Journal of Research in Medical Sciences最新文献

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.

Background: Reducing the frequency of self-monitoring of blood sugar, due to needle phobia, pain, stress, and costs associated with the procedure, can improve patient compliance and quality of life, provided that adequate blood sugar control is maintained. This study aimed to evaluate the effect of low-frequency blood glucose self-monitoring (LFBGSM) on glycosylated hemoglobin (HbA1_C) levels among older adults living with type 2 diabetes mellitus (T2DM), treated with or without insulin.

Materials and methods: This randomized controlled trial with a parallel design was conducted on 121 older adults with T2DM in Sabzevar, Iran, between 2018 and 2020. Initially, subjects were stratified based on the type of treatment (with or without insulin) and then randomly assigned to intervention (LFBGSM) and control (no blood glucose self-monitoring [no-BGSM]) groups. HbA1_C levels were measured at the beginning of the study and 3 months later for all study groups.

Results: The mean age of participants treated with and without insulin was 64.3 ± 9.60 and 64.7 ± 5.01 years, respectively. The ANCOVA test revealed a significant difference in the mean HbA1_C levels among the four groups 3 months postintervention (P < 0.001). The HbA1_C scores significantly decreased in the LFBGSM groups and increased in the no-BGSM groups at 3 months postintervention (insulin/LFBGSM, insulin/no-BGSM, noninsulin/LFBGSM, and noninsulin/no-BGSM: 7.74 ± 0.76, 8.34 ± 1.53, 7.70 ± 0.75, and 8.14 ± 1.11, respectively) compared to baseline (8.25 ± 0.67, 8.03 ± 0.64, 8.08 ± 0.69, and 7.83 ± 0.74, respectively). The least significant difference post hoc tests showed significant differences between specific groups, emphasizing subtle responses to interventions (P values ranging from 0.001 to 0.929).

Conclusion: Findings suggest a significant reduction in HbA1_C scores within the LFBGSM groups, while a discernible increase is observed in the no-BGSM groups over the 3 months. These findings underscore the efficacy of the interventions and emphasize the crucial role of personalized approaches in optimizing glycemic control for individuals with diabetes.

Background: The objective of the study was to systematically evaluate the efficacy and safety of semaglutide in overweight or obese adults with or without type 2 diabetes.

Materials and methods: The study, registered with PROSPERO (CRD42023450979), was designed as a systematic review and meta-analysis. Using a combination of subject matter and free words, a comprehensive search of Embase, PubMed, and Cochrane Library databases was performed to identify randomized controlled trials of semaglutide in overweight or obese adults with or without Type 2 diabetes mellitus from January 1, 2020, to July 14, 2023. The primary outcomes were the changes in body weight and adverse drug reaction (ADR). Random or fixed effects models were used in meta-analysis, pooling data as relative risks (RRs) or mean difference (MD) with 95% confidence intervals (CIs). Cochrane Collaboration's Risk of Bias tool was used to assess quality. Meta-analysis was performed using RevMan 5.3.

Results: A total of 2490 publications were retrieved. Fifteen publications were finally included, totaling 6984 overweight or obese adult patients. Meta-analysis showed that compared with the control group, the semaglutide group was reduced more significantly in body weight (MD = -7.49, 95% CI [-9.92, -5.07], P < 0.001), body mass index (MD = -3.35, 95% CI [-4.79, -1.92], P < 0.001), waist circumference (MD = -7.26, 95% CI [-9.94, -4.58], P < 0.001), as well as glycosylated hemoglobin (RR = -0.66, 95% CI [-1.07, -0.25], P = 0.002), fasting blood glucose values (RR = -4.81, 95% CI [-7.03, -2.60], P < 0.001), and systolic blood pressure (RR = -3.37, 95% CI [-5.32, -1.42], P < 0.001), and the proportion of patients who lost > 5%, 10%, 15%, and 20% of their overall body weight, respectively (RR = 3.19, 95% CI [1.89, 5.36], P < 0.001), (RR = 4.74, 95% CI [2.78, 8.11], P < 0.001), (RR = 6.17, 95% CI [3.88, 9.82], P < 0.001), and (RR = 9.14, 95% CI [6.05, 13.80], P < 0.001) were also superior to the control group. Regarding safety, the incidence of total ADR in the semaglutide group was close to the placebo group. Still, gastrointestinal adverse effects such as nausea, vomiting, abdominal pain, and diarrhea were higher than those in the control group.

Conclusion: Semaglutide can effectively lose weight in overweight or obese adults with or without diabetes, potentially providing cardiovascular benefits; however, gastrointestinal adverse should be closely monitored.

Background: The objective of this study was to investigate cognitive performance and brain volume profile in patients with neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS).

Materials and methods: In a historical cohort study, 29 MS patients, 31 NMOSD patients, and 20 healthy controls (HCs) underwent neuropsychological assessment using the Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS). Patients with MS and NMOSD also underwent a 1.5-tesla magnetic resonance imaging scan and high-resolution three-dimensional T1-weighted MPRAGE sequence.

Results: The Symbol Digit Modalities Test scores were significantly lower in MS (mean [standard deviation (SD)] =44.1 [14]) and NMOSD (mean [SD] =45.5 [14.3]) patients compared to HCs (mean [SD] =57 [9.5], P < 0.001). Scores of the Controlled Oral Word Association Test were also lower in MS (mean [SD] =25.9 [9.8]) and NMOSD (mean [SD] =24.6 [10.2]) patients compared to HCs (mean [SD] =36.6 [9.8], P < 0.001). Additionally, the MS group performed worse on the Brief Visuospatial Memory Test (BVMT) compared to the NMOSD group (9.4 ± 3.4 vs. 7.1 ± 3.7 P < 0.001). In MS patients, there was a significant correlation between all cognition scores and total brain lesions, as well as between every test except BVMT-Revised with thalamic volumes. In NMOSD patients, a correlation was found between gray matter volume and the learning phase of the California Verbal Learning Test-II as well as between total lesion percentage and verbal memory and information processing speed.

Conclusion: Both NMOSD and MS patients experienced impairment of information processing speed, working memory, and verbal fluency, whereas visuospatial memory impairment was only observed in MS patients. Despite lower total brain lesion and less thalamic atrophy, patients with NMOSD are at risk of cognitive impairment. Microscopic structural abnormalities may be a possible cause.

Background: Malaria, transmitted by Plasmodium parasites and anopheline mosquitoes, continues to be a leading cause of global disease and death. This retrospective investigation from 2018 to 2023 examines the epidemiological attributes of malaria in Saravan, southeastern Iran. It seeks to evaluate the prevalence, transmission causes, local population impact, and health system effects.

Materials and methods: Blood samples from suspected malaria cases in Saravan health centers were collected for this analysis. Each positive case was detailed with demographic data in a questionnaire. The SPSS 26 statistical program scrutinized data with t-tests comparing the variables.

Results: The study indicated fluctuating malaria cases peaking in 2023, with an annual parasite incidence. (API) of 17.27. Plasmodium vivax was the predominant species (P < 0.001), with the majority of cases in individuals over 15, notably males. A significant number of cases were reported in September (20.7%).

Conclusion: The findings emphasize the persistent malaria challenges in Saravan, accentuating the urgent need to strengthen prevention and control strategies. Reducing disease burden demands focused approaches, including improving prevention and treatment programs, enhancing surveillance systems, developing health infrastructures, and implementing localized therapies, especially considering recent climatic and rainfall patterns.