Melatonin Supplementation and Anthropometric Indices: A Randomized Double-Blind Controlled Clinical Trial.

Obesity, as the most common metabolic disorder in the world, is characterized by excess body fat. This study is aimed at determining the effects of melatonin supplementation on body weight, nody mass index (BMI), waist circumference (WC), and body fat mass percentage (BFMP) in people with overweight or obesity. Thirty eight overweight or class-I obese adult individuals were recruited in the study (8 men and 30 women). Participants prescribed a weight-loss diet and then randomly were allocated to melatonin or placebo groups. Participants received either a 3-milligram melatonin or placebo tablet per day for 12 weeks. In order to assess differences at the significance level of 0.05, repeated measure ANOVA and paired t-test were used. According to the results, a significant reduction was found in participants' body weight, WC, and BMI in both groups (p = 0.001). However, for the last six weeks, significant reductions of these parameters were observed only in the melatonin group (p = 0.01). The BFMP of participants in the melatonin group showed a significant reduction at the end of the study compared to the initial measurements (p = 0.008). Nevertheless, the results of the present study alone are not sufficient to conclude on the effects of melatonin consumption on anthropometric indices, and it seems that further studies are required in this regard.

Fabrication of cumin loaded-chitosan particles: Characterized by molecular, morphological, thermal, antioxidant and anticancer properties as well as its utilization in food system.

The aim of this study was the fabrication of stable encapsulated cumin essential oil using ionic gelation method and its application in mayonnaise as a natural antioxidant. The obtained nanoparticles exhibited a positively charged surface with diameters ranging from 269 to 326 nm. In addition, results from encapsulation efficiency demonstrated that excess concentration of initial essential oil reduced the amount of entrapped essential oil. From the obtained observation, the optimal weight ratio of chitosan to cumin essential oil of 1:0.5 was selected. In vitro release study indicated an initial burst at all different pH, although the most release rate was related to acidic media (pH = 3). Furthermore, an improvement of thermal stability and antioxidant properties was observed. Regarding cytotoxicity results, loaded particles had a good biocompatibility, while there were slight prevention effects on breast and brain tumor at the highest concentration. Finally, the antioxidant properties of fabricated nanoparticles were investigated in mayonnaise. It significantly reduced peroxidase value (POV) and thiobarbituric acid (TBA) values during storage period. Overall, our observations showed the encapsulated cumin essential oil could be used as natural antioxidant.

Effect of Honey on Diarrhea and Fecal Microbiotain in Critically Ill Tube-Fed Patients: A Single Center Randomized Controlled Study.

BACKGROUND: In patients admitted to the Intensive Care Unit (ICU), Enteral Nutrition (EN) is the first choice for feeding support, however, it is often complicated by gastrointestinal side effects, such as diarrhea. There are no studies that have specifically evaluated effect of a prebiotic, which prevents diarrhea during enteral nutrition. OBJECTIVE: This study aimed at evaluating the effect of honey in enteral diet during occurrence of diarrhea and fecal microbiotain in critically ill patients. MATERIALS AND METHODS: In this double-blind, randomized controlled single-center study, 32 patients were randomly selected to receive a high protein kitchen enteral diet and the study group had honey as 10% of its carbohydrate intake. Quantitative analyses of bifidobacterium and Lactobacillus species of fecal samples were assessed by Real-Time Polymerase Chain Reaction (PCR) on days 0 and 7. RESULTS: Patients in the honey group showed an insignificant increase in the frequency of bifidobacterium DNA by study day 7 in comparison with the control group. In the honey group, there was a considerable reduction in diarrhea (P = 0.09). A significant difference was found in length of Intensive Care Unit (ICU) stay (P = 0.001) and Sequential Organ Failure Assessment (SOFA) score (P = 0.04) in favor of the honey group. CONCLUSIONS: Enteral nutrition with honey might reduce the length of stay at the ICU and development of organ failure in critically ill patients. It seems that honey helps reduce the incidence of diarrhea.

Estimating postoperative survival of gastric cancer patients and factors affecting it in Iran: Based on a TNM-7 Staging System.

Recently, reports have shown that gastric cancer has high abundance in Iran and is at the second level in men, and fourth in total. This study aimed to determine the 5-year survival of gastric cancer patients and to investigate factors affecting the performance, based on TNM-7 staging system. In this study, we investigated 760 patients with gastric cancer since the beginning of 1993 to the end of 2006 in the Iran Cancer Institute who underwent surgery. Survival of these patients was determined after surgery, and the effects of demographic characteristics such as age (during operation), sex, and information on diseases such as cancer site, pathologic type, stage of disease progress (Stage), metastasis and sites of metastases were evaluated. The 5 -year survival probability of patients was 28 %, and median survival time was 25.69 months. Univariate tests showed that sex, cancer site, and pathologic type have no significant effects on patient's survival. But the probability of 5-year survival significantly decreases with increasing age, and as it is expected, those with metastases were significantly less likely to have 5-year survival, and disease stage was significantly effective on patients' life (P<0.001). Simultaneous evaluation of different variables' effects on the probability of survival using the multiple Cox proportional hazards models showed that age and stage disease variables were effective on the survival of patients. The 5-year survival of patients with gastric cancer is low in Iran, although it is improved compared to the past. It seems that one of the main reasons for low survival rate of these patients is a late referral of patients for diagnosis and treatment. Most patients refer in the final stages of the disease, at this stage most patients are affected by lymph nodes metastases, liver and as the result, their treatment will be more difficult.

Association of the Adductor Pollicis Muscle Thickness With Clinical Outcomes in Intensive Care Unit Patients.

BACKGROUND: Different parameters may be used to evaluate the nutrition status of individuals. However, their use in the critically ill is problematic, since the interference of acute disease or therapeutic measures on their results can affect their interpretation. The aim of this study was to assess whether measuring the adductor pollicis muscle is useful in identifying malnutrition and clinical outcomes in the intensive care unit (ICU). MATERIALS AND METHODS: In total, 127 patients were enrolled in this prospective observational study. Serum albumin levels, anthropometrics, adductor pollicis muscle (APM) thickness, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score were measured for each patient upon admission. APM thickness (APMT) was measured while the patient's elbow was flexed at a 90-degree angle and the forearm resting on the patient's torso. RESULTS: The dominant and nondominant APMT were significantly correlated with all anthropometric measurements (r = 0.41-0.68, P < .001 and r = 0.42-0.66, P < .001 respectively). Multivariate regression analysis adjusted by other risk factors, including APACHE II score, serum albumin, and age, showed that among all anthropometric variables, the APMT has the highest correlation with mortality (odds ratio [OR], 5.6; 95% confidence interval [CI], 0.02-0.12; P < .001), length of stay >10 days (OR, 11.3; 95% CI, 4.42-29.1; P < .001), and organ failure (OR, 14.5; 95% CI, 6.5-38.4; P < .001). CONCLUSIONS: The results showed that APMT is a low-cost, reliable, and easy method to assess nutrition status and to predict the patient's outcomes in the ICU.

Traumatic brain injury accelerates kindling epileptogenesis in rats.

OBJECTIVES: Traumatic brain injury (TBI) is a well-known cause of symptomatic epilepsy. In animal models of post-traumatic epilepsy (PTE), progression of trauma to epilepsy takes several weeks to months. Although this long process is similar to clinical PTE, it is costly and laborious. We used a combination of TBI and kindling as an accelerated animal model to develop epilepsy in much shorter period compared to that occurring in PTE. METHODS: Traumatic brain injury was exerted to parieto-temporal cortex of anaesthetised rats by controlled cortical impact (CCI, 5 mm round tip, 4.5 mm/seconds velocity and 150 ms duration). Chemical kindling started 24 hours after CCI by intraperitoneal injection of 30 mg/kg pentylenetetrazole (PTZ) every other day until manifestation of three consecutive generalised seizures. Rapid electrical kindling of the amygdala began 1 week after TBI by exertion of 12 daily threshold stimuli (50 Hz mono-phasic square-wave stimulus of 1 ms per wave for 3 seconds) with 5 minutes interval between each stimulation until the rats became kindled. RESULTS: Controlled cortical impact injury accelerated rate of both chemical and electrical kindling. Number of PTZ injections required for acquisition of generalised seizures decreased from 13.1 ± 1.6 in sham-operated animals to 7.1 ± 0.3 in traumatic rats (p < 0.05). The required number of stimuli to elicit electrically kindled focal and generalised seizures decreased from 24.0 ± 3.9 and 80 ± 6.5 in sham-operated animals to 6.6 ± 0.9 and 53 ± 6.5 in traumatic rats (p < 0.01), respectively. LIMITATIONS: Unlike the animal models of PTE in which recurrent seizures occur spontaneously after TBI, in our study, epilepsy is elicited by kindling stimulations. DISCUSSION: Traumatic brain injury facilitates acquisition of epilepsy in both chemical and electrical kindling models. Combination of trauma and kindling can be considered as an inexpensive and time-saving animal model in PTE studies.

Effect of oral olive oil on healing of 10-20% total body surface area burn wounds in hospitalized patients.

The purpose of this study was to evaluate the effect of consumption of oral olive oil on clinical outcomes and wound healing of thermally injured patients with hospital stays. One hundred patients (mean age; 33.34±7 years) with 10-20% total body surface area, deep second degree and more burn wounds were randomized to receive either oral olive oil or sunflower oil as the oil in their diet. Patients were evaluated daily for occurrence of wound infection, sepsis and healing of the grafted skin. Also the duration of hospitalization and admission to the intensive care unit were compared in two groups. Results showed that there was no significant difference between the olive oil group and the control group in percent of TBSA involvement (14.28±0.53 vs. 13.02±0.48, P=0.7), albumin concentration (3.25±0.5 vs. 3.13±0.5, P=0.5) and mean calorie intake (2034±216.9 kcal vs2118±192.1 kcal, P=0.2). We found a significant difference in the duration of wound healing (7.2±0.5 vs. 8.7±0.5, P=0.04) and duration of hospitalization (7.4±0.5 vs. 8.9±0.4, P=0.05) in the olive oil group versus the control group. We did not find any difference in ICU admission, wound infection and occurrence of sepsis between two groups. This study showed that an oral diet provided with olive oil in patients with burn may accelerate wound healing and decrease the duration of hospitalization.

Effects of pomegranate juice consumption on inflammatory markers in patients with type 2 diabetes: A randomized, placebo-controlled trial.

BACKGROUND: Diabetes causes the increased concentration of circulatory cytokines as a result of inflammation. Considering that pomegranate juice (PJ) is known to have antioxidant and anti-inflammatory properties, the purpose of this study was to determine the effects of PJ consumption on markers of inflammation in patients with type 2 diabetes (T2D). MATERIALS AND METHODS: In a randomized, double-blind clinical trial study, 50 patients with T2D (40-65 years old) were randomly assigned to one of two groups. Participants in each group received either 250 mL/day PJ or a control beverage for 12 weeks. Biochemical markers including fasting plasma glucose (FPG), insulin and inflammatory markers were assayed on the baseline and follow-up blood samples. RESULTS: In all, 44 patients in two groups were included in the analysis: PJ (n = 22) and placebo (n = 22). After 12 weeks of intervention, in the PJ group, there were 32% and 30% significant decreases in plasma C-reactive protein (hs-CRP) and Interlukin-6, respectively (P < 0.05). The mean ± SD plasma interlukin-6 (7.1 ± 5.6 vs. 11.9 ± 14.4 mg/L) and hs-CRP (1791 ± 1657 and 1953 ± 1561 ng/mL) concentrations in the PJ group were significantly lower than the placebo group after intervention (P < 0.05). CONCLUSION: PJ consumption by patients with T2D does not affect FPG or the insulin resistance index (HOMA-IR), whereas it does reduce Interlukin-6 and hs-CRP concentrations in plasma. Therefore, PJ consumption may have an anti-inflammatory effect in patients with T2D.

The effects of high fat, low carbohydrate and low fat, high carbohydrate diets on tumor necrosis factor superfamily proteins and proinflammatory cytokines in C57BL/6 mice.

There has been considerable inconsistency regarding the potential relationship between dyslipidemia and bone metabolism. The inflammatory stimulation through the receptor activator of the nuclear factor kappa-B ligand (RANKL)/ receptor activator of the nuclear factor kappa-B (RANK)/ osteoprotegerin (OPG) pathway could be the infrastructural mechanism for hypercholesterolemia-induced bone loss.In this study, we investigated the effect of dyslipidemia on RANKL and OPG alongside with pro-inflammatory cytokines. Thirty male C57Bl/6 mice (4 weeks old) were randomized to two purified diet groups (15 animals in each group), high fat, low carbohydrate diet (HFLCD) and its matched low fat, high carbohydrate diet (LFHCD). After 12 weeks of feeding in standard situations, the plasma concentration of lipid profile, interleukin (IL) 1Beta, IL-6, tumor necrosis factor-alpha (TNF-α) and RANKL, OPG, and RANKL: OPG ratio were measured.In the present study, although the body weight significantly increased during 12 weeks in HFLCD and LFHCD groups, there were no significant differences in food intake, food efficiency ratio and weight gain between the two groups. The LFHCD group had significantly higher median RANKL and RANKL/OPG ratio. There was no significant difference in plasma IL-1ß, IL-6 and TNF-α concentration between LFHCD and HFLCD groups.These unexpected findings from LFHCD, that seem to be as a result of its higher carbohydrate proportion in comparison to HFLCD, implicate dietary carbohydrate rather than dietary fat as a more significant nutritional factor contributing to change in RANKL level and RANKL: OPG ratio.

How Much Weight Loss is Effective on Nonalcoholic Fatty Liver Disease?

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide with no specific treatment. Weight loss is the most effective therapeutic strategy in its management; however, there is no consensus on its specifics. Thus, this study was conducted to evaluate the effects of weight loss on liver enzymes, markers of inflammation, oxidative stress and CK18-M30 (cytokeratin 18) as a biomarker of hepatocellular apoptosis. OBJECTIVES: To study the effect of weight reduction diet as an exclusive treatment for NAFLD. PATIENTS AND METHODS: Forty four patients with NAFLD received a diet including a 500 to 1000 kcal per day intake reduction as30% fat, 15% protein, and 55% carbohydrate for six months. Anthropometric parameters, alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma glutamyl transferase (GGT), lipid profile, malondialdehyde (MDA), TNF-α, IL-6, CK18-M30 were measured at baseline and at the end of the study. At the end of follow up, patients were classified as adherent or nonadherent to treatment according to a weight loss of ≥ 5%, or < 5% of initial body weight, respectively. RESULTS: Twenty five patients were classified as adherent group and nineteen as nonadherent group (9.7% vs. 1.9% total body weight loss after 6 months, respectively). After 6 months, changes in adherent and nonadherent groups were as follows: reduction in body weight from 93.7 ± 15.8 kg to 84.2 ± 13.4 kg vs. 94 ± 16.6 kg to 92.2 ± 16.2 kg (P < 0.05), BMI from 32.7 ± 3.9 to 29.5 ± 3.2 vs.31.8 ± 5.4 to 31.1 ± 5.3 (P < 0.001), and waist circumference from 105.1 ± 12.6 cm to 97.4 ± 9.8 cm vs.106.8 ± 14.2 cm to 103.7 ± 14 cm (P < 0.001), respectively. Diastolic blood pressure was significantly decreased in adherent group (from 80.2 ± 5.1 mmHg to 76.9 ± 5 mmHg; P < 0.001). Also, total cholesterol, LDL, triglyceride, ALT, AST, GGT and CK18-M30 levels were significantly decreased in the adherent group compared to nonadherent group (P < 0.05). CONCLUSIONS: This intervention offers a practical approach for treatment of patients with NAFLD with diet therapy.

Assessing the effect of quantitative and qualitative predictors on gastric cancer individuals survival using hierarchical artificial neural network models.

BACKGROUND: There are numerous unanswered questions in the application of artificial neural network models for analysis of survival data. In most studies, independent variables have been studied as qualitative dichotomous variables, and results of using discrete and continuous quantitative, ordinal, or multinomial categorical predictive variables in these models are not well understood in comparison to conventional models. OBJECTIVES: This study was designed and conducted to examine the application of these models in order to determine the survival of gastric cancer patients, in comparison to the Cox proportional hazards model. PATIENTS AND METHODS: We studied the postoperative survival of 330 gastric cancer patients who suffered surgery at a surgical unit of the Iran Cancer Institute over a five-year period. Covariates of age, gender, history of substance abuse, cancer site, type of pathology, presence of metastasis, stage, and number of complementary treatments were entered in the models, and survival probabilities were calculated at 6, 12, 18, 24, 36, 48, and 60 months using the Cox proportional hazards and neural network models. We estimated coefficients of the Cox model and the weights in the neural network (with 3, 5, and 7 nodes in the hidden layer) in the training group, and used them to derive predictions in the study group. Predictions with these two methods were compared with those of the Kaplan-Meier product limit estimator as the gold standard. Comparisons were performed with the Friedman and Kruskal-Wallis tests. RESULTS: Survival probabilities at different times were determined using the Cox proportional hazards and a neural network with three nodes in the hidden layer; the ratios of standard errors with these two methods to the Kaplan-Meier method were 1.1593 and 1.0071, respectively, revealed a significant difference between Cox and Kaplan-Meier (P < 0.05) and no significant difference between Cox and the neural network, and the neural network and the standard (Kaplan-Meier), as well as better accuracy for the neural network (with 3 nodes in the hidden layer). Probabilities of survival were calculated using three neural network models with 3, 5, and 7 nodes in the hidden layer, and it has been observed that none of the predictions was significantly different from results with the Kaplan-Meier method and they appeared more comparable towards the last months (fifth year). However, we observed better accuracy using the neural network with 5 nodes in the hidden layer. Using the Cox proportional hazards and a neural network with 3 nodes in the hidden layer, we found enhanced accuracy with the neural network model. CONCLUSIONS: Neural networks can provide more accurate predictions for survival probabilities compared to the Cox proportional hazards mode, especially now that advances in computer sciences have eliminated limitations associated with complex computations. It is not recommended in order to adding too many hidden layer nodes because sample size related effects can reduce the accuracy. We recommend increasing the number of nodes to a point that increased accuracy continues (decrease in mean standard error), however increasing nodes should cease when a change in this trend is observed.

Development of a socioeconomic status index to interpret inequalities in oral health in developing countries.

PURPOSE: To develop an instrument to measure socioeconomic status (SES) in order to assess SES-related inequalities in oral health in a developing country. MATERIALS AND METHODS: In order to develop a SES measurement tool, an expert panel generated a primary item pool from which the items were revised after validity and reliability testing. The final instrument was used in a 1100-sample survey in Tehran. SES was calculated using the weights produced by both principal component analysis (PCA) and expert panel two-stage paired comparisons (TSPC) methods. RESULTS: The final instrument contained 10 items. Standardised SES scores derived from TSPC and PCA methods were significantly correlated (r = 0.749, P < 0.001). Five-level SES stratification by the two methods revealed a correlation coefficient of 0.701 (P < 0.001) for SES class. CONCLUSION: The newly developed SES index was appropriate to be used in exploring oral health inequalities in the studied sample of the Iranian population. When formulating SES, domestic experts' opinions could help the researchers explore and weight sub-construct factors.

Psychometric properties of a Farsi version of the authentic assessment perception questionnaire.

The term 'authentic assessment' has recently gained widespread use in education. A five-dimensional questionnaire for authentic assessment was translated into Farsi. The questionnaire which comprises 29 items, divided into 5 subscales (task, physical context, social context, result/form and criteria) was developed in English by Dr. Gulikers and her colleagues in the Netherlands. The questionnaire was translated using a forward-backward method and was pilot tested in terms of translation clarity and applicability. The psychometric properties of the Persian version of the questionnaire were evaluated in terms of face, content, and construct validity in addition to test-retest reliability. A convenience sample of 230 dental students (70 males and 160 females) studying in four dental schools in Tehran city was recruited to evaluate the reliability and construct validity of the Persian version. The quality rating of the translations was favorable, suggesting a high quality of both forward and backward translations. The Content Validity Index (CVI) and Ratio (CVR) for the final Farsi version of the questionnaire were found to be acceptable. Cronbach alpha coefficients for all subscales ranged from 0.78-0.91. These preliminary results suggest that a five dimensional questionnaire in its Farsi version may be a valuable tool in dental education assessment and studies.

Beneficial effects of a high-protein, low-glycemic-load hypocaloric diet in overweight and obese women with polycystic ovary syndrome: a randomized controlled intervention study.

OBJECTIVE: The recommended composition of a hypocaloric diet for obese women with polycystic ovary syndrome (PCOS) is unclear. The aim of this study was to investigate the effects of a high-protein, low-glycemic-load diet compared with a conventional hypocaloric diet on reproductive hormones, inflammatory markers, lipids, glucose, and insulin levels in obese women with PCOS. METHODS: A total of 60 overweight and obese women with PCOS who did not use insulin-sensitizing agents were recruited and randomly assigned to 1 of the 2 hypocaloric diet groups for a single-blind clinical trial. The groups included a conventional hypocaloric diet (CHCD) (15% of daily energy from protein) and a modified hypocaloric diet (MHCD) with a high-protein, low-glycemic load (30% of daily energy from protein plus low-glycemic-load foods selected from a list) that was prescribed via counseling visits weekly during 12 weeks of study. Anthropometric assessments and biochemical measurements including reproductive hormones, inflammatory factors, lipids, glucose, and insulin were performed on fasting blood samples at baseline and after 12 weeks of dietary intervention. RESULTS: Weight loss was significant and similar in the 2 groups. Mean of testosterone in the MHCD and CHCD groups decreased from 1.78 ± 0.32 to 1.31 ± 0.26 ng/ml and from 1.51 ± 0.12 to 1.15 ± 0.11 ng/ml, respectively (p < 0.001). Follicle sensitizing hormone (FSH), luteinizing hormone (LH), and blood lipids concentrations were not changed except low-density lipoprotein cholesterol (LDL-C) was reduced by 24.5% ± 12.3% (p < 0.001 for both) after 12 weeks of intervention. MHCD resulted in a significant reduction in insulin level, homeostatic model assessment for insulin resistance (HOMA), and high-sensitivity C- reactive protein (hsCRP) concentration (p < 0.001). CONCLUSIONS: In this study both hypocaloric diets significantly led to reduced body weight and androgen levels in these two groups of women with PCOS. The combination of high-protein and low-glycemic-load foods in a modified diet caused a significant increase in insulin sensitivity and a decrease in hsCRP level when compared with a conventional diet.

Legume intake is inversely associated with metabolic syndrome in adults.

BACKGROUND: Studies on the association between legume intake and metabolic syndrome (MetS) are sparse. The objective of this study is to evaluate the association between legume intake, MetS, and its components. METHODS: This study was conducted on 80 subjects (48% female) with MetS as cases and 160 age and gender-matched healthy controls. Anthropometric measures, blood pressure, fasting blood glucose, and lipid profiles were evaluated by standard methods. Dietary data were collected using a food frequency questionnaire (FFQ) and legume intake was determined. MetS was defined according to the definition of the Adult Treatment Panel III. RESULTS: The mean (SD) intake of legumes was 1.4 (0.9) servings/week for cases and 2.3 (1.1) servings/week for control subjects (P < 0.05). After adjustment for potential confounders, decreases in mean systolic blood pressure, fasting blood glucose, and increase in HDL cholesterol levels were observed across increasing quartile categories of legume intake. After adjustments for life style and food groups, subjects in the highest quartile of legume intake had lower odds of having MetS compared with those in the lowest quartile [odds ratio (OR): 0.25; 95% CI: 0.11 - 0.64, P < 0.05], an association that weakened after adjustment for body mass index (BMI), but remained significant (OR: 0.28; 95% CI: 0.12 - 0.81, P < 0.05). CONCLUSIONS: Legume intake is inversely associated with the risk of having MetS and some of its components.

Prevalence of OXA-type ß-lactamases among Acinetobacter baumannii isolates from Northwest of Iran.

Carbapenems have been considered as last line antibiotics for treatment of multidrug-resistant (MDR) Acinetobacter baumannii but carbapenem resistant A. baumannii has been increased during the last decade in many parts of the world. OXA-type ß-lactamase enzymes are the most common cause of carbapenem resistance in A. baumannii and presence of ISAba1 in upstream of these genes may increase the expression of these OXA genes. The aim of this study was to determine, for the first time, the antibiotic resistance pattern and prevalence of OXA type ß-lactamases among nosocomial A. baumannii isolates from northwest of Iran. A total of 100 A. baumannii isolates were recovered from hospitalized patients in a university hospital in northwest of Iran. Sixty-two percent of isolates were resistant to imipenem. All isolates carried bla(OXA-51)-like gene. Among imipenem resistant isolates, 88.7% carried bla(OXA-23)-like, 1.6% carried bla(OXA-40)-like, and 3.2% had bla(OXA-58)-like resistance genes. Ninety percent of isolates contained ISAba1 element and in 74.2% of imipenem resistant isolates, ISAba1 was located in upstream of bla(OXA-23)-like. The results of this study demonstrated high prevalence of OXA-type carbapenemase among MDR A. bumanii in the Northwest of Iran.

Effects of gabapentin on postoperative pain, nausea and vomiting after abdominal hysterectomy: a double blind randomized clinical trial.

PURPOSE: Gabapentin has demonstrated analgesic effects in some studies. This double blind randomized clinical trial (RCT) was conducted to evaluate whether the pre-emptive use of gabapentin 600 mg could reduce postoperative pain, nausea and vomiting, and meperidine consumption in patients after hysterectomy. METHODS: Between 2009 and 2010, a total of 170 patients who were candidates for abdominal hysterectomy were assessed for eligibility to enter the study. Thirty patients were excluded for different reasons; and 140 included patients were randomly assigned to one of two groups according to the method of treatment, gabapentin or placebo, in a double-blind manner before hysterectomy. Postoperatively, the pain was assessed on a visual analogue scale (VAS) at 1, 4, 8, 12 and 24 h at rest. Meperidine intramuscularly was used to treat postoperative pain on VAS score and patients demand. Total meperidine and anti emetic drug consumption in the first 24 h after surgery was also recorded. The trial is registered at irct.ir, number IRCT201106186829N1. RESULTS: Patients in the gabapentin group had significantly lower VAS scores at all time intervals, than those in the placebo group. The total meperidine consumed in the gabapentin group was significantly less than in the placebo group. Postoperative nausea and vomiting (PONV) and anti emetic drug consumption were significantly decreased in gabapentin group. CONCLUSION: Pre-emptive use of gabapentin 600 mg orally, significantly decreases postoperative pain and PONV, and also rescues analgesic and anti emetic drug requirements in patients who undergo abdominal hysterectomy.

Pregnancy outcomes in women with idiopathic thrombocytopenic purpura.

BACKGROUND: Idiopathic thrombocytopenic purpura (ITP) is a disease that commonly affects women of reproductive age and is associated with maternal and fetal complications. OBJECTIVE: The aim of the present study was to report the perinatal outcome in pregnant women with ITP. MATERIALS AND METHODS: Twenty one pregnant women with ITP admitted in a teaching hospital in Tehran, from October 2008 to February 2010, were enrolled in this prospective historical cohort study; course and perinatal outcome of pregnancies were studied. RESULTS: Seven (33.3%) cases had been diagnosed before pregnancy, while the other fourteen (66.7%) were diagnosed during pregnancy. During hospitalization, thirteen (62%) patients required treatment, eight (61.5%) of them with steroids, two (15.3%) received intravenous immunoglobulin (IVIG), and three (23%) were treated with steroids and IVIG. Three babies were delivered vaginally (14.3%), seventeen (81%) through cesarean section and one patient aborted her fetus. Nine mothers (42.9%) had platelet counts <50000/ml at the time of delivery; but postpartum hemorrhage occurred in 4 (19%) women and one women received platelet transfusion during cesarean section. Six (28.6%) women developed gestational diabetes. Pregnancy was complicated by preeclampsia in one woman and by abruptio placenta in another. One pregnancy terminated in intrauterine fetal death. Seventeen infants (89.5%) had normal platelet counts, and two (10.5%) had moderate thrombocytopenia. No infant showed signs of hemorrhage, but 2 neonates (10.5%) were diagnosed with intrauterine growth restriction. CONCLUSION: Rate of gestational diabetes in pregnant women with ITP is higher than the general population. Rate of gestinational diabetes is 3-5% and postpartum hemorrhage is 5-7% in general. Postpartum hemorrhage is common in these women. Severe thrombocytopenia and bleeding in the newborns are uncommon.

Improving neuropathy scores in type 2 diabetic patients using micronutrients supplementation.

AIM: The aim of the present study was to determine if micronutrients supplementation can improve neuropathy indices in type 2 diabetes. MATERIALS AND METHODS: In this randomized, double-blind, placebo-controlled clinical trial, 75 type 2 diabetes patients were assigned to three treatment groups, receiving one of the following daily supplement for 4 months: Group MV: zinc (20 mg), magnesium (250 mg), vitamin C (200 mg) and E (100 mg); Group MVB: both of the above mineral and vitamin supplements plus vitamin B1 (10 mg), B2 (10 mg), B6 (10 mg), biotin (200 µg), B12 (10 µg) and folic acid (1 mg); Group P: placebo. RESULTS: 67 patients completed the study. Neuropathic symptoms based on the MNSI questionnaire improved from 3.45 to 0.64 (p=0.001) in group MVB, from 3.96 to 1.0 (p=0.001) in group MV and from 2.54 to 1.95 in placebo group after 4 months. There was no significant difference between three treatment groups in MNSI examinations after 4 months supplementations. Over 4 months of treatment, patients showed no significant changes in glycemic control, capillary blood flow or electrophysiological measures in MV and MVB groups compared with placebo group. CONCLUSIONS: These studies suggest that micronutrients supplementation might ameliorate diabetic neuropathy symptoms.

Educational level and pseudohypacusis in medico-legal compensation claims: a retrospective study.

Pseudohypacusis or the intentional feigning of hearing loss is a challenging situation in the medicolegal evaluation of hearing levels. Few studies have been performed on predisposing factors that make compensation claims susceptible to malingering. The goal of this study was to investigate the relationship between educational level and frequency of pseudohypacusis in a group of medico-legal clients. Retrospectively, we studied the files of subjects (n=421) referred to the audiology clinic of a government hospital during a 12 month period. Educational levels of the individuals with and without pseudohypacusis were compared by the Chi-square test. The results show that individuals with pseudohypacusis have lower educational levels than cooperative clients. The relative frequency of individuals with pseudohypacusis among illiterates (43.5%) was clearly higher than individuals with higher educational levels (17.5%). The education level of a person filing a compensation claim may alert an examiner in detecting pseudohypacusis.