Association of social jetlag with gestational diabetes: Qazvin Maternal and Neonatal Metabolic Study.

The association of social jetlag (SJL), as a quantitative measure of circadian misalignment, with insulin resistance and metabolic syndrome has been reported. The present study was designed to investigate the association of SJL with gestational diabetes mellitus (GDM). Pregnant women with gestational age ≤14 weeks were enrolled in this longitudinal study. The participants with pre-GDM, shift workers and those who used alarms for waking up on free days were excluded from the study. SJL as well as behavioral and psychological parameters were evaluated at enrollment. The participants were categorized based on each 1-h increment of SJL. The association of SJL with the occurrence of GDM in the late second trimester was evaluated using univariate and multivariate methods. In total, 821 pregnant women entered the study, and after omitting individuals with excluding criteria, analyses were performed on 557 participants. The frequencies of SJL < 1 h,1 ≤ SJL < 2 h and SJL ≥ 2 h were 44.7%, 37.2% and 18.1%, respectively. Average sleep duration was higher in SJL < 1 h compared with the two other groups (p < 0.001). During follow-up, 90 (16.1%) women with GDM were identified. SJL ≥ 2 h was associated with a 4.4-5.6 times higher risk of GDM in different models of adjustment (p < 0.05). Pregnant women with high SJL are at a higher risk of GDM. Further studies for evaluating the mechanisms by which SJL affects GDM are warranted.

Exposure to stressful life events among patients with chronic obstructive pulmonary disease: a prospective study.

INTRODUCTION: Although depression and anxiety have been widely investigated among patients with chronic obstructive pulmonary disease (COPD), experiencing stressful life events and its effect on increasing risk of exacerbations was rarely assessed. This study aimed to clarify the association between facing with stressful events among COPD patients and their disease severity leading to hospitalization. MATERIAL AND METHODS: A prospective study was conducted among 128 COPD patients from the population of Qazvin, a north-west, industrialized city of Iran from December 2017 to December 2018. Patients were followed up for one-year and their related measures were gathered. To compare variables among patients stratified by reporting stressful life conditions, Pearson's chi-square and Fisher's exact tests were used. Furthermore, to assess the effect of several covariates on the response variable, a logistic regression modelling was applied. Results were reported in form of odds ratios and their 95% confidence intervals. RESULTS: Study findings affirmed that patients who had experienced stressful situation had lower BMI, were retired, experienced more frequent exacerbations, and reported higher levels of anxiety/ depression. Moreover, those with stressful conditions were among current or former smokers (p < 0.05). Logistic regression analysis revealed that facing with stressful situations was significantly associated with the severity of COPD disease (OR 1.9; 95% CI 2.5 to 5.6), smoking habit (OR 2.8; 95% CI 1.6 to 4.2; OR 1.5; 95% CI 1.4 to 2.2), and hospitalization during one-year follow up (OR 1.2; 95% CI 1 to 3.3). CONCLUSIONS: To improve health outcomes of COPD patients, close attention should be given to their psychological disorder and appropriate strategies should be applied to reduce patients' exposure to stressful life events and subsequent anxieties.

Comparing the effects of upper limb and breathing exercises on six-minute walking distance among patients with chronic obstructive pulmonary disease: a three-group randomized controlled clinical trial.

INTRODUCTION: Physical exercise can improve patient outcomes and reduce hospitalization and mortality rates among subjects with chronic obstructive pulmonary disease. This study aimed to compare the effects of upper limb and breathing exercises on six-minute walking distance among these patients. MATERIAL AND METHODS: This three-group randomized controlled clinical trial was conducted in 2017-2018 in Velayat hospital, Qazvin, Iran. Seventy-five patients were purposively selected from the outpatient lung clinic of the hospital and randomly allocated to either the 25-patient groups of upper limb exercise, breathing exercise, or control. The patients in the first group were performing upper limb exercises thrice weekly for one month in the study setting. Their counterparts in the second group were doing pursed-lip and diaphragmatic breathing exercises four times daily for one month at their homes. However, the patients in the control group received no exercise intervention. Six-minute walk test was performed by each participant both before and after the study intervention. The SPSS for Windows program (v. 23.0) was used to analyze the data via the Chi-square test, the paired-sample t test, and the one-way analysis of variance. RESULTS: Before the intervention, the groups did not significantly differ from each other respecting six-minute walking distance. During the study, walking distance in the control group did not change significantly, while it remarkably increased in both the upper limb exercise and the breathing exercise groups (p < 0.05). After the intervention, walking distance in the upper limb exercise group was significantly greater than the breathing exercise group (p < 0.05) and the control group (p < 0.05); however, the difference between the breathing exercise and the control groups was not statistically significant (p > 0.05). CONCLUSION: Upper limb exercise is more effective than breathing exercise in increasing walking distance among patients with chronic obstructive pulmonary disease. Therefore, upper limb exercise can be used as a safe, simple, and inexpensive rehabilitation technique for these patients.

Epidemiological and clinicopathological characteristics of lung cancer in a teaching hospital in Iran.

BACKGROUND: Lung cancer is one of the most commonly diagnosed cancers and the most frequent cause of cancer-related death worldwide. In Iran, it ranks second and third as the cancer-causing death in men and women, respectively. We carried out this study to find out the demographic, clinical, and histological characteristics and risk factors of lung cancer in a referral tertiary center in Iran. MATERIALS AND METHODS: A retrospective study was conducted on cases of primary lung cancer based on the results of registered cancer reports of cytological and pathological specimens between March 2001 and March 2012. Demographic variables, clinical manifestations, histology and location of tumors were determined based on the data found in the medical records of each patient. Definite or probable etiologic factors were identified. Data analysis was performed with SPSS version 16 and a p-value ≤ 0.05 was considered as significant. RESULTS: A total of 203 patients, with a mean age of 65.7 years (SD=11.2), with primary lung cancer were identified, 81.3% being men. Of the total, 110 cases (54.2%) were living in urban areas. In 53.2% of cases, the site of tumor was on the right side and in 72.9% of cases the lesion was centrally located. The histological types of lung cancer were squamous cell carcinoma (SCC) in 107 cases (52.7%), adenocarcinoma (AC) in 30 cases (14.8%), and small cell carcinoma (SC) in 27 cases (13.3%). Significant correlations between the gender and residence, smoking, and the histological type and location (central or peripheral) of tumor were found. The percentage of smokers was 75.2% in men and 15.8% in women. CONCLUSIONS: Smoking was the most important risk factor and squamous cell carcinoma the most common histological type of lung cancer in our study. Male sex and being a smoker was associated with histological types of SCC while being nonsmoker had relationship with adenocarcinoma.

Sleep Quality and Quality of Life in COPD Patients with and without Suspected Obstructive Sleep Apnea.

Present study was designed to obtain association between sleep apnea with sleep quality and quality of life in COPD patients. This cross-sectional descriptive study was conducted on 139 patients with COPD in a chest clinic of a university hospital. All patients were evaluated by pulmonary function test for determination of severity of their disease. Also, Berlin questionnaire, Epworth sleepiness scale, Pittsburgh Sleep Quality Index, and St. George Respiratory questionnaires (SGRQ) were employed for assessment of patients. Analysis of data showed that quality of sleep was significantly correlated with quality of life (P < 0.001). About half of the patients were at high risk for sleep apnea. The patients were divided into two groups according to the result of Berlin questionnaire. Significant differences were found between the groups for total score and each of three subscores of SGRQ suggesting worse quality of life in overlap syndrome (P < 0.001). Also, patients with overlap syndrome had worse quality of sleep compared to patients without it (8.1 ± 1.7 versus 6.2 ± 2.3; P < 0.001). Stepwise multiple regression analysis showed that severity of COPD, coexisting obstructive sleep apnea, and sleep quality accounted for the SGRQ significantly (r (2) (coefficient of determination) = 0.08, 0.21, and 0.18, resp.). It is recommended that patient with COPD be evaluated for sleep apnea and sleep disorders during routine examinations and followups.

Protective effects of Scrophularia striata in Ovalbumin-induced mice asthma model.

BACKGROUND: Scrophularia striata Boiss. (Scrophulariaceae) is a plant growing in the northeastern part of Iran and being used as a traditional herb for various inflammatory disorders.This study was designed to investigate the protective effects of the Scrophularia striata extract in Ovalbumin (OVA) induced-asthma mice model. METHODS: OVA-sensitized mice were intrapritonealy treated with two doses (100 and 200 mg/kg) of the extract on days 8 to 14 separately. Broncoalveolar lavage fluids (BALF) was collected 48 h after the final OVA challenge and then the number of eosinophils and other inflammatory cells were assessed by direct microscopic counting. In addition, total immunoglubolin (Ig) E and OVA-specific IgE levels in serum, IL-4 and IL-5 cytokines in BALF were determined by Enzyme-Linked Immunosorbent Assay. Moreover, phytochemical assay by thin layer chromatography (TLC) and the 2, 2 diphenyl-1-picrylhydrazyl (DPPH) were used to evaluate the main compounds and the antioxidant capacity of the plant extract, respectively. RESULTS: The results showed that the main components; including flavonoids, phenolic compounds and phenyl propanoids were presented in the S. striata extract. In addition, the treatment with extract significantly reduced the number of inflammatory cells and suppressed T-helper 2 (Th2) cytokines including IL-4 and IL-5 in BALF. Also, total IgE and OVA-specific IgE levels in the serum decreased. CONCLUSION: Collectively, it is concluded that the extract has the potential to modulate the Th2 cytokines and could be used as immunomodulatory agent in the treatment of allergic asthma.

Association between Anemia and COPD in Iranian Population.

BACKGROUND AND AIM: Chronic obstructive pulmonary disease (COPD) is one of the major causes of morbidity and mortality in adults. Anemia is known as comorbidity in many chronic diseases that can increase morbidity and mortality of COPD. Recent studies have shown that anemia may be more prevalent than expected in COPD patients and can increase disabilities of COPD. In this study we have evaluated the correlation between anemia and the severity of COPD in patients referred to teaching hospitals of the Tehran University of Medical Sciences (TUMS), Tehran, Iran. MATERIALS AND METHODS: In this cross-sectional study the severity of COPD in 760 patients with dyspnea who referred to teaching hospitals of Tehran University of Medical Sciences and 96 stable COPD patients were categorize using a GOLD criteria from mild to moderate, severe and very severe. Anemia was determined as hemoglobin <13 g/dL in men and <12 g/dL in women, respectively. Demographic characteristics, spirometry parameters and laboratory findings were compared between anemic and non-anemic groups using Student t-test and regression tests (SPSS v.18 software). RESULTS: The Mean age of patients was 65 ± 13.07 years (59.4% male). Overall prevalence of anemia was 27% and there was no correlation between severity of COPD and anemia. Anemic patients were significantly older than non-anemic patients (71.1 ± 8.5 years vs. 65.4± 12.8 years; p = 0.030). RBC count of anemic patients were significantly lower than non-anemic group (4.3 ± 0.5 vs. 5.02± 0.8 ×106/µL; p < 0.001). Erythropoietin levels in anemic group was significantly higher than non-anemic group (16.33±2.43 vs. 10.22 ± 2.67 mu/ml; p < 0.001) and there was a significant inverse correlation of hemoglobin vs erythropoietin (r= -0.8). CONCLUSION: There was a high prevalence of anemia in COPD patients. Anemia can increase disabilities of COPD. Thus, treatment of anemia may improve quality of life in these patients. Further comprehensive studies are needed for determination of exact prevalence of anemia and its physiologic effects in COPD.

Prevalence of Sleep Disorders and their Effects on Sleep Quality in Epileptic Patients.

INTRODUCTION: Epilepsy is a complex pervasive neurobehavioral and social condition accompanied by a wide range of comorbid conditions that can adversely affect the quality of life of patients. Sleep complaints are common among patients with epilepsy. The aim of this study was to assess the prevalence of subjective sleep disturbances and its effects on sleep quality in epileptic patients. METHODS: In this cross-sectional study, 152 consecutive epileptic patients and 152 controls were interviewed. We used Epworth Sleepiness Scale, Insomnia Severity Index, Berlin Questionnaire and Pittsburg Sleep Quality Index to measure excessive daytime sleepiness, insomnia, obstructive sleep apnea and sleep quality. R estless leg syndrome was diagnosed using three questions. RESULTS: The age, gender and average total sleep time was similar in patients and control group. The frequency of excessive sleepiness scale and subjective complaint of sleep maintenance was higher in epileptic patients than control group (P<0.05). The symptoms of restless leg syndrome were reported by 32.3% of patients and 11.8% of controls (P<0.05). DISCUSSION: Daytime sleepiness, difficulty in sleep maintenance, poor sleep quality and RLS appear to be common in patients with epilepsy. Further confirmatory studies are needed using objective sleep studies to detect underlying mechanisms of sleep disorders in these patients.

Validity and reliability of the Iranian version of the insomnia severity index.

BACKGROUND: The Insomnia Severity Index (ISI) is a short subjective questionnaire which helps physicians in making decisions about patients suffering from insomnia. The present study was an attempt to test the reliability and validity of the Iranian version of the ISI and to measure the correlation between ISI items and polysomnography results in chronic insomnia patients. METHODS: Two groups responded to the Persian translation of four questionnaires; ISI, Pittsburg Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and General Health Questionnaire (GHQ). The first group consisted of 135 patients diagnosed with chronic insomnia, and the second group was comprised of 55 normal people. After completing the questionnaires, the insomniac patients underwent standard overnight polysomnography. RESULTS: The internal consistency demonstrated by Cronbach's alpha coefficient was above 0.8 for both groups. The Intra-class correlation coefficient was above 0.7 after two weeks for both groups. The correlations between ISI, PSQI, ESS, and GHQ were high. In addition, close correlations were found between scores obtained from the ISI questionnaire items in insomniac patients with corresponding polysomnographic variables. CONCLUSION: The Iranian version of the ISI is a reliable and valid instrument. It is a valuable short and first-line questionnaire for insomnia research and clinical work.

Small airways involvement in patients with rheumatoid arthritis.

OBJECTIVES: One of the common causes of morbidity in patients with RA is pulmonary involvement. Some studies have shown that the possible abnormal results of pulmonary function tests in rheumatoid disease are higher than usual. We aimed to evaluate the prevalence of spirometric abnormalities in patients with RA. MATERIALS & METHODS: This case-control study was conducted on 99 patients with RA who referred to a rheumatology clinic in Qazvin, northwest Iran. Sixty five age- and sex-matched healthy controls were recruited as well. History taking, physical examination, laboratory tests and spirometry were performed for the participants. RA severity was assessed according to Disease Activity Score 28 (DAS28). The data were processed using SPSS software version 16. Chi square and student's t test and multiple logistic regressions were used as appropriated. RESULTS: The mean (±SD) age of the patients was 46 (±10.5) years. The mean (±SD) duration of disease was 4.8 (±5.4) years, and the mean (±SD) DAS28 was 2.5 (±1.1). Dyspnea was the most common respiratory complaint (6.1%). Three (3%) patients had mild restrictive, 2 (2%) patients mild obstructive, and one (1%) patient moderate obstructive diseases. In the control group, only one participant had mild restrictive pulmonary disease (P<0.05). A significant decrease of FEF25 [OR=3.2; 95%CI (1.9-4.5)], FEF50 [OR=2.5; 95% CI (1.7-3.1)], FEF75 [OR=2.3; 95% CI (1.4-2.7)] and FEF25-75 [OR=2.7; 95% CI (1.7-3.5)] was observed in patients compared with the control group. We found no correlation between the patients' age, duration and severity of the disease, and laboratory tests with spirometric indices. CONCLUSION: It is recommended that patients with RA be visited on a regular basis and PFT be done for them for the early diagnosis of pulmonary involvement.