Journal of Research in Medical Sciences最新文献

In the wake of the dominance of evidence-based thinking, clinical practice guidelines (CPGs) within the country's health system have gained a key position in recent years and playing an important role in enhancing all functions of this system. However, the absence of a standard model, the inadequacy of existing documentation for designing clinical guidelines, data obtained from the national self-care project (IMPROVE-CARE), the Persian Registry of Cardiovascular Disease, the national priorities declared by the Iranian Network of Cardiovascular Research, and most importantly, the order from the Ministry of Health, all highlight the necessity of establishing a structure followed by the creating of a standard model for the development of guidelines, and subsequently, the creation of Iranian clinical guidelines. This policy brief article discusses the process of establishing the structure and the produced content and presents the necessary policies for the development of national clinical guidelines.

Background: We aimed to develop risk models for predicting the onset of developing diabetes and prediabetes in the first-degree relatives (FDRs) of patients with type 2 diabetes, who have normal glucose tolerance (NGT).

Materials and methods: In this study, 1765 FDRs of patients with type 2 diabetes mellitus, who had NGT, were subjected to the statistical analysis. Diabetes risk factors, including anthropometric indices, physical activity, fast plasma glucose, plasma glucose concentrations 2-h after oral glucose administration, glycosylated hemoglobin (HbA1c), blood pressure, and lipid profile at the baseline were considered as independent variables. Kaplan-Meier, log-rank test, univariate, and multivariable proportional hazard Cox regression were used for the data analysis. The optimal cutoff value for risk score was created according to the receiver operating characteristic curve analysis.

Results: The best diabetes predictability was achieved by a model in which waist-to-hip ratio, HbA1c, oral glucose tolerance test-area under the curve (OGTT-AUC), and the lipid profile were included. The best prediabetes risk model included HbA1c, OGTT-AUC, systolic blood pressure, and the lipid profile. The predictive ability of multivariable risk models was compared with fasting plasma glucose (FPG), HbA1c, and OGTT. The predictive ability of developed models was higher than FPG and HbA1c; however, it was comparable with OGTT-AUC alone. In addition, our study showed that the developed models predicted diabetes and OGTT-AUC better than the Finnish Diabetes Risk Score (FINDRISC).

Conclusion: We recommend regular monitoring of risk factors for the FDRs of patients with type 2 diabetes as an efficient approach for predicting and prevention of the occurrence of diabetes and prediabetes in future. Our developed diabetes risk score models showed precise prediction ability compared to the FINDRISC in Iranian population.

Background: Traumatic brain injury (TBI) can result in different complications. Posttraumatic headache (PTH) is a disabling complication of TBI. We investigated the therapeutic effect of memantine on patients with PTH.

Materials and methods: This randomized and double-blinded clinical trial was performed in 2020 in a hospital on 90 patients with head trauma. Patients were divided into two groups. The active group received 5 mg memantine tablet for 2 weeks followed by 10 mg tablet daily for up to 6 months. The control arm received identical placebo tablets. Patients were evaluated at 3 months and 6 months. Headache severity was measured with a Visual Analog Scale for Pain. Headache frequency (per week) and duration were also recorded.

Results: After 3 months, the patients in the memantine group had significantly lower headache severity (P = 001) and frequency (P = 0.008) in comparison to baseline of the study. However, in the placebo group, there was only significant reduction in the headache duration (P = 0.001), and there was no significant reduction in headache intensity and frequency. After 6 months, there was a significant reduction in headache intensity and duration in both groups (P < 0.05), but only in the memantine group, headache frequency was significantly reduced (P < 0.001). Finally, patients in the memantine group had less headache intensity, frequency, and duration after 6 months of taking memantin than the placebo group.(P < 0.05 for all).

Conclusion: The administration of memantine for 6 months could significantly lower the severity, duration, and frequency of PTHs.

Diabetic foot ulcers (DFUs) are a common yet serious complication in individuals with diabetes, often presenting as chronic, nonhealing wounds that significantly impair quality of life. The healing process of DFUs is largely influenced by the local microenvironment, which encompasses factors such as hypoxia, inflammation, and the involvement of various cell types. Poor blood circulation in the affected area results in hypoxia, compromising cellular function and restricting nutrient supply, thereby delaying wound healing. In addition, chronic inflammation disrupts immune system balance, with excessive pro-inflammatory cytokines not only failing to facilitate tissue repair but also exacerbating tissue damage. Moreover, key cell types, including fibroblasts, keratinocytes, and macrophages, play crucial roles at different stages of the healing process, contributing to collagen production and skin regeneration. A comprehensive understanding of the complex dynamics within the DFU microenvironment is essential for developing more precise therapeutic approaches, such as advanced drug delivery systems and bioactive materials, aimed at promoting wound healing and reducing the risk of recurrence.

The production of specific antibodies occurs in response to pathogens, whether encountered naturally or introduced through vaccination, serving as markers of immunity. As novel vaccines are developed and deployed, especially in response to emerging infectious diseases, the ability to distinguish between vaccine-induced and infection-induced antibodies becomes increasingly important. Vaccines are designed to mimic this natural infection process without causing the disease itself. Serological assays are critical tools in immunology, enabling researchers and clinicians to differentiate between antibodies produced by vaccination and those generated by natural infection. By understanding whether an individual's antibodies are the result of previous infection or vaccination, healthcare providers can modify booster recommendations more effectively. It also plays an important role in identifying people with hybrid immunity and in assessing the effectiveness of vaccination campaigns.

The aim of this narrative review is to familiarize clinicians, especially digestive surgeons, to adequately use of serum C-reactive protein as a reliable noninvasive biomarker in diverse practical clinical situations. We hope that the review will help clinicians for their decision-making when facing various digestive diseases including operative and nonoperative pathologies such as anastomotic leakage, pancreatitis, emergency situation, and digestive cancer management and prognosis.

Inflammatory demyelinating pseudotumor (IDP) mimics intracranial neoplasms in terms of both clinical presentation and imaging features. IDP with Marburg-like features represents a severe form of inflammatory demyelinating encephalomyelitis, marked by a dramatic onset, aggressive course, absence of remission, and the presence of tumor-like central nervous system demyelinating lesions. Key features of IDP in brain magnetic resonance imaging include open or incomplete ring enhancement, low T2 rim, peripheral diffusion restriction, absent or mild mass effect, and perilesional edema. In brain magnetic resonance spectroscopy (MRS), elevated glutamate, choline, and lactate peaks are observed; however, brain MRS findings can be nonspecific and nondifferentiating. Pathologic findings show prominent perivascular lymphoid infiltrates consisting predominantly of leukocyte common antigen (LCA)+ and PAX5+ B lymphocytes in immunohistochemistry staining, parenchymal and perivascular macrophages (CD68+), some with visible myelin globules on Luxol Fast Blue staining, preferential loss of myelin with relative axonal preservation and the formation of axonal spheroids (swellings), reactive astrocytosis (GFAP+ and ATRX-), and remyelination with thinner myelin sheaths than background axons at the periphery of the plaque. A review of previous case reports revealed that prompt aggressive immunosuppression therapy in the IDP with Marburg-like features may lead to a favorable response. Initiating treatment with a cycle of high-dose corticosteroids followed by rescue immunosuppressive therapy using cyclophosphamide, mitoxantrone, rituximab, or alemtuzumab demonstrated positive outcomes. In addition, maintenance immunosuppressive therapy with B-cell-depleting agents, such as rituximab and ocrelizumab, showed potential for controlling disease activity and improving long-term prognosis.

Background: There are conflicting results regarding survival in preemptive versus non-preemptive kidney transplant recipients. The present study aimed to estimate the risk of death in preemptive versus non-preemptive kidney transplant recipients.

Materials and methods: In the present retrospective cohort study, all end-stage renal disease (ESRD) patients who underwent kidney transplantation between 1996 and 2021 in referral kidney transplantation centers in Isfahan province were investigated. In total, 499 patients who received dialysis before kidney transplantation (non-preemptive) and 168 patients who received no dialysis before kidney transplantation (preemptive) were included in the final analysis. Data regarding demographic and clinical variables including sex, age, body mass index (BMI), follow-up duration, immunosuppressive regimen change, kidney donor type, underlying causes of ESRD, and comorbidities before and after kidney transplantation were collected.

Results: The mean age was 55.47 ± 15.53 years in preemptive and 54.87 ± 14.69 years in non-preemptive patients (P = 0.65). Mortality rates were 24.44/1000 person-years of follow-up for preemptive and 18.25/1000 person-years of follow-up for non-preemptive patients (P = 0.013). In the crude model of Cox regression analysis, preemptive kidney transplant recipients had a significantly higher risk of mortality compared to non-preemptive kidney transplant recipients (hazard ratio [HR] = 1.59; 95% confidence interval [CI]: 1.09-2.33; P = 0.015). However, the association attenuated and became insignificant after adjustment for confounders, including age, BMI, immunosuppressive regimen change, kidney donor type, and comorbidities (HR = 1.35; 95% CI: 0.92-1.99; P = 0.12).

Conclusion: The results of the present study indicated that there is no independent association between preemptive kidney transplantation and increased risk of mortality.

Background: Body compassion combines the concepts of body image and compassion for oneself. This concept includes the three components of defusion, common humanity, and acceptance. Due to the importance of this concept, this study was conducted to investigate the psychometric properties of the Persian version of the Body Compassion Scale (BCS) in clinical and nonclinical samples.

Materials and methods: This research is of correlational type in the field of psychometrics. The statistical population of the clinical sample included patients referred to cosmetic surgery clinics in Tehran in 2019-2020. Accordingly, 379 people were selected using the convenience sampling. They completed the BCS, Body Image Shame Scale, The Levels of Self-Criticism, Appearance Anxiety Inventory, and Body Image Acceptance and Action Questionnaire. The statistical population in the nonclinical sample includes people present in public places (such as public parks and cinemas) and universities in Kermanshah in 2020-2019. Ultimately, 367 people were selected using the convenience sampling method. Participants completed the BCS, External Shame Scale, Self-Compassion Scale, and Body Imaging Psychological Inflexibility Scale. Data were analyzed using LISREL 8.80 and SPSS 24 software.

Results: The results showed that the three-factor structure of the BCS in both clinical and nonclinical samples has a good fit. Reliability was appropriate by calculating Cronbach's alpha and the test-retest of scale in clinical and nonclinical samples. Convergent and divergent validity of the scale was also good in both clinical and nonclinical samples.

Conclusion: The results showed that the Persian version of the BCS has good psychometric properties in both clinical and nonclinical samples. Therefore, this scale can be a valuable instrument in clinical and research work in the Iranian society.