Showing papers in "Journal of Research in Medical Sciences in 2013"

Zinc and its importance for human health: An integrative review.

Abstract: Since its first discovery in an Iranian male in 1961, zinc deficiency in humans is now known to be an important malnutrition problem world-wide. It is more prevalent in areas of high cereal and low animal food consumption. The diet may not necessarily be low in zinc, but its bio-availability plays a major role in its absorption. Phytic acid is the main known inhibitor of zinc. Compared to adults, infants, children, adolescents, pregnant, and lactating women have increased requirements for zinc and thus, are at increased risk of zinc depletion. Zinc deficiency during growth periods results in growth failure. Epidermal, gastrointestinal, central nervous, immune, skeletal, and reproductive systems are the organs most affected clinically by zinc deficiency. Clinical diagnosis of marginal Zn deficiency in humans remains problematic. So far, blood plasma/serum zinc concentration, dietary intake, and stunting prevalence are the best known indicators of zinc deficiency. Four main intervention strategies for combating zinc deficiency include dietary modification/diversification, supplementation, fortification, and bio-fortification. The choice of each method depends on the availability of resources, technical feasibility, target group, and social acceptance. In this paper, we provide a review on zinc biochemical and physiological functions, metabolism including, absorption, excretion, and homeostasis, zinc bio-availability (inhibitors and enhancers), human requirement, groups at high-risk, consequences and causes of zinc deficiency, evaluation of zinc status, and prevention strategies of zinc deficiency.

Pharmacokinetic drug-drug interaction and their implication in clinical management.

Abstract: Drug-drug interactions (DDIs) are one of the commonest causes of medication error in developed countries, particularly in the elderly due to poly-therapy, with a prevalence of 20-40%. In particular, poly-therapy increases the complexity of therapeutic management and thereby the risk of clinically important DDIs, which can both induce the development of adverse drug reactions or reduce the clinical efficacy. DDIs can be classify into two main groups: pharmacokinetic and pharmacodynamic. In this review, using Medline, PubMed, Embase, Cochrane library and Reference lists we searched articles published until June 30 2012, and we described the mechanism of pharmacokinetic DDIs focusing the interest on their clinical implications.

Microteaching, an efficient technique for learning effective teaching

Abstract: Microteaching, a teacher training technique currently practiced worldwide, provides teachers an opportunity to perk up their teaching skills by improving the various simple tasks called teaching skills. With the proven success among the novice and seniors, microteaching helps to promote real-time teaching experiences. The core skills of microteaching such as presentation and reinforcement skills help the novice teachers to learn the art of teaching at ease and to the maximum extent. The impact of this technique has been widely seen in various forms of education such as health sciences, life sciences, and other areas. The emerging changes in medical curricula by the Medical Council of India and the role of medical teachers envisage the need of this special training of teachers and monitoring of their skills for their continued efficient performance at any age. The alleged limitations of microteaching can be minimized by implementing this at the departmental level in several sequences. The author made literature search of research and review articles in various educational databases, journals, and books. From the reference list of published articles, books were also reviewed. This paper presents an outline of the various phases of microteaching, core teaching skills, implementation aspects, and the impact of microteaching on medical education.

Oxidative stress and the paradoxical effects of antioxidants.

Abstract: Sir, Oxidative stress is referred to imbalance between the reactive oxygen species and antioxidants system to detoxify the reactive intermediates or to repair the resulting damage.[1,2,3] Oxidation is a chemical reaction that transfers electrons or hydrogen from a substance to an oxidizing agent.[4,5,6] Although oxidation reactions are crucial for life, they can also be damaging.[1,2,7,8,9] Insufficient levels of antioxidants or inhibition of the antioxidant enzymes, cause oxidative stress which may damage all components of the cell, including proteins, lipids and deoxyribonucleic acid.[1] The oxidative stress is thought to be involved in the development of atherosclerosis, heart failure, myocardial infarction, cancer, Parkinson's disease, Alzheimer's disease, sickle cell disease, lichen planus, vitiligo, autism, chronic fatigue syndrome and renal failure.[1,2,6,10,11,12,13,14] Antioxidants are reducing agents such as thiols, ascorbic acid, or polyphenols molecules that inhibit the oxidation of other molecules by being oxidized themselves. Plants and animals maintain complex systems of multiple types of antioxidants such as glutathione, vitamin C, vitamin A and vitamin E as well as enzymes such as catalase, superoxide dismutase and various peroxidases.[1,2,6,13] Antioxidants are widely used in dietary supplements and have been investigated for the prevention of diseases such as cancer, coronary heart disease and even altitude sickness. Although initial studies suggested that antioxidant supplements might promote health, later large clinical trials with a limited number of antioxidants detected no benefit and even suggested that excess supplementation with certain putative antioxidants may be harmful.[11,14] From the literature review we may conclude that the diets high in antioxidants (fruits and vegetables) are nearly almost beneficial, but this is not the case for diet supplementations. The possible explanation is that, in the diet, there is a mix of antioxidants and it is well recognized that they work as a continuous chain, while supplementation is usually given using one or two substances. Therefore, the antioxidant chain is not completely available.[1,2,6,13] In this regard, it is well-known that after scavenging free radicals, if an antioxidant is not restored by the following antioxidant in the chain, it begins to be a pro-oxidant. In this situation, the final effect of such supplementations would be no effect or a damaging effect.[14,15] Therefore, in antioxidant therapy complimentary antioxidants cannot always substitute the fruits and vegetables high in antioxidants.

Prevalence of osteoporosis in Iran: A meta-analysis.

Abstract: . 12.00 Background: Several studies have investigated the prevalence of osteoporosis among general population in several parts of Iran. However, the results have been inconsistent. This meta-analysis was conducted to estimate the overall prevalence of osteoporosis. Materials and Methods: International and national electronic databases were searched until April 2012, including Web of Knowledge, Medline, Scopus, Ovid, ScienceDirect, Science Information Database, IranMedex, MagIran, as well the relevant conference databases. The reference lists of included studies were screened as well. The cross-sectional studies addressing the prevalence of osteoporosis among Iranian general population were retrieved irrespective of age and sex. Bone mineral density (BMD) based on T-score was classified as follows: (a) normal (T-score ≥−1); (b) osteopenia (–2.5SD < T-score <−1SD); (c) osteoporosis (T-score ≤–2.5). Study quality was assessed using the recommended checklist of STROBE. Results: Of 2598 retrieved studies, 31 studies comprising 34,814 people was used for meta-analysis. The overall prevalence of osteoporosis in lumbar spine was 0.17 (95% CI: 0.13, 0.20) and that of osteopenia was 0.35 (95% CI: 0.30, 0.39). The prevalence was higher in older age groups, in women, and in the northern regions of the country, with an increasing trend in recent years. Conclusion: This meta-analysis indicated that osteoporosis and osteopenia are common problems among Iranian population older than 30 years. Furthermore, increasing trend of the diseases in recent years is promising a critical public health problem in Iran in the near future. However, due to the heterogeneity between the studies’ results, further evidence based on a national survey is needed to estimate the exact prevalence of the diseases in the country. Key words: Iran, meta-analysis, osteopenia, osteoporosis, prevalence, systematic review Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:3.0pt; mso-para-margin-right:-.7pt; mso-para-margin-bottom:0in; mso-para-margin-left:0in; mso-para-margin-bottom:.0001pt; line-height:12.5pt; mso-line-height-rule:exactly; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;}

A quick review of carbamazepine pharmacokinetics in epilepsy from 1953 to 2012.

Abstract: Background: Carbamazepine has been used as AEDs since 1965, and is most effective against partial seizures. Two basic mechanisms of action have been proposed: 1) enhancement of sodium channel inactivation by reducing high-frequency repetitive firing of action potentials, 2) and action on synaptic transmission. The aim of this study was to provide a review of carbamazepine pharmacokinetics and its management guidelines in Iranian epileptic population.

Body mass index and body fat percentage are associated with decreased physical fitness in adolescent and adult female volleyball players.

Abstract: Background: The objectives of this study were to examine (a) the prevalence of overweight/obesity, and (b) the relationship between body mass index (BMI), body fat percentage (BF) and physical fitness in adolescent and adult female volleyball players.

Radio Frequency Identification (RFID) technology and patient safety

Abstract: Background Radio frequency identification (RFID) systems have been successfully applied in areas of manufacturing, supply chain, agriculture, transportation, healthcare, and services to name a few. However, the different advantages and disadvantages expressed in various studies of the challenges facing the technology of the use of the RFID technology have been met with skepticism by managers of healthcare organizations. The aim of this study was to express and display the role of RFID technology in improving patient safety and increasing the impact of it in healthcare. Materials and methods This study was non-systematical review, which the literature search was conducted with the help of libraries, books, conference proceedings, PubMed databases and also search engines available at Google, Google scholar in which published between 2004 and 2013 during Febuary 2013. We employed the following keywords and their combinations; RFID, healthcare, patient safety, medical errors, and medication errors in the searching areas of title, keywords, abstract, and full text. Results The preliminary search resulted in 68 articles. After a careful analysis of the content of each paper, a total of 33 papers was selected based on their relevancy. Conclusion We should integrate RFID with hospital information systems (HIS) and electronic health records (EHRs) and support it by clinical decision support systems (CDSS), it facilitates processes and reduce medical, medication and diagnosis errors.

Association of serum uric acid with proteinuria in type 2 diabetic patients.

Abstract: Background: Various findings suggest that uric acid is an inflammatory factor and may have a role in endothelial dysfunction and act as a mediator of diabetic nephropathy. The objective of this study was to evaluate the relationships between serum uric acid level and level of proteinuria in type 2 diabetic (T2D) patients. Materials and Methods: A cross‑sectional analytical study was conducted in 60 patients with T2D without a history of gout. None was treated with allopurinol. Venous blood samples were obtained in fasting state for determinations of serum creatinine, uric acid, and hemoglobin A1c (HbA1c) (reference range 3.8-5.5%); 24‑h urine proteinuria was also measured. Results: Mean age of the patients was 57 ± 8.3 years. Mean ± standard error (SE) of serum creatinine was 0.98 ± 0.028 mg/dL, mean ± SE of serum uric acid was 4.5 ± 0.15 mg/dL, and mean ± SE of proteinuria was 388 ± 28.7 mg/day (median = 303.5 mg/day). There was no significant difference in serum uric acid, HbA1c, and creatinine level between males and females (P > 0.05). There was a significant positive association between body mass index (BMI) and serum uric acid levels (r = 0.428, P = 0.001). After adjustment for weight, a significant positive association of serum uric acid with level of proteinuria was seen (r = 0.47, P < 0.001). Conclusion: Serum uric acid had a significant positive association with diabetic nephropathy. It might be hypothesized that serum uric acid plays a role in diabetic nephropathy in T2D.

Prevalence and trend of hepatitis C virus infection among blood donors in Iran: A systematic review and meta-analysis

Abstract: Background: Hepatitis C virus (HCV) is the main causative agent of post-transfusion hepatitis. The virus is distributed worldwide with varying prevalence in different countries, which could easily lead to chronic infections, cirrhosis, and even hepatocellular carcinoma. The aim of this study was to investigate prevalence of HCV infection and its trend in Iranian blood donors. Materials and Methods: Literatures on the HCV prevalence among blood donors in Iran were acquired through searching PubMed, Magiran, IranMedex, Scientific Information Databank, and Google databases. All the potentially relevant papers were reviewed independently by two investigators by assessing the eligibility of each paper and abstracting data. Prevalence was calculated using random effects model for meta-analysis. Results: Forty-eight studies with total samples of 10,739,221 persons from 1996 to 2011 were combined and meta-analyzed, the pooled prevalence of HCV infection among blood donors in Iran provinces and cities was 0.5 (95 CI: 0.4-0.6). Trend of HCV infection was decreasing in recent years. Conclusion: This study provides a comprehensive and reliable data on the prevalence and trend of HCV infection among blood donors and may be helpful in providing insight into disease burden and opportunities for prevention. In comparison with countries in this geographic region, Iran has the lowest rate of HCV infection.

The prevalence of cigarette smoking among students of Iran's universities: A systematic review and meta-analysis.

Abstract: Background: Studentship period is a time when most behavioral traits are being created and fixed; this is a special time when students may start smoking. Thus in the present research, prevalence of smoking in university students in Iran has been evaluated. Materials and Methods: Having extensively explored Iranian and International databases (SID, Iranmedex, Magiran, Medlib,Irandoc, Pubmed, Google Scholar, and WHO) with broad keywords, we looked for relevant papers about the frequency of cigarette smoking among students in Iranian universities in recent years. We recruited only those primary papers with required information and acceptable methodology by reviewing their titles, abstracts, and full-texts. The main data about the prevalence of smoking,age and sex distribution of subjects, sample size, date, and location of studies were extracted from the full-text of eligible papers. Results: A total of 22 valid articles were selected. Among the findings of these studies, the lowest and highest prevalence of smoking among male students was 13.4 and 39.9, respectively, while it was 0.7 and 25.5%, respectively, among female students. Meta-analysis results reveals that smoking frequency among male and female students in Iran’s universities is 19.8% (17.7-21.9) and 2.2% (1.4-3.02), respectively. Conclusion: The variation of smoking in students in different universities shows that the tendency of smoking varies in different locations. Furthermore, compatible with the prevalence of smoking in the general population in Iran, female students smoke much less than male students. Key words: Cigarette, Iran, meta-analysis, systematic review, students Normal 0 false false false EN-US X-NONE AR-SA /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;}

Factors associated with mortality in tuberculosis patients

Abstract: Background: Tuberculosis (TB) is one of the main causes of morbidity and mortality in different societies. Understanding factors leading to death following diagnosis of TB is important to predict prognosis in TB patients. The aim of this study was to identify common risk factors associated with death in patients with an in-hospital diagnosis of TB, in a city in Iran with the highest prevalence and incidence of TB in the country.

Preoperative carbohydrate nutrition reduces postoperative nausea and vomiting compared to preoperative fasting

Abstract: Background: The aim of this prospective, randomized, single-blinded study was to compare the effects of a carbohydrate drink 400 mL given 2 h before the surgery with preoperative overnight fasting on the gastric pH and residual volume, postoperative nausea and vomiting (PONV) and antiemetic consumption in patients undergoing laparoscopic cholecystectomy. Materials And Methods: Forty American Society of Anesthesiologists physical status I-II patients who underwent elective laparoscopic cholecystectomy. Randomized, prospective, controlled study, Gulhane Medical Faculty and Guven Hospital Department of Anesthesiology and Reanimation. Patients were randomly assigned into two groups: Pre-operative carbohydrate drink group (group C, n = 20) and preoperative fasting group (group F, n = 20). Group C was given a 400 mL carbohydrate drink 2 h before to the surgery. The patients of group F were fasted 8 h before the surgery. Both groups were operated under general anesthesia with volatile anesthetics. Results: Hemodynamic parameters, demographic data, gastric acidity and residual volumes were similar for both groups. No complications were observed. PONV and antiemetic consumption was lower in group C compared to group F (P = 0.001). Patient’s satisfaction was higher in group C (P < 0.001). Conclusion: This study showed that pre-operative carbohydrate drink may be used safely and also improves patient’s satisfaction and comfort in patients undergoing laparoscopic cholecystectomy. Key words: Laparoscopic cholecystectomy, post-operative nausea and vomiting, pre-operative carbohydrate nutrition, pre-operative fasting

The association between natural disasters and violence: A systematic review of the literature and a call for more epidemiological studies

Abstract: The links between disasters and violence either self-directed or interpersonal are now more recognized. Nevertheless, the amount of research is limited. This article discusses the underlying association of disasters and violence and it also outlines a systematic review of the literature from 1976 to 2011. Finally, it concludes and recommends particular approaches for further epidemiological research.

Malnutrition is associated with depression in rural elderly population.

Abstract: Three hundred and seventy rural elderly aged over 60 years were examined in a cross‑sectional study by systematic sampling method and using mini nutritional assessment (MNA), which is a standard questionnaire for evaluating nutrition status Depression was evaluated by a validated questionnaire in the elderly Correlation between Socio‑demographic characteristic, diseases, and nutrition status was obtained by

Cognitive impairments in patients with intractable temporal lobe epilepsy

Abstract: BACKGROUND: Cognitive impairment associated with temporal lobe epilepsy (TLE) has been recognized in multiple studies. We designed this study to find a specific cognitive profile in patients with TLE who were can didates for epilepsy surgery. We also sought to find if neuropsycholo gical assessment could differentiate left TLE, righ t TLE and normal subjects. METHODS: The sample of this study consisted of 29 patients with right TLE, 31 with left TLE, and 32 subjects w ithout history of seizure as the control group. For all re cruited patients and controls, demographic question naire, Wechsler Memory Scale-III (WMS-III) and Wechsler Adult Intelligence Scale-R (WAIS-R) were administered. Multivariate analysis of variance was carried out to reveal diff erences in memory and intelligence performance between the three groups. RESULTS: All of the mean scores of the WMS-III indexes were significantly higher in the control group in compa rison with the right or the left TLE groups (p < 0.001). There were not any significant differences between mean scores of WMS-III indexes of the right and the left. The WAIS-R also showed significantly better mean scores of full scale intelligence quotient (FSIQ) and performance intelligenc e quotient (PIQ) in the control groups than both of the right and left TLE patients (p < 0.001). Although the verbal intel ligence quotient (VIQ) mean scores were significant ly different between the left TLE and the control group (p = 0.037 ), there were not any significant differences betwe en the right TLE patients and the control group. CONCLUSIONS: These findings indicated that WMS-III and WAIS-R can differentiate patients with refractory temporal lobe epilepsy from normal subjects. However, the ob tained cognitive profile could not differentiate be tween the right and the left TLE.

Newborn Screening for inherited metabolic disorders; news and views

Abstract: Newborn screening is important for the early detection of many congenital genetic and metabolic disorders, aimed at the earliest possible recognition and management of affected newborns, to prevent the morbidity, mortality, and disabilities associated with an inherited metabolic disorder. This comprehensive system includes; testing, education, follow up, diagnosis, treatment, management, and evaluation. There are major differences among many of the disorders being considered for inclusion in newborn screening programs. In recent times, advances in laboratory technology such as tandem mass spectrometry (MS/MS), which is more specific, sensitive, reliable, and comprehensive than traditional assays, has increased the number of genetic conditions that can be diagnosed through neonatal screening programs at birth. With a single dried filter paper blood spot, MS/MS can identify more than 30 inherited metabolic disorders in around two to three minutes. Advances in the diagnosis and treatment and an increased understanding of the natural history of inborn errors of metabolism have produced pressure to implement expanded newborn screening programs in many countries. Even as many countries throughout the world have made newborn screening mandatory, in Iran, nationwide newborn screening for inherited metabolic disorders other than hypothyroidism has not been initiated, hence, there is little information about these diseases. This article aims to review the recent advances in newborn metabolic screening and its situation in Iran and other countries.

Obesity predictors in people with chronic spinal cord injury: Common mistake.

Abstract: Sir, I was interested to read the paper by Sabour. H and colleagues published in J Res Med Sci in March 2011.[1] The purpose of the authors was to assess obesity predictors of people with spinal cord injury (SCI) using a cross-sectional study. Why did the authors use a cross-sectional design! For prediction studies, we need two different sets of cohort data or at least one cohort dataset splitting that to develop our prediction model and then to validate it. Therefore, by using a cross-sectional design, we cannot say anything about prediction.[2,3,4] As the authors pointed out, waist circumference (WC) is classified based on Standard Classification (men >102 cm, women >85 cm). Standard classification for WC is not applicable for the Iranian population as there is no difference between men and women regarding mean WC.[5] Therefore, applying such a classification will actually lead to overestimation of the obesity in women as well as underestimation of the outcome in men. Because self-reported height and weight were used in this study, validity (accuracy) and reliability (precision) of the data cannot be guaranteed. Moreover, these variables have been used to calculate another variable such as body mass index (BMI)! Thus, any interpretation based on these variables cannot be clinically correct. Most of the times, misleading results can easily affect the main results and conclusions of such researches. Moreover, for prediction purposes, using the Pearson Correlation Test is one of the common mistakes in reliability analysis as well as prediction researches.[2,3,4]

The effects of Ramadan fasting on sleep patterns and daytime sleepiness: An objective assessment.

Abstract: Background: Ramadan fasting and its associated lifestyle changes have been linked to changes in sleep and daytime sleepiness This study was designed to assess the effects of Ramadan fasting on patterns of sleep and daytime sleepiness

Medical publication and scientometrics.

Abstract: As the fact that today is conducted a number of scientific research works in the field of medicine, it is necessary to define the steps by which it is carried out to make it universal and to have scientific value. This paper describes the research methods, study design, the way in which one should be written, and why it is important to publicize the same. Special emphasis is placed on scientometrics as the science that evaluates scientific papers and their citation in the selected sample of journals. The paper also answers why scientific research works should be carried out and what kind of satisfaction they provide to the researcher.

Resistance pattern of Helicobacter pylori strains to clarithromycin, metronidazole, and amoxicillin in Isfahan, Iran.

Abstract: Background: Helicobacter pylori (H. pylori) resistance to antibiotics has become a global problem and is an important factor in determining the outcome of treatment of infected patients. The purpose of this study was to determine the H. pylori resistance to clarithromycin, metronidazole, and amoxicillin in gastrointestinal disorders patients. Materials and Methods: In this study, a total of 260 gastric antrum biopsy specimens were collected from patients with gastrointestinal disorders who referred to Endoscopy Section of the Isfahan Hospitals. The E-test and Modified Disk Diffusion Method (MDDM) were used to verify the prevalence of antibiotic resistance in 78 H. pylori isolates to the clarithromycin, metronidazole, and amoxicillin. Results: H. pylori resistance to clarithromycin, metronidazole, and amoxicillin were 15.3, 55.1, and 6.4%, respectively. In this study¸ we had one multidrug resistance (MDR) isolates from patient with gastritis and peptic ulcer disease. Conclusion: Information on antibiotic susceptibility profile plays an important role in empiric antibiotic treatment and management of refractive cases. According to the results obtained in this study, H. pylori resistance to clarithromycin and metronidazole was relatively high. MDR strains are emerging and will have an effect on the combination therapy. Keywords: Amoxicillin, clarithromycin, Helicobacter pylori, metronidazole

An association of hyperglycemia with plasma malondialdehyde and atherogenic lipid risk factors in newly diagnosed Type 2 diabetic patients

Abstract: Background: Oxidative stress (OS) generated by hyperglycemia, is one of the major focuses of recent research related to diabetes mellitus. Studying associations between hyperglycemia, OS and atherogenic dyslipidemia (AD) is therefore important. Materials and Methods: Plasma was obtained form a total of 52 subjects with newly diagnosed Type 2 diabetes mellitus (T2DM) and 52 healthy controls to study associations between hyperglycemia, lipid risk factors for atherogenicity and malondialdehyde (MDA), a lipid peroxidation product. Ferric reducing ability of plasma (FRAP) was evaluated as a measure of total antioxidant capacity (TAC). Results: Diabetic patients had significantly higher ( P < 0.05) plasma triglycerides (TG)), very‑low‑density lipoprotein cholesterol (VLDL‑C), TG to high‑density lipoprotein cholesterol ratio (TG/HDL‑C), atherogenic index (AI), and MDA. Whereas FRAP levels were depleted significantly in the patients compared to that of controls ( P = 0.000). Pearson correlation analyses showed MDA correlates significantly with Fasting blood sugar (r = 0.39, P = 0.004), TG/HDL‑C (r = 0.45, P = 0.001), and AI (r = 0.40, P = 0.003), and a significant negative correlation with LDL‑C (r = ‑0.33, P = 0.019) which was lost upon nullifying the effect of FBS by partial correlation analysis (r = ‑0.28, P = 0.050). Receiver operating curve (ROC) analysis showed high Area under curve for TG/ HDL‑C and AI (0.62; P = 0.03). Conclusion: Hyperglycemia of diabetes is associated with elevated levels of plasma MDA. This study suggests that TG/HDL‑C and AI may be particularly useful as atherogenic risk predictors in newly diagnosed patients with T2DM.

The relationship between serum levels of vitamin D and migraine.

Abstract: Background Migraine is common worldwide. In recent years, vitamin D deficiency has been determined as a global health problem. A few studies have shown inverse relationship between serum vitamin D levels and headache. Thus, in this study, we assessed relationship between serum vitamin D levels with migraine. Materials and methods The present study was a cross-sectional. Seventy-six migraine patients aged 10-61 years were included. The multiple linear regression was used to show association between serum 25-0H-D3 and migraine. Adjustments were performed for age, sex, waist circumference, body mass index (BMI), number of chronic diseases, and education level. Results The positive weak relationship was observed between serum vitamin D and headache diary result (P = 0.042, r = 0.19). But, no significant relationship was observed between serum vitamin D and migraine severity (P = 0.741). Conclusion High levels of serum 25-OH-D3 was related to higher headache diary result. After adjustment for confounding variables, this significant association remained. No significant relationship was shown between serum vitamin D and migraine severity.

Ultrasound guided lumbar puncture in emergency department: Time saving and less complications.

Abstract: Background: Lumbar puncture (LP) is an essential procedure in the diagnosis and treatment of several critical situations. This procedure is routinely performed by palpating external landmarks to fi nd the most appropriate inter-spinous space. In the current study, we compared surface landmark and ultrasound (US) guided LP in different aspects. Materials and Methods: This clinical trial study was conducted at the emergency department (ED) of a teaching hospital from March 2009 to March 2010. Eighty patients were allocated randomly in two equal groups. In first group, LP was performed by US-guided method and in the control group by palpation of external landmarks of spinal column. Pain score, number of attempts for successful dural penetration, numbers of traumatic LP, and procedure time were compared between two groups. The performance of US-guided LP was assessed with regard to body mass index (BMI) of patients too. Results: The mean of procedure time and pain scores were markedly higher in land mark group in comparison to US group (6.4 ± 1.2 and 7.4 ± 1.1 vs. 3.3 ± 1.2 and 4.4 ± 1.4 respectively).Number of attempts and number of traumatic LPs were significantly lower in US group too. In patients with different subgroups of BMI, US-guided LP showed better results and less complication when compared with surface landmark guided technique. All of these results were statistically significant. Conclusion: This study showed that US was able to find pertinent landmarks to facilitate the LP in patients admitted to ED and resulted in less pain and less time wasting. Moreover, patients who have high BMI may benefi t more than others. Key words: Complication, emergency department, lumbar puncture, ultrasound Normal 0 false false false EN-US X-NONE AR-SA /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;}

Students' perception of educational environment at Public Sector Medical University of Pakistan.

Abstract: Background: 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.

Role of cyclin D1 in breast carcinoma.

Abstract: Cyclin D1 was strong (S), intermediate (I), weak (W), and negative (N) in 19.1%, 44.9%, 14.6%, and 21.3% of the cases, respectively. Estrogen receptor (ER), progesterone receptor (PR), and HER2- neu were positive in 60.7%, 58.4%, and 36% of the cases, respectively. There was a statistically significant reverse relationship between tumor grade and cyclin D1 (P = 0.009). The relationship between cyclin D1 and both hormone receptors was also statistically significant (P = 0.0001). There was no statistically significant relationship between cyclin D1 on one hand and age, stage, and HER2-neu on the other (P > 0.05). Conclusion: The reverse relationship between cyclin D1 overexpression and tumor grade as well as its positive relationship with ER and PR in invasive ductal carcinoma suggest that cyclin D1 may directly or indirectly result in maturation and differentiation of tumor cells.

Challenging comparison of stroke scales.

Abstract: Stroke scales can be classified as clinicometric scales and functional impairment, handicap scales. All studies describing stroke scales were reviewed by internet searching engines with the final search performed on January 1, 2013. The following string of keywords was entered into search engines; stroke, scale, score and disability. Despite advantages of modified National Institute of Health Stroke Scale and Scandinavian stroke scale comparing to the NIHSS, including their simplification and less inter-rater variability; most of the stroke neurologists around the world continue using the NIHSS. The modified Rankin scale (mRS) and Barthel index (BI) are widely used functional impairment and disability scales. Distinction between grades of mRS is poorly defined. The Asian stroke disability scale is a simplified functional impairment, handicap scale which is as valid as mRS and BI. At the present time, the NIHSS, mRS and BI are routine stroke scales because physicians have used to work with these scales for more than two decades, although it could not be an acceptable reason. On the other side, results of previous stroke trials, which are the basis of stroke management guidelines are driven using these scales.

Comparing the efficacy of preemptive intravenous paracetamol on the reducing effect of opioid usage in cholecystectomy

Abstract: BACKGROUND The purpose of the present study was to determine the post-operative analgesic effects of preemptive intravenous (iv) paracetamol and the amount of reduction in tramadol (Contramal(®)) consumption. MATERIALS AND METHODS Following local research ethics committee approval, ASAI-II, 300 patients were assigned in a randomized manner into three groups: Group I (preemptive) received iv paracetamol 1 g/100 mL 10 min before skin inscision and 100 mL of saline solution at the end of the operation, Group II (post-operative) received 100 mL of saline solution 10 min before skin inscision and iv paracetamol 1 g/100 mL at the end of the operation and Group III (placebo) received 100 mL of saline solution 10 min before skin insicision and 100 mL of saline solution at the end of the operation as well. The time to first analgesic requirement use and 24 h total analgesic consumption were recorded. Visual analog scale (VAS) pain scores were obtained from all patients at 15, 30, min 1, 2, 4, 6, 8, 12 and 24 h after the end of the operation. RESULTS Time to first analgesic requirement was significantly longer in Group I and Group II, compared to Group III (P < 0.05). Time to first analgesic requirement was significantly longer in Group I compared to Group II (P < 0.05). Total analgesic consumption and postoperative VAS pain scores recorded were significantly lower in Group I and II, compared to Group III. Total analgesic consumption and postoperative VAS pain scores recorded were significantly lower in Group I compared to Group II (P < 0.05). CONCLUSION In conclusion, preemptive iv paracetamol provided effective and reliable pain control after cholecystectomy surgeries and reduced post-operative pain scores, the need for and use of supplementary opioids and the time to first request of analgesics.

Comparison of medical treatments in cryptogenic stroke patients with patent foramen ovale: A randomized clinical trial

Abstract: Background This randomized clinical trial compared rates of stroke or transient ischemic attack recurrence or death in patients with cryptogenic stroke and patent foramen ovale (PFO) who received medical treatment with aspirin or warfarin. Materials and methods Forty-four Iranian patients with cryptogenic stroke and patent foramen ovale participated in this randomized, single-blind trial between July 2007 and June 2010. All patients underwent transesophageal echocardiography and contrast-transcranial Doppler sonography to confirm the presence of patent foramen ovale. The patients were randomly assigned to receive aspirin or warfarin and were followed for 18 months for the recurrence of ischemic events or death. The principal investigator was blind to the group assignment. This trial is registered under number IRCT138805192323N1. Results Five (11.4%) patients had a stroke, 2 (4.5%) had a transient ischemic attack and 2 (4.5%) died. There was no difference in the rate of ischemic events or death between the aspirin- and warfarin-treated groups (hazard ratio: 0.45; 95% CI: 0.1-1.8; P = 0.259). Conclusion There was no difference in ischemic event recurrence, death rates or side-effects between patients with cryptogenic stroke and patent foramen ovale who were treated with aspirin vs. warfarin.

Prevalence and clinical characteristics of headache among medical students, Isfahan, Iran.

Abstract: Background Headache is one of the most common complaints during medical curriculum and it occurs due to numerous psychological and physical stressors, which are more common in medical students than general population. The purpose of this study was to evaluate the frequency of different types of headache and associated factors. Materials and methods This cross-sectional study was conducted in Isfahan University of Medical Sciences, from September 2011 to January 2012. First- to seven-year medical students who have experienced some forms of headache in their life and had headache attacks during the past 6 months were included in this study. All medical students completed a structured check list, which consisted of demographics data, associated factors, and headache characteristics. Results A total of 480 (258 [53.8%] males and 222 [46.2%] females) students (93.7%) were evaluated. The prevalence of headache was 58.7%, the prevalence of migraine, and tension-type headache was 14.2% (10.5% in male vs. 18.5% in female, P = 0.08) and 44.2% (49.2% in male vs. 39.2% in female, P = 0.006), respectively. A family positive history was found in 9.5% of students with headache. The lower socio-economic status, year of study (3(rd) and 5(th) year students), was seemed to had higher prevalence in students with headache. There was no significant difference between headache and concomitant disease. Conclusion The results demonstrate that prevalence of headache is high among medical student. Socio-economic and the year of study might be significant factors in the prevalence of headache. Further multicenter studies would be necessary to evaluate headache epidemiology among medical students in the whole country.