. Even though patients are exempted from observing this religious duty, they may be eager to share this particular moment of the year with their family and peers. However, there are no guidelines or standardized protocols that can help physicians to properly address the issue of patients with chronic kidney disease (CKD) fasting in Ramadan and to correctly advise them. Moreover, in a more interconnected and globalized society, in which more and more Muslim patients live in the Western countries, this topic is of high interest also for the general practitioner. For this purpose, we carried out a systematic review, including also articles written in Arabic, Turkish, and Persian languages. Our main fi ndings are that:1. recipients of kidney allograft can safely fast during Ramadan;2. evidences for safety in patients with nephrolithiasis and CKD are instead mixed and controversial. On the other hand,3. most studies have been carried out during Ramadan falling in cold seasons, and there is scarce information about Ramadan fasting in hot seasons. For these reasons, the fi ndings may be not generalizable and therefore cautions should be taken and applied; the physicians should carefully monitor their patients during the fasting period with an adequate follow-up, in order to avoid any injurious eff ect.

Brucellosis is a zoonotic disease with widespread prevalence. It presents with in various range and often with the presence of nonspecifi c clinical signs and symptoms. Brucellosis also may cause diff erent manifestations in eyes such as uveitis, keratitis, conjunctivitis and neuro-ophthalmic defects. Ocular brucellosis is rare among children. Herein, we present a 7-year-old girl with systemic and ocular brucellosis. After treatment with systemic steroid and antibiotics, her signs and symptoms disappeared. Since early treatment is important in preventing permanent visual loss and the other complications of ocular brucellosis, examination of the eyes in brucellosis patients must always be noticed by clinicians working in this fi eld.

Placental polyp is retained placental tissue within the endometrial cavity, which forms a nidus for infl ammation and bleeding. Th ere are very few reported cases of the clinical placental polyp. Here, we report a case of 34-year old G4L3Ab1 woman with the chief complaint of intermittent vaginal bleeding since her last normal vaginal delivery 3 months ago. Serum human chorionic gonadotropin (hCG) titer was slightly elevated. A polypoid mass was detected within the endometrial cavity by imaging studies. History of the patient, mass lesion within the endometrial cavity and slightly elevated serum hCG titer raised the suspicion of trophoblastic neoplasms. Endometrial curettage yielded unsatisfactory specimen containing only fi brin deposition and was followed by total hysterectomy. Th e uterus showed slight global enlargement resulting from the presence of a polypoid mass within the endometrial cavity. Th e redcolored mass had a smooth outer surface and fragile consistency without any permeation into the myometrium. Pathology reported it as the placental polyp. Although very rare, placental polyp should be kept in mind as one of the reasons of abnormal uterine bleeding in parous women. Defi nite diagnosis is made by pathology examination.