Electronic Physician最新文献

Background: Helicobacter pylori (H. pylori) is a major cause of peptic ulcer disease (PUD) and chronic active gastritis that may progress to gastric cancer. Globally, it has been estimated that 50% or more of the world's population is infected by H. pylori, making it the most widespread infection across the globe.

Objectives: To determine the prevalence of H. pylori infection and to identify factors associated with H. pylori infection in Saudi patients presenting with dyspepsia.

Methods: In this prospective cross-sectional study, a total of 404 gastric biopsies were endoscopically obtained from 404 patients with dyspepsia from September 2014 to April 2016 (Jazan Province, Saudi Arabia). The specimens were analyzed using the real-time polymerase chain reaction (PCR). The data was examined using descriptive statistics as well as determining the prevalence, and employing Chi square and Fisher exact test. A p-value of ≤0.05 was considered statistically significant in examining the research hypotheses.

Results: The overall prevalence of H. pylori in Jazan Province was 46.5% (95% CI: 41.7-51.4) and the prevalence was lower among those > 55 years old. Prevalence was higher among urban (50.0%; 95% CI: 43.1-56.8) versus rural (42.1%; 95% CI: 35.1-49.3), but with no significant difference. Prevalence did not show significant difference among different Body Mass Index (BMI) categories, ranging from 40.2% to 47.7%. The prevalence of H. pylori in females was 47.1% (95% CI: 40.4-53.9) versus 45.6% (95% CI: 38.7-52.6) in males. Histopathology findings were associated with H. pylori infection with prevalence of 58.1% among patients with chronic active gastritis, compared to 24.1% and 34.8% among mild and chronic gastritis, respectively.

Conclusion: Our results indicate that there is a high prevalence of H. pylori among Saudi patients with dyspepsia. Prevalence of H. pylori was high in ages below 55 years. Chronic active gastritis was significantly associated with H. pylori infection. In depth studies are needed to determine associated factors with of H pylori infection in the region.

Background: Being overweight is associated with cardiometabolic risk, and lifestyles including smoking and good sleep hygiene are also implicated. We aimed to assess the dietary habit, time spent on social media, and sleep duration relationship to body mass index (BMI) among medical students in Tabuk, Saudi Arabia.

Methods: A cross-sectional study was conducted among 147 clinical phase medical students in the Medical College, University of Tabuk (Saudi Arabia) from January 2018 to May 2018. A checklist questionnaire was used to measure variables such as age, sex, smoking, level of exercise, whether taking meals and snacks regularly, eating fast food, fruit and vegetable consumption, sleep duration, time spent on social media, and breakfast skipping. Data were analyzed by IBM-SPSS version 20, using one-way ANOVA and Pearson's production-moment correlation (r). A p-value of less than 0.05 was considered statistically significant.

Results: Participants consisted of 51% males, mean age (Mean ± SD) was 22.90±1.27 years, sleep duration was 7.50±2.17 hours, time spent on social media was 5.54±3.49 hours, body mass index was 24.8±5.19, and breakfast skipping, fast food consumption, smoking, and regular exercise were reported in 52.4%, 87.7%, 12.9%, and 36.1% respectively. A significant negative correlation was evident between BMI and sleep duration (r= -0.185, p=0.025), cigarette smokers were more likely to be obese compared to their counterparts (27.28±6.85 vs. 24.10±4.98, p=0.018). No significant statistical relationship was evident between BMI, breakfast skipping, fast food, fruit and vegetable intake, and time spent on social media.

Conclusion: BMI was higher among smokers and those with shorter sleep duration, there was no association between BMI and other students' characteristics. Measures to smoking quitting and good sleep hygiene are recommended.

Background: Marital conflicts and divorce are among the most crucial problems of society. Therefore, it is important to maintain family stability at the optimal level in order to prevent divorce and its consequences in the family and community.

Objective: This study was conducted to design and validate the Family Stability Questionnaire (FSQ) in married couples.

Methods: This study was the second stage of a large study. The FSQ was constructed based on a qualitative research in our previous study in 2016. It was developed through interviews by family therapists, psychiatrists, and couples on 10 dimensions (areas) and was based on McMaster's Family Assessment Device (FAD). Then, in the present study, a confirmatory factor analysis was conducted on 270 males and females (135 couples) of Yazd City (Iran) from January to May 2017. The construct validity and reliability of the scales were examined using exploratory and confirmatory factor analyses (EFA and CFA) and Cronbach's alpha coefficient, respectively. Test-retest reliability was assessed with intra-class correlation coefficients (ICC) for the agreement between the individual items and domains. SPSS 21 and AMOS 21 were used for statistical analyses (p≤0.05).

Results: At first, the results of the CFA on 70 items of FSQ could not confirm (RMSEA=0.06, CFI=0.91, GFI=0.72), but FSQ with 56 questions indicated that it had sufficiently high validity and reliability to measure family stability (RMSEA=0.04, CFI=0.95, GFI=0.96) with an acceptable fit index. A positive significant correlation was observed between the FSQ and FAD (r=0.45, p<0.001) indicating that FSQ has convergent validity. The Cronbach's alpha and ICC of more than 0.7 in 10 domains of this tool indicated a good internal consistency among the items and their high relevance (0.90 and 0.84, respectively).

Conclusion: FSQ, as a multi-dimensional questionnaire, is a useful and reliable instrument to assess family stability. It consists of ten factors, which were constructed for the first time in Iran. Given the proper features, this instrument can be utilized to carry out more research regarding family stability in Iranian populations.

Background: Orthodontic tooth movement (OTM) is based on induction of periodontal tissue remodeling. Mechanical tooth stimulation results in the release of pro-inflammatory mediators. These mediators cause bone resorption and deposition at the pressure and tension sites and play a role in OTM. Thus, assessment of chemical biomarkers can help determine the exact amount of load and its duration of application required for each tooth and select the most efficient treatment plan with minimal complications.

Objective: This study aimed to determine the level of tumor necrosis factor alpha (TNFα) and interleukin 6 (IL-6) in gingival crevicular fluid (GCF) during OTM.

Methods: This randomized split-mouth clinical trial (parallel) was performed on 10 patients who were presenting to the Orthodontic Department of Qazvin University of Medical Sciences from November 2015 to June 2016. A canine tooth was randomly selected as the study group and subjected to distalization force while the contralateral canine tooth served as control. Using paper strip, GCF was collected from the study and control teeth prior to orthodontic force application (T0), one hour after (T1) and 28 days after force application (T2), then the level of TNFα and IL-6 was measured using ELISA. Data were analyzed using SPSS version 20 via Friedman and Wilcoxon test, and considering the significance level at p<0.05.

Results: The level of TNFα (p=0.0799) and IL-6 (p=0.678) at both sides of study teeth was higher than both side of control teeth at T1. Also, the level of IL-6 (p=0.515) and TNFα (p=0.508) were higher at the tension side compared to the pressure side; but the difference was not statistically significant.

Conclusion: Due to the free circulation of GCF in gingival sulcus, the level of mediators in the GCF collected from the mesial and distal areas alone cannot serve as a suitable index for assessment of activity at the tension and pressure sites.

Trial registration: The trial was registered at the Iranian Registry of Clinical Trials with the IRCT ID: IRCT2017030632903N2.

Funding: The present study was supported by a grant from the Research Council, Qazvin University of Medical Sciences, Qazvin, Iran (thesis no.: 40).

Reduction mammaplasty in huge breasts poses a great challenge for plastic surgeons. The classic technique is free nipple and areola grafting after breast amputation. This paper is a short technical report of reduction mammoplasty on 40 patients with severe breast ptosis (suprasternal notch to nipple >35 cm) and giganticomastia (anticipated resection of more than 1 kg per breast) were operated upon using superomedial pedicle technique for reduction mammaplasty. All patients were satisfied with their results aesthetically, and showed relief in their neck pain. There were no cases of total nipple-areola loss. In one breast, the nipple-areolar complex (NAC) was congested intra-operatively and free nipple grafting was done. The NAC sensation was preserved in 36 cases, and all other complications were minimal and self-limiting. The superomedial pedicle technique has proven to be a safe and reliable method for reduction mammaplasty in huge breasts. Compared to the classic free nipple and areola technique, this method showed promising results in preserving the nipple sensation and giving more pleasant natural projecting breasts.

Background: Diabetes is one of the most common metabolic disorders which are rapidly increasing. Distance training is a cost-effective, easy and accessible way in which time and place dimensions of communication are removed.

Objective: To determine the effects of mobile text messages on raising knowledge of men with type 2 diabetes.

Methods: This educational experiment recruited 76 people selected by convenient sampling from a population of male patients with type 2 diabetes presenting to Sedigheh Tahereh Research Center in Isfahan, Iran, in 2015. They were randomly assigned into intervention and control groups. Data were collected with a questionnaire of demographic characteristics and questions pertaining to the variable of knowledge, through interview. The intervention group received training and follow-up through cell phones and text messages for 12 weeks. Data were analyzed in IBM-SPSS version 20 using Mann-Whitney test, Chi-square, Independent-samples t-test and paired-samples t-test.

Results: Findings suggested that patients' knowledge in both groups significantly increased after the training (p<0.001). However, this rise in the intervention group was significantly higher than that of the control group (p<0.001).

Conclusion: The results indicated that designing and implementing educational programs based on text messages and cell phones can improve knowledge in diabetics.

Introduction: Tumefactive multiple sclerosis is a demyelinating disorder that appears tumor-like on MRI. To most physicians, diagnosing tumefactive MS by applying clinical, radiological, or laboratory examination like Cerebrospinal fluid (CSF) analysis, can be challenging and ultimately biopsy is necessary to confirm the diagnosis.

Case presentation: This paper reports a case of a 37-year-old woman who presented with progressive headache and a strong family history of cancer and was misdiagnosed as having a CNS glioma. After considering the MRI features, CSF analysis results and observing improvement with IV steroids, the diagnosis of tumefactive MS was made. The patient refused biopsy to rule out the possibility of tumor or abscess. Nine months later, she presented with another relapse and an injectable disease modifying treatment (DMT) was initiated, and her course has been stable in follow up.

Take-away lesson: The overall clinical importance of this case report is to highlight the real possibility of being forced to decide between Tumefactive demyelinating lesions (TDLs) and brain tumors in clinical practice, in order to avoid unnecessary biopsy.

Background: The field of medicine has been influenced by the growth and development of information systems such as the Computerized Provider Order Entry (CPOE) System.

Objective: This study aimed to evaluate the usability of CPOE systems for electronic prescription in Tehran, Iran.

Methods: This was an evaluation study conducted in 2017. The research population consisted of the CPOE systems used in hospitals of Tehran (Iran) and nurses who had access to, and used, the CPOE systems. Five hospitals with CPOE systems were included in the research sample. The data were collected using a questionnaire, and included a total of 50 questions. The questionnaires were distributed among 254 nurses who were the users of the systems. Data analysis was performed by IBM-SPSS version 21, using independent-samples t-test. A p-value of ≤0.05 was considered statistically significant.

Results: Among the four aspects assessed, the "user-friendliness" (3.87±0.59) had the highest mean score. The lowest mean score (2.01±0.58) was related to the "decision support" feature of the systems. The highest and lowest mean scores for "prescription support" criterion belonged to system E (3.26±0.23) and system C (1.90±0.16), respectively. There was a statistically significant difference between the usability of the systems used in the private and the public hospitals (p<0.001). It was found that the CPOE systems in private hospitals had a higher level of usability (3.42+0.10) compared to those in public hospitals (2.91+0.25).

Conclusion: Two main functions of the studied CPOE systems i.e., decision support and prescription support should be developed to make electronic prescription safer and more intuitive. Addressing usability aspects of CPOE systems in practice could improve the usability of these systems for prescription.

Background and aim: Cardiovascular diseases are a problem in low- and middle-income countries, such as Iran. The present research was performed to identify risk factors contributing to cardiovascular diseases and their distributions among the adult population of Mashhad (Iran) using the Framingham criteria.

Methods: This cross-sectional population-based study performed in 2015 on 2,976 adults living in Mashhad (Iran) using Stratified cluster-random sampling method. Demographic information was acquired by surveyors in the research team using a checklist and referring to a medical laboratory for laboratory assessments. The 10-year risk of cardiovascular diseases for the participants was calculated using the Framingham criteria and was classified into three classes: low risk (<10%), intermediate risk (10-20%), and high risk (>20%). The analysis was done by SPSS Version 11.5 by using the Independent-samples t-test, Kruskal-Wallis, and analysis of variance (ANOVA).

Results: A total of 2,978 participants aged 16-90 participated in our cross-sectional study with an average age of 43.5±14.7 years. Total risk scores among men and women were 7.29±6.3 and 5.8±6.03, respectively. Compared to women, men exhibited a significantly higher risk of cardiovascular diseases (p<0.001). Average heart age among men and women was estimated at 50.37±18.7 and 48.8±17.0 respectively, i.e. significantly older heart age was obtained for men compared to women (p<0.001).

Conclusion: According to this study, men are at a great risk of cardiovascular events, so we should develop our screening and educational program especially for this population.