Journal of Research in Medical Sciences最新文献

Background: Few comparative studies have been carried out into the effects of nonpharmacological interventions on reducing fatigue in hemodialysis patients. This study compared the effect of warm footbath with effleurage and petrissage massages on fatigue in hemodialysis patients.

Materials and methods: Seventy patients undergoing hemodialysis referring to two dialysis centers in 2016 were included in this clinical trial study. However, 62 hemodialysis patients finally completed the study. The patients were selected through a nonrandom sampling method, but were later assigned to one of the three groups of warmwater footbath, effleurage, and petrissage massages based on randomized blocked allocation. Using a multidimensional inventory, fatigue was assessed before the commencement of the interventions, at the end of the first and the 2^nd month of the interventions. The data were analyzed using statistical software of SPSS, version 25, through descriptive statistics by running median and Friedman tests with considering 95% confidence interval.

Results: Warmwater footbath, effleurage, and petrissage resulted in a significant reduction or improvement in global fatigue and types of fatigue of patients undergoing hemodialysis at the end of the first and 2^nd month of the interventions (P = 0.001). The results of the between-groups comparison showed that there was no significant difference (P > 0.05) in fatigue reduction among the three groups of warmwater footbath, effleurage, and petrissage massages in terms of the median index of fatigue scores.

Conclusion: Warmwater footbath, effleurage, and petrissage massages have similar positive effects on fatigue in patients undergoing hemodialysis.

Background: Given the high prevalence of hypertension in older adults, this study was conducted to identify the factors affecting the 5-year survival of older people with hypertension.

Materials and methods: In this cohort study, individuals aged 60 and over living in Amirkola, north of Iran who were diagnosed with hypertension were followed up for 5 years, and the effect of various factors on their survival was analyzed.

Results: Among 1439 older people, 892 individuals (61.99%) had hypertension. Age (adjusted hazard ratio [aHR] =1.052, 95% confidence interval [CI] =1.019-1.086, P = 0.002), diabetes mellitus (aHR = 2.166, 95% CI = 1.398-3.354, P = 0.001), serum creatinine (aHR = 2.163, 95% CI = 1.391-3.363, P = 0.001), female gender (aHR = 0.460, 95% CI = 0.276-0.766, P = 0.003), body mass index ≥30 kg/m² (aHR = 0.386, 95% CI = 0.212-0.701, P = 0.002), physical activity score >150 (aHR = 0.382, 95% CI = 0.162-0.898, P = 0.027), each one unit increase of social support score (aHR = 0.914, 95% CI = 0.861-0.970, P = 0.003), and instrumental functional ability score (aHR = 0.907, 95% CI = 0.843-0.974, P = 0.009) showed a significant effect on 5-year survival of older people.

Conclusion: Multiple factors (such as age, gender, social support, lifestyle behaviors, and comorbidities including diabetes mellitus and renal function) might predict the 5-year survival of the elderly with hypertension. They should be considered in health-care package of these patients.

Background: Sarcopenia, characterized by reduced muscle strength and mass, is commonly observed in patients with kidney disease. This study aimed to investigate the factors that influence sarcopenia in patients undergoing maintenance hemodialysis (HD patients).

Materials and methods: A case-control study was conducted from 2022 to 2023, involving a total of 137 HD patients receiving regular dialysis. Relevant data were collected, and based on diagnostic criteria, patients were classified into sarcopenia and nonsarcopenia groups. All patients received polysulfone membrane HD at a flow rate of 500 mL/min. Bioelectrical impedance analysis was used to evaluate phase angle (PhA), muscle volume, and body composition.

Results: The prevalence of sarcopenia among maintenance HD patients was found to be 40.14%. There was a higher proportion of women (76.36%) with sarcopenia compared to men (P < 0.001). Furthermore, a significant difference was observed in PhA (P < 0.006) between patients undergoing maintenance HD with and without sarcopenia. PhA was positively associated with body mass index, body cell mass, basal metabolic rate, fat-free mass, soft lean mass, and minerals, whereas age and skeletal muscle index showed an inverse significant correlation.

Conclusion: Sarcopenia, a condition associated with increased mortality risk, affects a considerable proportion of dialysis patients. It is imperative to urgently identify and develop preventive and therapeutic strategies to counteract the detrimental effects of sarcopenia on the health outcomes of kidney patients.

Background: Knee osteoarthritis (KOA) is the most expected diagnosis for an arthropathy that causes discomfort and disability in older adults. Radiography is frequently used to assess patients with KOA and there have been few prior research evaluating the diagnostic efficacy of ultrasonography (US). The current study sought to assess the diagnostic efficacy of the US in identifying various characteristics of KOA in the scientific literature.

Materials and methods: This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta Analyses statement. A systematic search in PubMed, Web of Science, Scopus, and Embase databases was completed in March 2023. This study focused on the diagnostic value of US in KOA, including sensitivity, specificity, positive predictive value, and negative predictive value. The quality assessment was conducted using the Joanna Briggs Institute critical appraisal tools.

Results: Out of 552 records of database searches, finally, two studies met this systematic review's eligibility criteria and were included in the study. Both of the included studies were cross sectional studies. US demonstrated remarkable sensitivity with adequate specificity for the detection of radiographic knee OA; however, it was found not to be an appropriate method for the detection of early KOA.

Conclusion: This study as the first systematic review aims to evaluate the diagnostic performance of US in detecting KOA. These findings shed light on the importance of investigating the different US features in the evaluation of KOA to reach appropriate sensitivity and specificity in the diagnosis.

Background: Paraquat poisoning remains a critical public health issue with no established effective treatment. Hemoperfusion (HP) has been recognized for its potential to remove toxins and is widely employed in several developing countries for managing acute paraquat poisoning cases. However, the reluctance of some patients to undergo this recommended treatment has been observed but not thoroughly investigated. This study aimed to explore the factors associated with the refusal of HP in patients suffering from paraquat intoxication.

Materials and methods: In this retrospective study, data of 358 patients with acute paraquat poisoning were analyzed in Xi'an, China. The outcome of our study was mortality, and the influential factors were age, gender, marital status, educational level, symptoms at presentation, and laboratory findings. A logistic regression model was utilized to explore the independent risk factors.

Results: In a total of 358 paraquat-poisoned patients, the significant differences were found between patients who underwent HP and those who did not, particularly regarding mean age (48.02 years vs. 42.32 years; P = 0.01), mental disorders (15.6% vs. 6.1%; P = 0.01), poisoning severity score (2.36 vs. 2.57; P = 0.03), organ failure (10.9% vs. 23.5%; P = 0.02), and mechanical ventilation (18.8% vs. 33.3%; P = 0.02). Patients who refused HP exhibited a higher mortality (20.3% vs. 10.9%; P = 0.03) compared to those who received HP. Age (odds ratio (OR), 1.76; 95% confidence interval (CI): 1.01-3.82; P = 0.01) and history of mental disorders (OR, 2.81; 95% CI: 1.19-6.61; P = 0.02) were identified as significant independent predictors for the refusal of HP.

Conclusion: The results of this study showed that elderly individuals and those with a history of mental disorders were independently associated with refusing HP in patients with acute paraquat poisoning.

Oxidative stress plays a key role in brain damage because of the sensitivity of brain tissue to oxidative damage. Biomarkers with easy measurement can be a candidate for reflecting the oxidative stress issue in humans. For this reason, we need to focus on specific metabolic products of the brain. End products of free radical reactions such as malondialdehydes form fluorescent products known as lipophilic fluorescent products (LFPs). The distinctive feature of LFPs is their autofluorescent properties. LFPs are detectable in the brain and cerebrospinal fluid. Furthermore, because of the diffusion into the bloodstream, these lipophilic molecules can be detected in the blood. Accumulations of these compounds produce more reactive oxygen species and increase the sensitivity of cells to oxidative damage. Hence, LFPs can be considered a danger signal for neurons and can be introduced as a strong index of oxidative damage both in the central and in the peripheral.

Background: The aim of this study was to determine whether mammographic and sonographic features of malignant breast lesions are correlated with tumor histologic grade, hormonal receptor, human epidermal growth factor receptor 2 (HER2), and Ki-67 status.

Materials and methods: In this retrospective study, imaging and histopathological findings of 187 biopsy-proven breast cancer cases from November 2019 to February 2021 were reviewed. The Chi-square test was used to examine the potential correlation between mammographic and sonographic characteristics with histopathological features such as hormonal receptor, HER2 status, Ki-67 labeling index, and histological grade.

Results: We observed that microlobulated margin as well as oval/round morphology in mammograms correlate with triple-negative intrinsic subtype (P = 0.006 and P = 0.004). The presence of calcification in sonography was significantly higher in the luminal-B subtype (P = 0.002). Furthermore, ill-defined margins in mammography were significantly higher in amplified HER2 expression (P = 0.004) in the same manner as an oval/round shape in higher levels of Ki-67 (P = 0.030).

Conclusion: Mammography and sonography features may reflect the biological behavior of various subtypes of breast cancer and can detect more aggressive breast cancers that can mimic benign or less malignant appearing lesions. These findings may be an excellent predictor for some subtypes like triple-negative breast cancer. Studying the range of these imaging characteristics may help in better understanding the prognosis, choosing a treatment strategy, and predicting response to treatment.

Both diabetes and peripheral arterial disease (PAD) have complex interactions with COVID-19. PAD is one of the most important underlying factors in the development of diabetic foot. The COVID-19 pandemic has also caused an increase in cardiovascular complications in those with chronic diseases, including diabetics, due to both the thrombophilic course of the viral disease and the lockdown measures applied for prevention. Since both COVID-19 and diabetes mellitus predispose to thrombosis, PAD is likely to have a more severe course in diabetic patients with COVID-19. The aim of our study is to discuss the complications, prophylaxis, and treatment of PAD, which is a serious complication of diabetes, during the pandemic period.

Background: Oxidative stress has a role in many pathologic conditions, including oral diseases and temporomandibular joint disorders (TMDs) pathophysiology. This study compared the selected oxidative biomarkers' levels in TMD patients and healthy controls in a systematic review and meta-analysis.

Materials and methods: Medline/PubMed, Scopus, Web of Science, Google Scholar, and Embase were systematically searched for English articles up to October 2022 using MeSH and free keywords. Joanna Briggs Institute checklist was used to assess the risk of bias. Differences between biomarker levels in TMD patients were compared to the control group.

Results: Ten case-control studies were included based on inclusion and exclusion criteria with a total of 659 patients: 314 with TMD and 345 healthy controls. The studies investigated 15 markers, including total oxidant status (TOS), total antioxidant status, and malondialdehyde (MDA). There was a significant difference in the salivary MDA of patients with TMD in comparison with healthy people; standard mean difference = 3.22 (95% confidence interval [CI]: 0.28-6.16); I ² = 96.0%). The Antioxidant status in serum was significantly lower in patients with TMD in comparison with healthy people; weighted mean difference = -0.52 (95% CI: -0.90 to -0.14; I ² = 97.0%). The result of TOS was inconclusive.

Conclusion: Salivary MDA and serum total antioxidative status measurements may be used as a biomarker for diagnosing TMD. Due to the lack of sufficient evidence, it is not possible to express a definite relation between the amount and type of marker and TMD diagnosis, which suggests that more case-control studies with larger sample sizes are required.