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Cytomegalovirus infection and risk of preeclampsia: A meta-analysis of observational studies
Get PDFBackground: Cytomegalovirus (CMV) infection is one of the most common infectious diseases in pregnant women in terms of global impact and is related with many adverse health consequences during pregnancy. For the first time, we performed a systematic review and meta-analysis study to evaluate the possible association between CMV infection and preeclampsia (PE).
Methods: A comprehensive literature search to identify the relevant papers published earlier than February 2018 was performed in PubMed, ISI (Web of Science), Google Scholar and SCOPUS databases. We followed the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines for design, analysis and interpretation of results. Pooled odds ratio (OR) and 95% confidence intervals (CI) were estimated using a random-effects meta-analysis model. Heterogeneity was assessed with Q-test and I2 statistics.
Results: A total of 13 studies including 6158 pregnant women (2734 women with PE and 3424 healthy controls) met the eligibility criteria. The results of meta-analyses based on PCR (OR: 3.09; 95% CI:0.72–13.24; I2=57.3%), IgG-ELISA (OR: 1.24; 95% CI:0.83–1.85; I2=71%) and IgM-ELISA (OR: 1.04; 95% CI:0.66–1.65; I2=0.0%) demonstrated that CMV infection could not be a potential risk factor for PE.
Conclusions: In conclusion, results of the present study demonstrated that CMV infection could not be a potential risk for developing PE. More epidemiological and experimental studies are needed to investigate the impact of CMV infection on the development of PE
Glomerular filtration rate determination by creatinine and cystatin-C in patients with acute pyelonephritis
Get PDFBackground: Measurement of glomerular filtration rate (GFR) and monitoring of it in any patient on nephrotoxic drugs is very important. Recently, cystatin C (cys-C) has been introduced as a better marker for determining and monitoring renal function than creatinine especially in a mild decrease of GFR. This study was done to assess the change of GFR measurement based on serum Cys-C and creatinine and their comparison in children with acute pyelonephritis on amikacin.
Methods: All children with acute pyelonephritis who were admitted in Nephrology ward were enrolled in this study. Serum creatinine, serum cys-C and the GFR calculation based on them were measured in patients on the day of admission (day zero) and then on days 3 and 7 after the start of treatment with amikacin and p-value less than 0.05 was considered significant.
Results: Among the 70 children, 61 patients were females and the others were males. Mean age was 42.66±41.53 months. Estimated GFR based on creatinine on day 0 (before amikacin administration), 3 and 7 were 72.41±20.89 ml/min/1.73 m2, 78.42±21.15 ml/min/1.73 m2 and 80.5±22.43 ml/min/1.73 m2, respectively. Moreover, GFR based on cys-C during these days were 116.23±58.9 ml/min/1.73 m2, 116.49±53.31 ml/min/1.73 m2 and 108.37±51.02 ml/min/1.73 m2, respectively (p<0.05).
Conclusions: According to this study, decrease of GFR calculation based on Cys-C was seen and estimated GFR was not changed according to creatinine. So, we recommend the use of cys-C for the monitoring of renal function in any patient treated with nephrotoxic drugs such as amikacin
Adjuvant effect of oral Silymarin on patients’ wound healing process caused by thermal injuries
Get PDFBackground: According to the side effects of the usual treatment of burns, in improving the patients’ prognosis, there is a need to introduce faster and more effective adjuvant therapies to treat wounds, thus to improve the prognosis of patients. The aim of this study was to investigate the effect of adjuvant treatment with oral silymarin on wound healing process caused by second degree-burns among the patients admitted to Valiasr Hospital of Arak.
Methods: This randomized, double-blind clinical trial study was carried out on 80 patients with second-degree burns covering 20 to 30 percent of the body with flame. Patients were randomized into 2 groups with an equal number: The intervention group (treated daily with oral 140-mg silymarin) and control (under the administration of placebo). Patients were treated for 8 weeks and at the end of weeks 1, 2, 3 and 4 according to the degree of wound healing (grade 1, 2 and 3) were followed during 2016-2017.
Results: Changes in degrees of burn wound healing in both the intervention and placebo groups during the 4 weeks of treatment, significantly improved grade 3 completely. Based on the results, the complete remission in all four follow-up stages was significantly higher in silymarin group than the placebo group: Week 1 (intervention: 9 (22.5%), control: 0 (0%), (p=0.011), week 2 (intervention group: 18 (45%), placebo: 7 (17.5%), (p=0.000), week 3 (intervention: 24 (60%), placebo: 11 ( 27.5%), (p=0.051); week 4 (intervention: 27 (67.5%), control: 19 (47.5%), (p=0.003).
Conclusions: According to our results, the 4-week adjuvant treatment with oral silymarin resulted in the full and faster wound recovery in patients with second degree-burn. So, it is recommended to use adjuvant treatments to obtain effective results
Effect of different torques on dentinal crack formation following canal preparation using neoniti rotary system
Get PDFIntroduction: The aim of this study was to determine the incidence of dentinal cracks in the mesial root of maxillary molar during canal preparation using Neoniti system in different torque settings.
Materials &Methods: In this in-vitro study, 60 maxillary molars extracted for various reasons were selected. The teeth were divided into 4 groups: one group(n=15) without preparation was considered as a control group (unprepared control group), the other 3 groups prepared with rotary neoniti system: group with standard torque (1.5 N/CM2)(n=15), group with high torque (2N/CM2)(n=15), and group with low torque (1N /CM2)(n=15). After a canal preparation procedure, the teeth were horizontally sectioned at 3, 6 and 9 mm from the apex. All sections were examined for determining the presence of cracks using a stereomicroscope. Data were analyzed using chi-square test.
Results: There was no crack in the control group. The number of cracks was significantly higher in the high-torque group (80%) than standard- and low-torque groups (20%, 26.7%, respectively) (p<0.001). However, no significant difference was found between the standard-torque group and low-torque group (p<0.001).
Conclusion: According to this study result, to avoid crack formation in higher torques using motors with torque control option is suggested
Triglyceride to HDL cholesterol ratio and risk for gestational diabetes and birth of a large-for-gestational-age newborn
Get PDFBackground: Using oral glucose for glucose challenge test (GCT) and glucose tolerance test (GTT) is problematic, especially in early pregnancy when the pregnant woman is experiencing gastrointestinal complications. This research seeks to investigate the relationship between the ratio of Triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) and the risk of gestational diabetes and large for gestational age (LGA) fetus for suggesting a more appropriate index for diagnosis of gestational diabetes.
Methods: The present cross-sectional study investigated pregnant women visiting the Perinatal Clinic of Ayatollah Rouhani Hospital in Babol for prenatal care from September 2015-2016. The GCT was performed on these pregnant women at 24-28 weeks as a screening test and their lipid profile, including HDL-C and TG, was simultaneously assessed after eight to 14 hours of fasting.
Results: Significant differences were observed between women with and without gestational diabetes in terms of mean triglyceride, HDL, LDL/HDL ratio, triglyceride/LDL ratio and triglyceride/HDL ratio. The cut-off point of TG/HDL in the GTT was 4.254 with a sensitivity of 79.07% and specificity of 78%.
Conclusions: According to the results obtained, lipid profile can help predict the risk of gestational diabetes, especially TG/HDL ratio that has a high sensitivity to diagnose gestational diabetes, while, lipid indices could not predict birth of a LGA neonate
Clinical diagnosis challenges in Zika virus infection
Get PDFDear Editor,
Will Zika virus (ZIKV) infection as a mosquito-borne illness with symptoms similar to flu difficult to diagnose?
To answer this question, we need to know this infectious disease well and its clinical symptoms. So, first we need to point to the mentioned case. ZIKV is an emerging viral infection in the Flaviviridae family, transmitted by Aedes aegypti.
At present according to the reports of health organizations, this infection has spread throughout the USA, the Pacific Islands, and the Southeast Asia. This flu like infection causes mild symptoms resolved in two weeks, like fever, headache, rash, myalgia, redness, and conjunctivitis (1).
Thus, the temperature is usually low grade fever (within 38.0°C) and skin rashes are likely immune-mediated and pruritic in many cases which begin within 1–4 days onset. Definitely, the complicated features comprising Guillain-Barré syndrome (GBS) and fatal encephalitis in adults, an abnormally small head size (microcephaly) in newborn infants, immune thrombocytopenic purpura (ITP) were documented (2).
There are many flu like illnesses, which may make clinicians doubtful in the diagnosis of ZIKV infection. Among these diseases can be referred to such terms as herpes simplex virus (HSV), acquired immune deficiency syndrome (HIV/AIDS), hepatitis C, Lyme disease, Q fever, dengue fever (DF), measles, and so on.
In other words, it is confirmed that these common clinical presentations of ZIKV infection performed to be very similar to some arboviral diseases, like as Chikungunya virus (CHIKV) and Dengue virus (DENV) infection, as a result, a confounding diagnosis. Consequently, a study that was conducted in 2015 revealed 224 dengue cases screened for ZIKV infection, seven patients had positive results for ZIKV infection(3).
Several in vitro studies suggested cross-reactivity between antibody responses in dengue virus (DENV) as an arthropod‑borne virus and a member of the genus Flavivirus, and Zika virus(4). Even few research studies suggest that dengue virus enters to cells with Tyro 3, Axl, and Mertk (TAM) and T-cell immunoglobulin and mucin domain (TIM), and these receptors are engaged in ZIKV infection (5). Although other studies showed the differences between these infections that they are very helpful in solving the misdiagnosed problem.
Rashes in ZIKV infection are more likely to occur in the first week than dengue infection. In the event, rashes regularly appear during recovery phases of dengue disease. Contrary to dengue, hemorrhagic episodes and abnormality in laboratory findings as thrombocytopenia occur less frequently in ZIKV.
It has shown that different types of edema are more common in ZIKV infections than in DENV illness. In general, people with ZIKV infection, unlike dengue fever, less likely develop severe illnesses and need to be hospitalized. As a consequence, it can be concluded that diagnosis of ZIKV infection and the complete and accurate verification is a great challenge due to low-level viremia and cross- reactivity related to immune system functions. On the other hand, detection of this infection is best during the early-phase, though, diagnosis is seriously problematic at this stage because the disease occurs in this phase asymptomatically (3).
As a result, the best and the most reliable things are the careful evaluation of infection regarding clinical and paraclinical (hematologic) parameters alongside the use of RT-PCR with high specificity and sensitivity as the gold standard for ZIKV detection. Meanwhile, RT-PCR is effective in serum, saliva and semen in 1-2 weeks post infection. Moreover, it is recommended to use acute and recuperating samples for better diagnosis (5).
The use of molecular tests such as Trioplex Real-Time RT-PCR (rRT-PCR) by the Centers for Disease Control and Prevention (CDC) is recommended specially for those who have recently traveled to regions with risk of Zika and even show some symptoms of a disease such as Chikungunya virus (CHIKV) and DENV(5)
Investigation of Mutations of Exon 11-A of BRCA1 Gene in Women with Breast Cancer in the Northwest of Iran
Get PDFBACKGROUND AND OBJECTIVE: Breast cancer is the most common cancer in women, which is associated with genetic changes such as mutations in carcinogenic genes and tumor suppressor genes. One of the most important tumor suppressor genes involved in breast cancer is the BRCA1 gene. The mutation in this gene is a common occurrence in human breast cancer. The purpose of this study is to investigate the mutations of exon 11-A of BRCA1 gene in women with breast cancer in the northwest of Iran.
METHODS: In this descriptive study, blood sample were collected form 40 patients with breast cancer whose cancer was diagnosed before the age of 40 years and the exon 11-A of BRCA1 gene was examined using PCR and direct sequencing methods to detect mutations. Sequencing results were analyzed using Chromas software.
FINDING: In the present study, a nonsynonymous mutation was reported as a new mutation of BRCA1 gene for the first time: Ala584Thr mutation was also observed in two samples. The mutations of codon 694 (Ser694Ser) showed a higher incidence (52.5%). Other mutations were observed in codons 693, 356, 486, 550 and 628.
CONCLUSION: Based on the results of this study, mutations and polymorphisms of exon 11 of BRCA1 gene were observed for the first time in the northwestern population of Iran. One new case of mutation was observed in exon 11-A of BRCA1 gene
The Effect of Camellia Sinensis Ointment on Perineal Wound Healing in Primiparous Women
Get PDFBACKGROUND AND OBJECTIVE: Delay in recovery of episiotomy can lead to infection and persistence of perineal pain. Perineal pain is a stressful problem for primiparous women and has a negative effect on their function.The present study was conducted to determine the effect of Green tea ointment on the healing process of episiotomy.
METHODS: This three-blind clinical trial was conducted on 60 primiparous participated in this research, were divided in two groups: Green tea ointment and placebo ointment. According to the routine of the hospital, 500 mg capsule cephalexin was given to all mothers every six hours for seven days. Mothers used an ointments every 12 hours for a period of ten days in the area of sutures. Wound healing was measured on the fifth and tenth day after delivery using REEDA scale.
FINDINGS: There was no significant difference in demographic features and obstetric variables (for example age and weight newborn). Before the intervention, two groups did not have a significant difference in score of the perineal evaluation scale (p=0.475). The average of this scale on the fifth day in the green tea group was (1.83±1.147) and in placebo group it was (3.33±1.155) on the 10th day, the average of the perineal evaluation scale was (1.2±0.805) for the green tea group and (2.63±1.066) for the placebo group. The average of REEDA scores on the 5th and 10th day after delivery was significantly different between the two groups(p<0.00001)
CONCLUSION: Green tea can improve episiotomy wound healing, due to its healing propertie
The Effect of Educating the Use of Developmental Positions of Premature Infants on the Clinical Performance of Neonatal Intensive Care Unit Nurses
Get PDFBACKGROUND AND OBJECTIVE: One of the early interventions in neurodevelopmental disorders in neonatal intensive care units is providing proper conditions for infants. Premature infants have lost their last three months of life in the uterus, and as a result, have not reached a collapsed status, which is a developmental position that indicates brain growth in the infant. Considering the importance of the neonatal position in developmental positions and achievement of better neural evolution, this study was conducted to implement educational intervention to improve the performance of nurses in order to properly implement the developmental positions of premature infants in neonatal intensive care unit.
METHODS: This interventional study was carried out among 85 neonatal intensive care unit nurses in Shahid Akbar-Abadi and Ali Asghar Hospitals in Tehran in three stages. First, the nurses' performance was evaluated regarding the supportive developmental positions of the premature infants in the neonatal intensive care unit through a neonatal assessment tool (IPAT with a maximum score of 12 and a minimum score of 3). Then, nurses were educated by slides and face to face and the performance of nurses was evaluated and compared after the first week after training and two months after the training.
FINDINGS: Demographic data showed that the education level of most nurses (98.8%) was bachelor's degree and most nurses (48.2%) were older than 30 years of age. The highest work experience of nurses (42.4%) was in the range of 5–10 years. In addition, the nurses' performance score regarding the supportive developmental position of premature infants in the pre-training stage (5.84±0.03), the first week after training (8.35±1.42) and two months after training (8.71±1.16) had a significant difference (p<0.001).
CONCLUSION: Based on the results of this research, educating the use of developmental positions of premature infants has positive effects on the clinical performance of neonatal intensive care unit nurses
Analysis of Association between IL-17 gene rs2275913 Single Nucleotide Polymorphism and Chronic Hepatitis B Infection
Get PDFBACKGROUND AND OBJECTIVE: Hepatitis B disease is one of the main causes of inflammation and liver damage that can lead to chronic hepatitis B virus infection. Single nucleotide polymorphism in the cytokines gene can affect the host immune response. Interleukin 17 produced by Thelper17 cells has been shown to play a role in immune function in infectious and inflammatory diseases. This study was conducted to investigate the association between polymorphism in IL-17 gene (rs2275913) and chronic hepatitis B infection.
METHODS: This case-control study was performed on 130 chronic patients as a case group and 130 healthy individuals as control. Patients with positive result of ELISA test for HBsAg and Anti-HBc Ab and control subjects with negative result of this test were enrolled. PCR-RFLP was used to genotype extracted DNA from blood samples.
FINDINGS: The genotype frequencies of rs2275913 did not show significant difference between patients and control groups. Distribution of genotypes inpatients were, 40.8% GG, 41.5% AG, 17.7% AA and in control group were, 42.3% GG, 45.4% AG, 12.3% GG (p=0.469).
CONCLUSION: The results of study showed no relation between IL-17 gene polymorphism rs2275913 and chronic HBV