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Determination of celiac disease frequency in type 1 diabetes mellitus children in the Pediatric Endocrinology Clinic of Sari, Mazandaran
Get PDFBackground: Diabetes mellitus, type 1 (T1DM) and celiac disease (CD) are both immune-mediated. The mean rate of clinical overlap is 8%. The aim of this study was to discover the frequency of CD in children with type 1 diabetes in Mazandaran province.
Methods: This retrospective descriptive study was performed in the pediatric endocrinology referral center, in Sari from 2012 to 2014. We screened all individuals aged between six months and 18 years with diabetes diagnosis after ketoacidosis, positive anti-GAD 65 antibodies, and insulin therapy. Patients with a positive tissue Transglutaminase Immunoglobulin A (tTG-IgA) antibodies test underwent endoscopic biopsy. Categorical data were tested using chi-square and quantitative data with independent sample T-test in SPSS. Date reported with 95% confidence interval. P<0.05 was considered statically significant.
Results: Of the 119 children enrolled, six cases (5%) were positive for tTG-IgA antibodies and all of them were boys (P=0.013). Histopathologically, CD was confirmed in 5 persons (4.2%). The mean age of seropositive patients was 10.3±3.3 years. History of DKA was mostly negative (83.3%) in them. The mean breastfeeding duration was 21±3.2 months, and only one had started formula after 12 months of birth.
Conclusions: The results of the current study showed that the frequency of CD in T1DM children in north of Iran was similar to that other countries but lower than that in previous reports of Iran. The periodic screening test for CD in this high-risk group is necessary to diagnose the asymptomatic disease and prevent its complications
Comparison of the Effect of Short-Term Consumption of Probiotic (Bacillus Coagulans) and Ordinary Cake on Salivary Streptococcus Mutans
Get PDFBACKGROUND AND OBJECTIVE: Consumption of food causes changes in oral flora. Foods that create an appropriate media for Streptococcus mutans and other cariogenic microflora, cause increase the rate of tooth caries. The aim of this study was the assessment of short-term consumption of probiotic cake (contain Bacillus coagulans) on salivary streptococcus mutans count and comparison with ordinary cake.
METHODS: A cross over blind study was conducted on 30 healthy adult volunteers in two groups (16 males and 14 females). The first group ate probiotic cake (75 grams daily) for 1 week and after 2 weeks wash out period, they ate ordinary cake. The second group first ate ordinary cake and after 2 weeks wash out period, they ate probiotic cake (75 grams daily). Non-stimulating salivary samples, before (as baseline) and after eating probiotic and ordinary cake, were collected. Then counting of streptococcus mutans was done with colony counter.
FINDINGS: Of the 30 patients, 16 (53.33%) were male and 14 (46.67%) were female with an average age of 40.86±17.15 years. Number of Streptococcus mutans in baseline saliva samples was (7.872±1.430)106 CFU/ml and in the saliva samples after consumption of probiotic cake was (4.652±0.841)106 CFU/ml and in saliva samples after consumption of ordinary cake was (21.386±3.895)106 CFU/ml. There was no significantly difference between mutants count before and after eating probiotic cake (p=0.769) but after consumption of ordinary cake than probiotic cake the count of streptococcus increased significantly (21.3±39.9 compared with 4.65±0.84) (p=0.032).
CONCLUSION: Based on the results of this study, the addition of probiotic bacteria to sweet and high-consumption foods can reduce the adverse effects of foods such as cakes on oral health
The Genes Responsible for Maple Syrup Urine Disease, Molecular Pathomechanisms and Causative Mutations in Iranian Population
Get PDFBACKGROUND AND OBJECTIVE: Maple syrup urine disease is a rare inborn metabolic inherited disorder caused by deficiency of branched chain α-keto acid dehydrogenase complex and leading to accumulation of branched chain amino acids in body fluid. The incidence of MSUD is higher in populations with high consanguineous marriage. BCKD is a mitochondrial complex which is encoded by four nuclear genes (BCKDHA, BCKDHB, DBT, and DLD) and MSUD can be caused by mutation within any of these four genes. Accumulation of metabolic is associated with impairment of energy metabolism, provoke apoptosis, dysfunctional neurotransmitter synthesis and neuropathological defects such as seizure, psychomotor delay and coma. In the present study, we investigated the incidence of MSUD in Iran, compiled previously reported mutations in Iranian population and also explained molecular pathomechanisms underlying MSUD.
METHODS: To compile MSUD mutations, we systematically reviewed PubMed and magiran databases to find related articles in English and Persian language, respectively. The key words "MSUD" and "Iran" was used as query.
FINDINGS: Until 9th December 2018, twenty four MSUD mutations were collected from Iranian population of which 18 mutations have been only identified in Iran and were not reported in other populations yet. Likewise, because of high consanguineous marriages, the incidence of MSUD were higher than worldwide average in different provinces.
CONCLUSION: Identification and compiling of MSUD mutations in Iranian population can be useful for prenatal genetic diagnosis in at risk families and play crucial role in early diagnosis and also treatment before starting neurological symptoms in newborns
Is 99m Tc-methylene diphosphonate bone scintigraphy a sensitive method for detecting bone lesions in multiple myeloma?
Get PDFBackground: Bone lesion in multiple myeloma (MM) is most commonly presented as a lytic lesion in this disease. Determination of extent of bone lesions in MM is necessary to follow-up the patients. Whole body bone scan with 99m, Tc-methylene diphosphonate (MDP) has a lower sensitivity than other modalities.
Methods: From the patients with MM admitted to Ayatollah Rouhani Hospital of Babol-Iran from 2009 to 2015, who had undergone whole body bone scan during diagnostic process, were entered into the study. Findings of bone scan were compared with MRI.
Results: Of the 19 patients, sixteen (84.2%) of them had positive finding in bone scan, fifteen (78.9%) had MRI of the spine. While of the thirteen patients who had positive finding in MRI, seven (53.8%) had more positive finding in thorcolumbosacral MRI than in bone scan.
Conclusions: 99m-Tc MDP bone scan is a sensitive but insufficient method for detecting bone lesions in MM
Can chronotropic incompetence predict life-threatening ventricular arrhythmias in patients with stable ischemic heart disease?
Get PDFBackground: Chronotropic incompetence has prognostic value of all-cause and cardiovascular mortality in both patients with asymptomatic and symptomatic ischemic heart disease (IHD), regardless of traditional risk factors. The aim of this study was to investigate the relationship between chronotropic response during exercise test and the development of ventricular arrhythmias.
Methods: 153 patients with stable ischemic heart disease were screened and observed during the 24 months since October 2014 in a university hospital in Astana Kazakhstan. They underwent bedside electrocardiography, 24h heart rate Holter monitoring, echocardiography, exercise stress test (treadmill) for assessment of chronotropic index calculating at first contact. Holter- electrocardiography was repeated three times (at 3, 6, 12 months of follow-up period) to reveal life-threatening ventricular arrhythmias.
Results: The quantity of the ventricular extrasystoles was higher in the group with low chronotropic index. Low chronotropic index increased the risk of high grade ventricular extrasystoles more than two times (P=0.015); episodes of non-sustained VT more than three times (p<0.001); and episodes of sustained VT more than nine times (p<0.001).
Conclusions: Chronotropic index less than 35.6 increases the risk for life-threatening ventricular arrhythmias in patients with stable chronicle ischemic heart disease irrespectively of severe left ventricle systolic dysfunction
Cardiac patients’ perception about psychological risk factors on chest pain intensity and discomfort
Get PDFDear Editor,
Perceived heart risk factors including psychological and non-psychological factors (components of behavioral, biological, environmental, and physiological) are as part of the mental representation of illnesses that arise from patients' health knowledge and independently can predict their health behavior (1-2). Causal beliefs and perceived risk factors are associated not only with patient's health and adjustment but also the impact on their adherence to treatment recommendations (3). Patients' cognition has a significant impact on disease course and progression during all stages of illness experience including understanding signs, looking for a reason to link the disease to it, and considering a change in an individual’s behavior (3), so it is suggested that patients with perceived psychological risk factors and who experienced more anxiety and depression be compared to other patients in the stage of secondary prevention (2, 3). Angina and suffering caused by it are other clinical representations of heart disease that almost a third of these patients complain of it even after successful revascularization and express inability to control it (4). It seems that pain intensity and discomfort, as important aspects of angina, were not affected only by cardiac event or procedure and nonphysical factors also play a role in its experience. Thus, since identifying factors associated with angina in the secondary prevention can be effective in improving the quality of life and returning patients to normal life, it seems that there is a need to conduct further studies with regard to the relationship between perceived risk factors and clinical representation of angina in heart patients.
Based on these considerations, a study was conducted to compare the chest pain severity and discomfort in heart patients with and without perceived psychological risk factors. From May to July 2015, 219 cardiac patients (23- 79 years with the mean [SD] = 58.5±9.4) after cardiac surgery were invited to participate in the study in Imam Ali Hospital of Kermanshah City (Western part of Iran). After obtaining a written informed consent to participate in the study, demographic data and medical histories of the patients were
evaluated and recorded by an expert cardiologist. Then, a brief pain inventory (5), pain discomfort scale of Jensen et al. (6), and open single-item related to perceived heart risk factors (2, 4), as appropriately validated scales were provided for the patients by a clinical psychologist. Descriptive statistics and independent t-test were used to compare the differences between the two groups in terms of pain intensity and discomfort. All statistical analysis was performed using SPSS 20 software.
According to descriptive data, 63% of patients were males, 89.4% married, 34.7% housekeepers, 32.2% self-employed, 8.2% employees, and 21.9% retires. In terms of level of education, 70.3% were below high school level 18.3% high school graduate and 11.4% with a college degree. In addition, the results show that 118 and 110 people respectively are with the perceived non-psychological and psychological risk factors. The means (SD) of pain intensity respectively were 3.751.94 and 4.321.86 for the patients with perceived non-psychological and psychological risk factors. Also, the means (SD) of pain discomfort respectively were 9.486.52 and 12.307.58 for patients with the perceived non-psychological and psychological risk factors. In relation to the main analysis, the independent t-test results show that there is a significant difference between the two groups in term of pain intensity (P=0.030) and discomfort (P=0.004) and the patients with perceived psychological risk factors indicate more pain severity and discomfort compared with the patients with perceived non-psychological risk factors. Our results showed that the severity of pain and pain discomfort are more in patients with perceived psychological risk factors compared with those patients with perceived non-psychological risk factors. In this regard, the results of the two studies showed that the patients with perceived psychological risk factors experience more anxiety and depression compared to others (2, 3). Since the patient's perception of illness directly linked to actual risk factors of disease (1), and considering the relationship between chest pain and psychological symptoms, it seems that the identification of patients perceived risk factors can play an important role in screening patients suffering from angina. Therefore, there is the possibility that we can quickly recognize and control the psychological symptoms (3) and discomfort or pain through changing the patients’ perception of disease risk factors in the stage of secondary prevention
Impairment, disability and fatigue in multiple sclerosis
Get PDFBackground: Identifying the predictors of pain is important for both health professionals and researchers, because pain has repeatedly been found to be a strong predictor of activity limitations and participation restrictions. The objective of this study was to determine the predictors of pain presence and severity in a large, well-designed sample of community dwelling individuals with multiple sclerosis (MS).
Methods: This was a cross-sectional study. A center-stratified random sample including 188 persons with MS were recruited from three major MS clinics in the Greater Montreal, Canada. Main outcomes included pain prevalence and severity. Predictor variables included depression, anxiety, perceived health status, fatigue, sleep problems, and perceived cognitive deficits. Participants completed three questionnaires: the first asked about the socio-demographic and clinical information of the subjects, the second assessed the pain characteristics of the subjects, and the third covered the predictor variables.
Results: The prevalence of pain in our sample was 42%. MS- related disability was found to be in the main predictor for both pain presence and intensity. Fatigue also was a main contributor to pain presence. The results of this study also showed that pain was associated with higher levels of depression, anxiety, sleep problems, and perceived cognitive deficits, and diminished perceived health status.
Conclusions: The results of this study indicated that pain is a common symptom among people with MS. Pain presence was predicted by MS-related disability and fatigue, while pain intensity was only predicted by MS severity
The Association of miR-451 and miR-21 in Plasma with Lymph Node Metastases in Breast Cancer
Get PDFBACKGROUND AND OBJECTIVE: The expression of some circulating microRNAs (miRNAs) in biological fluids of healthy individuals is different from cancerous patients. circulating miRNAs are a new class of cancer biomarkers because of their high stability and sensitivity, ease of measurement and specificity due to their correlation with various cancer states. According to the miR-451 and miR-21 functions in the metastasis of some cancers, the aim of this study was to investigate the differences of expression levels of miR-451 and miR-21 in the plasma of breast cancer (BC) patients with and without lymph nodes metastasis (LNM).
METHODS: In this descriptive-analytical study, blood samples were collected from 47 women with BC and 24 healthy women with mammography confirmation. The presence/or absence of LNM was recognized from patients' medical records. The expression levels of miR-451 and miR-21 in the plasma, were investigated using Real-Time PCR.
FINDINGS: The median of expression of miR-451 in BC patients with LNM and without LNM was 1.739 and 3.187, respectively, and its expression in lymph node metastatic patients decreased 0.444 folds in comparison with non-metastatic patients (p=0.031). The median of expression of miR-21 in patients with LNM and in non-metastatic lymph nodes patients was 5.922 and 2.157, respectively, and its expression in metastatic status was 2 folds higher than non-metastatic (p=0.029).
CONCLUSION: The results of this study indicated that decreased miR-451 and increased miR-21 expression in plasma of BC patients was associated with LNM status
Investigation of the Relationship between the Presence of Chromosomal and Plasmid-Encoded AmpC Genes and Type of Clinical Specimen in Pseudomonas Aeruginosa
Get PDFBACKGROUND AND OBJECTIVE: Different clinical specimens play a decisive role in the type and nature of drug resistance in pathogenic organisms. Occasionally, the presence of certain antibiotic resistance genes is associated with the type of clinical specimen. The aim of this study was to determine the relationship between the presence of chromosomal and plasmid-encoded AmpC genes and type of clinical specimen in Pseudomonas aeruginosa.
METHODS: In this descriptive and experimental study, 114 isolates of Pseudomonas aeruginosa, and clinical specimens including blood, urine, wound secretion, burn injuries were collected from teaching hospitals in Hamadan. The presence of chromosomal and plasmid-encoded AmpC genes was evaluated using multiplex PCR technique.
FINDINGS: The plasmid-encoded AmpC genes were observed more than chromosomal genes in Pseudomonas aeruginosa isolates. The FOX gene with a value of 29 (37.66%) (p≤0.037) and DHA gene with a value of 5(6.4%) (p≤0.015) in plasmid-encoded AmpC genes, while FOX gene with a value of 39 (48.75%) (p≤0.001) and MOX gene with a value of 2 (7.36%) in chromosomal AmpC genes had the highest and lowest frequency, respectively.
CONCLUSION: The results of the study showed that the presence of chromosomal and plasmid-encoded AmpC genes may have various frequencies according to the type of clinical specimen
A Comparison of the Effect of Short Abdominal Skin-To-Skin Contact and Kangaroo Skin Contact on Initiation of Successful Breastfeeding
Get PDFBACKGROUND AND OBJECTIVE: Kangaroo skin contact is an important factor in breastfeeding. However, in contrast to abdominal contact, it is considered timely. Therefore, while shortening the contact time, this study aims at comparing the effects of short abdominal skin-to-skin contact and Kangaroo skin contact on successful breastfeeding.
METHODS: This clinical trial study was conducted among pregnant women in maternity hospitals of Torbat Heydarieh in 2015. Sixty-eight primigravida women with term pregnancy and aged 18-40 years were selected through convenience sampling and were divided into two groups of intervention (Kangaroo skin contact) and control (abdominal skin contact). Questionnaires about demographic, fertility and medical data were completed for both groups. Infants with 8-10 Apgar and birth weight of 2500 – 4000 g were exposed to Kangaroo skin and abdominal skin contact for 5-10 minutes. After delivery, The Infant Breastfeeding Assessment Tool (IBFAT) was completed and the mean values of feeding desire, searching, latch on and sucking pattern were analyzed (IRCT: 2014090419039N1).
FINDINGS: The mean feeding desire in the intervention group was 2.63±0.6 and in the control group was 2.61 ± 0.6, searching was 2.76±0.43 and 2.73±0.44, latch on was 2.76±0.43 and 2.79±0.41, sucking pattern was 2.82 ± 0.54 and 2.64 ± 0.64, and total score was 11.84 ± 5.10 and 10.79 ± 1.82, respectively, indicating no significant difference in any of the dimensions.
CONCLUSION: The results of the study showed that short abdominal skin-to-skin contact and Kangaroo skin contact did not differ significantly regarding their effect on initiation of successful breastfeeding