Journal of Research in Medical Sciences最新文献

Background: The incidence of colorectal cancer (CRC) is rising in Iran, but reports vary across different regions due to diverse methods and data sources. This study aimed to conduct a systematic review and meta analysis to provide an overview of the incidence rate of CRC and its trend among Iranians in various provinces.

Materials and methods: A comprehensive literature search based on the Preferred Reporting Items for Systematic Reviews and Meta Analyses checklist was performed using national and international databases for papers published up to December 2023. CRC incidence rates were extracted from the numbers, crude rates, and age standardized rates (ASRs). A meta analysis was conducted to calculate the incidence rate and 95% confidence intervals (CIs) in subgroups of sex and province.

Results: The initial database search retrieved 1287 papers, with 47 studies meeting the inclusion criteria after further screening. Overall, the trend of CRC incidence has been increasing, although a different pattern was observed in 2008. The pooled incidence rate of CRC was 8.46 (95% CI: 7.16-9.86) per 100,000 population before the publication of the annual continuous reports of the Iranian National Cancer Registry. The latest national data (2014-2017) indicated an ASR of approximately 15 per 100,000 population.

Conclusion: The incidence of CRC in Iran is lower than the global average. However, inconsistent cancer registration policies and gaps in registration have hindered the ability to establish a reliable trend of CRC incidence over time.

Background: Aluminum phosphate (ALP) poisoning has a high mortality rate (MR) secondary to cardiogenic shock. Recently, extracorporeal membrane oxygenation (ECMO) showed a successful result in this issue. We conducted a systematic review and meta-analysis to compare the MR of patients with ALP poisoning who underwent ECMO versus those with conventional treatment.

Materials and methods: Two parallel databases' reviews were done to find the ECMO treatment-applied studies or conventional treatment-applied studies according to the PRISMA protocol. All studies in any languages and English conference abstracts were included for ECMO treatment-applied studies. Only English-language human observational studies, which reported MR, were included in conventional treatment-applied studies. All ETAS case reports were summarized and used as a newly generated cross-sectional study (NGCSS) for inclusion in the meta-analysis.

Results: Out of 167 and 1043 records, 17 case reports (24 cases), 3 cross-sectional studies, and 9 conventional treatment-applied studies were selected. In meta-analysis NGCSS applied as the fourth cross-sectional ECMO treatment-applied studies. The overall MR of ECMO-treated cases (23% [95% confidence interval (CI): 7%-39%]) was significantly less than conventionally treated cases (60% [95% CI: 39%-63%]; P < 0.001). In ECMO-treated cases, the weighted mean difference (WMD) for age, blood pH, ALP dose, hospitalization, ECMO lag time, and ECMO duration were not statistically significant between survived and nonsurvived cases. However, WMD of cardiac ejection fraction (4.6%; 95% CI: 2.76%-6.39%; P < 0.0001), exposure to hospitalization lag time (-2.05; 95% CI: -4.05-0.14 h; P = 0.06), and length of hospital stay (16; 95% CI: 12.0-20.5 days; P < 0.0001) between survived and nonsurvived ETC were significant.

Conclusion: ECMO reduced the MR of ALP-poisoned patients; however, it is a highly invasive and complicated procedure.

Background: Diabetic retinopathy (DR) is one of the complications of diabetes. This study was conducted to investigate the effect of curcumin-piperine on laboratory factors and macular vascular in DR.

Materials and methods: The present study was a randomized, placebo-controlled, double-blind, parallel-arm clinical trial that was conducted on 60 patients with DR aged 30-65 years. Patients were randomized into two groups to receive (i) 1010 mg/day of curcumin-piperine (two tablets per day, each tablet containing 500 mg curcuminoids and 5 mg piperine) (n = 30) or (ii) the matched placebo (n = 30) for 12 weeks. The investigated factors included optical coherence tomography (OCT), optical coherence tomography angiography (OCTA), oxidative stress factors, C-reactive protein (CRP), fasting blood glucose (FBG), triglycerides (TGs), blood urea nitrogen (BUN), and creatinine.

Results: The trial was completed by 27 patients in the intervention group and 29 patients in the placebo group. Curcumin-piperine significantly increased total antioxidant capacity (0.86 ± 0.66 vs. 0.45 ± 0.89; P = 0.022) and superoxide dismutases (0.77 ± 2.11 vs. -0.45 ± 3.08; P = 0.031), while it decreased and malondialdehyde (MDA) (-1.06 ± 5.80 vs. 1.89 ± 6.12; P = 0.043) and creatinine (-0.04 ± 0.16 vs. 0.03 ± 0.05; P = 0.042) compared with placebo. However, this supplement had no significant effect on CRP, FBG, TG, BUN, OCT, and OCTA. There were no adverse reactions.

Conclusion: Curcumin-piperine is effective in improving oxidative stress and reducing creatinine in DR. Further trials are necessary to confirm these promising findings.

Background: Evidence-based screening is crucial to detect myocardial ischemia in high-risk diabetics. We explored the relationship between nitric oxide (NO) levels, lipid profile indices, and atherogenic index of plasma (AIP) in type 2 diabetics with coronary artery disease (CAD) and to determine their potential as prognostic markers.

Materials and methods: A case-control study included 50 diabetics with CAD (cases), 30 diabetics without CAD (control 1), and 23 healthy controls (control 2). Biochemical parameters were determined using standard protocols; plasma NO was measured via the Griess reaction.

Results: Cases had the highest levels of NO, fasting blood sugar, glycated hemoglobin (HbA1c), and triglycerides, and the lowest total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) levels. Cases exhibited the highest TC: HDL-C, LDL-C: HDL-C, and AIP ratios. A significant positive correlation between NO and HbA1c (r = 0.328, P = 0.020).

Conclusion: Chronic hyperglycemia could enhance NO overproduction driven by inducible isoform, suggesting a potential role for chronic hyperglycemia in endothelial dysfunction and vascular complications in diabetes.

Background: Proteinuria is a key indicator of kidney damage in diabetic nephropathy, and its severity correlates with the progression of the disease. In diabetic patients, it is crucial to identify reliable predictors for proteinuria and its severity for early detection and management of kidney damage.

Materials and methods: This cross-sectional study was conducted from November 16, 2022, to May 20, 2023, on patients with type 2 diabetes mellitus (T2DM) who were outpatients at clinics of Shahid Modarres Hospital, Tehran, Iran. Participants were categorized based on their level of proteinuria during 24-h as follows: group A1 (normal to mildly increased proteinuria), Group A2 (moderately increased proteinuria), and Group A3 (severely increased proteinuria). Then, complete blood cell count and other laboratory parameters, were compared between study groups.

Results: In this cross-sectional study, 128 participants, including 53 (41.4%) men and 75 (58.6%) women with T2DM, were enrolled. The mean age of participants was 56.40 ± 13.31 years. Although there were no significant differences between cell count and parameters of three groups, a statistically significant difference was seen in neutrophil-to-lymphocyte ratio (NLR) (1.93 ± 0.76, 2.34 ± 0.93, and 2.73 ± 1.07 in A1, A2, and A3 groups, respectively; P = 0.003). Further analysis showed that NLR was significantly higher in Group A3 compared to A1 (2.73 ± 1.07 vs. 1.93 ± 0.76, respectively; P = 0.006), but there was no significant difference between Groups A3 and A2 (2.73 ± 1.07 vs. 2.34 ± 0.93, respectively; P = 0.482) and between Groups A2 and A1 (2.34 ± 0.93 vs. 1.93 ± 0.76, respectively; P = 0.257).

Conclusion: Overall, this study suggests that some routine laboratory parameters may be associated with proteinuria and its severity in patients with T2DM. NLR, in particular, showed this association in our study, promising future studies evaluating this association and whether it can help as a predictor or not.

Background: Few studies explore the patient heterogeneity, trajectory development, and factors influencing the functional recovery of the postacute care cerebrovascular disease (PAC-CVD) program. The objective of the study was to analyze the group-based trajectory and different functional improvement for patients with acute stroke participating in the PAC-CVD program.

Materials and methods: A total of 328 patients with acute stroke who had participated in PAC-CVD program in rehabilitation departments of three hospitals from 2014 to 2017 were enrolled in this retrospective cohort study. Latent profile analysis (LPA) was applied to analyze the clinical characteristics between high- and low-function groups (LFGs). The analysis of variance and Chi-square test were used to analyze the association between functional grouping and patients' characteristics.

Results: In the study baseline, patients could be divided into high function group (HFG; 85/328 = 25.9%), medium function group (MFG; 128/328 = 39.02%), and (LFG; 115/328 = 35.06%) by LPA. age (P = 0.001), length of hospital stays (P = 0.001), male sex (P = 0.048), and lesion type (P = 0.023) were significantly associated with being grouped in the high-function group. After 6 weeks of rehabilitation training, 100% of HFG remained as HFG, 49.04% of MFG transitioned to HFG, and 50% of MFG continued to remain as MFG. 8.41% of LFG transitioned to HFG, 57% of LFG transitioned to MFG, but still, 34.58% of LFG continued to remain as LFG.

Conclusion: Identifying initial functional groups can guide medical professionals to target patients for PAC service use. PAC-CVD high-intensity rehabilitation significantly enhances acute stroke patients' functional recovery, though effectiveness varies over time. These factors highlight the need for further development of rehabilitation programs to boost patient independence.

Background: There have not been any clear studies on the use of mesenchymal stem cells (MSCs) to treat osteoarthritis (OA) in the knee.

Materials and methods: This study investigates the effects of different MSC dosages on pain alleviation in individuals with OA in the knee by conducting a meta-analysis of existing randomized controlled trials. Electronic resources such as Google Scholar, PubMed, Cochrane Library, and Web of Science were searched up until June 2023. Treatment effect sizes were computed using the knee osteoarthritis outcome score (KOOS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Knee Society Score (KSS). Random or fixed effect models were applied to aggregate the data. We performed a subgroup analysis according to dosage level. The heterogeneity of the research was investigated using the Chi-square test and the I2 index.

Results: The meta-analysis included 26 studies with a total sample size of 739 patients. A significant reduction in pain was observed 1 year and 2 years following the injection of MSCs into the injured joint, as indicated by the Visual Analogue Scale, WOMAC, KOOS, and KSS indexes (P < 0.05). Patients on MSCs reported much reduced pain after 1 and 2 years compared to the control group (P < 0.05). Subgroup and meta-regression analyses revealed no statistically significant variations in the effectiveness of MSC dosage (P < 0.05). The studies did not report any adverse effects.

Conclusion: Different dosages of MSCs had the same pain-relieving effects on patients with OA in the knee. MSC injections were safe and beneficial in such cases.

Background: This study investigated the effects of humor therapy on the fatigue levels of patients receiving hemodialysis (HD).

Materials and methods: A single-blind, randomized clinical trial of 66 HD patients for 3 weeks was conducted, in which two groups were randomly allocated - humor therapy and control. In the intervention group, humor therapy sessions were conducted twice a week for 3 weeks. As a pre- and postintervention assessment, the Fatigue Symptom Inventory (FSI) was completed.

Results: According to the repeated-measures ANOVA test, FSI values exhibited a significant decline in the humor therapy group and an increase in the control group at the first, second, and third visits (humor therapy vs. control: 30.38 ± 8.75 and 61.80 ± 13.92, P < 0.001; 35.71 ± 10.05 and 69.53 ± 15.32, P < 0.001; and 34.85 ± 9.24 and 70.34 ± 22.26, P < 0.001, respectively) compared with baseline (humor therapy vs. control: 49.26 ± 5.19 and 52.09 ± 11.69, P = 0.204).

Conclusion: Findings suggest that humor therapy can effectively reduce fatigue levels in patients presenting with HD.

Background: Primary biliary cholangitis (PBC) can impact both the quality of life and the survival of patients. The study aimed to determine the survival rate and associated variables in patients with PBC.

Materials and methods: This cohort research comprised 65 patients diagnosed with PBC who were admitted to the pathology section between January 2010 and December 2019. Survival was determined by reviewing hospital medical data and following up with the patients. The impact of demographic factors, clinical, laboratory, and histopathological aspects on patient survival time was investigated using Kaplan-Meier survival analysis and Cox regression.

Results: The average period of follow-up was 6.25 years with a standard deviation of 3.2 years. In surviving patients, the baseline bilirubin level was 2.83, but in deceased or transplanted patients, it was 8.95 (P = 0.002). The baseline albumin level was 3.99 in surviving patients and 3.66 in deceased or transplanted patients (P = 0.024). The incidence of cirrhosis in those who survived was 1.8%, but in patients who died or underwent a transplant, it was 40%. Out of 65 cases, 3 patients (4.7%) died and 7 (10%) had liver transplants. Survival rates of patients vary based on factors such as jaundice (P = 0.002), weariness (P = 0.03), cirrhosis (P < 0.001), and vitiligo (P = 0.033). There were notable variations in the average Mayo score between the two groups of patients who had liver transplantation and survived, with scores of 7.21 and 5.61, respectively.

Conclusion: The study found that aspartate aminotransferase and alanine aminotransferase levels, baseline and final bilirubin, albumin, antinuclear antibody, the presence of cirrhosis, and jaundice significantly influenced patient survival with PBC.