Journal of Research in Medical Sciences
Volume:19 Issue: 10, Oct 2014

Irritable bowel syndrome (IBS) is gastrointestinal functional disorder which is multifactorial with unknown etiology.Th ere are several modalities for treatment of it. Acupuncture is increasingly used in numerous diseases, also in gastrointestinal disorders like IBS. The purpose of the study was to assess the eff ects of catgut embedding acupuncture in improving of IBS. A randomized double blind sham control clinical trial was designed. A total of 60 IBS patients assigned to three separated groups. The first group received clofac as drug only group (DO). The second one received catgut embedding acupuncture in special point (AP) and the last group received sham acupuncture (SA). Symptoms, pain, depression and anxiety assessed before and after two weeks at the end of study. There was statistically signifi cant diff erence between AP and SA and DO in constipation and bloating. Differences that were statistically significant favored acupuncture on pain (F = 6.409, P = 0.003), and depression (F = 6.735,P = 0.002) as the other outcomes. Th e average (standard deviation (SD)) of weight loss was 2 kg (0.88) in acupuncture group. Our finding showed a significant positive associated between acupuncture and IBS. Catgut embedding acupuncture is a new method which can eliminated IBS symptoms and can use as alternative therapeutic method for improvement of IBS.

ackground: Sentinel lymph node biopsy (SLNB) is standard care to evaluate axillary involvement in early breast cancer. It has fewer complications than complete lymph node dissection; however, using blue dye in SLNB is controversial. We have evaluated the detection rate and local complications associated with methylene blue dye (MBD) used in SLNB in early breast cancer patients and compared these results to patent blue dye (PBD). In a cohort prospective study, 312 patients with early breast cancer without axillary lymph node involvement were divided into two groups according to dye type. All of the patients received radiotracer and one type of blue dye. We filled out a checklist for the patients that contained demographic data,size of tumor, stage, detection of sentinel lymph node, and complications and then analyzed the data. Demographic and histopathologic characteristics were not significantly different in both groups. Mean (standard deviation [SD]) tumor size in all patients was 2.4 (0.8) cm. Detection rate in the MBD group was 77.5% with dye alone and 94.2% with dye and radioisotope;and in the PBD group it was 80.1% and 92.9% respectively (P > 0.05). We had blue discoloration of the skin in 23.7% in the PBD and 14.1% in the MBD group (P < 0.05) local inflammation was detected in one patient in the PBD and five in the MBD group (P < 0.05). Skin necrosis and systemic complications were not observed. Methylene blue has an acceptable detection rate, which may be a good alternative in SLNB. Complication such as blue discoloration of the skin was also lower with MBD.

Leishmaniasis is an infection caused by leishmania protozoa. Knowledge about health eff ects associated with environment situation and human behavior in national and local levels seems to be very necessary. Th is cross-sectional case-control study was carried out in three adjacent counties of Isfahan province in Iran. Data were collected by face-to-face interviewing and recorded structured questionnaire. Statistical analysis was performed using Chi-square test and logistic. P < 0.05 was considered assignifi cant. The economic level had signifi cant association with cutaneous leishmaniasis (CL) transmission (P < 0.05). However,there was no significant association between existence of food storage and transmission of CL. We, however, found significant reduction of CL transmission following use of insect control measures (P < 0.05). The odds ratio for peridomestic transmission was 0.420 for houses that weren’t round with any old or ruined houses. We conclude that among aforementioned risk factors, the impact ofperidomestic factors is stronger in CL transmission when compared with domestic and behavioral factors.

Sumac (Rhus coriaria L.) has been used in traditional treatment of some diseases. The aim of this study was to determine the eff ect of sumac (R. coriaria L.) powder on insulin resistance (IR), malondialdehyde (MDA), high sensitive C-reactive protein (hs-CRP), and paraoxonase 1 (PON1) activity in type 2 diabetic patients. A double-blind randomized placebo controlled trial on 41 type 2 diabetic volunteers was conducted. Participants randomly assigned into 3 g per day sumac powder (n = 22) or placebo (n = 19) groups for 3 months. IR was assessed using the homeostatic model assessment of IR (HOMA-IR), which including measurement of insulin by immunoassay method and measurement of glucose by enzymatic method. MDA and PON1 activity were measured colorimetrically, hs-CRP turbidimetrically. There were a significant increase in PON1 activity (from 84.72 ± 30.59 to 92.91 ± 32.63) and significant decrease in insulin (from 7.09 ± 4.28 to 5.32 ± 3.22), HOMA-IR (from 2.56 ± 1.58 to 1.67 ± 0.94), MDA (from 2.71 ± 0.73 to 1.97 ± 0.49), and also hs-CRP (from 18.49 ± 16.96 to 15.89 ± 16.70) in the sumac group at the end of study compared with initial values (P < 0.05). Furthermore, there were signifi cant diff erences in MDA and PON1 between the two groups at the end of the study (P < 0.05). Furthermore, the mean of differences of insulin, HOMA-IR, MDA, hs-CRP and PON1 activity between groups were significant (P < 0.05). We concluded that daily intake of 3 g sumac for 3 months may be beneficial for diabetic patients to make them less susceptible to cardiovascular disease.

Opium dependence is one of the most challenging health problems in the developing countries as well as Iran. Among several health problems due to opium dependence, there are limited reports indicating the presence of lead in opium. The aim of this study is to investigate the blood lead level (BLL) in oral and inhalational opium dependents and its association with anemia. A cross-sectional study was done among 86 opium dependent patients who were referred to fi ve large detoxification centers in Tehran city and 48 healthy individuals. BLL was assessed using the atomic absorption spectrometry technique. Multivariate analysis of variance and binary logistic regression analysis were performed for statistical assessment using SPSS version 18 for Windows. The highest BLL was detected in oral opium dependent group (mean = 11.75, standard deviation (SD) = 6.06) in comparison to inhalational opium dependent group (mean = 7.07, SD = 3.61) and healthy control group (mean = 6.05, SD = 1.83).Anemia was detected in 38% of oral-opium dependent and 43% of inhalational-opium dependent group. Age (odds ratio (OR): 1.06,95% confi dence interval (CI): 1.03-1.09) and opium dependence (OR: 3.59, 95% CI: 1.69-7.59) were signifi cant predictors of anemia in these patients (P < 0.001). The results of this study confi rmed the higher BLL in opium dependents, especially with an oral form of consumption.

Because of the excessive and pathologic effects of depression and anxiety, it is important to identify the role of protective factors, such as effective coping and social support. This study examined the associations between perceived social support and coping styles with depression and anxiety levels. This cross sectional study was part of the Study on the Epidemiology of Psychological, Alimentary Health and Nutrition (SEPAHAN) project. A total 4658 individuals aged? 20 years was selected by cluster random sampling. Subjects completed questionnaires, which were used to describe perceived social support, coping styles, depression and anxiety. T test,? 2 test, Pierson’s correlation and Logistic regression analysis were used in data analyses. The results of Logistic regression analysis showed after adjusting demographic characteristics for odd ratio of anxiety, active copings such as positive re-interpretation and growth with OR; 95% CI: 0.82 (0.76, 0.89), problem engagement [0.92 (0.87, 0.97)], acceptance [0.82 (0.74, 0.92)] and also among perceived social supports, family [0.77 (0.71, 0.84)] and others [0.84 (0.76, 0.91)] were protective. In addition to, for odd ratio of depression, active copings such as positive re-interpretation and growth [0.74 (0.69, 0.79)], problem engagement [0.89 (0.86, 0.93)], and support seeking [0.96 (0.93, 0.99)] and all of social support types (family [0.75 (0.70, 0.80], friends [0.90 (0.85, 0.95)] and others [0.80 (0.75, 0.86)]) were protective. Avoidance was risk factor for both of anxiety [1.19 (1.12, 1.27)] and depression [1.22 (1.16, 1.29)]. This study shows active coping styles and perceived social supports particularly positive re- interpretation and family social support are protective factors for depression and anxiety.

The Rome II and III diagnostic criteria for dyssynergic defecation recommended the exclusion of irritable bowel syndrome (IBS). This study determined the effect of biofeedback therapy on dyssynergic constipation in patients with or without Irritable Bowel Syndrome. This study was a non-randomized, single blinded, semi experimental study. Dyssynergic defecation patients with and without IBS were asked to undergo biofeedback therapy 8 sessions. The defecation dynamics and balloon expulsion time were evaluated before, at the end and one month after the biofeedback therapy. IBS symptoms were graded using a 4-point Likert scale. Mann-Whitney U test, Wilcoxon test and Friedman test were applied to analyse data by SPSS software package. After the biofeedback therapy, the IBS symptoms have been decreased significantly (the median of 2 before and 1 after therapy, P<0.01). The biofeedback therapy significantly decreased the anismus index in IBS group by the mean of 0.75±0.31, 0.28±0.07and 0.28±0.06 in three phases, respectively. Similar results were found in non-IBS patients (the mean of 0.74±0.32, 0.28±0.08, 0.27±0.08 in three phases, respectively). The symptoms of constipation (sensation of incomplete evacuation, difficult and painful defecation), defecation facilitative manual maneuver frequency, pelvic floor muscles resting amplitude and strain amplitude decreased and squeezing amplitude improved significantly after biofeedback therapy in both groups with and without IBS (P<0.001). There were not significant differences between patients with and without IBS (P>0.05) with respect to outcome. No complication was observed in treatment groups. Dyssynergic constipation patients with and without IBS will likely benefit from biofeedback therapy.

After cleft palate repair, oronasal fi stula (ONF) formation is one of the considerable and troublesome complications. Conchal cartilage graft is one option that can be used in recurrent fi stula correction. The aim of the current study is investigating the recurrence rate of the hard palate ONF or ONF at the junction of hard and soft palate after utilizing conchal cartilage graft and comparing this rate with other methods. In this observational prospective study, 29 patients suff ering from ONF with small, medium and large sizes who were referring to Alzahra university hospital, Isfahan, Iran and FatemeZahra university hospital, Tehran, Iran between November 2011 and November 2012 were enrolled. All patients had midline cleft palate, 29.6% of them had cleft lip too that was repaired previously. All patients were followed-up for 2 years (every 2 months) after repair. The mean (range) age of studied samples was 10.7 (2-23) years. 16 patients (55.7%) were female, and reminders were male. During 2 years followup, we detected recurrence of ONF in 6 patients (20.68%) and the success rate was 79.32%. The recurrence rate, after applying the current approach, among who experienced the several times of recurrence was signifi cantly higher than among those who experienced fi rst time of recurrence (33.3% vs. 7.1%; P < 0.001). Th e mean [±SD] age of failed and successfully repaired patients were 11.3 (±4.5) and 8.4 (±5.25) years, respectively (P > 0.1). Using of conchal cartilage graft for recurrent ONF with? 1 cm was safe and effi cacious, in ONF >1 cm conchal cartilage graft can be used as a primary method and if recurrence occurred chooses other complex procedure.

The finding of bundle branch block (BBB) in patients with syncope suggests that paroxysmal atrioventricular block (AVB) or ventricular tachyarrhythmia (VT) may be the cause of syncope. Guidelines for cardiac pacing and cardiac resynchronization therapy have been recommended to perform electrophysiological study (EPS) for confi rming main cause of syncope. Therefore, the aim of our study was to evaluate the role of EPS in patients with syncope and BBB. We evaluated 133 patients (mean age 63 ± 13.8 years) with past history of syncope and BBB from April 2002 to December 2010 who referred to Arrhythmia clinic in two tertiary care centers. All patients were under EPS on admission time.The frequency distributions of AVB and VT in patients were determined. Left bundle branch block was diagnosed in 184 (82.1%) patients. 133 of them had preserved left ventricular ejection fraction (LVEF? 45%) that in 91 (68.4%) of those, EPS fi nding was normal. In 41 (30.8%) patients AVB was reported.In 2 (1.5%) patients VT and atrioventricular nodal reentrant tachycardia were seen. Coronary artery disease was more common in patients with AVB and abnormal EPS fi nding (P = 0.02). Ventricular tachyarrhythmia was a rare electrophysiological finding in those with syncope, bifascicular block, and preserved LVEF. Considering cost-effect benefit, pacemaker or implantable loop recorder implantation is suggested; however, EPS may not be necessary to perform before permanent pacemaker implantation.

Paradoxical reactions to benzodiazepines including restlessness, anxiety and sometimes violent behavior sometimes occur. Most of the known predicting factors of disinhibitory reactions such as age, gender, genetic or the psychological backgroundare not modifi able. Th is study was conducted to evaluate the eff ect of rate of midazolam administration, as a controllable factor, on the occurrence of paradoxical reaction to midazolam (PRM) in pediatric patients. In a randomized, double-blind clinical trial 98 American Society of Anesthesiologists physical status I, II, aged from 6 months to 6 years, and undergoing elective surgery,were enrolled in the study. Patients were randomly allocated to receive midazolam 0.1 mg/kg as a 0.1% solution at an injection rate of 0.2 ml/s or 1 ml/s. Th e occurrence of PRM was compared between the two groups with Chi-square test. Th e occurrence of PRM in the rapid injection group was signifi cantly higher than the slow injection group (20.4% vs. 4.1%, P < 0.05, relative risk CI: 95% 6.03 (1.24-29.4)). Slow intravenous administration of midazolam signifi cantly reduces the occurrence of paradoxical reactions and should be respected in premedication of pediatric patients.

The objective of this study was to compare neonatal outcomes in women with gestational diabetes mellitus (GDM) treated with either metformin or insulin. A randomized clinical trial carried out on year 2011 on 109 women with GDM who did not adequately control by dietary measures. They received metformin 500 mg once or twice daily or insulin 0.2 IU/kg/day initially. The dose was titrated to achieve target blood glucose values. Neonatal outcomes such as hypoglycemia, birth weight,Apgar score, umbilical artery pH, and hyperbilirubinemia in the 50 women who remained exclusively on metformin were compared with 50 women who treated with insulin. Two groups were similar in mean fasting blood sugar (P = 0.7) and postprandial measurements (P = 0.8) throughout GDM treatment. Pregnancy complications or preterm labor were not diff erent signifi cantly between two groups. Considering neonatal outcomes between insulin and metformin groups, such as hypoglycemia (2 [4%] and 0 [0%], respectively), birth weight (3342 ± 506 mg and 3176 ± 438 mg, respectively), 5th min Apgar score <7 (no one in either group),umbilical artery pH <7.05 (no one in either group) and hyperbilirubinemia (1 [2%] and 0 [0%], respectively), no significant statistical differences were seen. Based on these preliminary data, considering neonatal outcomes, metformin appears to be a safe as insulin in the treatment of GDM.

This study aimed to assess the effectiveness of Topiramate, a glutamate-modulating agent, in patients with treatment-resistant obsessive-compulsive disorder (OCD) as an adjunct to serotonin reuptake inhibitors (SRIs). Thirty-eight patients with refractory OCD, were randomly assigned to receive Topiramate or placebo. This study was designed as a 12-week, double-blind, placebo-controlled trial. Primary outcome measures were the change in Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score and the rate of treatment response in each group at the study end point. Treatment response was considered as 25% or more reduction in Y-BOCS score. 13 patients in the Topiramate group and 14 ones in the placebo group completed the trial. Topiramate-assigned patients showed significantly improved mean Y-BOCS score over time (p<0.001). Although differences between two groups was significant in the Y-BOCS score at the first two months (p=0.01), this was not significant at the end of study (p=0.10). Changes of Clinical Global Impression (CGI)-Severity of Illness scale score and CGI-Improvement scale score were not significantly different between two groups (p>0.05).Treatment response was almost significantly different in the Topiramate group comparing placebo group (p=0.054). Mean Topiramate dosage was 137.5 mg/day (range, 100-200). This study didn’t show effectiveness of Topiramate as an agent to augment SRIs in treatment-resistant OCD patients.

The aim was to evaluate eff ects of 5-week whole body vibration (WBV) training with diff erent amplitudes and progressive frequencies on fi brinolytic/coagulative factors. 25 subjects were divided randomly in high or low-amplitude vibration, and control groups. Training consisted of 5-week WBV with amplitudes 4 or 2 mm. Plasma samples were analyzed before and after training. Statistical analysis was done using one-way analysis of variance and Wilcoxon signed ranked test. P <0.05 was considered signifi cant. High-amplitude vibration caused an increase in tissue plasminogen activator (tPA) (P = 0.028) (pretest: 1744.61 ± 707.95; posttest: 2313.63 ± 997.19 pg/ml), and decrease in plasminogen activator inhibitor-1 (PAI-1) (P = 0.033) (pretest: 97.94 ± 34.37; posttest: 85.12 ± 36.92 ng/ml). Fibrinogen and plasminogen were not changed signifi cantly. Low-amplitude vibration caused an increase in tPA (P = 0.006) (pretest: 2208.18 ± 1280.37; posttest: 3492.72 ± 3549.22 pg/ml). PAI-1, fibrinogen and plasminogen were not changed signifi cantly. There were no significant differences between groups. Amplitude of vibrations in WBV training may aff ect fi brinolytic factors.

Fasting during Ramadan is an Islamic rule. Although previous review studies have assessed the impact of Ramadan on cardiovascular risk factors, athlete performance, diabetes and transplantation, in this study we have appraised some on these reviews by focusing on limitations and also, we have reviewed more recently published study and several recent studies which are not reviewed till now. In this article, we reviewed recently conducted studies in regarding the impact of Ramadan fasting on weight, lipid profile, diabetes, immune system and gestation. MEDLINE (www.pubmed.com) was searched by using “Ramadan” as keyword and the most recent articles in mentioned topics since 2009 until Feb 2014 were selected. Although weight has been decreased during Ramadan in the most studies, weight regain is prevalent during the following months. Meta-analysis of pre-Ramadan lipid profile in comparison to post-Ramadan values had been showed that total cholesterol and triglyceride were decreased in men and HDL was increased among women. In regarding diabetes and fasting, diabetic patients should be aware that medical, nutritional and physical activity consulting is necessary for individuals with diabetes who want to fast during Ramadan. Although published studies shows that Ramadan fasting had no serious adverse effect on offspring, it is strongly recommended that pregnant women avoid fasting because of the limitations of studies. The effect of fasting during Ramadan on immune system is favorable. Ramadan fasting have no impact on kidney function and urine component. Studies showed that Ramadan fasting has health protective effects. More precise studies should be conducted for more reliable conclusion.

Childhood obesity is a global health problem with short- and long-term health consequences. This systematic review presents a summary of the experiences on diff erent family-, school-, and clinic-based interventions. Electronic search was conducted in MEDLINE, PubMed, ISI Web of Science, and Scopus scientifi c databases. We included those studies conducted among obese individuals aged up to 18 years. Our search yielded 105 relevant papers, 70 of them were conducted as high quality clinical trials. Our fi ndings propose that school-based programs can have long-term eff ects in a large target group. This can be related to this fact that children spend a considerable part of their time in school, and adopt some parts of lifestyle there. They have remarkable consequences on health behaviors, but as there are some common limitations, their effects on anthropometric measures are not clear. Due to the crucial role of parents in development of children’s behaviors, family-based interventions are reported to have successful eff ects in some aspects; but selection bias and high dropout rate can confound their results. Clinic-based interventions revealed favorable eff ects. They include dietary or other lifestyle changes like increasing physical activity or behavior therapy. It seems that a comprehensive intervention including diet and exercise are more practical. When they have different designs, results are controversial. We suggest that among different types of interventional programs,a multidisciplinary approach in schools in which children’s family are involved, can be the best and most sustainable approach for management of childhood obesity.

Coexistence of familial Mediterranean fever (FMF) and other infl ammatory disorders has been frequently reported, but no specific underlying factor has been identified. We report a patient with FMF who is presented with long-standing ankylosing spondylitis(AS) and cutaneous leukocytoklastic vasculitis (LV) of the lower limbs. It is the first report on combination of FMF with AS and LV. The Mediterranean Fever (MEFV) gene mutation of heterozygote (R202Q/R726A) and HLA-B27 are detected in this case, and are believed to form genetic susceptibility to LV.

To review cases of simultaneous radical cystectomy and colorectal cancer (CRC) resection for synchronous carcinoma of bladder and colorectum. Between May 1997 and September 2010, fi ve patients were diagnosed with synchronous bladder cancer and CRCs. The primary colorectal tumors included three sigmoid cancers, one ascending colon cancer and one rectal cancer. All patients underwent simultaneous radical cystectomy and CRC resection. Pathologic types were confi rmed by the biopsies of cystoscopy and colonoscopy.All patients were performed synchronous radical cystectomy and CRC resection. Four of them received adjuvant chemotherapies for CRC. Two of them died of liver metastasis 32.8 months and 13 months after surgery. Although patients with synchronous carcinoma of bladder and colorectum are rare, the Urologist should be alerted to this possibility when evaluating patients for the initially presenting symptoms and/or detected tumors. The simultaneous surgery is technically feasible for the selected patients.

Small bowel obstruction is a common cause of an emergency admission in the surgical wards. Acute appendicitis presenting with small bowel obstruction due to appendiceal knotting is a very rare and unsuspected condition in an emergency scenario. We reporta case of acute small bowel obstruction in a 26-year-old male who, on exploration was found to have small bowel strangulation due to appendiceal knotting. Though rare, the possibilities of such a diagnosis should be kept in mind in patients with small bowel obstruction with no known identifi able etiology.