Journal of Research in Medical Sciences最新文献

Background: Considering the insufficient data regarding the relationship between isocaloric substitution of macronutrients, sleep, and mental health in the Middle East, we sought to examine this association among Iranian adult men.

Materials and methods: This cross-sectional study was performed on 354 middle-aged Iranian men (mean age: 38.6 ± 5.34 years). Dietary data were collected using a validated food frequency questionnaire, and participants were divided into tertiles based on dietary macronutrient intake. Sleep quality was assessed using the Pittsburgh Sleep Quality Index, and sleep-related outcomes (daytime sleepiness and insomnia) and mental health (depression, anxiety, and stress) were evaluated using standard questionnaires. Multivariable logistic regression was applied to indicate the associations.

Results: Participants in the highest tertile of protein intake showed significantly lower odds of poor sleep quality in both crude (odds ratio [OR]: 0.55; 95% confidence interval [CI]: 0.32, 0.95) and adjusted (OR: 0.53; 95% CI: 0.30, 0.93) models. Substituting carbohydrates with an equivalent amount of protein was associated with 26% lower odds of poor sleep quality (OR: 0.74; 95% CI: 0.55, 0.99). In addition, substituting animal protein with the same amount of plant protein was linked to 29% lower odds of poor sleep quality (OR: 0.71; 95% CI: 0.51, 0.99). No other significant associations were found in both pairwise and substitution models.

Conclusion: Our findings indicate that isocaloric substitution of carbohydrates with protein, and animal protein with plant protein, is related to lower odds of poor sleep quality. We found no other significant associations between isocaloric substitution of macronutrients and sleep-related and mental health outcomes.

Background: Achieving successful vascular access for hemodialysis is critical for patients with end-stage renal disease. The creation of an autologous arteriovenous fistula (AVF) is the preferred approach; however, patients with small-caliber radial arteries often face challenges, leading to high rates of AVF failure. Balloon dilation-assisted AVF (BDA-AVF) creation has emerged as a promising technique to address these limitations. This meta-analysis evaluates the effectiveness of BDA-AVF creation in improving primary patency rates at 6 and 12 months in patients with small-caliber radial arteries.

Materials and methods: A systematic review and meta-analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 25 studies involving 2450 patients were included. The primary outcomes were 6- and 12-month primary patency rates, assessed through a random-effects model. Secondary outcomes included procedural success, maturation rates, and complications. Data extraction and quality assessment were performed independently by two reviewers.

Results: BDA-AVF creation demonstrated a pooled 6-month primary patency rate of 87.8% (95% confidence interval [CI]: 85.8%-89.8%) and a 12-month rate of 75.2% (95% CI: 73.2%-77.2%). Comparatively, traditional AVF techniques achieved significantly lower patency rates (6 months: 61%, 12 months: 50%). Procedural success was reported in 92% of cases, with a maturation rate of 88%. Complications were minor and included localized hematoma (5%) and mild arterial spasm (3%). BDA-AVF creation is a safe and effective intervention for patients with small-caliber radial arteries, offering superior patency rates compared to traditional methods.

Conclusion: These findings support the adoption of balloon dilation as a standard practice in selected cases, enhancing vascular access outcomes and improving the quality of care for hemodialysis patients. BDA-AVF creation shows promising short- and mid-term outcomes, particularly in patients with small-caliber radial arteries, but evidence for long-term durability is lacking. However, limited long-term follow-up across included studies restricts conclusions about AVF durability, and further high-quality trials are warranted. Future studies should focus on long-term outcomes and cost-effectiveness to further refine this technique.

Background: To investigate the risk factors of preoperative bone metastasis (BM) of prostate cancer (PCa) by using semi-quantitative single-photon emission computed tomography/computed tomography (SPECT/CT) whole-body bone imaging and peripheral blood biomarkers, and to establish a morphological map model to evaluate its prediction accuracy.

Materials and methods: Clinical data of 220 patients diagnosed with PCa were retrospectively analyzed. BM was identified using SPECT/CT. Based on the presence or absence of BM, patients were divided into two groups. Univariate and multiple logistic regression analyses were performed on various factors, including age, laboratory parameters, prostate volume determined, clinical tumor stage (cTx), and Gleason score (GS). Draw the receiver operating characteristic curve and calculate the area under the curve (AUC), and analyze the predictive efficacy. In addition, we construct a nomogram representing the BM prediction model using clinical data and generate a calibration plot to assess the accuracy of our predictions.

Results: The analysis of univariate and multiple logistic regression demonstrated that (target area-nontarget area)/nontarget area (T-NT)/NT, alkaline phosphatase (ALP), total prostate-specific antigen (tPSA), cTx, and GS were independent predictors of BM in PCa. The tPSA displayed the highest AUC of 0.68 (95% confidence interval [CI]: 0.62-0.75) among the five independent predictors. The best predictive efficacy was shown when the predictive model was established using these five factors, as evidenced by the AUC of 0.80 (95% CI: 0.75-0.86) being higher than any single indicator. The predictive model's external validation data sensitivity and specificity metrics were 66.67% (8/12) and 95.65% (22/23), respectively, which were consistent with the model's initial sensitivity of 58.02% and specificity of 87.77%, indicating high accuracy and stability.

Conclusion: The established predictive model, incorporating (T-NT)/NT from semi-quantitative SPECT/CT, ALP, tPSA, cTx, and GS, exhibits strong predictive efficacy with high accuracy and stability, providing a reliable tool for preoperative assessment of BM risk in PCa patients.

Background: The current study was conducted to assess the effect of grape seed extract (GSE) supplementation on inflammatory biomarkers, oxidative stress, clinical symptoms, and quality of life in migraine patients.

Materials and methods: In this randomized double-blinded controlled clinical trial, 50 patients with migraine were randomly allocated to receive either 200 mg/day GSE supplement (n = 25) or placebo (n = 25) for 8 weeks. Severity, frequency and duration of migraine attacks, headache daily result (HDR), quality of life, migraine disability, mental health, anthropometric indices, blood pressure, and serum levels of calcitonin gene-related peptide (CGRP), vascular cell adhesion molecules-1, total antioxidant capacity, and malondialdehyde were measured at baseline and end of the trial.

Results: Based on the within-group comparison, patients in the GSE group had a significant reduction in severity, frequency and duration of migraine attacks, HDR, migraine disability, systolic blood pressure, and serum levels of CGRP. GSE group also had better scores in the migraine-specific quality of life questionnaire and mental health questionnaire. When we performed the analysis using the univariate analysis of variance, the effect of GSE on serum CGRP levels (-0.07 ± 0.03 in the GSE group vs. 0.07 ± 0.03 in the placebo group, P = 0.003) remained significant.

Conclusion: This study provides evidence supporting the beneficial effects of GSE supplement on the serum levels of CGRP.

Trial registration: IRCT20121216011763N56.

Background: Postoperative pain is a significant concern following percutaneous nephrolithotomy (PCNL). While tubeless PCNL has reduced discomfort, effective and simple analgesic techniques are still needed.

Materials and methods: A double-blind, randomized controlled trial was conducted at two tertiary hospitals with 120 adult patients having solitary renal pelvic stones <3 cm. Patients were randomized into two groups: the intervention group received 20 mL of 0.25% bupivacaine infiltrated into the tract at surgery end, and the control group received no infiltration. Postoperative pain was assessed using the visual analog scale (VAS) at 6, 12, and 24 h. Both patients and outcome assessors were blinded. Data from 57 intervention and 56 control patients were analyzed.

Results: Baseline demographic, anatomical, and perioperative characteristics were well-matched between the two groups (all P > 0.05). Repeated-measures analysis of variance revealed a significant main effect for both time (P < 0.001) and treatment group (P = 0.006). The bupivacaine group consistently reported significantly lower mean VAS pain scores at 6 h (4.33 ± 0.97 vs. 4.85 ± 1.05, P = 0.008), 12 h (2.68 ± 0.81 vs. 3.16 ± 0.95, P = 0.005), and 24 h (1.53 ± 0.68 vs. 1.84 ± 0.71, P = 0.018) than the control group postoperatively.

Conclusion: Infiltration of the nephrostomy tract with 0.25% bupivacaine is a simple and effective method for significantly reducing postoperative pain at 6, 12, and 24 h after tubeless PCNL. This technique provides a sustained analgesic benefit and should be considered for routine implementation to enhance patient recovery.

Background: Propofol and midazolam are the most commonly used sedatives in endoscopic procedures. The purpose of this study was to compare these two sedation regimens prescribed during outpatient endoscopy and colonoscopy procedures.

Materials and methods: In this randomized clinical trial, 242 low-risk anesthesia patients (American society of anesthesilogist [ASA] I-II) referred to the endoscopy and colonoscopy ward of Al-Zahra Hospital, Isfahan, from January to June 2025, were studied. Patients were divided into two groups: sedation with propofol (P) and midazolam + propofol (M + P). After the collection of data, they were analyzed through SPSS version 18 software.

Results: In the procedures, the P group had lower systolic blood pressure (BP) readings (P = 0.003) and a lower respiratory rate (RR) (P < 0.001) compared to the control group. Heart rates were not different. Pain visual analogue scale scores were lower in the P group (P = 0.012), but endoscopist satisfaction scores and patient satisfaction scores were not different between groups. Recovery was lowered in the P group (P < 0.001). Even though the requirement for the booster dose was more variable - occurring more often in the P group with endoscopy (P = 0.040) and in the M + P group with colonoscopy (P < 0.001) - the average booster dose was equal (P = 0.126). A correlation was found between body mass index and the booster dose of propofol in the P group.

Conclusion: Propofol supplementation with midazolam enhanced some of the physiological parameters, like RR and systolic BP stability. However, it was at the expense of prolonged recovery and increased pain experience. Propofol alone ensured quicker recovery and greater analgesia but needed increased monitoring as a result of larger physiological excursions.

Background: Endocrine-disrupting chemicals (EDCs), which can interfere with endocrine hormones even before the prenatal period, can disrupt the development and function of the immune system and ultimately increase the susceptibility to allergies later in life.

Materials and methods: We performed a meta-analysis of studies examining the impact of environmental EDCs on allergic disorders. We searched PubMed, EMBASE, Medline, Web of Science, and Scopus up to February 2025 for relevant observational human studies. Allergies studied included allergic rhinitis, asthma, wheezing, atopic dermatitis, chicken pox, eczema, food allergy, hay fever, nonatopic asthma, otitis media, rhinoconjunctivitis, and wheeze.

Results: In the first stage, 2340 studies were included in our review, and finally, we identified 23 studies, including 12736 participants. The pooled results were calculated by the random-effects model. We observed a statistically significant association between EDCs and risk of allergies (pooled RR = 1.07; 95% confidence interval [CI] = 1.04, 1.10; I2 = 42.80%; P < 0.001) for overall population. The findings of meta-analysis showed also a positive significant association between exposure to environmental EDCs and risk of allergies in females (pooled RR = 1.12; 95% CI = 1.06, 1.20; I2 = 28.20%; P = 0.021) and males (pooled RR = 1.14; 95% CI = 1.09, 1.19; I2 = 20.40%; P = 0.061).

Conclusion: While most allergies showed a clear link with environmental pollution, the limited studies on specific allergies highlight the need for further research to enhance precision. Deeper investigations into underlying mechanisms and clinical implications are crucial for comprehensively understanding this association.

Background: Since inflammation and oxidative stress are risk factors for cardiovascular diseases, so it seems that α-lipoic acid consumption as a potent antioxidant can improve vascular function and reduce the risk of vascular disease. The aim of this study is determine the impact of ALA supplementation on vascular function and inflammatory markers in patients who newly experienced stroke.

Materials and methods: In this randomized double-blind, placebo-controlled clinical trial, 80 patients were randomly divided into two groups: α-lipoic acid (600 mg ALA daily for 12 weeks) and placebo groups. Serum concentration of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and high-sensitivity C-reactive protein (hs-CRP) were measured by the ELISA method, and carotid intima-media thickness (CIMT) and flow-mediated dilation (FMD) were assessed using the Doppler ultrasound method. All statistical analyses were conducted using SPSS-16 and P values <0.05 were considered statistically significant.

Results: After 12 weeks' supplementation, CIMT, FMD and hs-CRP changed between the ALA and placebo groups, significantly but we observed no significant difference in TNF-α and IL-6 levels either within or between the groups.

Conclusion: The results showed that 600 mg ALA supplementation for 12 weeks improved CIMT, FMD and hs-CRP significantly so it seems that ALA supplementation may reduce the risk of cardiovascular disease.

Background: The rapid global increase in mobile phone use has raised concerns about the potential long-term health effects of radiofrequency electromagnetic fields. While most studies have focused on brain tumors, evidence regarding breast cancer remains limited. The objective of the study is to examine the association between mobile phone use and breast cancer risk among women in Iran.

Materials and methods: In this multicenter case-control study, 226 women were recruited from diagnostic, mammography, and radiotherapy centers across Iran and classified as controls (no history of breast cancer, n = 97), suspected cases (advised to undergo mammography due to breast-related complaints or physician recommendation, n = 52), and confirmed cases (histologically verified invasive breast cancer, n = 77). Structured questionnaires collected demographic, reproductive, lifestyle, and environmental data, including mobile phone call duration, screen time, and phone placement. Associations were analyzed using multinomial logistic regression, adjusting sequentially for demographic, reproductive, environmental, and lifestyle variables.

Results: In fully adjusted models, women reporting more than 60 min of daily mobile phone conversations had higher odds of confirmed breast cancer (odds ratio [OR] = 3.49, 95% confidence interval [CI]: 1.02-11.97) and suspected status (OR = 10.84, 95% CI: 2.29-51.41) compared with those using phones <10 min daily. Longer screen time (>4 h/day), later age at menarche, lower education level, and exposure to environmental pollutants were also associated with increased odds.

Conclusion: Prolonged mobile phone use was associated with higher odds of breast cancer, but this does not imply causation. Given self-reported exposures and potential residual confounding, findings should be interpreted cautiously. Larger prospective studies with objective exposure assessment are warranted.

Background: Several kinds of procedures have been introduced for surgical rectification of pelvic organ prolapse (POP) and/or stress urinary incontinence (SUI) using various synthetic meshes such as polypropylene (PP) material. Polyvinylidene fluoride (PVDF) meshes have been proven to have higher biocompatibility, lower morbidity, and also less inflammatory and fibrotic reactions in comparison with PP meshes. Here, we intend to report a 2-year follow-up report of patients who had undergone transvaginal surgery using PVDF meshes to rectify POP and concomitant SUI.

Materials and methods: Between August 2015 and May 2024, 38 peri- or postmenopausal women with high-grade anterior compartment prolapse and concomitant SUI, who were nonresponsive to conservative management, were scheduled and underwent double-sling (anterior retropubic mid-urethral sling and posterior transobturator tape) surgery using a four-arm PVDF mesh. The patients were followed up for at least 24 months.

Results: Thirty-eight patients were enrolled in the study and followed for an average of 5.7 years. A statistically significant subjective improvement was observed after 2 years (P = 0.029) regarding the vaginal symptom score and SUI. Two-year outcomes for all these patients revealed an 83% anatomical success rate. Two mesh exposures were observed (5.2%) after 4 years. No other severe mesh-related complications were registered.

Conclusion: Double sling with PVDF implant is a safe and convenient procedure for the selected women with high-grade anterior compartment prolapse and symptomatic concomitant stress urine incontinence (SUI).