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Vitamin D level in Alzheimer's disease: a case control study
Vajiheh Aghamollaii , Abbas Tafakhori , Shakila Meshkat , Arezoo Shafieyoun , Amir Salimi ,
Volume 78, Issue 1 (4-2020)
Abstract
Background: Alzheimer's disease (AD) is a chronic neurodegenerative disease characterized by a progressive decline of cognitive performance, which has a harmful impact on social activities. AD is the main cause of dementia and loss of functional independence in the elderly. AD is a worldwide concern because of its adverse consequences and expanding prevalence and incidence. Vitamin D is the most common nutritional deficiency worldwide among children and adults. In addition to its classical function of bone metabolism regulation, vitamin D exhibits multiple biological targets mediated by the vitamin D receptor (VDR). Vitamin D is a risk factor for a wide range of diseases and, as a neurosteroid, has an essential role in nervous system development and protection. Vitamin D regulates mechanisms involved in the pathogenesis of AD, including phagocytosis of amyloid-beta plaques, anti-inflammatory action, antioxidant action, regulation of intraneuronal calcium, ischemic zone size reduction, regulation of choline acetyltransferase enzyme and neurotrophic agents. This study aimed to evaluate the association between AD and vitamin D deficiency.
Methods: In this case-control study, 44 Alzheimer’s disease patients (diagnosed based on DSM-IV-TR criteria) compared with 40 patients that had no disease related to vitamin D. This study was performed in the neurology clinics of Roozbeh and Imam Khomeini Hospitals in Tehran, from April to March 2015. The demographic data were collected. After obtaining informed consent, venous blood was taken by clinical staff to measure the level of 25-hydroxyvitamin D3. Statistical analysis was performed on data.
Results: The Mean age was 71.55 years old (69.88 for females and 73.74 for males) in the case group. Mean vitamin D levels were 26.31 ng/ml and 36.41 ng/ml in case and control groups, respectively. Vitamin D level was deficient (< 30 ng/ml) in 75% of patients, of which 23% were severely deficient (< 10 ng/ml). Statistical analysis showed no significant relationship between Alzheimer's disease and vitamin D levels (P=0.057), but when participants categorized into three groups based on serum vitamin D levels (deficient, insufficient, sufficient), we found a significant relationship between them (P=0.019).
Conclusion: Our results confirm the association between vitamin D deficiency and Alzheimer's disease. Vitamin D supplementation should be considered in individuals at risk of Alzheimer's disease to reach sufficient vitamin D level.

Diagnostic error, benign infiltrative pseudotumor or malignant primary lymphoma of cervix: case report
Malihe Hassanzadeh , Amir Hosein Jafarian , Fatemeh Homaee, Lida Jeddi , Parnian Malakuti, Leila Mousavi Seresht ,
Volume 78, Issue 1 (4-2020)
Abstract
Background: Although cervical malignancy rate had grown up in recent years, primary cervical lymphoma is so rare. It must be high index of suspicious for primary cervical lymphoma diagnosis in patient with malignancy-like signs and symptoms for early detection. Primary cervical lymphoma has no standard treatment or follow-up protocol; so the management still is in doubt and based on previous case reports. In the other hand, the precise prognosis of patient is undetermined. In the present study, a case of primary cervical lymphoma is presented which was misdiagnosed at first. The patient accurate diagnosis was made at last due to multidisciplinary team working.
Case presentation: A 51-year-old woman, gravida 2, para 2, presented with complaint of abnormal vaginal bleeding and discharge, with no abnormal finding in cervical cytology and sonography, so uneventfully a diagnostic error had happened in the assessment of her. After several months and multiple different treatment, the patient referred to the Oncology Department of Obstetrics and Gynecology Center, Ghaem Hospital, Mashhad, Iran in May 2017. Re-assessment was performed by biopsy and imaging, and the final pathologic diagnosis of diffuse large B-cell non-Hodgkin's lymphomas was confirmed.
Conclusion: Primary cervical lymphoma is an uncommon malignancy; the diagnosis could be missed simply by low suspicious due to low accuracy of Pap smear and imaging in this situation. So an accurate evaluation and pelvic examination, high suspicious and close communication between clinician and pathologist are needed. By timely diagnosis of patient in early stage and appropriate approach, the prognosis could be excellent most of the time.

A review on the relation between obesity and vitamin D with pediatric asthma, and a report of a pilot study in Tehran, Iran: review article
Mansoureh Shariat, Ezoddin Rostamian, Heshmat Moayeri, Mamak Shariat, Laleh Sharifi,
Volume 78, Issue 5 (8-2020)
Abstract
Asthma is an inflammatory and chronic disease that affects about 300 million people globally. The disease is more common in developed countries. The increase in the prevalence of asthma is not only due to genetic factors, but also to many environmental factors related to urbanization and type of nutrition. It has been reported that obesity is an independent risk factor for asthma and obese children are at higher risk of asthma. The researchers found that many of the common phenotypes of obesity and asthma are due to genetic effects and some genetic component is common to asthma and obesity. Genetic data suggest that there are areas of genetic overlap between the obesity and asthma genes. These children experience more severe asthma and have a poor treatment outcome. On the other hand, there is an association between vitamin D deficiency in the earlier stages of life and incidence of asthma in the following years. Interestingly, obesity is a common risk factor for both asthma and vitamin D deficiency. Therefore, study on the interaction of asthma, obesity, and vitamin D deficiency may play an important role in unraveling the intricate nature of asthma. Prevalence of Pediatric asthma in 6-7 and 13-14 years-old children has been reported more than 10% in Iran. In this review we aimed to assess the latest findings about pediatric asthma and its association with obesity and vitamin D in Iran and the other countries. In addition, the results of a pilot study that has examined the frequency of overweight and obesity, as well as vitamin D deficiency in children with asthma in Tehran, are briefly presented. Enrolling a national study on obesity and vitamin D levels in children with asthma, can provide excellent information on the effects of obesity and vitamin D deficiency on asthma in Iranian children. Also the results could provide a basis for ecological studies to measure correlation between pediatric asthma and Sunlight and food and cultural habits in different parts of the country. Also, it is recommended that for a better understanding of the subject, experimental studies examine the effect of vitamin D supplementation and vitamin D-rich diets on the prevention and treatment of pediatric asthma in different age groups as well as different ethnicities of Iran.

The effect of low dose of ketamine on intraocular pressure in patients undergoing cataract surgery
Mehdi Sanatkar, Mehrdad Goudarzi, Ebrahim Espahbodi,
Volume 78, Issue 6 (9-2020)
Abstract
Background: Cataract surgery is one of the most common surgeries in the world, especially in elderly patients, and often performed topically with sedative agents. Ketamine is one of the most commonly used agents and the effect of different doses on intraocular pressure is in dispute. The present study investigates the effect of a low dose of ketamine on intraocular pressure in patients undergoing cataract surgery.
Methods: This case-control study was performed in Farabi Hospital, Tehran University of Medical Sciences from January 2020 to February 2020. In this study 92 patients undergoing cataract surgery were randomly divided into two groups of 46 patients. Patients' intraocular pressure and blood pressure were measured at baseline, and then all patients received 1 mg midazolam and 1 μg/kg fentanyl before initiation of the study. In the case group, 0.15 mg/kg ketamine was injected intravenously. Intraocular pressure and blood pressure of all subjects were measured three minutes after injection of sedation. Also, postoperative pain, need for opioids and, postoperative nausea and vomiting were compared between the two groups.
Results: There was no significant difference in age, sex and weight between the two groups. Mean intraocular pressure in both groups was not significantly different at baseline. The trend of changes in intraocular pressure was lower in both groups after sedation and there was no statistically significant difference between the two groups. After sedation injection, the mean arterial blood pressure changes in the control group were decreasing while in the case group showed an increasing trend and this difference was statistically significant. Five patients in the control group and one in the case group complained of moderate to severe pain postoperatively. There was no significant difference between the two groups regarding nausea and vomiting and the need for postoperative opioids.
Conclusion: Low-dose ketamine administration had no significant effect on intraocular pressure and did not cause side effects of ketamine such as nausea, vomiting and hallucinations and it may improve the hemodynamic stability of patients if they are injected with sedative medications.
 

Familial adenomatous polyposis, diagnosis and surveillance strategies: review article
Sima Sedighi, Maliheh Moradzadeh, Mehrdad Aghaei, Ashraf Mohamadkhani, Mohammad Hassan Jokar,
Volume 78, Issue 7 (10-2020)
Abstract
Familial adenomatous polyposis is characterized by over 100 colorectal adenomas in the colorectum. The disease equally affects both sexes, with an incidence estimated at 1.14025-1.8300. The disease is premature in people with familial adenomatous polyposis. Patients suffering from familial adenomatous polyposis have a range of extra-intestinal diseases such as papillae, gastric, small intestine, and duodenal polyps; cutaneous wounds (lipomas, fibromas, and epidermoid cysts); desmoid tumors; osteomas; nephroderma retinal pigment epithelium, including hepatoblastoma and thyroid cancers; and pancreas, biliary system, and brain cancer. Familial adenomatous polyposis is characterized by >100 polyps in the colon that are often observed on the left side of the colon and rectum. A germline mutation in the adenomatous polyposis coli gene that can be clinically and genetically diagnosed is responsible for this disease. Several methods are available for testing the adenomatous polyposis gene. Whole-gene sequencing of all adenomatous polyposis coli exons and exon-intron boundaries with maximum sensitivity for determining adenomatous polyposis coli mutations is not affordable. Another method, the protein shortening assay, correctly identifies 80% of the mutations in families who show familial adenomatous polyposis and is less expensive than complete gene sequencing. The application of a COX-2 inhibitor for chemical prevention is limited in patients showing familial adenomatous polyposis because of cardiovascular toxicity. Aspirin does not negatively impact cardiovascular diseases and is even used as primary pharmacotherapy in patients who demonstrate cardiovascular risk factors.   After 55.7 months of the diagnosis in hereditary CRC carriers, the incidence of cancer can be decreased by a dose of 600 mg/day aspirin for 25 months. After diagnosis, patients should undergo prophylactic proctocolectomy or ileoanal pouch. Undiagnosed patients having a family history of FAP must be referred to a genetic counselor and enrolled in optimal genetic and clinical surveillance programs. Recent advancements in endoscopic technology, e.g. high-resolution endoscopy, double-balloon endoscopy, and capsule endoscopy have enabled the comprehensive study of the gastrointestinal tract. Despite the limited evidence, more studies on these novel endoscopic technologies may modify the surveillance strategies for FAP patients.

Evaluation of the effect of intratracheal ketamine on sore throat after intubation in patients undergoing strabismus surgery
Mehdi Sanatkar, Mehrdad Goudarzi, Mostafa Mohammadi, Ebrahim Espahbodi,
Volume 78, Issue 8 (11-2020)
Abstract
Background: Sore throat after endotracheal intubation during general anesthesia is a common complaint of patients especially in children. Strabismus surgery in one of the common procedures in child patients. The present study investigates the use of intratracheal ketamine administration in reducing sore throat after strabismus surgery.
Methods: This study was performed on 60 patients undergoing elective strabismus surgery under general anesthesia from December 2019 to February 2020 in Farabi eye hospital, Tehran University of medical sciences, Tehran, Iran. These cases were referred to our center for strabismus operation from other centers of our country. Patients were randomly divided into two equal groups. After sufficient depth of anesthesia with sevoflurane and injection of fentanyl, endotracheal intubation was performed. In the control group, the endotracheal tube was inserted and 2 ml of ketamine solution at a concentration of 5 mg/ml were administered in endotracheal tube. The severity of sore throat, length of stay in recovery, incidence of delirium in recovery, satisfaction of recovery nurses and their parents and other complications were compared between the two groups.
Results: Mean age, sex and weight were not significantly different between the two groups and were comparable. The mean duration of stay in recovery was higher in the case group than in the control group. The mean postoperative sore throat was significantly higher in the control group. Moreover, the mean incidence of delirium in the postoperative phase was higher in the case group. Besides, the rate of nurse satisfaction in the control group was higher than the case group. The incidence of bronchospasm, laryngospasm, and postoperative nausea and vomiting was not significantly different between the two groups.
Conclusion: Intratracheal ketamine can reduce postoperative sore throat and the need for postoperative analgesic medications. Postoperative complications were not increased with this strategy, but the length of recovery stay increased in these patients.

Studying the level of satisfaction from family physician plan in rural areas of Rafsanjan: brief report
Hasan Alinezhad, Reza Vazirinezhad , Ahmadreza Sayadi, Zeinab Hajaliakbari, Mahdi Alinezhad,
Volume 78, Issue 10 (1-2021)
Abstract
Background: One of the most important duties of a family physician is primary health care. The family doctor plan is one of the developmental measures to provide easy and low-cost access for patients to health care centers. The family doctor and her team are fully responsible for the health of the individuals and families covered. Therefore, this study was conducted to assess the satisfaction of rural areas of Rafsanjan city with the family physician plan.
Methods: This study is a descriptive-analytical study that was conducted in rural areas of Rafsanjan from October to December 2018. The study population consisted of twelve randomly selected villages in Rafsanjan. The required sample size was examined according to the size of the statistical population of 480 people. In this study, to collect the required data, a researcher-made checklist was used, which was prepared by reviewing the texts of the questions. The sampling method was cluster random. To check the validity of the checklist, the opinions of 10 health education experts were used. To check the reliability, the checklist was provided to 20 villagers and the reliability was determined using Cronbach's alpha method of 82%. The mean was used to describe the data and inferential statistics t-test and ANOVA were used to analyze the data and analyzed by SPSS.
Results: The average satisfaction of villagers with the family physician program was relatively good. The Highest satisfaction is with diploma education and income below 1 million 2.21% and the lowest satisfaction score is 21-30 years old and income over three million 2.16%.
Conclusion: Satisfaction with the implementation of the family physician program in rural areas indicated that the health system reform processes were successful and to increase this satisfaction, we must improve the level of service and improve the quality of family physician services day by day because the health system with effective health care is an important element of family physicians.

Studying the effect of vitamin d on the intensity of torsional nystagmus in Benign paroxysmal positional vertigo (BPPV) in Rohani hospital of Babol
Mahboobeh Sheikhzadeh, Mohsen Monadi , Yones Lotfi, Abdolah Moosavi, Enayatollah Bakhshi,
Volume 78, Issue 11 (2-2021)
Abstract
Background: Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo and nystagmus in clinics. Vertigo has many causes and the recurrence of vertigo is unknown. Among a lot of factors, vitamin D deficiency is more important. This study was conducted to determine the effect of vitamin D supplementation on torsional nystagmus in BPPV patients. This study wants to show the deficiency of vitamin D leads to the recurrence of BPPV.
Methods: This case-control study was conducted from April 2017 to May 2018. All eligible patients with BPPV were presented to the Audiology clinic of Babol Rouhani hospital consecutively. Diagnosis of BPPV and the presence of nystagmus were confirmed and serum vitamin D was assessed. Dix-halpike maneuver and videonystagmography (VNG) for assessing nystagmus were done and for serologic assessment, ELISA was performed for analyzing the level of hydroxy 25 vitamin D.Vitamin D sufficient patients (more than 20 ng/ml) with BPPV were considered as the control group and vitamin D deficient patients (less than 20 ng/ml) were as the test group.
  In all the patients of two groups, torsional nystagmus (vertical, horizontal and oblique) were studied and compared.
Results: Twenty-seven patients in each group have completed the study. The mean age of the control group and test group was 48.2+4.8, 47.8+5.7 and 47.2+4.9 years respectively (P=0.91). Two groups were comparable regarding nystagmus severity. All patients had at least two attacks During the last six months. The mean of serum 25 OHD was 33.81 in the control group and 11.41 in the test group that was statistically significant (P=0.001 for all) and the severity of torsional nystagmus in three axes of horizontal, vertical and oblique in the control group was 4.98, 9.06, 5.40 respectively and 3.32, 8.86, 6.93 in the test group that was statistically significant as compared with the control group (P=0.001).
Conclusion: Findings of this study indicate a relationship between vitamin D deficiency and recurrence of nystagmus in BPPV patients

A comparison of sedation quality with midazolam-ketamine versus propofol-ketamine during Phacoemulsification surgery
Hamidreza Shetabi, Seyed Morteza Haidari , Darush Moradi Farsani , Zahra Bechari,
Volume 79, Issue 1 (4-2021)
Abstract
Background: Phacoemulsification surgery is one of the most common surgeries in the world. Various drugs have been used alone or in combination with each other to provide effective and safe sedation in patients, but so far, a drug method agreed upon by anesthesiologists has not been proposed. The purpose of this research was to evaluate the sedative quality of midazolam or propofol with a low dose of ketamine in phacoemulsification surgery.
Methods: This study was a double-blind randomized clinical trial conducted from November 2017 to August 2019 at Faiz Hospital, Isfahan. In this study, 68 patients were assigned in the groups of midazolam (M) and propofol (P) using randomization software entered the study. The midazolam (M) group received 0.04 mg/kg and the propofol (P) group received 0.5 mg/kg, then in both groups, ketamine 0.3 mg/kg was injected intravenously. The quality of sedation, cardiovascular response and patient and surgeon satisfaction were assessed and recorded. Data were entered into SPSS 23 software and analyzed by using ANOVA and Independent samples t‐test.
Results: In this study, between the two groups in terms of demographic characteristics there was no significant difference (P>0.05). In the KM group, higher percentage of patients achieved the desired quality of sedation, but, between the two groups no statistically significant difference was shown (P=0.75). Surgeon satisfaction was higher in the KP group (P=0.18) and patient satisfaction was higher in the KM group (P=0.18) but there was no significant difference (P>0.05). Recovery time between groups was Similar and no statistically significant difference was shown (P>0.98). In the KM group at 5 minutes, systolic blood pressure (SBP) was notably greater than the other group (P=0.02) and diastolic blood pressure was notably greater than the KP group (P=0.08).
Conclusion: It can be stated that adding a small dose of ketamine to propofol and midazolam is associated with effective sedation and a similar cardiovascular response during phacoemulsification surgery.
 

The effect of auditory sensory stimulation with familiar voice on recovery from anesthesia in patients undergoing rhinoplasty
Mohammadhossein Dehghani , Seyedmohammadreza Niktabar , Amirreza Samei, Shamsodin Mohammadi,
Volume 79, Issue 1 (4-2021)
Abstract
Background: Anesthesia duration can play a significant role in post-operative complications. Therefore, the present study investigated the effect of auditory sensory stimulation with a familiar voice on anesthesia return in patients undergoing rhinoplasty.
Methods: This study was performed on 80 patients who were candidates for rhinoplasty surgery in Yazd Trauma and Burn Hospital from September-2018 to October-2019. The patients were randomly divided into two groups of 40: control and intervention. For patients in the control group, routine nursing care was performed after entering the recovery room. In addition to routine care, the patients in the intervention group were stimulated with a 15-minute pre-recorded audio. Patients' hemodynamic parameters were recorded before and after hearing stimulation. Also, the return time of the patient from anesthesia was recorded. Finally, the collected data were entered into SPSS software (Ver. 22) and analyzed using an independent sample t-test and Repeated mesasure ANOVA.
Results: The results of this study showed that from the fifth minute after auditory sensory stimulation, the mean arterial pressure (MAP) in the intervention group was significantly higher than the control group (P<0.05). So that MAP in recovery (as the last follow-up) in the intervention group with a mean of 86.85±4.11 mmHg was significantly higher than the control group with a mean of 81.88±6.68 mmHg (P<0.001). Besides, the duration of recovery from anesthesia in the intervention group was significantly less than the control group (mean time: 24.05±3.39 min vs. 34.70±70.73 min; P<0.001). Finally, nausea was observed in only 7.5% of patients in the control group and agitation was reported in 5% of the control group and 5% of the intervention group (P>0.05).
Conclusion: According to the results, the use of auditory sensory stimuli with a familiar voice can significantly decrease the duration of recovery from anesthesia. Also, it plays a crucial role in changing the SBP, DBP, and MAP of these patients to normal levels.

Comparison of dexmedetomidine versus midazolam on hemodynamic parameters, bleeding, satisfaction of surgeons and patients who Underwent laminectomy surgery by spinal anesthesia
Behzad Nazemroaya, Mehrdad Masoudifar , Motahare Rajabi Moghadam ,
Volume 79, Issue 5 (8-2021)
Abstract
Background: One of the most empirical subjects particularly in substantial operations for example in surgeries involving the vertebral column, are the implication of sedatives in a manner which would create the least complications such as changes in the hemodynamic parameters. Two such drugs that are widely used in this capacity in clinical settings are midazolam and dexmedetomidine. Hemodynamic stability is particularly important in surgical operations, especially during spinal surgery. One of the ways to prevent hemodynamic changes during surgery is the use of drugs such as midazolam and dexmedetomidine.
Methods: This double-blind randomized clinical trial recruited 105 patients undergoing laminectomy spinal surgery under spinal anesthesia at Al-Zahra Hospital, Isfahan between 21 April 2019 till 1 September 2019. Patients were randomly divided into 3 groups: First was the midazolam group, second the dexmedetomidine group and the third was the control group. Data were presented as mean±standard deviation and percentages. In order for the evaluation of differences to be performed between all groups, an evaluation using the one-way analysis of variance was utilized. Statistical analysis was done by means of the SPSS software version 23 (IBM Corporation, Armonk, New York, USA). The P-value which was accepted as significant was P less than 0.05. (P<0.05)
Results: There differences in age and gender were not statistically significant among the studied groups (p>0.05). Results from the ANOVA test showed that the effects when taking into consideration time (P<0.001) and group (P<0.001) were statistically significant on Mean of Arterial Pressure, Systole Blood Pressure and Diastole Blood Pressure. However, Heart Rate and oxygen saturation (SPO2) were not significantly different inter-group as well as intra-group over time (before, during, and after the operation) (P=0.12).  Furthermore, the mean of the hemorrhage amount and duration of recovery stay had significant differences over time between all three groups (P<0.05).
Conclusion: The incidence of complications during surgery in the dexmedetomidine group was less than the midazolam group. Additionally, the frequency of complications in the subjects given midazolam was higher than the dexmedetomidine group during recovery.

The effect of Ibuprofen Apotel and Morphin alone in postoperative pain management of patient undergoing lumbar discopathy surgery
Hamidreza Azizi Faresani , Shayesteh Khorasanizadeh, Noormohammad Arefian , Houman Teymourian , Gholamreza Mohseni , Faranak Behnaz , Hamideh Ariannia ,
Volume 79, Issue 5 (8-2021)
Abstract
 
 
 
 
 
Background: This study aimed to evaluate the effect of intravenous Ibuprofen Apotel analgesia in comparison with intravenous Morphine alone regimen in patients undergoing lubmar disc surgery.
Methods: This study was a double-blind clinical trial that was performed on patients with moderate to severe lumbar disc pain (VAS score or Visual analog scale more than 4) in August 2019 at Shohada Tajrish hospital. Patients in the Ibuprofen-Apotel group (group A) recieved intravenous Ibuprofen (800 mg) in 100 cc Normal saline in the first 30 minutes of Recovery, then 400 mg in 100 cc Normal saline every 6 hours (48 hours after surgery), plus 30 mg Apotel for each kilogram in100 cc Normal saline in 15 minutes every 8 hours. In group B, Morphine has injected with 70 µg/kg bolus and then 20µg/kg/h infused with a PCA pump with a Maximum Rate of 1mg/hr. Then 60 minutes after surgery, patients' pain was measured using an analog scale.
The primary outcome was defined as a reduction in pain intensity of 3 or more VAS units (which was considered as therapeutic success) and the incidence of side effects was considered as secondary outcomes.
Results: Based on the results of this study, the mean age of the subjects was 33.28±12.48 years. Also, the mean age in the group of Ibuprofen-Apotel and Morphine alone were 35.4±13.6 and 31.16±11.75 years. So, there is not a significant difference between the groups. 77.14% of the subjects (54 people) were male and 22.86% (16 people) were women. In comparing the frequency distribution of individuals in terms of gender and the method of creating analgesia, no significant difference was observed between the groups studied.
According to the results, after the intervention, the highest pain intensity in both groups was significantly decreased. However, no significant difference was observed between the two groups.
Conclusion: The study indicated that Ibuprofen can be effective in controlling postoperative pain. 


Evaluation of the relationship between serum vitamin D levels and disease recurrence in patients with ulcerative colitis
Ahmad Hormati, Majid Azad, Abolfazl Mohammadbeigi , Vajihe Maghsoudi, Sajjad Rezvan, Mohammad Hossein Mokhtarian, Mahboubeh Afifian,
Volume 79, Issue 6 (9-2021)
Abstract
Background: one of the growing diseases in the world that affects patient life quality is Inflammatory bowel disease (IBD), including ulcerative colitis (UC). Many environmental factors, including nutritional deficiencies, may influence the development of the disease. This study aims to evaluate the role of the level of vitamin D in UC recurrence.
Methods: We performed this cross-sectional study at Qom University of Medical Sciences from September 2017 to September 2018 on 50 patients with inactive UC, at least six months after diagnosis, in Shahid Beheshti Hospital in Qom. Patients entered the study sequentially from the target population after describing how to perform the plan and obtaining informed consent. Demographic information, including gender, age, medical history, diseases, and body mass index (BMI), were collected using a checklist. Patients were followed for six months for symptoms and the frequency of disease relapse. During the visits, in terms of adherence to treatment and case of recurrence, the number and severity of recurrence were examined, and the results were recorded in the checklist of each patient. At the end of this period, serum vitamin D level was measured. Data were collected by a checklist and analyzed by independent samples t-test, Chi-square, and variance analysis in SPSS version 18.
Results: Examining the correlation between vitamin D levels and demographic variables shows that low vitamin D levels are significantly associated with an increase in the frequency of recurrences. However, there was no significant relationship between disease duration, age, and body mass index. Among 50 patients, 23 (%46) were male, and 27 (%54) were female, with a mean age of 35.24±10.07 and a mean duration of disease for 15.14±6.67 months. The mean frequency of relapse was 1.34±1.89. The mean level of serum vitamin D was 22.30±13.45 ng/dl. It was significantly associated with the frequency of relapse with a P<0.001.
Conclusion: Vitamin D insufficiency is associated with an increased risk of recurrence in patients with ulcerative colitis.
 

Comparison of serum vitamin D levels in children one to six years with urinary tract infections and healthy children
Fatemeh Khanamani Falahati Pour, Saeedeh Parvaresh, Maedeh Jafari,
Volume 79, Issue 7 (10-2021)
Abstract
Background: Urinary tract infection is one of the most common infectious diseases in children, the most severe form of which is acute pyelonephritis. Vitamin D plays a very important role in regulating the immune system, this study was conducted to compare vitamin D levels in children with urinary tract infections and healthy children in Kerman, Iran in 2020.
Methods: This cross-sectional study was performed on 63 children with pyelonephritis hospitalized in Afzalipour Hospital and 68 healthy children who were referred to Samen Al-Hojaj Clinic in Kerman, Iran from January 2020 to January 2021. Inclusion criteria for patients include the following: a) the presence of clinical signs and symptoms of infection such as fever b) pyuria, neurogenic bladder, urinary stones, chronic renal failure and previous diagnosis of urinary reflux. The case group was evaluated by taking a complete history, completing a questionnaire and clinical examination, and laboratory tests. The two groups were compared in terms of variables of sex, age and vitamin D levels.
Results: The mean age of the case group was 34 months and that of the control group was 38 months. The mean serum levels of vitamin D in the case and control groups were 34.66 and 42.9, respectively). P=0.016( Each group was divided into three groups according to the amount of vitamin D, including groups 1, 2 and 3, respectively, with vitamin D levels below 25 nanomoles per liter of deficiency, 25 to 50 inadequate and above 50 as the appropriate amount of vitamin D was considered. There was no significant difference between girls and boys in terms of vitamin D deficiency compared to the three groups of vitamin D levels.
Conclusion: Inadequate vitamin D levels are associated with the prevalence of urinary tract infections, and vitamin D supplementation can be a low-risk option for preventing urinary tract infections.

Effect of low level laser irradiation with vitamin A on cell viability and apoptosis induction of human skin melanoma
Maral Banihashemi Torshizi , Seyed Mehdi Tabaie, Mina Sadat Naderi, Saeed Hesami Tackallou ,
Volume 79, Issue 10 (1-2022)
Abstract
Background: Skin cancer is the most prevalent type of cancer and melanoma is the deadliest kind of skin cancer in the world. Due to enhanced induction of apoptosis and ROS levels, low-level lasers can be utilized to destroy skin cancer cells. Lasers are used to treat some skin lesions. Vitamin A is beneficial in the prevention and treatment of skin cancer. Vitamin A inhibits the pathway of cancer signals in the skin and suppresses tumor growth. In this study, the combined effect of low-level laser radiation (LLL) and vitamin A on cellular factors of skin melanoma cancer cells was investigated.
Methods: An in-vitro interventional laboratory study was performed in the cell culture laboratory of Medical Laser Research Center, Yara Institute in 2020-2021 (July 2020 to July 2021). First, A375 skin cancer cells were cultured in DMEM with 10% FBS. After preparation and culture of A375 cell lines, different concentrations of vitamin A (1, 5, 50, 100 μM) and LLL energy doses (1, 2, 5, 10 J/cm2) as treatments were done. Combination research of these treatments was performed to eliminate skin melanoma cancer cells. The rate of viability was determined using the MTT test, and the rate of apoptosis was determined using flow cytometry.
Results: The results indicated that a low-level laser with energy dosages of two and 5 J/cm2 and vitamin A treatment with a concentration of 50 μM in the A375 skin cancer cell line had the lowest viability and the highest induction of apoptosis. Furthermore, the results of the combination of Vitamin A and LLL treatments showed a synergistic effect with a greater reduction in the viability of skin melanoma cells and a greater amount of apoptosis.
Conclusion: In general, vitamin A and Low-level laser diminish the viability of cancer cells. Combination therapy of Low-level laser in the effective dose with vitamin A in optimal concentration provides anti-cancer effects. Further reductions in cancer cell viability caused by vitamin A and low-level laser radiation could pave the way for a novel approach in cancer treatment.
 

Providing a model for predicting blood pressure fluctuations after induction of general anesthesia with data mining: a brief report
Monireh Hosseini, Zahra Manouchehri ,
Volume 79, Issue 12 (3-2022)
Abstract
Background: Fluctuations in blood pressure after induction of general anesthesia have played a significant role in complications of surgery. Therefore, the present study was performed by identifying the causes of blood pressure fluctuations after induction of anesthesia, predicting and preventing them.
Methods: For this study which is a retrospective cohort, data mining methods in the data set including the information related to 3150 patients who underwent anesthesia and surgery from April 2018 to September 2019 in Imam Khomeini Hospital in Kermanshah were used. The data set included patients aged 18 years and older (age range of 18 to 96) who underwent a general anesthesia induction test using Propofol and subsequently endotracheal intubation for non-cardiac surgery. If patients did not have intubation, data were missing, or patients underwent intubation after repeated trials, they got excluded. In total, 2640 patients were included in this analysis. Preoperative patient clinical information was collected from pre-anesthesia evaluation records. Intraoperative data were obtained from computer anesthesia records. This data from the patient monitoring system and the anesthesia machine was automatically stored in the anesthesia files, while drug doses and anesthesia techniques were recorded manually. The data were then pre-processed using SPSS software, version 26 (IBM SPSS, Armonk, NY, USA).
Results: In this study, 53 features of patients' records were used (The maximum number of features used in previous studies were 48 features, which compared to them, 5 new features were included in the study) for which a P-value was calculated. Finally, features with a P<0.05 (Indicates the level of significance of the variable) were selected. Then, three data mining algorithms, logistic regression, neural networks and decision tree (the most repetitive data mining algorithms based on previous studies) were used to predict blood pressure. Also, using the criteria of accuracy, precision, sensitivity and F function, the performance of three prediction algorithms in data mining was evaluated.
Conclusion: Six features with P<0.05 were selected that the logistic regression model was more accurate, which was presented as the final model for predicting increased blood pressure fluctuations with path coefficients.
 

Evaluation of serum vitamin D levels in children with tic disorder who were referred to Besat clinics in Kerman during, 2019-2020: a brief report
Saeedeh Parvaresh, Mahin Eslami Shahrbabaki , Elaheh Hayatbakhsh , Maedeh Jafari, Fatemeh Karami Robati ,
Volume 80, Issue 2 (5-2022)
Abstract
Background: Tic disturbances are a group of developmental neurological disorders that often occur in childhood because of abrupt and automatic constrictions of muscles. This study aimed to evaluate the serum levels of 25-hydroxyvitamin D in children with a tic disorders.
Methods: This present case-control research was performed on 63 children with tic disorders and 63 children who were healthy and were referred to Besat clinics in Kerman, Iran from October 2019 to October 2020. The clinical information of patients with tic disorders was collected using a questionnaire. Serum vitamin 25(OH) D3 levels were assessed in patients with tic disturbances after identifying tic disorder.
Results: In the group of children with tic disorders, the highest number of patients were girls and in the group of children who were healthy, the highest number of patients were girls. The average age of patients in the case group was 10.37±0.31 years old and the average age of patients in the control group was 10.06±0.41 years old. The average age difference between the children with tic disorders and healthy children was not statistically significant (P=0.971). The average body mass index (BMI) in the case group was 16.98±0.35 and the average BMI in the control group was 16.0±84.56. The average body mass index difference between the children with tic and healthy children was not statistically significant (P=0.838). The mean serum Vit 25(OH) D3 levels in the control group were higher than the average serum level of vitamin D in the case group. The mean serum vitamin D level difference between the children with tic disorders and healthy children was statistically considerable (P=0.036).
Conclusion: The results showed that the average serum level of vitamin D in children with tic disorders was significantly lower than in children who were healthy. To investigate and confirm this relationship, more long-term studies with a larger number of patients are needed.

The effect of oral calcium on serum level of vitamin B12 in patients with type 2 diabetes
Mahmoud Parham, Davoud Oulad Dameshghi , Hossein Saghafi, Azam Sarbandy Farahani, Saeed Karimi Matloub, Rasool Karimi Matloub,
Volume 80, Issue 8 (11-2022)
Abstract
Background: Vitamin B12 deficiency is one of the most well-known disorders due to long-term use of metformin due to interference with its absorption.
Methods: This double-blind randomized trial was conducted from June to October 2016 at Shahid Beheshti Hospital in Qom on 60 patients in the age group of 30 to 60 years with a history of type 2 diabetes for one to two years and taking metformin in the amount of one to two grams. Patients were divided into two groups of 30 people. The intervention group received metformin with 1 gram of calcium carbonate daily, and the control group received metformin without calcium. Each of the patients in the intervention group was given 200 calcium carbonate tablets. Vitamin B12 levels of the patients in both groups were measured before the start of the intervention, and they were evaluated in terms of neuropathy according to the Michigan questionnaire. Vitamin B12 of patients and neuropathy in two groups were measured before the intervention and after three months.
Results: There was a difference between the two groups in terms of gender, and no significant difference was observed between the mean ages in the two groups. The mean level of vitamin B12 before receiving calcium in group A (intervention) was lower than group B (control) (P=0.036) and after receiving calcium, the level of vitamin B12 in the intervention group increased (P=0.002). In the control group, the level of vitamin B12 decreased (P=0.030). (P=0.006), and in the control group there was no significant difference in the examination of neuropathy (P=0.2).
Conclusion: Oral calcium daily intake increases vitamin B12 levels in patients with type 2 diabetes and calcium may be able to moderate the decrease in serum vitamin B12 levels induced by metformin in patients with type 2 diabetes.

Comparison of the effectiveness of intranasal ketamine compared with intravenous ketamine in controlling pain during cataract surgery
Hamidreza Shetabi , Khosro Naghibi, Alireza Peyman, Hamed Norouzi,
Volume 80, Issue 8 (11-2022)
Abstract
Background: To improve the quality of sedation in procedures, different medications are used alone or in combination with each other, but so far, no administration method that is agreed upon by anesthesiologists has been presented. This study aimed to investigate the effectiveness and safety of intranasal ketamine in comparison with intravenous ketamine in cataract surgery.
Methods: This clinical trial was performed from December 2016 to March 2017 in Feyz Hospital, Isfahan. Ninety patients over the age of 18 who were candidates for cataracts surgery were randomly assigned to receive 1 mg/kg ketamine through the nasal route (INk) or intravenously (IVK). Ten minutes before the surgery, ketamine was administered in the INK group and intranasal saline in the IVK group. Two minutes before the start of surgery, normal saline was administered in the INK group and ketamine was administered intravenously in the IVK group. Patients received intravenous midazolam 0.04 mg/kg during prep and drape. The quality of sedation and analgesia, vital signs, patient and doctor satisfaction, and side effects were recorded during the study period. Data were analyzed using of SPSS software, version 23 (IBM SPSS, Armonk, NY, USA).
Results: In this study, 90 people were included in the study, 53 of whom (58.9%) were men. The mean age of the patients was 61.5±10.6. Two groups had a significant difference in terms of gender (P=0.696), age (P=0.960), weight (P=0.212), height (P=0.632), underlying disease (P=0.094), and type of disease (P=0.090). Two groups were not significantly different in terms of mean heart rate (P=0.77), mean arterial blood pressure (P=0.13), mean blood oxygen saturation (P=0.58), patient satisfaction (P=0.470) and surgeon satisfaction (P=0.115), pain intensity (P=0.506), level of sedation level (P=0.477) and side effects (P=0.221).
Conclusion: Intranasal administration of ketamine provides similar sedation and cardiovascular response compared to intravenous administration of ketamine. Administering ketamine intranasally is a non-invasive, safe and effective method with easy application and can be a suitable alternative to intravenous administration.

Comparative study of the sedative effect of ketamine-dexmedetomidine (Ketodex)with ketamine-midazolam(Ketomid) in candidates of fibroptic bronchoscopy
Behzad Nazemroaya , Samin Jahanbin,
Volume 80, Issue 8 (11-2022)
Abstract
Background: A variety of sedatives like ketamine, propofol, opioids, and benzodiazepines are used during Fibroptic bronchoscopy. The effectiveness of ketamine-dexmedetomidine and ketamine-midazolam on pain level and sedation after Fibroptic bronchoscopy was examined.
Methods: A double-blind, randomized clinical trial was carried out from October 2020 to April 2021 at educational hospitals affiliated with Isfahan University of Medical Sciences. The participants were 60 candidates for fibroptic bronchoscopy who were allocated randomly into two groups of 30 people. Group one (Ketodex) received 1mg/kg ketamine and 1 µg/kg dexmedetomidine for 10 min followed by an infusion of 0.5 µg/kg of dexmedetomidine and 0.5mg/min ketamine. Group two (Ketomed) received 2.5mg of midazolam and 1mg/kg of ketamine for 10min along with infusion of 1 µg/kg/min midazolam and 0.5mg/min of ketamine. The variables under the study were systolic blood pressure (SBP), mean arterial pressure (MAP), diastolic blood pressure (DBP), percentage of arterial oxygen saturation (SpO2), heart rate (HR), and level of pain. Furthermore, the sedation score of patients were recorded on the basis
of sedation score is a 5-point scale from 1 to 5. The obtained data were analyzed in SPSS (v.26). To compare the data collected at different occasions and different groups, repeated measure tests and independent t-test were used (P<0.05).
Results: Compared to the Ketomed group, the sedation term in patients in the Ketodex group was longer significantly (P<0.001) with a significantly shorter recovery term (P<0.001). In addition, the differences between the groups were insignificant in terms of diastolic blood pressure, systolic blood pressure, mean arterial pressure, heart rate, and percentage of arterial oxygen saturation (P>0.05). The pain levels were notably lower in patients who received Ketomed compared to Ketomed during 20 min (P=0.04) and 30 min (P=0.001) following the procedure.
Conclusion: The use of Ketodex was associated with a longer sedation duration and significantly shorter stay in the recovery room and lower pain intensity compared to Ketomed, therefore it may be more preferable in bronchoscopy.

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