Journal of Research in Medical Sciences1735-1995201220160112Risk factors for lung diseases after renal transplantation1037510375EN20151230<p>Background: Lung diseases are one of the major causes of morbidity and mortality after renal transplantation. The aim of the study is to define the risk factors for infectious and noninfectious pulmonary complications in kidney transplant patients. Materials and Methods:We prospectively studied 267 patients after renal transplantation. The kidney recipients were followed-up for the development of pulmonary complications for a period of 7 years. Different noninvasive and invasive diagnostic tests were used in cases suspected of lung disease. Results: The risk factors associated with the development of pulmonary complications were diabetes mellitus (odds ratio [OR] =4.60; P = 0.001), arterial hypertension (OR = 1.95; P = 0.015), living related donor (OR = 2.69; P = 0.004), therapy for acute graft rejection(OR = 2.06; P = 0.038),immunosuppressive regimens that includes mycophenolate (OR = 2.40; P = 0.011),azathioprine (OR = 2.25;P = 0.023), and tacrolimus (OR= 1.83; P = 0.041). The only factor associated with the lower risk of complications was a positive serology test for Cytomegalovirus of the recipient before transplantation (OR =0.1412; P = 0.001). Conclusion: The risk factors can be used to identify patients at increased risk for posttransplant lung diseases. Monitoring of higher-risk patients allow timely diagnosis and early adequate treatment and can reduce the morbidity and mortality after renal transplantation.</p><p><br />Key words: Kidney transplantation, pulmonary complications, recipient, risk factors</p>http://jrms.mui.ac.ir/index.php/jrms/article/view/10375http://jrms.mui.ac.ir/index.php/jrms/article/download/10375/5040Journal of Research in Medical Sciences1735-1995201220160112Comparison of open surgical discectomy versus plasma-laser nucleoplasty in patients with single lumbar disc herniation1037710377EN20160111<p>Background: Intervertebral disc herniation is a major cause of low back pain. Several treatment methods are available for lumbar disc herniation including Chemonucleolysis, open surgery, nucleoplasty, laser disc decompression, and intradiscal electrothermal therapy. The high prevalence of lumbar disc herniation necessitates a minimally invasive yet effective treatment method. In this study, we compared the outcomes of open surgery and nucleoplasty method in patients with single lumbar disc herniation. Materials and Methods: This study was a noninferiority randomized clinical trial conducted in one of the University Hospitals of Isfahan Medical University; The Alzahra Hospital. About 200 patients with the diagnosis of lumbar disc herniation were recruited and were assigned to either the treatment or control groups using block randomization. One group received open surgery and the other group received nucleoplasty as the method of treatment. Patients were revisited at 14 days, 1, 2, 3 months, and 1-year after surgery and were assessed for the following variables: Lower back pain, lower limb pain, common complications of surgery (e.g., discitis, infection and hematoma) and recurrence of herniation. Results: The mean (standard deviation) severity of low back pain was reduced from 6.92 (2.5) to 3.43 (2.3) in the nucleoplasty group (P = 0.04) and from 7.5 (2.2) to 3.04 (1.61) in the discectomy group (P = 0.73). Between group difference was not statistically significant (P = 0.44), however, time and treatment interaction was significant (P = 0.001). The level of radicular pain evaluated 1 year after treatment was reduced from 8.1 (1.2) to 2.9 (1.2) (P = 0.004) and from 7.89 (2.1) to 3.6 (2.5) (P =0.04) in the discectomy and the nucleoplasty groups respectively, significant interaction between time and treatment options was observed (P < 0.001) while there was no significant difference between two treatment groups (P = 0.82). Conclusion: Our results show that while nucleoplasty is as effective as open discectomy in the treatment of lumbar disc herniation, it is also less invasive with higher patient compliance. Taking factor such as decreased cost and duration of the surgery, as well as faster recovery in patients into account; we suggest considering nucleoplasty as an effective method of treatment in patients with single-level disc herniation.</p><p><br />Key words: Intervertebral disc herniation, nucleoplasty, open discectomy</p>http://jrms.mui.ac.ir/index.php/jrms/article/view/10377http://jrms.mui.ac.ir/index.php/jrms/article/download/10377/5041Journal of Research in Medical Sciences1735-1995201220160112Roles of osteopontin and matrix metalloproteinase-7 in occurrence, progression, and prognosis of nonsmall cell lung cancer1037810378EN20160111<p class="Default"><strong>Background: </strong>This study detected osteopontin (OPN) and matrix metalloproteinase-7 (MMP-7) expressions to explore the roles of OPN and MMP-7 in the occurrence, progression, and prognosis of nonsmall cell lung cancer (NSCLC). <strong>Materials and Methods: </strong>A retrospective study was conducted on NSCLC tissues (<em>n </em>= 152; case group) and adjacent nonneoplastic lung parenchyma (adjacent to tumor >5 cm; <em>n </em>= 152; control group) collected from 152 NSCLC patients. The protein expressions of OPN and MMP-7 were detected by immunohistochemistry. OPN and MMP-7 messenger RNA (mRNA) expressions were detected by reverse transcription polymerase chain reaction (RT-PCR). <strong>Results: </strong>The protein and mRNA expressions of OPN and MMP-7 in NSCLC tissues were evidently higher than those in adjacent nonneoplastic lung parenchyma (all <em>P </em>< 0.05). OPN protein and mRNA expression were associated with the degree of differentiation, tumor node metastasis (TNM) staging, and lymph node metastasis in NSCLC (all <em>P </em>< 0.05). MMP-7 protein expression was associated with TNM staging and lymph node metastasis (both <em>P </em>< 0.05) while MMP-7 mRNA expression was associated with the degree of differentiation, TNM staging, and lymph node metastasis (all <em>P </em>< 0.05). A significantly positive relativity was revealed between OPN expression and MMP-7 expression (protein: <em>r </em>= 0.789, <em>P </em>< 0.001; mRNA: <em>r </em>= 0.377, <em>P </em>< 0.001). Lymph node metastasis, TNM staging, OPN, and MMP-7 protein expressions were independent risk factors for the prognosis of NSCLC (all <em>P </em>< 0.05). <strong>Conclusion: </strong>High MMP-7 and OPN protein expressions are closely related to the occurrence, progression, and prognosis of NSCLC, and can be served as unfavorable prognostic factors for NSCLC.</p> <p class="Default"> </p> <p>Key words: Lymph node metastasis, matrix metalloproteinase-7 (MMP-7), nonsmall cell lung cancer (NSCLC), osteopontin (OPN), prognosis, tumor node metastasis (TNM) staging</p>http://jrms.mui.ac.ir/index.php/jrms/article/view/10378http://jrms.mui.ac.ir/index.php/jrms/article/download/10378/5042Journal of Research in Medical Sciences1735-1995201220160112Study of 2 years follow-up of referral patients with abnormal Pap smear1037910379EN20160111<p>Background: Abnormal Pap smear consists of premalignant or malignant cervical lesions. Many of premalignant cervical lesions will never progress to invasive malignancy, or even may regress over the time. Thus, there is always a risk of overtreatment of patients with an abnormal Pap smear. A long-term follow-up of these patients can reveal final events associated with each subtype of abnormal Pap smear, and, therefore, help us to prevent unnecessary interventions. The aim of our study was to present 2 years follow-up of referral patients with abnormal Pap smear. Materials and Methods: A total of 334 consecutive women aged more than 16 who were referred with an abnormal Pap smear were entered into the study. Patients were followed with biannual Pap smear and annual colposcopy and biopsy for 2 years. Results: At baseline, the majority of patients with abnormal Pap smear were normal on colposcopy and biopsy (68% and 86%, respectively). Six months after first abnormal Pap smear majority of patients in each group showed a significant regress to normal or less invasive lesion (P < 0.001). Twelve patients (4%) had no change in Pap smear, whereas 313 (94%) had at least one stage improvement. Only nine (3%) patients had deteriorated Pap smear after 6 months. All 308 patients who underwent colposcopy and biopsy had normal Pap smear 24 months after the first abnormal Pap smear. Conclusion: Pap smear is associated with a high rate of false-positive results. In addition, the majority of low-grade cervical lesions can spontaneously regress. A long-term follow-up of a patient with abnormal Pap smear can help us to avoid needless interventions.</p><p><br />Key words: Atypical squamous cell, cervical cancer, colposcopy, Pap smear</p>http://jrms.mui.ac.ir/index.php/jrms/article/view/10379http://jrms.mui.ac.ir/index.php/jrms/article/download/10379/5043Journal of Research in Medical Sciences1735-1995201220160112Single-incision laparoscopic cholecystectomy versus mini-laparoscopic cholecystectomy: A randomized clinical trial study1038010380EN20160111<p>Background: Surgical technique using small-diameter instruments and single-incision laparoscopy are two new options for less invasive laparoscopic cholecystectomy (LC). In this study, we have compared mini-LC (MLC) with single-incision LC (SILC). Materials and Methods: This study is a randomized clinical trial conducted on the patients diagnosed with symptomatic cholelithiasis who underwent LC. Forty patients were randomized to two equal groups of MLC and SILC. They were compared in terms of demographic data, operation time, and surgical complications. Results: Baseline characteristics were similar in two groups. Operation time in MLC was significantly shorter than that in SILC (45.1 ± 69 min vs 63.75 ± 7.57 min, P-value < 0.001). Also, the total length of the wound in SILC group was shorter than that in MLC group (P-value < 0.003). Postoperative pain scores were similar in two groups.Hospital stay was shorter in MLC (1.2 ± 0.6 days vs 1.6 ± 0.8 days, P < 0.021). There was no difference in postoperative complications in two groups. Conclusion: MLC because of less operation time is preferred than SILC. Also, by subjective measures, it was a more comfortable method compared to SILC.</p><p><br />Key words: Cholecystectomy, incision laparoscopic cholecystectomy, laparoscopic, mini-laparoscopic cholecystectomy (MLC),operation time, single-incision laparoscopic cholecystectomy (SILC)</p>http://jrms.mui.ac.ir/index.php/jrms/article/view/10380http://jrms.mui.ac.ir/index.php/jrms/article/download/10380/5045Journal of Research in Medical Sciences1735-1995201220160112A comparative study of vaginal estrogen cream and sustained-release estradiol vaginal tablet (Vagifem) in the treatment of atrophic vaginitis in Isfahan, Iran in 2010-20121038110381EN20160111<p>Background: Atrophic vaginitis is a disease, which affects up to 50% of postmenopausal women. This study compared the effectiveness and user-friendliness of Vagifem (an estradiol vaginal tablet) and vaginal estrogen cream in the treatment of atrophic vaginitis. Materials and Methods: One hundred and sixty postmenopausal women with symptoms of atrophic vaginitis were randomly divided into two groups of treatment with Vagifem or with vaginal estrogen cream for 12 weeks. Patients used the medication daily for the first 2 weeks of the study, and twice weekly. Severity of vaginal atrophy and four main symptoms of atrophic vaginitis including dysuria, dyspareunia,vaginal itching, and dryness were evaluated and compared before and after treatment. In addition, patients were asked regarding userfriendliness and hygienic issues of medications. Results: Both vaginal estrogen cream and Vagifem significantly improved symptoms of atrophic vaginitis but in terms of effectiveness for the treatment symptoms of atrophic vaginitis, there was no significant difference between the two medications. Vagifem compared to estrogen cream resulted in significantly lower rate of hygienic problems (0% versus 23%, P < 0.001), and was reported by the patients as a significantly easier method of treatment (90% versus 55%, P < 0.0001). Conclusion: This investigation showed that Vagifem is an appropriate medication for the treatment of atrophic vaginitis, which is as effective as vaginal estrogen creams and is more user-friendly.</p><p><br />Key words: Atrophic vaginitis, patient acceptability, Vagifem, vaginal estrogen cream</p>http://jrms.mui.ac.ir/index.php/jrms/article/view/10381http://jrms.mui.ac.ir/index.php/jrms/article/download/10381/5044Journal of Research in Medical Sciences1735-1995201220160112Hyperglycemia is a predictor of prognosis in traumatic brain injury: Tertiary intensive care unit study1038210382EN20160111<p>Background: Hyperglycemia is frequently encountered in critically ill patients and has been shown to contribute to both morbidity and mortality. We aimed to study the predictive role of blood glucose level in clinical outcomes of mechanically ventilated patients with traumatic brain injury during intensive care unit (ICU) stay and to explore its relationship with Glasgow coma scale (GCS) and acute physiology and chronic health examination (APACHE) II scores that are used in the evaluation of ICU patients as predictor.Materials and Methods: A total of 185 patients with craniocerebral trauma who were hospitalized in the ICU were included in the study. Comparisons of mean glucose values (MGVs) and APACHE II scores between survivors and nonsurvivors were made with Student’s t-test and chi-square test. Survival analysis was performed with log rank (Mantel-Cox) test and Cox regression was used for mortality risk factors analysis. Results: MGVs at the initial, last, and all measurements were significantly higher for nonsurvivors than for survivors. Hazard rate at any given time point for patients with mean glucose value (MGV) between 150 and 179 was found to be 3.691 times that of patients with MGV values between 110 and 149. The hazard rate at any given time point for patients with MGV values ?180 was found to be 6.571 times that of patients with MGV values between 110 and 149. Conclusion: High glucose level is an independent risk factor for mortality in mechanically ventilated ICU patients with traumatic brain injury.</p><p><br />Key words: Acute physiology and chronic health examination (APACHE) II, Glasgow coma scale (GCS), glucose, hyperglycemia,intensive care unit (ICU), mortality, traumatic brain injury</p>http://jrms.mui.ac.ir/index.php/jrms/article/view/10382http://jrms.mui.ac.ir/index.php/jrms/article/download/10382/5046Journal of Research in Medical Sciences1735-1995201220160112Outcomes of pediatric inguinal hernia repair with or without opening the external oblique muscle fascia1038310383EN20160111<p>Background: Considering that complications and outcome of each method of pediatric inguinal hernia repair are one of the<br />determinants for pediatric surgeons for selection of the appropriate surgical technique, we compared the early and late complications of two inguinal repair techniques, with and without opening the external oblique muscle fascia. Materials and Methods: In this double-blind clinical trial study, boy children aged 1-month to 6 years with diagnosed inguinal hernia were included and randomly allocated into two groups for undergoing two types of hernia repair techniques, with and without opening the external oblique muscle fascia. Surgical complications such as fever, scrotal edema and hematoma, and wound infections classified as early complication and recurrence, testis atrophy and sensory impairment of inguinal area classified as late complications. The rates of mentioned early and late complications were compared in the two interventional groups. Results: In this study, 66 patients were selected and allocated to the two interventional groups. The prevalence of early and late complications in two studied groups were not different significantly in two interventional groups (P > 0.05). Operation time was significantly shorter in inguinal repair techniques without opening the external oblique muscle fascia than the other studied technique (P = 0.001). Conclusion: The findings of our study indicated that though early and late complications of the two repair methods were similar, but the time of procedure was shorter in herniotomy without opening the external oblique muscle, which considered the superiority of this method than inguinal hernia repair with opening the external oblique muscle.</p><p><br />Key words: Children, complication, herniotomy, inguinal hernia</p>http://jrms.mui.ac.ir/index.php/jrms/article/view/10383http://jrms.mui.ac.ir/index.php/jrms/article/download/10383/5047Journal of Research in Medical Sciences1735-1995201220160112Effect of vitamin E succinate on inflammatory cytokines induced by high-intensity interval training1038410384EN20160111<p>Background:: The anti-inflammatory effect of vitamin E under moderate exercises has been evaluated. However, the effect of vitamin E succinate, which has more potent anti-inflammatory effect than other isomers of vitamin E has not been evaluated. Therefore, the aim of the present study was to evaluate the effects of vitamin E succinate on tumor necrosis factor alpha (TNF-?) and interleukin-6 (IL-6) production induced by high-intensity interval training (HIIT). Materials and Methods: In the present study, 24 rats were randomly divided into control (C), supplementation (S), HIIT, and HIIT + supplementation (HIIT+S) groups. HIIT training protocol on a treadmill (at a speed of 40–54 m/min) and vitamin E succinate supplementation (60 mg/kg/day) was conducted for 6 weeks. Results: Serum IL-6 in the HIIT group significantly increased compared with the C group (350.42 ± 123.31 pg/mL vs 158.60 ± 41.96 pg/mL; P = 0.002). Also, serum TNF-? concentrations<br />significantly enhanced (718.15 ± 133.42 pg/mL vs 350.87 ± 64.93 pg/mL; P = 0.001) in the HIIT group compared with the C group. Treatment of the training group with vitamin E numerically reduced IL-6 and TNF-? when compared with the HIIT group (217.31 ± 29.21 and 510.23 ± 217.88, respectively, P > 0.05). However, no significant changes were observed in serum TNF-? (P = 0.31) and IL-6 (P = 0.52) concentrations in<br />the HIIT + S group compared with the C group. Conclusion: HIIT-induced IL-6 and TNF-? decreased by administration of Vitamin E succinate.</p><p><br />Key words: High-intensity interval training (HIIT), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-?), Vitamin E succinate<br />decreased the elevation of IL-6 and TNF-? by HIIT</p>http://jrms.mui.ac.ir/index.php/jrms/article/view/10384http://jrms.mui.ac.ir/index.php/jrms/article/download/10384/5069Journal of Research in Medical Sciences1735-1995201220160112The value of otoendoscopy in the management of middle ear cholesteatoma1038510385EN20160111<p>Background: The surgical management of cholesteatoma is a controversial issue, particularly regarding intact-canal-wall mastoidectomy (ICWM) versus canal-wall-down mastoidectomy (CWDM). The current experiment compared the quality of visualization in different middle ear structures using ICWM with otoendoscopy with findings of CWDM by microscopy.Materials and Methods: The patients diagnosed with cholesteatoma underwent tympanomastoidectomy, and then the patients selected for CWDM were included in the study (25 patients: 11 females and 14 males). After removing the cholesteatoma from the involved areas, otoendoscopic examination was done with a 4 mm, 0° endoscope by a neurootologist. All five middle ear structures (lateral epitympanum, sinus tympani, posterior crus of the stapes, round window niche, and Eustachian tube orifice) suspected of occult cholesteatoma were evaluated in terms of having or lacking the pathology. Then, CWDM was performed and all of the mentioned sites were reevaluated for diagnosing occult cholesteatoma. Results: The symmetric measures were 73%, 92%, 63%, 81%, and 100% for lateral epitympanum, sinus tympani, posterior crus of the stapes, round window niche,and Eustachian tube orifice, respectively.Conclusion: Otoendoscopy was confirmed to have a great potential to be adopted by surgeons as a less invasive procedure in the surgical management of middle ear cholesteatoma.</p><p><br />Key words: Canal-wall-down mastoidectomy (CWDM), cholesteatoma, otoendoscopy</p>http://jrms.mui.ac.ir/index.php/jrms/article/view/10385http://jrms.mui.ac.ir/index.php/jrms/article/download/10385/5048Journal of Research in Medical Sciences1735-1995201220160112Management of ovarian cysts in infants1038710387EN20160112<p>Background: To discuss the experience of diagnosis and treatment of ovarian cyst in infants. Materials and Methods: A retrospective review was conducted on 20 infants who suffered from ovarian cyst. Results: There were no dysplasia ovarian was found in children which were preoperatively diagnosed simplex cyst. Within thirteen children preoperatively detected mixed cystic-solid lesion, six cases ovarian cysts disappeared and two cases underwent poor blood supply in the following time. Conclusion: Adverse effects for ovarian cyst in infants can be prevented by agressive surgical intervention. Harmful effects of ovarian cyst can be prevented by positive surgical intervention despite the diagnostic difficulties in children with clinical symptoms of this condition.</p><p><br />Key words: Infants, laparoscopic, ovarian cyst</p>http://jrms.mui.ac.ir/index.php/jrms/article/view/10387http://jrms.mui.ac.ir/index.php/jrms/article/download/10387/5055Journal of Research in Medical Sciences1735-1995201220160113A systematic review and meta-analysis on screening lipid disorders in the pediatric age group1038810388EN20160112<p>Background: Different viewpoints exist about lipid screening in all children or only in children with positive family history (FH)of premature cardiovascular diseases (CVDs) or hypercholesterolemia. This systematic review and meta-analysis aim to assess the effectiveness of lipid screening in children and adolescents according to the existence of positive FH of CVD risk factors.Materials and Methods: PubMed, Scopus, and Google scholar were searched to identify relevant papers that were published from November 1980 until 30 November 2013. Irrelevant studies were set aside after studying their title, abstract, and full text. Then, the relevant studies were assessed by using a quality appraisal checklist. We used random effect model for meta-analysis and calculating the total estimation of sensitivity, specificity, and the positive predictive value (PPV) of FH in predicting dyslipidemia among children and adolescents. Results: Overall, 17,214 studies were identified in the primary search, out of which 19 primary studies were qualified for study entry. The sensitivity of positive FH of premature CVD or dyslipidemia for predicting dyslipidemia among children varied between 15 and 93. Moreover, the effectiveness of screening children for dyslipidemia according to premature CVD or dyslipidemia in their relatives was low in 86.9% of the primary studies. The total estimation of sensitivity, specificity, and predictive value was 42.6,59, and 20.7, respectively, according to the meta-analysis results. Conclusion: The present meta-analysis indicated that selecting target population for screening children and adolescents for dyslipidemia according to their FH has low sensitivity.</p><p><br />Key words: Children, family history (FH), lipid, meta-analysis, screening</p>http://jrms.mui.ac.ir/index.php/jrms/article/view/10388http://jrms.mui.ac.ir/index.php/jrms/article/download/10388/5054Journal of Research in Medical Sciences1735-1995201220160112Gastric varices: Classification, endoscopic and ultrasonographic management1038910389EN20160112<p>Gastric varices (GV) are responsible for 10-30% of all variceal hemorrhage. However, they tend to bleed more severely with higher mortality. Around 35-90% rebleed after spontaneous hemostasis. Approximately 50% of patients with cirrhosis of liver harbor gastroesophageal varices. In this review, new treatment modalities in the form of endoscopic treatment options and interventional radiological procedures have been discussed besides discussion on classification and pathophysiology of GV.</p><p><br />Key words: Endoscopic treatment, gastroesophageal varices, sclerotherapy</p>http://jrms.mui.ac.ir/index.php/jrms/article/view/10389http://jrms.mui.ac.ir/index.php/jrms/article/download/10389/5049Journal of Research in Medical Sciences1735-1995201220160112Features and application of wearable biosensors in medical care1039010390EN20160112<p>One of the new technologies in the field of health is wearable biosensor, which provides vital signs monitoring of patients, athletes,premature infants, children, psychiatric patients, people who need long-term care, elderly, and people in impassable regions far from health and medical services. The aim of this study was to explain features and applications of wearable biosensors in medical services. This was a narrative review study that done in 2015. Search conducted with the help of libraries,books, conference proceedings,through databases of Science Direct, PubMed, Proquest, Springer, and SID (Scientific Information Database). In our searches, we employed the following keywords and their combinations; vital sign monitoring, medical smart shirt, smart clothing, wearable biosensors, physiological monitoring system, remote detection systems, remote control health, and bio-monitoring system. The preliminary search resulted in 54 articles, which published between 2002 and 2015. After a careful analysis of the content of each paper, 41 sources selected based on their relevancy. Although the use of wearable in healthcare is still in an infant stage, it could have a magic effect on healthcare. Smart wearable in the technology industry for 2015 is one that is looking to be a big and profitable market. Wearable biosensors capable of continuous vital signs monitoring and feedback to the user will be significantly effective in timely prevention, diagnosis, treatment, and control of diseases.</p><p><br />Key words: Medical smart shirt, monitoring, physiological, vital signs, wearable biosensors</p>http://jrms.mui.ac.ir/index.php/jrms/article/view/10390http://jrms.mui.ac.ir/index.php/jrms/article/download/10390/5050Journal of Research in Medical Sciences1735-1995201220160112WHO and UNICEF: Updates on immunization coverage and how can we improve upon?1039110391EN20160112---http://jrms.mui.ac.ir/index.php/jrms/article/view/10391http://jrms.mui.ac.ir/index.php/jrms/article/download/10391/5051Journal of Research in Medical Sciences1735-1995201220160112Science growth and human development index in Iran1039210392EN20160112---http://jrms.mui.ac.ir/index.php/jrms/article/view/10392http://jrms.mui.ac.ir/index.php/jrms/article/download/10392/5052Journal of Research in Medical Sciences1735-1995201220160113Chromogenic agar medium for rapid detection of extended-spectrum ?-lactamases and Klebsiella pneumoniae carbapenemases producing bacteria from human immunodeficiency virus patients1039410394EN20160112---http://jrms.mui.ac.ir/index.php/jrms/article/view/10394http://jrms.mui.ac.ir/index.php/jrms/article/download/10394/5053