Showing papers by "Mohammad Hossein Khosravi published in 2016"

Diabetes knowledge, attitude and practice (KAP) study among Iranian in-patients with type-2 diabetes: A cross-sectional study.

Abstract: Summary Aim Recent studies highlight barriers of diabetes educational programs in Iran and also present some successful experiences carried out for improving the knowledge, attitude, and practice (KAP) of type-2 diabetic patients. Hence, evaluation of patients’ KAP seems to be needed. We designed a multicenter study evaluating level of KAP in type-2 diabetic patients in the capital city of Tehran and identifying variables that affect this KAP level. Methods This multicenter analytical cross-sectional study was approved by Shahid Beheshti University of Medical Sciences Ethics Committee. Questionnaires were designed for evaluation of diabetes-related KAP in patients. After validating the questionnaires by endocrinologists, test–retest method was used for questionnaire reliability by checking in 15 diabetic patients. Two hundred type-2 diabetic patients admitted to 4 hospitals of Tehran filled out the questionnaires. Using SPSS software, the level of KAP and its confounders were evaluated in patients. Results Two hundred type-2 diabetic patients with the mean age of 60.17 years were evaluated (106 male and 94 female). The mean diabetes duration was 13.06 years. The levels of patients’ good knowledge, attitude, and practice were 61.41%, 50.44% and 52.23%, respectively. Age, treatment methods, DM duration, and existence of diabetic retinopathy had significant correlations with KAP level. Conclusions The results of this study showed that recent educational programs in Iran improved KAP level. Patients’ KAP increases as their condition worsens/progresses. Hence education should be considered as a priority for newly diagnosed patients and those with lower KAP levels before occurrence of diabetes complications.

Comparison of efficacy and safety of two available natural surfactants in Iran, Curosurf and Survanta in treatment of neonatal respiratory distress syndrome: A randomized clinical trial

Abstract: Introduction The benefit of surfactant prescription for respiratory distress syndrome (RDS) has been approved. Curosurf and Survanta are two commonly used natural surfactants in Iran. Previous studies did not report priority for one of these two drugs. The present study aimed to compare the effectiveness and safety of Curosurf and Survanta in treatment of RDS. Methods In this randomized clinical trial, neonates were born with RDS diagnosis in two governmental and referral hospitals of Tehran (the capital of Iran) in 2014 were randomly selected. Neonates were randomly assigned into two groups receiving 100 mg/kg Curosurf or Survanta as soon as possible after randomization. Complications, mortality and needing the second dose were compared between the two groups. Results A total 112 patients with the mean gestational age of 32.59 ± 3.39 weeks were evaluated (56 patients in each group). There were no significant differences regarding birth weight, gestational age, delivery method, and parity between the two groups (P > 0.05). The complications were occurred in 18 neonates (32.1%) of Curosurf group and 20 neonates (35.7%) of Survanta group (RR = 0.922, 95% CI = 0.617–1.379). There were no significant differences regarding complications, mortality, and needing nasal CPAP and endotracheal tube between the two groups. In the neonates with gestational age of 29–32 weeks the IVH and NEC incidence were significantly more in Curosurf group compared to Survanta group (27.8% vs 0% and 22.3% vs 0%, P Conclusion There was no significant difference in complications or mortality between those two groups; however Curosurf was associated with less need of ET tube (in >32 birth weeks subgroup) and NCPAP (in 29–32 birth weeks subgroup) (p = 0.008). Further evaluations with longer follow-up duration are needed for comparing these two surfactants.

The Effect of Probiotics on Reducing Hospitalization Duration in Infants With Hyperbilirubinemia

Abstract: Background: Approximately 60% of term and 80% of premature infants are hospitalized for hyperbilirubinemia in the first week of life. Hyperbilirubinemia is the most common cause of infant hospitalization and readmission. Due to the high frequency of hyperbilirubinemia in infants and the high costs of treatment, it is necessary to find a way to decrease hospitalization duration. Objectives: The aim of this study is to assess the adjunctive effect of probiotics on decreasing hospitalization time for infants with hyperbilirubinemia. Methods: In this randomized, controlled clinical trial, 92 term infants with hyperbilirubinemia who met the inclusion criteria were randomly assigned to either the probiotic or control group. Patients in both groups underwent common phototherapy. Once a day, those in the probiotic group were also given half of a capsule of Prokid probiotic, while those in the control group received half of a placebo capsule. The duration of phototherapy and hospitalization, the blood groups of mothers and infants, and each patient’s bilirubin levels before and after phototherapy, direct Coombs test results, and levels of hemoglobin, G6PD, and reticulocytes were recorded. Results: Data from 92 patients with a mean age of 5.25 ± 2.35 days underwent analysis. The control group had 47 (51.1%) patients with a mean age of 5.19 ±2 .51 days and the probiotic group had 45 (48.9%) patients with a mean age of 5.31 ± 2.19 days (P = 0.81). The 92 patients had a mean bilirubin level of 16.70 ± 3.07 mg/dL, with a mean of 16.42 ± 3.53 mg/dL in the control group and 17.00 ± 2.49 mg/dL in the probiotic group (P = 0.37). The duration of hospitalization averaged 3.34 ± 0.70 days overall, with an average of 3.55 ± 0.74 days for the control group and 3.13 ± 0.70 days for the probiotic group. The probiotic group had a significantly lower hospitalization stay in comparison to the control group (P = 0.004). Conclusions: Our findings suggest that probiotics may be beneficial as an adjunct treatment for infants with hyperbilirubinemia by reducing the duration of hospitalization.

Pleural Effusion in Children: A Review Article and Literature Review

Abstract: Pediatrics pleural effusion is an abnormality that frequently develops from collection of fluids in the pleural space and commonly caused by a primary phenomenon or secondary to variety of disorders such as infections. This accumulated fluid can be originated from excessive filtration or defective absorption caused by different infectious agents such as Streptococcus pneumoniae , which is the most common, or non-infectious factors like lymphoma or congestive heart failure. It may present a various range of complications from a self-limited one to respiratory failure. Pediatrics pleural effusion is most commonly seen in boys and younger children. The incidence and distribution of pleural effusion is increasing in most industrial countries according to the population studies. The prognosis is highly related to the underlying disorder as well as treatment approach. early drainage of fluid may dramatically reduce the rate of mortality and morbidity. Clinical manifestations are variable depended on the underlying disease, size, and location of the effusion. They range from persistent fever, cough, anorexia, malaise, tachypnea, dyspnea, and chest pain, like in infectious pneumonia, to abdominal pain, distension and vomiting. In physical examinations a pleural rub may be the only initial manifestation during the early stage of pleurisy. A large amount of fluid diminishes the chest excursion on the affected side and may shift the mediastinum and displace the trachea and cardiac apex to the contralateral side, unilaterally. Initial diagnostic test for ruling out the different causes of pleural effusion is analyzing the pleural fluid apparently and biochemically. Also imaging tests could be used such as chest radiography so as to ensure the existence of pleural effusion. Ultrasonography and computed tomography (CT) scanning are also beneficial for a more accurate assessment. In most affected cases removing underlying etiologies and also applying supportive care are sufficient to heal effusion, which can range from antibiotic therapy and using fibrinolytics to chest tube drainage. Surgical therapy in patients with pleural effusion with the failed medical management has remained controversial, though. Thus, selection of the best management approach can result in favorable outcomes and significantly reduces morbidity and mortality rates.

Comparison of the Vitamin D Status of Children Younger and Older Than 2 Years in Tehran: Are Supplements Really Necessary?

Abstract: Background Vitamin D is a vital lipid-soluble vitamin in the body, helping the growth and development of bones. Vitamin D deficiency in children has several adverse effects. The most important preventative factor is determining the deficiency at an early stage and prescribing vitamin D-containing supplements. Objectives To investigate the vitamin D status of children younger and older than 2 years and determine the utility of prescribing vitamin D supplements. Patients and methods Three hundred healthy children who attended the pediatric clinic for routine assessments were enrolled in this study. Their parents were asked to complete a questionnaire, which included questions about demographics, nutrition, and supplements. Blood levels of vitamin D, calcium, and phosphorus were then measured. Results The final study consisted of 286 children, 140 males and 146 females, with a mean age of 4.46 ± 2.82 yr. Of these, 218 (76.22%) children, with a mean age of 5.09 ± 2.82 yr, had vitamin D deficiency, and 76 children (23.78%), with a mean age of 2.58 ± 1.88 yr, had normal vitamin D levels (P = 0.001). The mean level of vitamin D was 29.71 ± 14.42 ng/mL in 88 (30.8%) patients up to 2 years and 17.11 ± 14.02 ng/mL in 198 (69.2%) patients older than 2 years (P = 0.0001). Conclusions The vitamin D levels of children aged more than 2 years are lower than those of children aged less than 2 years. Thus, prescribing vitamin D-containing supplements in children older than 2 years may be beneficial.

Assessment of Toxoplasma Seropositivity in Children Suffering from Attention Deficit Hyperactivity Disorder

Abstract: Background: Toxoplasmosis, a protozoan infection caused by Toxoplasma gondii , is suggested to be a risk factor for many psychological disorders such as schizophrenia and depression. Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common psychiatric disorders among children. Previous studies have assessed the correlation between ADHD and infectious diseases like toxoplasmosis. So we aimed to investigate the possible correlation between Toxoplasma seropositivity and ADHD in children. Materials and Methods: in this case-control study children with signs of ADHD were regarded as patients and underwent clinical assessments. Diagnosis of these patients was based on DSM-IV-TR system which was performed by pediatric psychiatrist. Fourty-eight Children without signs of ADHD or other psychic disorders were considered as control, and 48 patients were considered as case group. Parents were asked to answer a questionnaire including demographic, pregnancy and habitual questions. Blood samples were taken of all individuals and assessed for anti-Toxoplasma IgM and IgG antibodies. Results: Ninety-six male and female patients with a mean age of 8.12 years underwent analysis. Seropositivity rate for anti- T.gondii IgG antibody was 4.2% in case and 2.1% in control individuals (p=0.92). Anti- T.gondii IgM antibodies were not found in control individuals while it was found in 2.1% of case individuals (p=0.745). There was no statistically significant association between seroprevalence of IgM (p=0.745) and IgG (p=0.920) antibodies and ADHD in study individuals. Conclusion: Our findings suggest that the toxoplasmosis has no direct effect on the incidence of ADHD. Further studies are needed with a larger amount of individuals.

Reliability of fine-needle aspiration and ultrasound-based characteristics of thyroid nodules for diagnosing malignancy in Iranian patients.

Abstract: Background Sonography and fine-needle aspiration biopsy (FNA-B) have been approved as method of choice in diagnosis of malignant thyroid nodules. Unnecessary FNA-B not only is invasive and costly but also results in second biopsy or unnecessary surgery. So we aimed to determine the specificity and sensitivity of sonography and FNA-B, without sonography guidance, in diagnosis of malignant and benign thyroid nodules. Methods Patients with thyroid nodule referred to Baqiyatallah Hospital in 2014–2015 and candidates for surgical nodule resection were selected using simple random sampling method. Patients were evaluated by sonography and FNA. Sonographic characteristics of nodule were described. All patients underwent surgical resection and gross samples were sent for pathological evaluation, the gold standard for measuring the specificity and sensitivity of sonographic findings and FNA in diagnosis of malignant nodules. Results Ninety patients with the mean age of 45.95 ± 12.3 years were evaluated (17 male and 73 female). Comparing the patients with correct and incorrect sonography-based diagnosis showed significant differences in nodule's width, area, calcification, border, and cervical lymphadenopathy (P < 0.05). Comparing the patients with correct and incorrect FNA-based diagnosis showed significant differences in patients' age and tall-shape nodule (P < 0.05). The diagnosis of sonographist had 56.25% sensitivity and 95.9% specificity, and the FNA-based diagnosis had 81.25% sensitivity and 93.7% specificity. Conclusion Among sonography findings, width and area of nodule, calcification, and nodule border have significant effect on malignancy diagnosis. Also FNA is necessary in nodules with calcification, border irregularity, and less width and area, especially in younger patients. Diagn. Cytopathol. 2016;44:269–273. © 2016 Wiley Periodicals, Inc.

Dual Ectopic Multinodular Goiter: A Case Report

Abstract: Background: As the first endocrine gland to form during embryogenesis, Thyroid develops in the 7th embryonic week through migration from foramen cecum to its adult position, anterolat­eral of 2nd and 4th tracheal cartilages. Ectopic Thyroid can be found anywhere along the migra­tion path with or without co-existence of a normally located Thyroid. Ectopic thyroid glands at two different locations are so rare that only about 24 cases of dual ectopia have been reported. We present the first case of dual ectopic submandibular multinudolar goiter. Case Report: We describe a 35-year-old housewife who consulted us complaining two huge and gradually-grow­ing swellings in right and left upper neck regions. In physical examination, two great well-de­fined masses, one in right and one in left submandibular regions, were seen which had firm for­midability with no mobility, tenderness or evidence of inflammation. Imaging and fine-needle aspiration confirmed the diagnosis of dual ectopic submandibular multinodular goiter in our patient as the first case of occurrence. Conclusion: Finally, we recommend ectopic thyroid to be considered in the diagnosis of laterally located and submandibular neck masses especially in the absence of normally located thyroid. Additionally, we confirmed the idea that not all the laterally-located ectopic thyroids are malignant. [GMJ.2016;5(2):98-102]

Student Research Committee as a Model for Development of Medical Research Projects.

Abstract: Student Research Committee (SRC) has been developed a subset of each university’s Vice chancellor for research in purpose of research training for motivated students and conducting their research interests. In this paper, we evaluated effect of SRCs on Iran’s research through Scopus database and showed that SRCs has a remarkable impact on Iran’s publication performance.

Improvement of Tinnitus following Tympanoplasty and Tympanomastoidectomy Surgeries in Patients with Chronic Otitis Media

Abstract: Background: After otorrhea and hearing loss, Tinnitus is the most common symptom in pa­tients with chronic otitis media (COM). The aim of this study was to evaluate the improvement of tinnitus in COM patients after tympanoplasty and tympanomastoidectomy surgeries. Mate­rials and Methods: This cross-sectional study was conducted on COM patients suffering from Tinnitus referred to Baqiyatallah hospital, Tehran, Iran undergoing tympanoplasty or tympano­mastoidectomy surgeries between March 2013 and August 2014. Tinnitus Handicap Inventory (THI) and Visual Analogue Scale (VAS) questionnaires were filled before and two months after surgery by each patient, and considered subjects were compared with each other. Audiometry test was taken from each patient before and two months after surgery. Audiometry results as well as Air-Bone gap were measured and evaluated prior and after surgery. Data were analyzed using SPSS software by ANOVA, sample t-test and Chi-square tests. Results: Eventually, 26 male and 24 female patients with a mean age of 38.62±11.88 years were enrolled. Air conduc­tion at all frequencies was 49.99±17.37 before and 36.98±22.06 after surgery (P<0.001). Sever­ity of tinnitus was 62.92±30.54 before and 30.54±20.08 after surgery based on THI (P<0.001). Also, it was 7.46±1.66 before and 3.5±2.06 after surgery based on VAS evaluations (P<0.001). Tinnitus severity reduction was significantly associated with the improvement of hearing loss and decrement of air-Bone gap (P<0.001). Tinnitus symptoms such as loudness, annoyance, impact on life and perception of Tinnitus significantly reduced after surgery. Moreover, Tym­panomastoidectomy was more effective on the improvement of Tinnitus in comparison with Tympanoplasty (P=0.019). Conclusion: It seems that, both tympanomastoidectomy and tympa­noplasty surgeries are effective on the improvement of tinnitus in patients with COM; however, Tympanomastoidectom surgery was shown to be more effective. [GMJ.2016;5(2):63-69]

Histopathological Distribution of Ovarian Masses Occurring After Hysterectomy: A Five-Year Assay in Iranian Patients

Abstract: Background: Ovarian cancer, the third most important genital cancer and fifth cause of cancer-related death in women, is diagnosed at terminal stages in 70% of cases. Therefore, it is imperative to know the possible risk factors associated with ovarian cancer. Only a few studies have discussed the histopathological features of ovarian masses occurring after hysterectomy. Objectives: The study aimed to investigate the five-year prevalence and histopathological distribution of ovarian masses after hysterectomy in Iranian patients and to determine the need for prophylactic salpingo-oophorectomy. Patients and Methods: This descriptive cross-sectional study enrolled all patients with ovarian masses and a history of hysterectomy for benign conditions who were visiting the gynecology clinic of Baqiyatallah Hospital, Tehran, between May 2009 and May 2014. Demographic information, pathological features of ovarian masses, family history, the time between hysterectomy and ovarian mass surgery, and method of hysterectomy were recorded in a predesigned checklist. The level of tumor markers such as CA125 and alpha-fetoprotein (α-FP) were measured. Results: Of the 1052 patients with ovarian masses, 45patients (mean age, 53.11 ± 9.56 years) who had undergone abdominal hysterectomy underwent analysis. The study participants had a mean age of 47.92 ± 1.58 years at the time of hysterectomy. The mean time interval between hysterectomy and diagnosis of ovarian mass was 5.38 ± 4.15 years. Based on pathological reports, serous cystadenoma was the most frequent (43.2%) pathological diagnosis, followed by mucinous cystadenoma (17.5%). Conclusions: A majority of ovarian masses, especially those diagnosed within a short duration after hysterectomy, are benign. Iranian patients with such ovarian masses when asymptomatic and associated with negative tumor markers could be followed up, and prophylactic oophorectomy may not be necessary.

Comparing the Role of Physical Examination and Radiography in Diagnosis of Scaphoid Fracture; Superiority or Collaboration?

Abstract: Background: Scaphoid bone fracture is the most common fracture of the wrist. The most important point is its early diagnosis so as to prevent consequent complications. Physical examination and radiography are two main ways of diagnosis. Objectives: So we aimed to evaluate the accuracy of clinical and radiographic examinations in the diagnosis of scaphoid fracture. Patients and Methods: In this prospective study, 48 patients suspicious for scaphoid fracture attending to emergency ward of our hospital were enrolled. Scaphoid tubercle tenderness test, compression and anatomical snuffbox tenderness tests were done and radiographies of four views of hand (anterior-posterior, lateral, ulnar oblique and radial oblique) were taken from patients. In case of positive finding in one or more clinical tests and normal radiographies, patient’s wrist was immobilized by cast for two weeks. Then a second radiography was taken and the results of clinical examinations and primary radiography were compared with second radiography in order to determine sensitivity and specificity of radiographies and clinical assessments. Results: Eventually 48 patients including 31 (64.6%) males and 17 (35.4%) females with a mean age of 38 years old underwent analysis. Scaphoid tubercle tenderness test had the maximum sensitivity (95.24%), specificity (74.07%) and diagnostic accuracy (56.25%) as well as the least false positive cases (25.92%). Anterior-posterior (AP) radiography had the maximum sensitivity (47.61%), specificity (100%) and diagnostic accuracy (20.83%) as well as the least false negative cases (28.94%). Conclusions: Scaphoid tubercle tenderness tests in association with x-ray radiographies, especially anterior-posterior view, are the most useful tests for diagnosis of scaphoid fractures.

Varicella Susceptibility in Iran Military Conscripts: A Study Among Military Garrisons

Abstract: Background: Promoting varicella vaccination for military personnel and conscripts, as one of the susceptible and high-risk groups, is an important governmental approach in every society. The present study aimed to address the seroprevalence of this infection and its immunization level among Iranian military conscripts. Objectives: This study was conducted to determine seroprevalence of varicella infection and its immunization level among Iranian military conscripts. Methods: Four hundred and sixty-four conscripts, using cluster-stratified sampling, were selected from all military garrisons in Tehran. Seroprevalence of infection among each participant was determined by measuring varicella IgG antibody level via the enzyme-linked immunosorbent assay (ELISA). Results: The mean antibody titer among the participants was 109.66127.47; 86.9% of studied samples were seropositive. Place of residence could somewhat predict the seropositivity against varicella; seropositivity was significantly higher in participants, who lived in the capital city than those wholived in other regions (OR: 4.008, 95%CI: 0.947 - 16.953, P=0.059). Age, education level, marital statusandduration of military were not associated with seropositivity. Conclusions: Susceptibility to varicella infection is considerably lower among military garrisons in Tehran and is mainly dependent on their place of residence. However, the current study could not provide a comprehensive picture of the immunological status of the varicella in Iran military garrisons, and we suggest further studies in more cities to aid with the design of immunization programs for these individuals.

Letter to the Editor: Should We Really Take Anti-Viral Therapy into Account in Chronic Hepatitis B Patients with Normal Liver Function?

Abstract: Dear Editor-in-Chief We read with a great interest the article written by Lee and colleagues entitled "Hepatocellular Carcinoma Risk of Compensated Cirrhosis Patients with Elevated HBV DNA Levels according to Serum Aminotransferase Levels" which was recently published in your Journal of Korean Medical Science (1). The authors concluded the beneficial effects of prescribing appropriate anti-viral therapy (AVT) for reducing HCC risk in cirrhotic patients with elevated HBV DNA and normal aminotransferase levels. They have done a valuable work with an appropriate sample size which has considered a really challenging and important subject in chronic hepatitis B (CHB) patients. Despite our interest to the results of the Lee et al. study there are some challenging points about their work; so some comments may be of benefit. The first, the authors have claimed that high levels of ALT were associated with higher risk of HCC in patients with high HBV DNA level. Regarding available data, there is an overlap between high ALT and high HBV DNA levels in their study where they both increase the chance of HCC independently (2). Also high ALT level may be related to high HBV DNA level or possible non-alcoholic fatty liver (NAFLD) in the study individuals that will enhance the risk of HCC (3). Due to limitations of retrospective studies, no information was provided regarding patients??BMI by Lee et al. for considering this subject in their study. Another important issue is that the authors have concluded that AVT duration is associated with lower HCC risk in patients with normal aminotransferase levels and suggested prompt AVT to be considered in these patients. This conclusion involves providing more evidence since there are efficient data on higher risk of HCC in chronic hepatitis B patients with high ALT and HBV DNA levels. However, it is difficult to conclude that AVT can have protective effect on HCC in patients with normal ALT level, high HBV DNA level and without liver damage; as it has been shown that these patients could be considered as HBV inactive carriers (IC) regarding treatment (4). On the other hand, it was concluded that treatment naive patients who underwent AVT may have even higher risk of HCC development than patients with inactive stage CHB (5). Previous data have clarified the role of HBs Ag in differentiation of CHB from IC patients; however it was mentioned not to be cost-effective (6). It was concluded that CHB patients had higher levels of HBV DNA, HBs Ag and ALT levels in comparison with IC patients (6). In conclusion we appreciate the valuable effort of the authors, however we are wondering if we could kindly ask them to interpret better our concerns.