The Relationship Between Vascular Endothelial Growth Factor Cis- and Trans-Acting Genetic Variants and Metabolic Syndrome.

BACKGROUND: We have investigated the association between 4 cis- and trans-genetic variants (rs6921438, rs4416670, rs6993770 and rs10738760) of the vascular endothelial growth factor (VEGF) gene and metabolic syndrome (MetS) and its individual components in an Iranian population. MATERIAL & METHOD: Three hundred and thirty-six subjects were enrolled and MetS was defined according to the International-Diabetes-Federation (IDF) criteria. Genotyping was carried out in all the individuals for 4 VEGF genetic variants using an assay based on a combination of multiplex polymerase chain reaction and biochip array hybridization. RESULTS: As may be expected, patients with MetS had significantly higher levels of serum high-sensitivity C-reactive protein, waist circumference, hip circumference, body mass index, fat percentage, systolic blood pressure, diastolic blood pressure and triglyceride, whereas the high-density lipoprotein cholesterol levels were significantly lower, compared to the control group (P < 0.05). We also found that 1 of the VEGF- level associated genetic variants, rs6993770, was associated with the presence of MetS; the less common T allele at this locus was associated with an increased risk for MetS. This association remained significant after adjustment for confounding factors (P = 0.007). Individuals with MetS carrying the AT + TT genotypes had markedly higher levels of fasting blood glucose, triglyceride and systolic blood pressure (P < 0.05). CONCLUSIONS: We have found an association between the rs6993770 polymorphism and MetS. This gene variant was also associated with serum VEGF concentrations. There was also an association between this variant and the individual components of the MetS, including triglyceride, fasting blood glucose and systolic blood pressure.

Process and barriers to organ donation and causes of brain death in northeast of Iran.

INTRODUCTION: Organ transplantation is the treatment of choice for some diseases. However, the need for cadaveric organ donation has either plateaued or is on a decreasing trend in some countries, especially in developed ones. In this study, we aimed to identify the barriers to organ donation in brain dead patients, who were referred to the organ procurement organizations (OPO) in northeast Iran. METHODS: In this cross-sectional study during 2006 to 2013, data were collected from medical records of brain dead patients. Demographic information, cause of brain death, the process of obtaining informed consent, and the reasons for declining organ donation were obtained from the OPO records. The data were analyzed using chi-square test by SPSS 13 software. RESULTS: Of 1034 brain dead patients, 751 cases (72.6%) were eligible for organ donation, and, ultimately, 344 cases underwent organ donation. The rate of organ donation increased during the course of the study; medical and legal reasons as well as family refusal to authorize donation were the main barriers to the process. CONCLUSION: Based on the pattern of mortality, the need for living donors in developing countries, such as Iran and other countries in the Mediterranean region, can be reduced by improving the quality of healthcare, efficient identification of brain death, and obtaining consent with appropriate strategies.

Diagnostic Value of Leukocyte Esterase Test Strip Reagents for Rapid Clinical Diagnosis of Spontaneous Bacterial Peritonitis in Patients Admitted to Hospital Emergency Departments in Iran.

BACKGROUND: Spontaneous bacterial peritonitis (SBP) is a common and important clinical problem and is life-threatening in decompensated liver disease. Ascites fluid test by leukocyte esterase test strip has been recently proposed as an effective and rapid method to diagnose SBP in patients with cirrhosis. OBJECTIVES: This study aimed to evaluate sensitivity and specificity of leukocyte esterase test strip in the diagnosis of SBP. PATIENTS AND METHODS: The population of this research was all patients with cirrhosis and ascites admitted to the emergency room at Imam Reza (AS) hospital, Mashhad. A written consent was taken for inclusion in the study. 50 mL ascites sample was taken from all patients for use in a urine test strip (LER) (Urine Test Strips Convergys®Urine Matrix 11). The patient's ascites samples were evaluated for cell counting. Positive dipstick test for LER in this study considered as grade 3 +. The values of WBC > 500 cell/mm(3) or PMN > 250 cell/mm(3) considered as positive result of the gold standard method for the diagnosis of SBP. RESULTS: In this study, 100 patients with ascites due to cirrhosis, with an average age of 38.9 ± 6.54 years were evaluated. Twenty cases had positive results, of whom 17 cases were also detected based on the standard diagnostic criteria and other three cases were healthy individuals. Thus, sensitivity, specificity, positive and negative predictive values, and accuracy of the method were 95%, 96.3%, 85%, 97.5% and 95%, respectively. CONCLUSIONS: The use of leukocyte esterase urine dipstick test can be a quick and easy method in early diagnosis of SBP to start the treatment until preparation of SBP-cell count results.

A randomized, controlled trial of acupuncture for chronic low-back pain.

BACKGROUND: Chronic low-back pain (cLBP) is a common condition throughout the world, and acupuncture is widely sought for treatment. As clinical evidence for the benefits of acupuncture grows, acupuncture for cLBP is receiving increased recognition and acceptance by both patients and professionals. Time method acupuncture has been previously researched with respect to chronic gastritis. OBJECTIVE: For individuals with cLBP in the current study, the research team examined the efficacy of adding confluent acupoints, related to the daytime period in time method acupuncture, to regular acupuncture and also evaluated the persistence of the benefits of such acupuncture in comparison with regular acupuncture. DESIGN: The study was a randomized, controlled trial (RCT). SETTING: The setting was an outpatient clinic of the Dongzhimen Hospital in Beijing, China. PARTICIPANTS: Participants were Chinese men and women with cLBP. INTERVENTION: Sixty participants were randomly divided into 2 groups to receive acupuncture. The control group received a treatment that followed a routine acupuncture (RA) protocol, while the intervention group received a treatment that followed an RA protocol plus acupuncture in confluent points related to time (TA). OUTCOME MEASURES: The research team measured the change in participants' scores using the visual analogue scale (VAS), the number of therapy sessions needed, the number of days that participants were absent from work during the treatment period and at 12 wk posttreatment, and the number of pain relapses between the end of treatment and the 4- and 12-wk follow-ups. RESULTS: VAS scores decreased from 69.6 ± 7.9 to 11.8 ± 4.9 in the intervention group compared with a decrease from 69.2 ± 8.0 to 15.7 ± 10.0 in the control group (P = .001). The intervention group received fewer therapy sessions (8.1 ± 2.0) than did the control group (10.1 ± 2.0, P < .001). Compared with the controls, the intervention group showed fewer days absent from work (0.5 vs 1.4; P = .03) and fewer pain relapses (4.0 vs 7.0; P = .04) at the 12-wk follow-up. In the 2 groups combined, VAS decreased from 69.4 ± 7.9 before the first session of acupuncture to 13.8 ± 8.0 after the last session (P < .001), and the number of therapy sessions needed for pain relief was 9.1 ± 2.2. CONCLUSION: Accompanying routine acupuncture with time method acupuncture can enhance the efficacy of treatment and the persistence of its benefits in individuals with cLBP.

Clinical Evaluation of Commiphora Mukul, a Botanical resin, in the Management of Hemorrhoids: A randomized controlled trial.

BACKGROUND: Hemorrhoids complaint is one of the most common problems in most society, especially in Asian countries. Current drug treatment protocols cannot cure the disease, and they are palliative. According to Persian traditional medicine, Commiphora Mukul (CM) resin is a medication choice. AIM: This randomized study was undertaken to evaluate the efficacy and safety of crude CM resin compared to a combination of lactolose and anti-hemorrhoid (LandA) in patients with uncomplicated hemorrhoids grade 1 and 2. MATERIALS AND METHODS: This trial was carried out on 99 patients with hemorrhoids, in Ghaem and Imam Reaza Hospitals of the Mashhad University of Medical Sciences, Iran. They randomly received CM 3 g/d for 4 weeks (as study group) or LandA (Lactolose syrup in laxative dose for 1 month and anti-hemorrhoid suppository daily for 10 days) as control group. Subjective and objectives variables including painful defecation, flatulence, constipation, gastro-esophageal reflux (GER), dyspepsia, proctorrhagia, anal protrusion, and colonoscopic grading were assessed before, immediately after, and 4 weeks after the treatment period. An intent-to-treat analysis was used. Safety was assessed with evaluation of clinical adverse effects by common toxicity criteria version 4.0. Forty-nine patients were assigned randomly to receive LandA and 50 to receive CM. After 4 weeks, flatulence, dyspepsia, GER, and colonoscopic grading scores significantly decreased in study group, whereas in control group constipation, painful defecation, and proctorrhagia showed better but not significant improvement. After 4-weak follow-up, the rate of constipation, and proctorrhagia also showed significantly improvement in study group. Constipation and proctorrhagia in control group recurred significantly in 4-week follow-up than after the treatment, whereas this recurrence in test group was not seen. CONCLUSION: CM was more effective than LandA in 4-week treatment of patients with uncomplicated hemorrhoids grade 1 and 2.