Iranian Journal of

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Pyomyositis is a pyogenic infection of the skeletal muscle characterized by muscle pain and swelling. The illness is more commonly seen in the tropics. The diagnosis of pyomyositis is difficult due to its vague clinical presentation and poor localizing signs. The differential diagnosis includes osteomyelitis, septic arthritis, muscle hematoma, muscle rupture and deep vein thrombosis. A delay in diagnosis may result in compartment syndrome, sepsis and death. Pyomyositis can be divided into three clinical stages: Stage 1 is characterized by crampy local muscle pain, swelling, low-grade fever and leukocytosis . The muscle may have a "woody" texture on palpation. Stage 2 is characterized by fever, muscle tenderness, and edema. Aspiration of the affected muscle typically yields pus. Stage 3 is characterized by bacteremia and a toxic appearance. Complications such as septic shock, endocarditis, pneumonia and some others may be present. Definite diagnosis should be made by aspiration or surgical drainage of the abscess. We report a 53 years old patient with diabetes who presented with a swelling and painful buttock and thigh, that was diagnosed with pyomyositis.

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Suppurative hidradenitis is a recurrent disease involving apocrine gland of skin with a predilection for intertriginous areas, including genital skin. It has a highly variable clinical course. Mild cases may present as recurrent isolated nodules, while severe instances of the disease with chronic inflammation may lead to abscesses , scarring, and rarely, squamous cell carcinoma. While genetic factors, hormones and infection play a role in disease expression, a comprehensive understanding of the pathogenesis remains to be elicited. Additionally, effective treatment is largely unknown. The mainstay of therapy had been surgery, and topical or systemic antimicrobial agents. We report a 65 years old diabetic man who had a long history of untreated suppurative hidradenitis with extensive gluteal area involvement. We search in pubmed and find 7 cases of suppurative hidradenitis with diabetes.

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Assessing of outcomes and risk factors in the form of qualitative variables is common in the most of medical studies and the research objectives are defined as the relationship between these variables. This paper introduces the concepts and basic and applied statistical tests to examine the relationship between these variables in these studies, including chi-square tests. Principles and method of calculating the statistics and hypothesis testing to assess the relationship between qualitative variables (or difference in proportions between groups), were presented taking into account relevant considerations. The method of reporting findings were introduced in the context of contingency tables, for all types of chi-square tests. To investigate the relationship between two binary or multi-category qualitative variables, Pearson chi-square test (in the case of establishing Cochran conditions), Yates continuity correction for small samples, in the case of not establishing Cochran conditions exact P-Value calculated on the basis of exact tests, trend chi-square test for ordinal qualitative variables and McNemar chi-square test for related samples should be used. In addition for tables larger than 2 × 2, when the overall relationship was significant, post hoc tests with appropriate correction is required. In each of these situations, examples based on research, calculations of tests were performed and their results were presented. To investigate the relationship between a set of risk factors and nominal or ordinal qualitative variables, the introduced analyses are recommended considering the situation and purpose of the proposed study.

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The P-Value cannot present a complete measure of association in medical studies considering the association between categorical variables. In such situations, measures are required to reveal the clinical importance of relation along with their statistical significance, as the effect size. This paper aims to introduce the measures of associations for categorical variables and inferences about them in these studies. Principles and method of calculating measures of associations and inference about them including confidence interval and hypothesis testing were presented to assess the relationship between qualitative variables for all types of medical studies taking into account relevant considerations. Additionaly, the method of reporting of findings were introduced in the context of contingency tables. To investigate the relationship between two binary qualitative variables, should be used the Odds Ratio in cross-sectional or case-control studies, the relative risk in cohort studies, and prevalence ratio in cross-sectional studies and risk difference in all type of studies along with their confidence intervals and/or their significance tests considering the independent or related groups of studies. Additionally, for bigger than 2 by 2 tables, the method of calculating of above mentioned measures considering a reference category and other measures such as Phi, Crammers V, contingency and uncertainty coefficients , Lambda, Gamma, Summers D, Kendals tau-b and tau-c would be recommended. In each of these situations, based on research based examples, calculations of tests were performed and their results were presented. To investigate the relationship between a set of risk factors and binary and multi-category qualitative variables, the introduced analyses are recommended considering the situation and purpose of the proposed study.

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In medical studies, measures are required to reveal the effect of exposures and interventions and also the precision of measurements. This paper aimed to introduce the measures of effect and agreement and inferences about them in these studies. Principles and method of calculating measures of effect and agreement and inference about them were presented for all types of medical studies taking into account the relevant considerations. To assess the effect of risk factors on outcomes in case-control and cohort studies, and to determine the relevant effect, the attributable risk and fraction in the exposed group and population were used along with their confidence intervals. Also the relative risk reduction, absolute risk reduction and number needed to treat were applied as the measures of effect of intervention in the interventional studies especially in trails. The sensitivity, specificity and related measures along with their confidence intervals were computed for diagnostic accuracy and screening studies. In addition it is needed to evaluate the precision of measurements using standard error of measurements, ICC, Altman and Bland’s limits of agreement and Lin’s concordance correlation coefficient for quantitative variables and using kappa and weighted kappa for nominal and ordinal variables. In each of these situations the results of research based examples were presented along with the methods of their calculations.To assess the measures of effect and agreement, the mentioned analyses are recommended considering the situation and purpose of the study.

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Background: Alpha-amylase is the most important enzyme in the digestion of starch. Activators of this enzyme could be potentially used as digestive aids and its inhibitors block the absorption of starch compounds and result in the control of blood sugar levels. This study aimed at the investigation of aromatic compounds on bovine serum alpha-amylase. Methods: Effect of carvacrol, cumyl phenol, tryptamine, tryptophan, N-acetyl-L-tryptophan, Bis phenol A, 2-benzyloxy phenol, 2,6 diisopropyl phenol and 4-chloro-2-isopropyl-5-methyl phenol was investigated on bovine serum alpha-amylase with use of artificial substrate (laboratory kit). Results: Most of tested aromatic compounds showed a similar pattern. All these compounds had 5-30% inhibitory effect on the tested serum with the exception of tryptamine which showed a 20% increase in the enzyme activity. The best inhibitory effect was obtained from cumyl phenol in the range of 30%. Conclusion: This study showed that aromatic compounds with one and two cycles have moderate inhibitory effect on bovine serum alpha-amylase and tryptamine showed a slight activator effect. With regard to these results, indolic and phenolic structures may be effective on alpha-amylase, and in the next step, investigation of these compounds derivatives is suggested.

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Background: Some studies showed that magnesium can prevent diabetes complications. The present study was designed to determine the role of calcium channels and adenosine receptors in Mg2+-induced relaxation in streptozotocin (STZ) induced diabetic rats' vessels.

Methods: Diabetes was induced by ip injection of 60 mg/kg STZ. Eight weeks after diabetes induction, superior mesenteric arteries were isolated and perfused according to the McGregor method. Prepared vascular beds were constricted with phenylephrine to induce 70–75% of maximal constriction. Mg2+ at concentrations of 10–4 to 10–1 M was added into the medium and perfusion pressure was recorded in intact and denuded endothelium. Glutamic acide (1 mM) and theophylline (1 mM), were added into medium 20 min before phenylephrine administration with intact and denuded endothelium.

Results: Mg could decrease perfusion pressure. Mg-induced vasorelaxation was not suppressed in the presence of glutamic acid, but in the presence of theophylline vasorelaxation induced was totally suppressed.

Conclusion: From the results of this study it may be concluded that Mg2+-induced relaxation is not mediated by calcium channel, but adenosine receptors play a role in Mg2+-induced vasorelaxation.

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Research, as systematic way to discover, interpret, explain, predict, modify, and control events, entails the knowledge-based performance of individuals, organizations and systems. Today, knowledge is a tool for development, entrepreneurship, and improving economic value added rather than be a product of development. Also, Health systems, with their increasing complexity and scope, are causes and especially effects of an increasing rate of production, translation and implementation of health-related knowledge. This knowledge, with complexity, vast range, and variety, is produced by variety of research projects which mainly resulted from different problems addressed and presumed epistemic positions by them.

Authors believe that a comprehensive outlook on the variety of research projects in the health system could help to change the stereotypical view on research in the health system. To the best of our knowledge, this paper is a novel, narrative review gathering and presenting various existing classifications of research projects in the light of an inductive distinction. It aims to help specialists in the different levels of health system to profoundly understand and meticulously apply research results and to help researchers and research bodies to more accurately define, manage, prioritize, and allocate resources for future research projects to solve upcoming problems.

Different aspects used in this paper to classify health research projects are the followings: The purpose of research, the research paradigms, tacit or explicit knowledge, primary or secondary knowledge, relation with known disciplines, functions of the health system, the partnerships of non-academic persons, decision-making level, taxonomy of questions, and levels of evidence.

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Background: It is critical to understand how accurately physicians can estimate the importance of each clinical finding in estimating the probability of a specific diagnosis in the process of clinical decision making. This study aimed to investigate whether physicians’ estimates of the importance of various clinical findings of ascites correlated with the positive likelihood ratios of these findings in diagnosis of ascites.
Methods: One hundred and ten physicians were asked to respond to a questionnaire. In this questionnaire they were presented with a clinical scenario about a patient suspected of having ascites followed by a list of clinical findings. Participants were asked to assign a weight (between 0 and 100%) to each clinical finding based on their perception of how much the presence of that finding changed the probability of ascites for the patient. Positive likelihood ratios of those findings were extracted from current best evidence. We investigated if the weights assigned by physicians were associated with the positive likelihood ratios of those findings.
Results: Significant differences were discovered between the weights assigned by the physicians and the positive likelihood ratios for each clinical finding. Significant positive correlation was observed between the weights assigned by different groups of physicians.
Conclusion: Physicians inaccurately estimated the importance of various clinical findings in the diagnosis of ascites. Further research is needed to determine if such inaccurate estimations would lead to any adverse clinical outcomes.

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Background: Type 1 diabetes is one of the most common metabolic abnormalities in childhood, with one in every 400 to 600 children affected by the disease. The aim of study was to evaluate the effectiveness of cognitive-behavioral therapy on emotional regulation of children with type 1 diabetes.
Methods: The research design was a quasi-experimental design with pre-test, post-test and follow-up and control group. The sample of 25 children aged 8 to 13 years with type 1 diabetes was diagnosed by endocrinologist. They were randomly assigned control (n = 15) and experimental (n = 10) groups. Subjects completed an cognitive emotion regulation questionnaire (Garnefski et al., 2007) in a pre-test, post-test, and one month and a half follow-up. Data were analyzed using repeated measure analysis of variances.
Results: The results of this study showed that there was a significant difference between the mean scores of emotional regulation in pre-test, post-test and follow-up (P <0.01). Also, there was a significant difference between emotional regulation in the experimental and control groups (P <0.05).
Conclusion: Cognitive-behavioral therapy can be considered as an effective intervention to regulate the excitement of children with diabetes.
 

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Background: The purpose of this study was to investigate the effect of eight weeks of aerobic exercise and supplementation of gensing on homocysteine levels, tiroid hormon and insulin resistant in obese women with hypothyroidism.
Methods: This study is quasi-experimental study. For this purpose, 40 obese women with hypothyroidism with an average age of 34.62 ± 3.55 years, weight 80.47 ± 3.85 kg and BMI of 32.2 ± 2.27 kg / m2, were randomly divided into four groups including aerobic training (10), ginsing (10), aerobic exercise and ginsing (10) and placebo (10) were divided.Aerobic exercise included 8 weeks of aerobic training, 3 sessions per week, 45 to 70 minutes, and 55 to 75% of maximum heart rate. Patients in the ginseng group and aerobic exercise with ginsing consumed each day a Jinsen's capsule containing 250 mg of granule Risomy ginseng powder was taken orally after 8 weeks for 8 weeks, while subjects in the placebo group received flour powdered capsules.Blood samples from the anterior vein were used to measure homocysteine, TSH, T3, T4, glucose and insulin before and after 8 weeks in four groups. For data analysis, dependent t-test and variance analysis were used (P≤0/05).
Results: The results showed that the plasma homocysteine, TSH, glucose concentrate, insulin resistance and insulin resistance were significantly decreased in all three experimental groups while T3 and T4 increased (P <0.05). These indices in the control group were not changed (P <0.05).
Conclusion: Therefore, aerobic exercise, along with supplementation with ginsing, can have an important role in preventing an increase in cardiovascular risk factors and hypothyroidism in obese women with hypothyroidism.


 

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Background: The purpose of this study is to identify patterns of information sharing in the field of evidence-based medicine to determine the main areas of evidence dissemination, including co-authorship patterns and citation networks, and to provide a scientific horizon for improving evidence-based medical research in Iran. Accordingly, evidence-based medicine related research at the Endocrinology and Metabolism Research Institute of Tehran University of Medical Sciences is suggested.
Methods: This study is a bibliographic study using scientometric methods. In this regard, the network of co-authorship and analysis of scientific articles indexed with the subject of evidence-based medicine in the Scopus database from 2004 to 2019 were analyzed.
Results: The status of scientific production of evidence-based medicine of Endocrinology and Metabolism research Institute has been increasing in recent years. The Journal of Diabetes and Metabolic Disorders contains a great collection of information about evidence-based medicine in this field and its contents have been widely cited in many Iranian journals. In lexical analysis, the most widespread evidence was osteoporosis.
Conclusion: The results indicated that evidence-based medical research topics are widely focused on other medical fields such as osteoporosis and obesity and have shifted from evidence-based clinical practice to evidence-based clinical management.

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Background: Vitamin D (vitD) deficiency is common in Iran. Although there are several studies on therapeutic doses of vitD, the optimal dose is to be evolved. we compared the effects of high dose supplemental vitamin D versus its recommended dose on the serum level of 25(OH)D.
Methods: This clinical trial was performed at Endocrine & Metabolism Research Institute in Shariati Hospital, Tehran, Iran within 2008-2009. The subjects were osteopenic women older than 50 years who had been referred to Bone Densitometry laboratory. They were received either (group P) 50000u vitD3 weekly for 3 months then monthly for another 9 months, or (group M) 800u vitD3 daily for one year. 1000 mg calcium carbonate was given to both groups. Serum 25(OH)D, calcium, phosphorus, and PTH was checked at base, 3rd, 6th and 12th month. 24h Urine for calcium was collected before and at the end of trial.
Result: Serum 25(OH)D level was significantly higher in group P at 3rd month (P< 0.05), but it gradually declined and there was not statistically difference to group M. PTH decreased in both groups. Urine calcium to creatinine ratio did not rise in both groups.
Conclusion: vitD supplement at doses of 50000u weekly for 3 months then monthly for another 9 months as compare to 800u vitD3 daily for one year increases serum 25(OH)D at higher level without causing hypercalcemia and hypercalciuria, but it seems that more frequent doses in monthly period would be required to maintain the optimal 25(OH)D level.