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Zeinab Moradi Kohnaki , Khairollah Asadollahi, Ghobad Abangah , Kourosh Sayehmiri ,
Volume 74, Issue 9 (12-2016)
Abstract

Background: Considering the high incidence and prevalence of nonalcoholic fatty liver disease (NAFLD) in the Iranian society and the limited number of studies to investigate its associated risk factors, the current study was designed to identify any relevant risk factor of this disease.

Methods: The present case-control study was performed among 150 nonalcoholic fatty liver disease patients and 150 normal liver participants who attended to gastroenterology clinics in Ilam city, Iran during 2014-2015. All demographic data, clinical trials and health behaviors associated with lifestyle such as nutritional status, smoking, physical activities were collected and compared between two groups.

Results: Among a total of 300 participants in the current study, the male female ratio was 46.54% and the mean±standard deviation of all participants was 42.13±12.15 years. The mean values of total cholesterol, triglycerides (TG), low density lipoprotein (LDL), alanine transaminase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase (ALP) were significantly higher in cases than controls group (P< 0.0001). A significant relationship was revealed between positive familial history, marriage, and low physical activities with NAFLD (P< 0.05). In the patient's group, consumption of red meat was significantly higher and dairy intake was significantly lower compared to the control group (P< 0.05). Using the multivariate logistic regression analysis, the adjusted odds ratio for variables of waist circumference, triglyceride, ALT and body mass index (BMI) were statistically significant [1.11, (1.04-1.18); 2.58, (1.01-6.67); 5.34, (1.84-15.52) and 7.28,) 1.89-27.99) respectively] (P< 0.05). Also, a significant association was observed among the variables of ALT, AST and BMI with the severity grade of NAFLD (P< 0.05).

Conclusion: The results of this study showed that waist circumference, BMI, serum level of ALT and TG concentrations can predict the occurrence of non-alcoholic fatty liver disease. BMI, ALT, and AST seem to be associated with the ultrasonography staging of liver in NAFLD. Therefore, these parameters could be used to predict the ultrasonography staging of liver in these patients.


Elham Hoveizi , Tayebeh Mohammadi ,
Volume 74, Issue 11 (2-2017)
Abstract

Background: One of the major causes of death in the world is cancer and therefore any study in the field of cancer biology is of great importance. Head and neck cancers represent approximately 2-5% of neoplasms which is higher in some countries. The most appropriate therapy for various cancers is identifying effective and efficient ways that contribute to initiation of apoptosis. Cyclophosphamide is an alkylating agent that stops the replication of DNA and then, it stops the cell proliferation and viability. Therefore, cyclophosphamide is used to treat various types of cancer. In this study we evaluate the cytotoxic effects of cyclophosphamide on viability of (head and neck cancer cells) HN5 cell line and compare it with fibroblast cells as noncancerous cells.

Methods: This experimental study was done in cell and developmental laboratory in faculty of science, Shahid Chamran University of Ahvaz in Spring of 2016. HN5 cell line and embryonic fibroblast cells were grown in DMEM supplemented with 10% fetal bovine serum (FBS), penicillin/streptomycin (100 U/ml, 100 µg/ml) at 37 °C, then the effects of different concentrations of cyclophosphamide on cell viability was evaluated by 3-(4,5-Dimethylthiazol-2-yl)-2,5-Diphenyltetrazolium Bromide (MTT) assay. 4',6-diamidino-2-phenylindole (DAPI) staining was performed to determine the proportion of apoptotic cells by manually counting pyknotic nuclei. According to standard procedures from day 13 embryos of outbred strains naval medical research institute (NMRI), fibroblast cells were isolated. In this study HN5 cell line and fibroblasts were exposed to cytostatics for 72 hours.

Results: Various concentrations of cyclophosphamide were effective in cytotoxicity of HN5 cancer and fibroblast cells. A significant cytotoxicity was observed with the examined concentration of 1 µg/ml of cyclophosphamide with 50% in 3th day and P< 0.001. Interestingly, at low concentrations, cyclophosphamide was more toxic than at higher concentrations.

Conclusion: Totally cyclophosphamide had low toxicity effects on both of the cell lines but the toxicity effects of cyclophosphamide on HN5 were significantly greater than fibroblast cells. These results indicate that cyclophosphamide can be a potential anticancer agent.


Homa Mohseni Kouchesfahani , Somayeh Ebrahimi-Barough , Jafar Ai , Azam Rahimi ,
Volume 74, Issue 12 (3-2017)
Abstract

Background: Small molecule Purmorphamin (PMA) is the agonist of smoothened protein in Sonic hedgehog (Shh) signaling pathway. Effect of purmorphamin small molecule on differentiation of mesenchymal cells into bone tissue has been studied previously. Use of Shh causes progression of neural differentiation, and the differentiated cells express specific neural markers. Neurofilament (NF) and acetylcholine esterase (Chat) are specific markers of motor neurons and their expression in differentiated cells indicates their conversion into motor neurons. The aim of this study was to evaluate the ability of PMA to differentiate the human endometrial stem cells (hEnSCs) into motor neurons.

Methods: This analytical study was done in Tehran University of Medical Sciences laboratory on September of 2015. In this study hEnSCs were enzymatically extracted from endometrial tissue. After third passages, the flow cytometry was done for mesenchymal stem cells markers. The mesenchymal stem cells were divided into control and differentiated groups. FBS 10%+DMEM/F12 was added to the culture medium of control group and the differentiating group was treated with differentiating medium containing N2, PMA, DMEM/F12, FBS, B27, IBMX, 2ME, FGF2, RA, BDNF. After 21 days immunocytochemistry (ICC) test was done for the expression of NF and Chat proteins and Real-time PCR analysis for expression of neural markers such as NF, Chat, Nestin and GFAP (as glial marker) at mRNA level.

Results: The flow cytometry analysis showed that hEnSCs were positive for mesenchymal markers CD90, CD105 and CD146 and negative for endothelial marker CD31, and hematopoietic marker CD34. The immunocytochemistry and Real time-PCR results showed that the cells treated with PMA expressed motor neuron markers of NF and Chat.

Conclusion: According to the results of this study, it can be concluded that small molecule PMA has the potency to induce the differentiation of hEnSCs into neural cells, specifically motor neurons by activating Shh signaling pathway.


Mahshid Hatami , Mohammad Esmaeil Akbari , Morteza Abdollahi , Marjan Ajami , Yasaman Jamshidinaeini , Sayed Hossein Davoodi ,
Volume 75, Issue 1 (4-2017)
Abstract

Background: Breast cancer is the most common cancer among females in the world. Identifying the nutrients that modify the risk of the disease is one of the key strategies for improving the quality of life and reducing treatment costs. Epidemiological studies support the role of macronutrients and vitamins involved in one carbon metabolism in the etiology of the disease. This study aimed in investigation of the relationship between the intake of macronutrients and vitamins involved in one carbon metabolism with breast cancer risk.

Methods: This case-control hospital base study was conducted at Shohada Hospital, Tehran from April to February 2015. Demographic data, physical activity level and nutrients’ intake from diet and supplements were collected through interview from 151 cases and 154 controls. Dietary intake was assessed by a valid and reliable 168-item semi-quantitative food frequency questionnaire. Then intake of macronutrients and B vitamins was assessed by Nutritionist 4 software (First Databank Inc., CA, USA). Comparing categorical variables between the two groups was done by Chi-squared test and the relationship between intake of studied nutrients and risk of breast cancer was determined using logistic regression test.

Results: There were no difference in age, menarche age, menopause age, body mass index (BMI), number of live births between two groups. But the difference in physical activity, energy intake, marital status, educational level, occupation, oral contraceptives use was significant (P< 0.001). After modifying the effects of confounding variables, the risk of breast cancer was significantly lower in the highest intake quartile category relative to the lowest quartile category for total protein, total fiber, intake of vitamins B2, B6, B12 and folate (Ptrend< 0.001). Before modifying the effects of confounding variables, the risk of breast cancer was significantly higher in the highest intake quartile category relative to the lowest quartile category for carbohydrate and fat; but after modifying the effects of confounding variables, results were not significant.

Conclusion: The results showed that high intake of protein, fiber, vitamins B2, B6, B12 and folate are associated with lower risk of breast cancer.


Leila Asefkabiri , Abbas Alibakhshi , Seyed-Hassan Emami-Razavi , Mahtab Mohammadifard , Alireza Abdollahi ,
Volume 75, Issue 3 (6-2017)
Abstract

Background: Hypocalcemia is one of the most prevalent complications following total thyroidectomy. Over recent years, in addition to hormone parathyroid hormone (PTH), vitamin D has been also studied as a factor causing post-total thyroidectomy hypocalcemia. This survey seeks to study the relationship between the serum level of vitamin D before surgery and during post-total thyroidectomy hypocalcemia.

Methods: A group of 57 patients volunteering for total thyroidectomy were studied on Vali-e-Asr Hospital, Tehran, Iran, from March 2013 to March 2015. In all these patients, pre-surgery calcium, vitamin D and parathyroid hormone (PTH) as well as the level of calcium during the post-surgery first two days were measured. Based on objectives of this study, the relationship be-tween pre-surgery vitamin D level and post-surgery hypocalcemia was examined.

Results: The average age of patients participating in the survey was 24.1±13.3. They included 19 women (33.3%) and 38 men, total of 40 patients (70.2%). Their average post-surgery calcium level was 9.2±0.77 milligrams per deciliters (mg/dl) and their average vitamin D content before the surgery was 42±12.1 nanomole per liter (nmol/l). The average calcium level before the surgery and the first post-surgery day were meaningfully different in terms of statistics (P<0.001). In terms of vitamin D, 37 patients (64.9%) had pre-surgery vitamin D deficiency and 20 patients (35.1%) had vitamin D insufficiency. Of 37 patients with pre-surgery vitamin D deficiency, 26 were diagnosed with post-surgery first-day hypocalcemia and of 20 patients with vitamin D insufficiency, 14 suffered post-surgery first-day hypocalcemia. This difference was not statistically meaningful (P>0.001). Of 37 patients with pre-surgery vitamin D deficiency, 31 suffered post-surgery second-day hypocalcemia and of 20 patients with vitamin D insufficiency, 18 suffered second-day hypocalcemia. This difference was not statistically meaningful either (P>0.001).

Conclusion: The current study showed that the serum level of vitamin D before total thyroidectomy does not have any role in the occurrence of post-surgery hypocalcemia which is almost common after this type of surgery.


Faegheh Behboudi Farahbakhsh, Hossein Maghsoudi, Hamid Asadzadeh Aghdaei , Ehsan Nazemalhosseini-Mojarad,
Volume 75, Issue 4 (7-2017)
Abstract

Background: Familial adenomatous polyposis (FAP) is the most common components polyposis syndromes. It incidence is for less than 1 percent of colorectal cancer cases. FAP is characterized by germline mutations in the adenomatous polyposis coli (APC) gene. Generally, there are hundreds to thousands of adenomatous polyps in colon and rectum of patients. The aim of the current study was to evaluate the germline mutation at codon 1309 of the APC gene and its association with extracolonic manifestations in Iranian patients with FAP.
Methods: This Cross-sectional study was conducted at the Gastroenterology and Liver Diseases Research Center, Taleghani Hospital, Tehran, Iran from July 2012 to February 2015. In this study, thirty-three patient with FAP was examined. Demographic and clinical data were gathered from patients. In addition, peripheral blood samples were collected to study the most common mutations of the APC gene and bidirectional sequencing was carried out after genomic DNA extraction by salting out method. Primers were designed by GeneRunner version 5.0.4 (http://www.generunner.com). The samples were run on an applied biosystems 3130XL genetic analyzer. The results were analyzed by SPSS software, version 23 (IBM, Armonk, NY, USA).
Results: After analyzing the mutation cluster region (MCR), we have identified five germline mutations with 5bp deletion at codon 1309 of the APC gene (c.3927_3931delAAAGA), that it is equivalent to 15.2% (5.33). This mutation has been known as a small deletion, that it is a variant of frameshift mutation. Mutation at codon 1309 has significant association with clinical and pathological features including the number of polyps (P=0.001), duodenum demonstration (P=0.008), fundic gland polyp (P=0.002) and congenital hypertrophy of the retinal pigment epithelium (P=0.021).
Conclusion: The analysis of the findings has shown that mutation in Codon 1309 of adenomatous polyposis coli gene may be associated with severe polyposis and extracolonic manifestations. In conclusion, there may be a correlation between a specific germline mutation and the extracolonic manifestations.

Majid Mohammad Shahi, Seyed Ahmad Hosseini , Bizhan Helli , Mohammad Hosein Haghighyzade , Mohammad Abolfathi ,
Volume 75, Issue 6 (9-2017)
Abstract

Background: Sleep quality may be directly related with vitamin D serum level. Some studies found that people with lower vitamin D serum level experienced a lower sleep quality. Consequently, this study aimed at determining the effect of vitamin D supplements on sleep point and quality in 20-50 year-old people with sleep disorders.
Methods: This double-blind, clinical trial was performed in Golestan Hospital of Ahvaz Jundishapur Medical Sciences University from November 2015 to February 2016 on 89 people with sleep disorders based on Pittsburgh Sleep quality index (PSQI). Participants of the study were selected based on inclusion and exclusion criteria. Patients under study were divided into two groups of vitamin D supplement and placebo recipients by random allocation. At the end of the study, the data on 89 subjects (44 in intervention group and 45 people in placebo group) were examined. Participants in intervention group received four edible pearls, each 50000 IU vitamin D, one in a fortnight. To placebo group, a placebo capsule (edible paraffin) was given one in a fortnight. Before and after intervention, Petersburg’s sleep quality questionnaire, Depression Anxiety Stress Scale (DASS-21) questionnaire, international physical activity questionnaire, general information questionnaire, sun exposure, vitamin D serum level and three-day food record questionnaire were assessed and recorded for all participants. To analyze data, Student's t-test, Chi-square test, ANCOVA, Mann-Whitney U test and Wilcoxon statistical tests were used.
Results: Mean score of Pittsburgh sleep quality questionnaire before and after intervention was 9.45±2.44 and 6.75±2.97 respectively (P=0.001) in interventional group and 10.51±3.14 and 9.73±3.04 respectively (P=0.18) in controls. Based on the results of the present study, at the end of the study score of Pittsburgh sleep quality questionnaire reduced significantly in vitamin D recipients as compared with placebo recipients (P=0.001).
Conclusion: This study shows that the use of vitamin D supplement reduced sleep score (PSQI) or improved sleep score, reduced sleep latency, increased sleep duration and increased subjective sleep quality after modifying confounding variables in adult people with sleep disorder.

Yousef Saberi , Bahloul Ghorbanian , Parviz Ansari ,
Volume 75, Issue 7 (10-2017)
Abstract

Background: One the ways to deal with the adverse effects of oxidative stress caused by exercise activities is to use oral antioxidant supplements or to apply natural remedies. Sesamin is the most prominent lignan compound found in sesame seeds, one of the two highest sources of lignans in the human diet (the other being flax). Sesamin is catered to be a nutritional supplement that confers antioxidant and anti-inflammatory effects or possibly being an estrogen receptor modulator and fat burner. For this purpose, the present study was conducted to evaluate the effect of 10 weeks supplementation of sesamin and aerobic exercise on plasma levels of total antioxidant capacity and glutathione peroxidase in athletic men.
Methods: In this quasi-experimental study, in Azarbayjan Shahid Madani University of Tabriz City from January to March of 2016 ,40 male subjects aged between 25 and 20 were randomly selected from placebo (10 subjects) and aerobic exercise (10 students), aerobic training+sesamin (10 people) and sesamin (10 people). The aerobic exercise protocol is (ten weeks / three days / 30-35 minutes). Blood samples were collected from subjects in six stages to evaluate the considered variables. Measurement of levels of antioxidant capacity and glutathione peroxidase measurements were conducted by the Antioxidant capacity and GPX assay kit (ZellBio, German). For data analysis, repeated measures of variance analysis at a significant level of 5 hundredths were used by employing SPSS software, version 20 (SPSS Inc., Chicago, IL, USA).
Results: Subjects who took sesamin supplementation and performed aerobic exercise showed a significant difference in the levels of total antioxidant and glutathione peroxidase capacity in the groups (P<0.05). Also, the changes in total antioxidant and peroxide levels after interference (steps 4, 5, 6) and before interference (steps 1, 2, 3) had meaningful differences in obtained results (P=0.001). Also, the interactive effects of group and time on total antioxidant capacity and glutathione peroxidase were also significant (P=0.001).
Conclusion: Aerobic exercise and supplementation of sesamin is an effective method to improve the health of mens athlete's immune system. In addition, combining supplementation with aerobic exercise can increase some of the beneficial effects of exercise during a 10-week period.

Forough Fasihi , Amirmansour Alavi-Naeini , Mostafa Najafi , Mohammad Reza Aghaye Ghazvini, Akbar Hasanzadeh ,
Volume 75, Issue 8 (11-2017)
Abstract

Background: The causes of Attention-deficit/hyperactivity disorder (ADHD) (the most common psychological disorder is still unknown. The main symptoms include impulsivity, hyperactivity and attention deficit. Some studies have shown the relationship between ADHD and oxidative stress, and yet some researches have shown the effects on vitamin D on the antioxidants level. This research intends to identify the effect of vitamin D supplementation on the antioxidant serum level in 6-13 years old children with ADHD.
Methods: This double blind clinical trial was conducted in Isfahan city, the center of Iran, from October 2015 to February 2016. The sample included 35 subjects of both groups that were randomly selected among 6-13 years old children with ADHD diagnosed by pediatric psychologist. The intervention group consumed 1000 IU of vitamin D3 daily for three months, and the control group used placebo for the same period of time. Their stature and weight were recorded by digital instruments without the shoes with the least clothes. The next step was to train the food record of the students to the parents so that 3 food records were taken during the study. 25-hydroxyvitamin D3 (25(OH)D3), TAC (Total antioxidant capacity), MDA (Malondialdehyde), CAT (Catalase) and GSH (Glutathione) of the participants of both groups were measured before and after the intervention.
Results: In this Study, both groups were adjusted in terms of their age, gender and BMI. The mean score of the variables of leisure time and sport showed no significant difference in the both groups. Comparing the average TAC and MDA between the two groups before intervention didn’t show a significant difference (P1TAC=0.06) (P1MDA=0.32), but after the intervention, the vitamin D intake group showed the increase in TAC and decrease in MDA (P2TAC=0.001) (P2 MDA=0.01). Moreover, CAT and GSH showed no significant difference in the two groups before and after intervention.
Conclusion: Vitamin D supplementation for 3 months led to the improvement of antioxidant capacity by the increase of TAC and decrease of MDA, but the CAT and GSH showed no significant change in the mentioned period of time.
 

Mahboobeh Sadat Hosseini , Mohammad Javad Bahoosh , Gholamhossein Alishiri , Nahid Khalili , Habib Yaribeygi ,
Volume 75, Issue 11 (2-2018)
Abstract

Background: The prevalence of diabetes mellitus due to existence of various factors is growing rapidly. The insulin resistance phenomenon is one of the main underlying causes of this disease, due to various reasons such as a decrease in serum levels of vitamin D3. In this study, we evaluated the relationship between plasma level of vitamin D3 and some other main plasma factors.
Methods: This clinical trial study carried out on type 2 diabetes mellitus subjects who referred to diabetes clinic of Baqiyatallah Hospital in Tehran city during June to September 2016. First demographic data of all patients were collected. Then the blood samples for evaluation of blood glucose, HbA1c, triglyceride, cholesterol, HDL, LDL and vitamin D3 were obtained. Based on plasma level of vitamin D3, diabetic subjects were divided into two separate treatment groups (with and without vitamin D3 deficiency) and then above-mentioned factors were compared between these two groups. Afterward, in group with vitamin D3 deficiency, treatment by vitamin D3 triggered (50000 unit per week for eight weeks orally) until plasma level of vitamin D3 reached above 30 ng/mL. Then, treatment continued by vitamin D3 (50000 Unit per week orally) and calcium (1.5 g/day PO) until 60 days. Finally, the patients were evaluated about fasting blood glucose, HbA1c, HDL, LDL and blood pressure.
Results: In total, 187 subjects (99 men and 88 women) were evaluated in this study. Total hypovitaminose incidence was 0.65% which was higher in subjects with higher body mass index (BMI). Serum content of vitamin D3 and calcium, significantly changed the values of fasting blood sugar (FBS), HbA1c, HDL and TG, but has no significant effects on other factors.
Conclusion: Our results clearly revealed that hypovitaminose vitamin D3 is one of the main factors that can leading to rise in plasma glucose and dyslipidemia occurrence. Also, our data are demonstrated that treatment by vitamin D3 and calcium can modify fasting blood glucose and dyslipidemia in type 2 diabetes mellitus subjects.

Ahmad Shamsizadeh , Roya Nikfar , Mina Safi , Tahereh Ziaei Kajbaf , Amir Saberi-Demneh, Reza Karbalaei ,
Volume 75, Issue 12 (3-2018)
Abstract

Background: Bronchiolitis is one of the most common diseases of the lower respiratory tract in infants. Vitamin D has been shown to be protective against lower respiratory infections; however, there are limited and contradictory results in relation to serum vitamin D level and the incidence of bronchiolitis in children. The aim of this study was to compare serum levels of this vitamin in healthy infants and infants with acute bronchiolitis.
Methods: This case-control study conducted at Abuzar hospital in Ahvaz city, during October to March of 2014. Three groups of 45 eligible infants including control, low and high intensity of bronchiolitis enrolled to study. The severity of bronchiolitis classified according to scores derived from the respiratory distress assessment index. One to eight scores considered as low intensity and 9 to 17 scores considered as high intensity of bronchiolitis. Subsequently, 3 ml of venous blood sample were taken from them and the serum levels of 25(OH)D were measured by using an enzymatic kit.
Results: 60 (44.4%) infants were girls. The mean age of the control, low and high intensity of bronchiolitis groups were 11.2±5.2, 10±5.8 and 9.8±4.7 months, respectively (P=0.1). The mean of 25(OH)D concentrations in the control, low and high intensity bronchiolitis groups were 28.3±19.4, 17.7±11.7 and 13.6±5.7 nm/l, respectively. There was a significant difference in levels of 25(OH)D between the control-low intensity bronchiolitis groups (P=0.001) and the control-high intensity bronchiolitis groups (P=0.002), this difference was not significant between the two groups of bronchiolitis. There was a direct and significant correlation between serum level of 25(OH)D and age (r=0.2, P=0.005), breast milk consumption (r=0.3, P=0.001), and vitamin D supplementation (r=0.6, P=0.000).
Conclusion: In the present study, levels of 25(OH)D were significantly lower in infants with bronchiolitis than control group. In addition, 25(OH)D levels did not affect the severity of bronchiolitis.

Bahman Hasannasab , Nadia Banihashem , Shahram Seyfi , Manizheh Yazdanmehr ,
Volume 76, Issue 6 (9-2018)
Abstract

Background: The post-dural puncture headache (PDPH) is a common complication in spinal anesthesia. Headache may occure seven days after dural puncture. The headache may be worsened in sitting position and be better in supine position. PDPH is common in younger and tall people. The incidence rate of PDPH related to the size of spinal needle and the number of try and decrease with small, cutting needle and less puncture try. PDPH is a well-known iatrogenic complication of spinal anesthesia, which continues to be a major problem. In this study, we assessed the effect of intravenous aminophylline on prevention of post-spinal anesthesia headache in who were elective for cesarean sections.
Methods: This double-blind randomized clinical trial was conducted on 140 women with 18 to 35 years old and American Society of Anesthesiologists Classification (ASA Class) I and II undergoing spinal anesthesia in elective cesarean section. Patients were randomly divided into two groups called case and control. After umbilical cord clamping 1 mg/kg aminophylline dissolved in 100 cc normal saline was infused to the case group but only 100 cc normal saline was infused for the control group. Patient's blood pressure and heart rate were recorded before spinal anesthesia, immediately after spinal anesthesia, after uterine incision and umbilical cord clamping, after drug injection and then every five minutes. The incidence of headache was assessed at 4, 8, 24, 48 and 72 hours after the surgery.
Results: Although severity and duration of headache in case group was more than in control group, no meaningful difference was found between two groups. The mean changes in systolic blood pressure were greater in control group (P<0.001). The mean changes in heart rate was greater in case group than control group (P<0.001).
Conclusion: This study showed that intravenous aminophylline although, caused hemodynamic changes in some case, but it doesn't have any effect on prevention of incidence and severity of post-spinal anesthesia headache in elective cesarean section.

Somaye Fatahi , Hamed Kord Varkaneh , Mehran Pezeshki, Amirhosein Ghahremanian , Sakineh Shab-Bidar ,
Volume 76, Issue 6 (9-2018)
Abstract

Background: Trying to find a drug with more clinical efficacy in treating obesity is one of the priorities. The aim of this study was to evaluate the efficacy of orlistat, sibutramine, lorcaserin and metformin on weight loss in obese people.
Methods: The databases of PubMed, Scopus, Google Scholar and Cochran Library were searched up to November 2016. In present study search strategy was performed by using selected keywords. Two independent investigators scanned and extracted the relevant data. The pairwise method was used to compare the difference between the mean difference weight loss for orlistat, sibutramine, lorcaserin and metformin in two direct methods (comparison of orlistat, sibutramine, lorcaserin and metformin with the control group) and non-direct (Compare orlistat, sibutramine, lorcaserin and metformin together). We assessed the quality of included trials using the quantitative 5-point Jadad scale. The heterogeneity across studies was assessed by using Cochrane’s Q and I2 tests. Publication bias was reported by means of funnel plots and Egger’s tests. 
Results: The present study performed on 36 clinical studies with a population of 3672. Our study results did show that sibutramine (mean difference -4.97 kg, 95% confidence interval -6.70 to -3.23), metformin (mean difference -4.45 kg, 95% confidence interval -9.27 to 0.38), orlistat (mean difference -2.37 kg, 95% confidence interval -3.45 to -1.30), lorcaserin (mean difference -2.36 kg, 95% confidence interval -4.58 to -0.15), respectively, had the most effect on weight loss compared with the placebo group. In addition, orlistat compared to lorcaserin (mean difference -0.01 kg, 95% confidence interval -2.47 to 2.45) resulted in more weight loss, but compared to metformin (mean difference 2.07 kg, 95% confidence interval -2.78 to 7.02) and sibutramine (mean difference 0.52 kg, 95% confidence interval -4.46 to 5.50) lead to less weight loss.
Conclusion: The present study indicated that orlistat had a greater effect on weight loss compared with lorcaserin, and had lower effect on weight loss compared with sibutramine and metformin in apparently healthy obese individuals.

Fatemeh Bahadori , Zahra Sahebazzamani , Leila Zarei, Neda Valizadeh,
Volume 76, Issue 9 (12-2018)
Abstract

Background: Gestational diabetes is one of the common causes of maternal and fetal complications. Due to fetal and maternal complications of diabetes, it is very important to reduce the prevalence of diabetes and its consequences. The relationship between vitamin D deficiency and type 2 diabetes has been reported. There is little information about the relationship between serum vitamin D levels and the risk of gestational diabetes mellitus (GDM). The aim of this study was to determine the relationship between the levels of vitamin D and gestational diabetes.
Methods: This case-control study was conducted in health centers of Urmia University of Medical Sciences in May 2015 until March 2016. A total of 100 pregnant women with gestational diabetes and 100 healthy pregnant women were entered into the study by nonrandom and available sampling. The level of vitamin D was measured and levels were divided into three levels. Vitamin D levels were considered less than 20 ng/ml, 20-30 ng/ml and more than 30 ng/ml as deficiency, insufficiency and sufficient, respectively. Exclusion criteria include pre-pregnancy glucose tolerance, history of medical disease, and supplementation with vitamin D.
Results: The mean age of women in the study group was 30.31±5 years and in the control group was 28.83±4.95 years (P=0.06). The vitamin D levels in GDM and control groups were 7.25±4.76 ng/ml and 11.93±16.12 ng/ml, which is lower in the gestational diabetes than the control group (P=0.01). The severe deficiency of vitamin D in the gestational diabetes group and in control group were 34% and 27% respectively (P<0.0001). There was a significant difference in mean fasting plasma glucose level between gestational diabetes group and healthy pregnant group (P<0.001). There was no relationship between vitamin D levels and body mass index of pregnant women (P=0.1).
Conclusion: In this study, the majority of patients had vitamin D deficiency and in the gestational diabetes group, vitamin D deficiency was significantly higher than the control group. The severe deficiency of vitamin D in the gestational diabetes group was higher than patients without gestational diabetes.

Mehdi Sanatkar , Mehrdad Goudarzi ,
Volume 77, Issue 3 (6-2019)
Abstract

Background: Cataract is one of the most common eye diseases especially in children and adolescents in two age ranges, and many of these patients need to surgery throughout life. The purpose of this study was to compare the efficacy and side effects of midazolam-ketamine and midazolam-fentanyl for sedation in adult cataract surgery.
Methods: In this study, which was a case-control study, 80 patients were referred to Farabi Hospital in Tehran from November to December 2018 for cataract surgery and underwent surgery. The patients were divided into two groups (n=40). In this study the method of using midazolam-ketamine (ketamine group) was compared with the combination of midazolam-fentanyl (fentanyl group). The hemodynamic variables such as blood pressure and heart rate before surgery were measured and then measured every 5 minutes during operation and were recorded. In addition to hemodynamic variables, other variables such as agitation, surgeon satisfaction, recovery nurse satisfaction, degree of oxygen saturation during surgery, and nausea and vomiting were compared between the two groups.
Results: In this study, 18 patients (45%) of fentanyl group and 17 patients (42.5%) of ketamine group were female. Patients in the two groups had similar demographic distribution before surgery. In this study about blood pressure after surgery, from 80 patients, 22 cases had blood pressure below 119.79 mmHg, of which 3 (13.6%) cases were in ketamine group and 19 cases (86.4%) in fentanyl group. In general, 7.5% of ketamine group and 47.5% of fentanyl group had a blood pressure lower than 119.79 mmHg. Hemodynamic changes and hypotension after sedation was more in fentanyl group. Two groups did not differ in terms of heart rate, arterial oxygen saturation during surgery, surgeon satisfaction during surgery, and postoperative nausea and vomiting.
Conclusion: Administration of ketamine-midazolam versus fentanyl-midazolam in patients who underwent cataract surgery by sedation led to more stable hemodynamic variables intraoperatively and other side effects such as heart rate, oxygen saturation, surgeon satisfaction, nausea and vomiting were similar between two groups.

Mitra Jabalameli , Seyyed Taghi Hashemi , Somayeh Asadpoor ,
Volume 77, Issue 5 (8-2019)
Abstract

Background: Post-dural puncture headache (PDPH) is commonly seen after neuraxial block and it usually lasts for up to two days or in some cases for up to two weeks. Several types of regimens have been suggested for treatment, such as theophylline and caffeine. This study aimed to evaluate the effects of aminophylline, paracetamol, and administration of aminophylline and paracetamol concurrently on prevention of PDPH.
Methods: In a double-blind randomized clinical trial, we evaluated 120 patients in four groups (n=30) undergoing spinal anesthesia for extremity surgery in educational hospitals of Isfahan University of Medical Sciences (Alzahra and Ayatollah Kashani Hospitals), Iran, from 2016 to 2017. In group A aminophylline was injected slowly intravenously (1.5 mg/kg), in group B paracetamol (1000 mg) was injected intravenously, in group C aminophylline and paracetamol was injected with the same dose and in control group (n=30) normal saline was injected intravenously. After patients entered the operating room, mean arterial blood pressure and heart rate were measured and oxygen saturation was monitored. Before spinal anesthesia, 15 minutes before leaving the recovery room, every 6 hours in first day and daily in first week after the surgery, incidence of PDPH in each group were evaluated. The frequency of nausea between the four groups was also studied.
Results: 42 patients (35%) out of the 120 ones suffered from headache. 40% of patients who had received aminophylline, 33.3% of patients who had received paracetamol, 20% of patients who had received aminophylline and paracetamol and 46.6% of patients who had not received any drug suffered from headache (P=0.05). The frequency of nausea was not significantly different between the four groups at any time. The average of heart rate, mean arterial pressure and oxygen saturation in recovery and 24 hours after operation were not significantly different between the four groups.
Conclusion: This study shows that intravenous administration of aminophylline and paracetamol significantly reduces the incidence of post-dural puncture headache (PDHP) in lower extremity surgery and we can use this regimen for prevention.

Saeedollah Noohi , Matin Ghazizadeh , Leila Maleki ,
Volume 77, Issue 6 (9-2019)
Abstract

Background: Vitamin D deficiency can cause frequent infection of tonsil and adenoid. Recurrent upper airway infections are associated with hypertrophy of lymphoid tissues (adenoid and palatine tonsils) in children. Obstructive sleep disorders, failure to thrive, facial deformity, and cognitive disorders are among the most important complications of adenotonsillar hypertrophy. Surgery is indicated in cases with symptomatic adenotonsillar hypertrophy, who did not respond to conservative management. This study aimed to evaluate the relation between serum vitamin D level and size of palatine tonsils and adenoid. If there was a significant relationship between them, vitamin D replacement therapy could replace surgery in many cases. It seems to be a logical way to prevent possible complications of adenotonsillar hypertrophy and avoid many adenotonsillectomies. 
Methods: A prospective cross-sectional study was conducted among 3 to 15-year-old children, who were referred to the Otorhinolaryngology Clinic of Taleghani Hospital, Tehran, from 2015 to 2017. The patients should not have any history of chronic diseases and not be treated with vitamin D supplements. Adenoid hypertrophy was evaluated in patients with suspected symptoms. Lateral nasopharyngeal x-ray was used to determine adenoid hypertrophy. The tonsillar size was assessed in all patients by careful oral physical examination. They were divided into 4 groups, according to the grade of tonsillar hypertrophy. Then, each group was subdivided as with or without adenoid hypertrophy.
Results: The total number of cases was 140. Sixty-nine girls (49.3%) and seventy-one boys (50.7%) were enrolled. The average of their age was 7.69 years (SD=3.28). There was no significant difference in the vitamin D levels among all groups (P=0.211), but children with grade 3 and 4 of tonsillar hypertrophy had lower serum vitamin D levels compared with others. Also, the difference between serum vitamin D levels in patients with or without adenoid hypertrophy was not significant (P=0.254).
Conclusion: Although vitamin D deficiency may predispose patients to recurrent infections, it has no effect on creating adenotonsillar hypertrophy. The serum level of vitamin D does not seem to correlate with the adenoid size, but lack of vitamin D may predispose patients to more sever tonsillar hypertrophy. More extended studies should be conducted in this regard.

Pedram Ataee , Rezvan Yahiapour , Bahram Nikkhoo , Nadia Shakiba , Ebrahim Ghaderi , Rasoul Nasiri , Kambiz Eftekhari ,
Volume 77, Issue 6 (9-2019)
Abstract

Background: Celiac disease is a chronic inflammation of small intestine which is caused by an increased permanent sensitivity to a protein named gluten. This protein is present in some cereals such as wheat, barley, and rye. The immunologic response to this protein can cause clinical symptoms in people with specific human leukocyte antigens (HLAs) (including HLADQ2 or HLADQ8). Most studies have reported an increased incidence of celiac disease in patients with diabetes mellitus type I. This study aimed to determine the prevalence of the celiac disease in patients with diabetes mellitus type I under the age of 18 years old.
Methods: This cross-sectional, analytic descriptive study was performed on forty children with diabetes mellitus type I in Sanandaj Diabetes Association (Kurdistan University of Medical Sciences), Iran, from September 2012 to September 2013. After obtaining consent from their parents, demographic data, including gender, age, family history of diabetes, duration of illness, symptoms of celiac disease, were recorded in the questionnaire. The measurement of the tissue transglutaminase (tTG) antibody and total immunoglobulin type A in the serum was necessary for the screening of celiac disease. Therefore in the laboratory, 5 ml of the venous blood sample was taken and then the serum levels of tTG antibody (from immunoglobulin type A) and total serum levels of this immunoglobulin were measured by the enzyme-linked immunosorbent assay (ELISA) method. Upper endoscopy with multiple biopsies from small intestine was performed in patients with positive serological screening. Finally, the disease was evaluated by histological finding.
Results: Forty children with diabetes mellitus type I included 19 boys (47.5%) and 21 girls (52.5%) were enrolled in the study. The mean age of these patients was 10.53±4.05. The prevalence of celiac disease was 7.5% in these individuals. In the subjects, there was no significant relationship between gastrointestinal symptoms and celiac disease.
Conclusion: In the present study, the prevalence of the celiac disease in type 1 diabetic patients was 7.5% which is higher than the normal population.

Semira Mehralizadeh, Majid Mirmohammmadkhani, Aylin Kalantarzade ,
Volume 77, Issue 8 (11-2019)
Abstract

Background: Previous studies have considered patent ductus arteriosus (PDA) a common finding in premature infants, leading to complications such as intracranial hemorrhage, necrotizing enterocolitis and pulmonary dysplasia. The aim of this study was to assess and compare the efficacy of oral ibuprofen and intravenous acetaminophen in the closure of arterial duct in premature newborns. We also evaluated the complications of each drug.
Methods: A cross-sectional and analytical study was conducted at Amiralmomenin Hospital, Semnan City in Iran from April 2012 to December 2017. Subjects were selected through convenient sampling and consisted of all premature infants with patent arterial duct. All of the infants with the diagnosis of PDA were treated with either intravenous acetaminophen or oral ibuprofen. Cardiac echocardiographic findings were assessed in two study groups before and after each treatment course. The complications associated with the two treatment approaches were evaluated in two groups after treatment of each drug.
Results: In general, twenty-four neonates (62.5% females) with the average gestational age of 31.46±3.43 weeks were studied. There was no significant difference in the echocardiographic characteristics in the two treatment groups at the pre and post-treatment periods as well as the side effects of the medications. The average number of treatment cycles in newborns treated with oral ibuprofen (1.06±0.25) was not significantly different compared to those with intravenous acetaminophen (1.25±0.46) (P=0.190). There was no significant difference concerning closure status of the arterial duct in the two treatment groups at the end of the first period (P=0.112) as well as after the second period of treatment (P=0.386).
Conclusion: Our study indicated similar efficacy of oral ibuprofen and intravenous acetaminophen in the closure of the arterial duct. The incidence of complications was not significantly different between the two groups. The results of this study suggest the use of intravenous acetaminophen as a suitable drug for PDA closure, particularly in cases of ibuprofen contraindications.

Reza Abdollahi , Bahman Vahidi , Mohammad Karimi ,
Volume 77, Issue 9 (12-2019)
Abstract

Background: Cerebral aneurysm disease causes intracranial hemorrhage by rupturing, which can eventually, lead to organ failure or death. For this reason, it is important to anticipate the reasons for rupturing of a cerebral aneurysm from biomechanical point of view. Investigating this disease may even help the physicians to find treatments and predict the patient’s situation. This research was conducted to understand risks of development and rupture of a patient-specific cerebral aneurysm.
Methods: In a computational simulation, fluid-structure interaction method has been used for a patient-specific case. Also, considering the speed of the systole as the initial condition of the problem, the blood fluid domain has been solved in three types of fluid mathematical models (Newtonian, non-Newtonian Carreau, and non-Newtonian power-law). Then, the pressure results on the wall have been transmitted to ANSYS software, version 15.0 (ANSYS Inc., Canonsburg, PA, USA) and the structure has been solved based on three material models (linear elastic, hyperplastic Neo-Hookean and hyperplastic Mooney-Rivlin, with 5 parameters). The study was done in University of Tehran, Iran, from October 2016 to September 2018.
Results: Shear stress, pressure, flow velocity, wall displacement and von-Mises stress have been extracted from the simulations. The average wall displacement of the aneurysm was 1.8 mm. Also, no significant difference was found in the amount of arterial wall displacement, with constant wall material model and different blood models. However, a significant difference has been observed in the case of considering constant blood model and different wall material models in the value of displacement.
Conclusion: With regard to the amount of displacement of the aneurysm wall in this particular patient, with the geometry and location of the specific aneurysm, the brain nerves 3 and 6 were under stress and exposed to damage. The minimum shear stress was in the aneurysm neck, which stimulates the endothelial cells in the area of aneurysm. In addition, the blood model didn’t had a significant effect on the displacement calculations, while the wall material model played a more decisive role.


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