Journal of Research in Medical Sciences最新文献

Background: Results from different studies on the effects of purslane consumption on blood pressure (BP) are still debated. To fill this knowledge gap, we investigated the overall effects of purslane consumption on systolic BP (SBP) and diastolic BP (DBP).

Materials and methods: A comprehensive literature search was conducted on Scopus, Web of Science, PubMed, Google Scholar, and Cochrane databases. A random-effect model was used to estimate the weighted mean difference (WMD) and 95% confidence interval (CI) for each outcome. Between studies heterogeneity was assessed by the I2 test. Prespecified subgroup analyses were performed to examine heterogeneity across sample size, age, sex, dosage, duration, and health status. This meta-analysis included randomized controlled trials (RCTs) involving adults (≥18 years) with either parallel or crossover designs. Studies must have included a control group, with the only intervention being purslane consumption and reported data suitable for calculating BP outcomes. Study quality was assessed using the Cochrane risk of Bias Tool and evidence certainty was rated through the grading of recommendations, assessment, development, and evaluation (GRADE) approach.

Results: Five trials were included in the meta-analysis. Pooled analysis showed that purslane consumption significantly reduced SBP (WMD: -3.06 mmHg, 95% CI: -6.02 to - 0.11, P = 0.042; I2 = 95.5%, P < 0.001). However, purslane consumption did not change DBP (WMD: -0.62 mmHg, 95% CI: -2.01-0.87 P = 0.386; I2 = 81.7%, P < 0.001). Nevertheless, after subgroup analysis a significant decrease in DBP levels was observed among participants who were older than 40 years, had diabetes, and underwent a 12-week intervention. According to the GRADE assessment, the certainty of evidence for SBP was rated as moderate due to serious concerns about indirectness, whereas the evidence for DBP was rated as low quality because of significant limitations related to both imprecision and indirectness.

Conclusion: Our findings suggest that purslane consumption may have a modest but clinically significant effect on reducing SBP compared to placebo and may improve DBP in specific subgroups. Given that even small reductions in SBP are associated with important reductions in cardiovascular risk, purslane may represent a promising complementary nutritional strategy for BP management. However, further well-designed RCTs with larger sample sizes are needed to confirm these effects and assess their long-term clinical significance.

Background: Bipolar disorder (BD) and attention deficit hyperactivity disorder (ADHD) are two distinct psychiatric disorders characterized by significant overlap in symptoms, making differential diagnosis challenging. Due to the lack of a definitive test for diagnosing and differentiating these disorders, the present study aimed to accurately diagnose and differentiate between patients with BD and ADHD using the support vector machines (SVM) with radial basis function, polynomial, and mixture kernels, as well as ensemble neural networks, to analyze functional magnetic resonance imaging (fMRI) data.

Materials and methods: In this study, 49 individuals with BD and 40 individuals with ADHD were analyzed. A protocol based on fMRI imaging and a switching task was proposed for diagnosing ADHD and BD. The graph theory method calculated the graph criteria using the CONN toolbox in 15 areas of the attention circuit. The effective features were then selected using the genetic algorithm (GA), and finally, the performance of the models was evaluated using four criteria: accuracy (ACC), sensitivity (SE), specificity (SP), and area under the curve (AUC).

Results: 57 effective and important features were selected as input features by GAs with 99.78% ACC. The performance score of the models showed that the SVM with mixture kernels model performed best among the other algorithms (ACC = 92.1%, SE = 92.6%, SP = 97.3%, and AUC = 0.931).

Conclusion: According to the evaluation criteria values, the best model for diagnosing ADHD from BD has been suggested. This approach can be useful in diagnosis, psychological, and psychiatric interventions.

Background: While numerous studies highlight the significant health benefits of physical activity, there is limited research on the effect of various exercise training in children with type 1 diabetes mellitus (T1DM). The current study aimed to investigate the effects of physical activity on the expression of microRNA (miRNA)-192, serum glucagon-like peptide-1 (GLP-1) level, and some factors related to T1DM in children.

Materials and methods: In this randomized clinical trial study, a total of 20 children with T1DM were randomly divided into the following two groups and trained for 8 weeks: home-based resistance training (HBRT) (n = 10, age = 12.6 years) and leisure-time physical activity (n = 10, age = 12.4 years). Metabolic biomarkers, serum levels of miRNA-192, GLP-1, and other relevant measurements were assessed in each patient 48 h before and after completing the 8-week training program.

Results: The findings showed that in both the training groups, fasting blood glucose concentrations decreased significantly, and maximum oxygen consumption (VO₂ max) increased significantly (P ≤ 0.05). Furthermore, a significant difference was identified between the cardiovascular endurance (VO₂ max) levels of the two groups, with the HBRT group demonstrating a more substantial improvement. Although increased levels of fasting insulin and decreased levels of glycated hemoglobin were not significant in both the groups (P ≥ 0.05), a significant increase was observed in the GLP-1 serum levels of both the groups and their miRNA-192 levels decreased by 58%-60% (P ≥ 0.05).

Conclusion: Encouraging children with T1DM to do appropriate exercise training workouts at home as well as proper physical activities during their leisure time can be effective in reducing potential complications in patients and improving their health.

Background: To investigate the level of agreement in the measurement of coronary artery calcification among radiology technicians and radiology specialists.

Materials and methods: This cross-sectional study was conducted on 544 cases in the Radiology Department of Al-Zahra Hospital in Isfahan in 2021. The archives of heart computed tomography scans were reviewed, and coronary artery calcium scores (CACS) reported by radiology technicians and radiologists were marked and compared.

Results: The level of agreement of the score measured by two evaluators in the whole sample is equal to intracluster correlation coefficient = 0.996 (95% confidence interval [CI]: 0.995-0.997) (P < 0.001) and the level of agreement based on calcification categories measured by weighted kappa was 0.968 (95% CI: 0.953-0.982)(P < 0.001), both of which indicate an excellent and significant intensity of agreement.

Conclusion: The results of our study demonstrate a high level of agreement regarding CACS between technicians and radiologists.

Background: ST-elevation myocardial infarction (STEMI) remains a significant global health concern, especially in low- and middle-income regions. This study aimed to identify long-term prognostic factors among STEMI patients, offering insights into improving patient outcomes.

Materials and methods: This study represents the 5-year follow-up of STEMI patients in the SEMI Cohort in Isfahan registry, a clinical-based registry of STEMI patients in Isfahan, Iran, from October 2015. All patients with STEMI within 24 h of symptom onset underwent a comprehensive evaluation. The dataset included demographic information, laboratory data, medical history, and clinical in-hospital data. Over 5 years, annual follow-ups were conducted to track hospitalization and patient all-cause mortality. Utilizing univariate and multivariate Cox regression proportional hazard modeling, we aimed to identify predictors of death.

Results: In this study, involving 759 patients (621 men and 138 women) with a mean age of 58.92 ± 11.79 years, 158 deaths (21%) with a mean age of 70.33 ± 12.66 years occurred after STEMI. In the multiple model our analysis revealed that the following variables significantly increased all-cause mortality independently: Older age (hazard ratio [HR]: 1.070, P < 0.001), lower body mass index (HR: 0.890, P < 0.001), hypertension status (HR: 2.441, P < 0.001), lower systolic blood pressure at initial presentation (HR: 0.983, P < 0.001), number of affected epicardial territories (HR: 2.979, P < 0.001), lower last ejection fraction before discharge (HR: 0.951, P < 0.001), lower hemoglobin level (HR: 0.747, <0.001), higher plasma glucose level (HR: 1.005, P < 0.001), and in-hospital complications (HR: 7.646, P < 0.001).

Conclusion: This study identified a range of factors that predict STEMI-related mortality. These findings are pivotal for future planning and decision-making regarding appropriate diagnostic and therapeutic strategies during patient follow-up, contributing to improved outcomes in STEMI care.

Background: For a long time, it has been proposed that aspirin might have a preventive property to reduce the risk of preeclampsia; however, recent assessments have changed the insights toward this medication. The current qualitative systematic review aims to thoroughly assess the outcomes of treatment with aspirin in high-risk preeclampsia women.

Materials and methods: The scope of this study was to evaluate: (1) the preventive role of treatment with aspirin on high-risk pregnancies for preeclampsia, (2) the applied dose on the incidence of preeclampsia, (3) the outcome of using aspirin alone versus in combination with an anticoagulant, and (4) the outcome of aspirin discontinuation on the incidence of preeclampsia. PubMed, Scopus, Web of Science, and Embase databases were searched from January 1, 2015, to December 31, 2023. English-written studies with trial designs (randomized or nonrandomized) assessing the use of aspirin on preeclampsia prevention among high-risk women for this phenomenon were included. Three authors independently surfed the databases and selected the studies; in case of any disagreement, the problem was resolved by the fourth author. Then, the papers were fully screened and those that met the study criteria were individually evaluated. The revised JBI critical appraisal tool for the assessment of risk of bias for randomized controlled trials was applied categorizing the studies into low-moderate and high risk of bias.

Results: Finally, data from twenty-three studies on 15,764 high-risk preeclampsia individuals with singleton pregnancies were extracted. Fourteen, 4, and 5 studies had low, moderate, and high risk of bias. Aspirin use regardless of its dosage was not remarkably associated with reduced risk of preeclampsia in the majority of studies. Besides, the time of initiation or discontinuation did not affect the outcomes. Moreover, aspirin combination with anticoagulant was not necessarily superior over aspirin alone.

Conclusion: Based on our findings, the body of evidence majorly found no remarkable role for prophylactic aspirin use to prevent preeclampsia incidence at any time during pregnancy; however, promising data, particularly in higher doses and earlier initiation of aspirin, have been noted.

Background: Osteoarthritis (OA) is a disease whose treatment is essential due to various complications, such as pain, inflammation, and disturbance in patients' quality of life (QOL). This study aimed to determine the effect of Helicobacter pylori eradication therapy on QOL and arthritis symptoms in patients with OA who are infected with H. pylori.

Materials and methods: In this clinical trial, 62 OA patients were categorized into two groups based on diagnostic tests: H. pylori positive and negative. The negative group received only standard OA treatment, while the positive group underwent eradication therapy in addition to standard treatment. Patients were assessed and compared before, 4 weeks, and 8 weeks after treatment using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analog Scale (VAS), and European Quality of Life Questionnaire. Data were analyzed using the SPSS software.

Results: Comparison of the two groups revealed a significant reduction in physical function, joint stiffness, pain, total WOMAC, and VAS scores in the H. pylori positive group over the study period (P < 0.05), whereas no significant changes were observed in the negative group (P > 0.05). QOL scores improved significantly in the eradicated group (P < 0.05). Significant improvements were seen between the eradicated and noneradicated subgroups in physical function, pain, total WOMAC, and VAS scores, with more significant improvements in the eradicated group (P < 0.05). After the intervention, self-care and QOL scores differed significantly between the groups, with the eradicated group showing better outcomes (P < 0.05).

Conclusion: In OA patients with H. pylori infection, eradication therapy improves specific symptoms, pain, and QOL.

Background: Cancer of unknown primary (CUP) is characterized by metastatic cancer cells with no identifiable primary tumor despite extensive diagnostics. This study investigates the epidemiologic, histopathological, and prognostic factors in 352 CUP cases in Iran.

Materials and methods: This retrospective study reviewed the clinical documents of CUP patients registered in MACSA, a charity-based referral center in central Iran, Isfahan, within 2016-2021. The patients' data were analyzed, and survival associations were assessed using Cox proportional hazards regression models.

Results: Altogether 352 CUP patients were included in the study. The mean age at diagnosis was 65.9 ± 14.3 years, with 52.6% being male. Abdominal pain (32.1%) was the most common presentation. Metastatic adenocarcinoma (31.5%) was the most frequent histopathological type, with the liver (48.6%) as the most prevalent metastatic site. Single-site metastasis was seen in 55.4% of patients. Immunohistochemistry, conducted in 40.3% of patients, was inconclusive in identifying the primary site. The median overall survival was 5 months (95% confidence interval [CI]: 4.0-7.0). Multivariable Cox regression analysis showed older age increased risk of death (hazard ratio [HR]: 1.028, 95% CI: 1.019-1.037). Neuroendocrine tumors were linked to a lower risk (HR: 0.553, 95% CI: 0.313-0.978), while metastasis to the liver (HR: 1.382, 95% CI: 1.076-1.774) and pancreas (HR: 2.138, 95% CI: 1.094-4.176) increased mortality risk.

Conclusion: This study provides large-scale evaluation of CUP in an Iranian population, revealing its poor prognosis and the limited diagnostic utility of IHC. The findings align with global data and highlight the urgent need for improved diagnosis and treatment to enhance patient outcomes.