Journal of Research in Medical Sciences1735-19952832202307081145111451EN20230619<p><strong>Background:</strong> Hyperbilirubinemia is a common problem in neonates that causes hospitalization. The aim of this study was to investigate the effects of concentrated pomegranate juice (CPJ) consumption by breastfeeding mothers on neonatal hyperbilirubinemia.</p><p><strong>Materials and Methods:</strong> In this open?labeled, add?on, randomized clinical trial, 86 breastfeeding mothers and their neonates were allocated into two groups. In the control group, neonates received phototherapy.Besides neonates’ phototherapy in the intervention group, their mothers received CPJ (1 tablespoon [15 g] three times a day) up to discharge. The bilirubin level was the primary outcome. The duration of phototherapy, the duration of hospital stay, and the need for exchange transfusions were secondary outcomes.</p><p><strong>Results:</strong> CPJ reduced the bilirubin level of hospitalized neonates within 48 h after consumption (P = 0.048, standard mean difference = 0.648). It also resulted in reduced duration of hospital stay and faster discharge of the neonates. Furthermore, in 48 h after discharge, bilirubin was significantly lower in the CPJ group (P = 0.003, partial eta squared = 0.123).</p><p><strong>Conclusion:</strong> Compared to the control group, consumption of CPJ by lactating mothers whose infants underwent phototherapy resulted in lower bilirubin levels, shorter hospital stay, and faster discharge.<br /><br /></p>http://jrms.mui.ac.ir/index.php/jrms/article/view/11451http://jrms.mui.ac.ir/index.php/jrms/article/download/11451/6260

Journal of Research in Medical Sciences1735-19952832202307081145211452EN20230619<p><strong>Background:</strong> Total knee arthroplasty (TKA) is associated with tremendous postoperative pain, and pain relief should concisely be considered. This study aims to compare the efficacy of preemptive periarticular multimodal drug injection versus placebo and oral celecoxib on postoperative pain control after TKA.</p><p><strong> Materials and Methods:</strong> This study is a randomized clinical trial on 146 patients candidate for TKA who were randomly allocated to three treatment groups, including (1) a cocktail consisting of bupivacaine, morphine, epinephrine, and ketorolac (n = 48), (2) only epinephrine (placebo group) (n = 49), and (3) 400 mg celecoxib orally (control group) (n = 49) using the Random Allocation software. The injections and oral therapy were performed within 15 min before the surgical procedure. The study’s primary outcome was the Knee Society Score (KSS) calculated at baseline, within 6 weeks and 6 months postoperatively. Range of motion (ROM) and Visual Analog Scale (VAS) to assess pain intensity as the other primary outcomes were evaluated before the procedure, within 24 h, 48 h, and 6 weeks postoperatively.</p><p><strong>Results:</strong> The three studied groups were similar regarding demographic characteristics, including age (P = 0.33), gender distribution (P = 0.65), and involved knee side (P = 0.94). Baseline comparison of KSS (P = 0.39), VAS (P = 0.24), and ROM (P = 0.37) among the groups revealed insignificant differences. All the studied groups showed a statistically significant trend of improvement in KSS, VAS, and ROM (P &lt; 0.001), while the comparison of the three groups in terms of KSS (P = 0.001), VAS (P &lt; 0.001), and ROM (P &lt; 0.001) revealed remarkable superiority of multimodal injection to the other treatments.</p><p><strong>Conclusion:</strong> Preemptive periarticular multimodal drug injection, including bupivacaine, morphine, epinephrine, and ketorolac, can cause  onsiderable postoperative pain relief and better ROM achievement in comparison to placebo or oral celecoxib.</p>http://jrms.mui.ac.ir/index.php/jrms/article/view/11452http://jrms.mui.ac.ir/index.php/jrms/article/download/11452/6261

Journal of Research in Medical Sciences1735-19952832202307081145411454EN20230619<p><strong>Background:</strong> Lung cancer (LC) is the second most common and deadliest cancer in the world. Despite the control of the progressive course of LC in developed countries, studies indicate an increase in the incidence of the disease in developing countries. We designed a stepwise approach?based surveillance system for registering LC in our region (fars lung cancer registry “FaLCaRe” Project).</p><p><strong>Materials and Methods:</strong> A questionnaire was designed and agreed upon by the steering committee using the Delphi method. Variables in<br />nine fields were divided into three groups based on their importance:  ore, expanded core, and optional. The web?based data bank software was designed. The informative site about LC and team services was  esigned and launched for professional and community (www.falcare.<br />org) educational purposes.</p><p><strong> Results:</strong> 545 variables in nine fields were  esigned (20 core variables). Primary data of 39 LC patients (24 men and 15 women) with a mean age of 62 years were analyzed. Twenty?six patients had a history of smoking. Moreover, 39% and 26% of patients had a history of hookah smoking and opium use, respectively. Adenocarcinoma was the most prevalent pathologic findings in cases. More than 80% of patients were diagnosed in stages 3 and 4 of cancer.</p><p><strong>Conclusion:</strong> FaLCaRe Project with the capabilities seen in it can be used as a model for national LC registration. With continuous valid data registry about LC, it is possible to make decisions at the national level for control and management its consequences while drawing the natural history of the LC.<br /><br /></p>http://jrms.mui.ac.ir/index.php/jrms/article/view/11454http://jrms.mui.ac.ir/index.php/jrms/article/download/11454/6263

Journal of Research in Medical Sciences1735-19952832202310071145711457EN20230708<p><strong>Background:</strong> Across the world, people are exposed to pesticide residues in agricultural products. Various materials are used to deal with effects of these residues. Considering the wide use of dichlorvos and acetamiprid in crops, pesticide residues in cucumber and its effects on the biochemical parameters of mice were calculated, and the protective role of donkey colostrum (DC) to deal with the pesticide effects was investigated.</p><p><strong>Materials and Methods:</strong> Dichlorvos (4 ml/l) and acetamiprid (0.5 g/l) residues, after spraying cucumber plants, were 0.5 and 1.5 mg/kg,  espectively. For 60 days, the mentioned doses were used in the drinking water of 4 groups of mice. No substances were added to mice drinking water in the control group while dichlorvos and acetamiprid groups received 0.5 and 1.5 mg/kg of pesticide, respectively, and the mixed group received a combination of two pesticides. In order to investigate the protective role of DC, 0.2 ml of colostrum was given to each of the groups in a similar division and timing.</p><p><strong> Results:</strong> In the biochemical sector, albumin (control 2.96, dichlorvos 1.86, acetamiprid 2.00, and mix 1.6 g/dl) and total protein levels reduced. Alanine aminotransferase (control 41.8, dichlorvos 56.2, acetamiprid 58.4, and mix 68 iu/l) and aspartate aminotransferase levels<br />increased. In the protective role of colostrum, albumin (control 2.96, dichlorvos 2.74, acetamiprid 2.80, and mix 2.50 g/dl) and alanine aminotransferase changes (control 41.8, dichlorvos 43.4, acetamiprid 46.0, and mix 52.2 iu/l) were recorded (P = 0.0001).</p><p><strong>Conclusion:</strong> Adding pesticides to mice drinking water causes liver disorders and DC can be effective in protecting these damages.<br /><br /></p>http://jrms.mui.ac.ir/index.php/jrms/article/view/11457http://jrms.mui.ac.ir/index.php/jrms/article/download/11457/6266

Journal of Research in Medical Sciences1735-19952832202310071146211462EN20230708<p><strong>Background:</strong> Using bone turnover marker (BTM) monitoring to identify “quick losers” who may develop osteoporosis in the coming years is one of the main challenges in clinical practice. This study was implemented to examine the association of BTMs with bone mineral density (BMD) as well as to determine their relationship with the fracture risk assessment tool (FRAX) in women in the postmenopausal period.</p><p><strong>Materials and Methods:</strong> This study was observational cross?sectional research that was done on women between the ages of 50 and 65 who were in the postmenopausal period. A dual?energy X?ray absorptiometry<br />was applied to select 120 eligible women with normal BMD and 120 women without normal BMD. BTMs were assessed using enzyme?linked immunosorbent assay. Osteoporosis’s Odds Ratio (OR) was estimated using a confounder?adjusted logistic regression model. The area under curve was calculated for the differentiation of low BMD in the postmenopausal period through receiver?operator characteristic (ROC) curves. To assess the probability of major osteoporotic fracture and hip fracture for the future 10 years, FRAX was applied.</p><p><strong>Results:</strong> Higher serum osteocalcin (OC) (OR: 1.134, 95% confidence interval [CI]: 1.086–1.184), osteopontin (OP) (OR: 1.180; 95%CI: 1.105–1.261), and alkaline phosphatase (ALP) (OR: 1.007; 95%CI: 1.001–1.144) concentrations were potential risk factors for developing low BMD in women after menopause. The area under curve (AUC) (95%CI) for OC, OP, and ALP was 0.75 (0.668–0.8130), 0.75 (0.685–0.812), and 0.602 (0.524–0.670), respectively. ROC analysis indicated that at the cut?off point of 16.28 ng/mL, sensitivity and specificity were 70.3% and 70.9%, respectively, for OC. Furthermore, at the cut?off point of 28.85 ng/mL, the sensitivity of 70.3% and specificity of 66.6% were obtained for OP. The serum OC and OP were significantly related to hip and major osteoporotic fractures (P &lt; 0.05).</p><p><strong> Conclusion:</strong> The higher serum concentration of OC, OP, and ALP had significant associations with lower BMD. These BTMs can be complementary tools and helpful in the postmenopausal period as measures for screening of bone loss and possible bone fracture.<br /><br /></p>http://jrms.mui.ac.ir/index.php/jrms/article/view/11462http://jrms.mui.ac.ir/index.php/jrms/article/download/11462/6271

Journal of Research in Medical Sciences1735-19952832202310071145311453EN20230619<p><strong>Background</strong>: Acute pain is one of the main complaints of patients after total knee arthroplasty (TKA), which causes delayed mobility, increased morphine consumption, and subsequently increased costs. Therefore, the present study was performed to evaluate the preventive effect of  reoperative celecoxib and gabapentin on reducing patient pain as a primary outcome after TKA surgery.</p><p><strong>Materials and Methods:</strong> This randomized, double?blind controlled  linical trial was performed on 270 patients with osteoarthritis that were candidates for TKA surgery allocated into three groups. In the first group, 900 mg of gabapentin was administered orally on a daily basis for 3 days before surgery. In the second group, 200 mg of oral celecoxib was  dministered twice daily for 3 days before surgery. In the third group, oral placebo was administered twice daily for 3 days before the surgery. The patients’ pain score and knee and its functional score were recoded.</p><p><strong>Results:</strong> The mean of reduction pain in gabapentin and celecoxib groups<br />was significantly lower than that of the control group at 12, 24, and 48 h after surgery (P &lt; 0.001); however, two groups were not significantly  ifferent from each other (P &gt; 0.05). Furthermore, the two medication groups were not significantly different in this regard (P &gt; 0.05). In addition, the knee score in the gabapentin group with the means of 85.40 ± 5.47 and the celecoxib group with the means of 87.03 ± 3.97 were significantly higher than those of the control group with the means of 78.90 ± 4.39 in the 1st month after the surgery (P &lt; 0.001).</p><p><strong>Conclusion:</strong> According to the results of the present study, the preventive administration of gabapentin and celecoxib showed a significant and similar effectiveness on reducing patient pain after TKA surgery and on improving the KSS and quality of life scores.<br /><br /></p>http://jrms.mui.ac.ir/index.php/jrms/article/view/11453http://jrms.mui.ac.ir/index.php/jrms/article/download/11453/6262

Journal of Research in Medical Sciences1735-19952832202307081145511455EN20230619<p><strong>Background:</strong> Diphenhydramine (DPH) is an antihistamine medication that in overdose can result in anticholinergic symptoms and serious  omplications, including arrhythmia and coma. We aimed to compare the value of various machine learning (ML) models, including light gradient boosting machine (LGBM), logistic regression (LR), and random forest (RF), in the outcome prediction of DPH poisoning.</p><p><strong>Materials and Methods:</strong> We used the National Poison Data System database and included all of the human exposures of DPH from January 01, 2017 to December 31, 2017, and excluded those cases with missing information, duplicated cases, and those who reported co?ingestion. Data were split into training and test datasets, and three ML models were compared. We developed confusion matrices for each, and standard performance metrics were calculated.</p><p><strong>Results:</strong> Our study population included 53,761 patients with DPH exposure. The most common reasons for exposure, outcome, chronicity of exposure, and formulation were captured. Our results showed that the average precision?recall area under the curve (AUC) of 0.84. LGBM and RF had the highest  erformance (average AUC of 0.91), followed by LR (average AUC of 0.90). The  pecificity of the models was 87.0% in the testing groups. The precision of models was 75.0%. Recall (sensitivity) of models ranged between 73% and 75% with an F1 score of 75.0%. The overall accuracy of LGBM, LR, and RF models in the test dataset was 74.8%, 74.0%, and 75.1%,  espectively. In total, just 1.1% of patients (mostly those with major  utcomes) received physostigmine.</p><p><strong>Conclusion:</strong> Our study demonstrates the application of ML in the prediction of DPH poisoning. Key words: </p>http://jrms.mui.ac.ir/index.php/jrms/article/view/11455http://jrms.mui.ac.ir/index.php/jrms/article/download/11455/6264

Journal of Research in Medical Sciences1735-19952832202310071145911459EN20230708<p><strong>Background:</strong> In addition to surfactant deficiency, secretion of fluid from blood to the lungs and increase in the fluid content of the lung play significant roles in the pathogenesis of respiratory distress syndrome (RDS). Thus, we aimed to evaluate the effect of salbutamol (a  eta?agonist) on fluid clearance from the lungs in neonates with RDS.</p><p><strong>Materials and Methods:</strong> This randomized controlled clinical trial included 82 neonates with RDS admitted to the neonatal intensive care units of Alzahra and Shahid Beheshti Hospitals of Isfahan University of Medical Science from 2017 to 2018. Patients were recruited through convenience sampling. They were randomized into two groups, using simple randomization: 42 were only treated with intra?tracheal surfactant (control group) and 40 with intra?tracheal surfactant plus salbutamol  intervention group). The two groups were compared regarding intubation<br />surfactant administration and extubation (INSURE) failure, duration of  asal continuous positive airway pressure, intubation, oxygen therapy, morbidity, and mortality.</p><p><strong>Results:</strong> INSURE failure leading to mechanical ventilation occurred in 3 neonates in the control group and 2 in the intervention group (P = 0.680). Mean hospital length of stay did not differ significantly between groups (P = 0.230). Comparison of controls with the intervention group regarding complications and the incidence of morbidities revealed no statistically<br />significant difference (P &gt; 0.05).</p><p><strong> Conclusion:</strong> Findings of this study were not in favor of the routine use of salbutamol in neonates with RDS as it did not improve the course of the disease among newborns.<br /><br /></p>http://jrms.mui.ac.ir/index.php/jrms/article/view/11459http://jrms.mui.ac.ir/index.php/jrms/article/download/11459/6268

Journal of Research in Medical Sciences1735-19952832202310071146011460EN20230708<p><strong>Background:</strong> With increasing age and joint?destructive diseases, the need for novel surgeries such as total knee arthroplasty (TKA) has increased. Complications such as pain exacerbation and persistent pain after  urgery may occur which increases rehabilitation programs. Factors such as body mass index (BMI), psychiatric disorders, spine diseases, and  omorbidities diseases can affect outcomes. Our study was conducted to evaluate the effect of BMI, psychiatric disorders, spine diseases, and underlying diseases on persistent and annoying pain after TKA.</p><p><strong> Materials and Methods:</strong> This is a case–control study that was conducted on patients who underwent TKA in Kashani Hospital in Isfahan City in 2020–2022. Demographic data of patients including age and BMI, diabetes mellitus (DM), history of psychiatric disorders, spine disorders such as spondylolisthesis or disc herniation, and other underlying diseases were obtained. Patients were assigned to case or control groups based on pain complaints after surgery. All patients were evaluated 6 months after the initial surgery. After collecting the study data, they were entered into SPSS software (version 25, IBM Corporation, Armonk, NY, USA) and analyzed.</p><p><strong>Results:</strong> We enrolled 35 patients in the case group and 39 patients in the control group between June 2020 and September 2022, based on the severity of pain measured using a Visual Analog Scale score. Our results<br />show that BMI and DM had a meaningful relationship with pain after surgery (P ? 0.01). Other factors did not show a significant difference between groups.</p><p><strong>Conclusion:</strong> Underlying diseases, psychiatric diseases, and spine disorders did not significantly affect the pain after TKA. Patients with DM and higher BMI experienced more persistent pain after TKA.<br /><br /></p>http://jrms.mui.ac.ir/index.php/jrms/article/view/11460http://jrms.mui.ac.ir/index.php/jrms/article/download/11460/6269

Journal of Research in Medical Sciences1735-19952832202310071146111461EN20230708<p><strong>Background:</strong> This study aimed to investigate reference Doppler  elocimetry indices (DVIs) of the fetal ductus venosus (DV) during 11–13 + 6 gestational weeks.</p><p><strong>Materials and Methods:</strong> In a prospective observation over referrals to a single tertiary care center in a 2?year interval, normal singleton  regnancies with fetal crown?rump lengths (CRLs) of 43–80 mm were examined by a single experienced sonographer for their DV pulsatility index (DVPI), DV resistance index (DVRI), and S?wave maximum velocity/A?wave minimum velocity (S/A ratio). Multinomial and quantile regression functions were used to analyze the effect of gestational age (estimated by CRL) on reference values (5th and 95th percentiles of the distribution in each gestational day/week). P &lt; 0.05 was considered significant.</p><p><strong>Results:</strong> Over a sample of 415 participants with a mean/median  estational age of 12 + 1 weeks, no significant correlations were found between the CRL and DVIs using multinomial regression functions (linear model best fitted for all [DVPI: B coefficient = 0.001, P = 0.235] [DVRI: B coefficient = 0.001, P = 0.287] [DV S/A: B coefficient = 0.010, P = 283]).<br />Quantile regression analyses of DVIs’ reference values were onsignificant across the CRL range except for the DVRI ([5th regression line: coefficient = ?0.004, P = 0.018] [95th regression line: coefficient = ?0.001, P = 0.030]).</p><p><strong> Conclusion:</strong> Reference values for DVPI, DVRI, and DV S/A ratios were established as 0.80–1.39, 0.62–0.88, and 2.57–6.70, respectively. Future meta?analyses and multicenter studies are required to incorporate DV  VIs into an updated universal version of the practice.<br /><br /></p>http://jrms.mui.ac.ir/index.php/jrms/article/view/11461http://jrms.mui.ac.ir/index.php/jrms/article/download/11461/6270

Journal of Research in Medical Sciences1735-19952832202310071145811458EN20230708<p>Background: The coronavirus disease 2019 (COVID?19) pandemic in Iran has led to a lack of intensive care unit (ICU) facilities. This study examines C?reactive protein (CRP), D?dimer, erythrocyte sedimentation rate (ESR), and troponin in ICU patients with COVID?19 in comparison to COVID?19 patients admitted to the wards in Iran.</p><p><strong>Materials and Methods:</strong> In a case–control study, troponin, CRP, ESR, and D?dimer were compared in the case samples of 109 COVID?19 patients admitted to the ICU, and in the control group, 140 COVID?19 patients admitted to the wards.</p><p><strong>Results:</strong> The mean of CRP (P &lt; 0.001) and D?dimer (P &lt; 0.001) was higher, whereas troponin (P &lt; 0.001) was lower in patients admitted to the ICU, but no significant difference was observed between the values of ESR (P = 0.292) in the two groups.</p><p><strong> Conclusion:</strong> This study showed that the values of CRP and D?dimer were higher in patients admitted to the ICU, but no significant difference was observed between the values of ESR in the two groups.<br /><br /></p>http://jrms.mui.ac.ir/index.php/jrms/article/view/11458http://jrms.mui.ac.ir/index.php/jrms/article/download/11458/6267

Journal of Research in Medical Sciences1735-19952832202307081145611456EN20230619<p><strong>Background:</strong> Glioma is one of the most malignant and aggressive tumors, with an extremely poor prognosis. Human telomerase reverse transcriptase (hTERT) promoter mutation is regarded as a risk factor in tumor growth. Although the prevalence of hTERT promoter (pTERT) mutation in gliomas has been investigated, the results are inconsistent. This meta?analysis aims to investigate the prognostic value of hTERT in glioma patients and its interaction with other biomarkers.</p><p><strong>Materials and Methods:</strong> We searched 244 citations from four databases: PubMed (2000–2021), Web of Science (2000–2021), Embase (2010–2021), and Cochrane Library (2000–2021) with 28 articles included.</p><p><strong>Results:</strong> We calculated hazard ratios (HRs) using the random effect model and the pooled result suggested that TERT promoter mutation predicted poorer overall survival (HR: 1.53, 95% confidence interval [CI]: 1.34–1.75, P &lt; 0.001, I2: 49.9%, pheterogeneity:0.002) and progression?free survival (HR: 1.55, 95% CI: 1.27–1.88, P &lt; 0.001, I2: 0.0%, pheterogeneity: 0.473). For subgroup analysis, we analyzed multiple factors including iso?citrate dehydrogenase (IDH) genotype,<br />age, diagnosis, pTERT region, so as to locate the sources of heterogeneity. Interestingly, in IDH mutant subgroup, pTERT mutation<br />became a beneficial prognostic factor (HR: 0.73, 95% CI: 0.57–0.93, I2: 22.3%, pheterogeneity: 0.277), which is contrary to the results in pooled analysis.</p><p><strong> Conclusion:</strong> In general, pTERT mutation may result in shorter survival time in glioma patients, but longer survival time when glioma patients are combined with IDH mutation.<br /><br /></p>http://jrms.mui.ac.ir/index.php/jrms/article/view/11456http://jrms.mui.ac.ir/index.php/jrms/article/download/11456/6265