Vitamin B12 deficiency after total gastrectomy for gastric cancer, prevalence, and symptoms: a systematic review and meta-analysis.

PURPOSE: Nutrient deficiency is one of the common complications in patients who undergo gastrectomy, especially those vitamins and minerals absorbed in the stomach or by substances in the gastric juice, such as vitamin B12. Hence, this systematic review and meta-analysis were conducted for the first time to investigate the prevalence of vitamin B12 deficiency and its symptoms in gastric cancer (GC) patients who underwent gastrectomy. METHOD: PubMed, Scopus, Google Scholar, and Web of Science databases were searched to find related studies. After screening, studies were selected based on the abstract and title of related studies. The heterogeneity and inconsistency between studies were evaluated using Cochran's Q, I 2 tests. Egger's test analyzed publication bias for studies. A 95% confidence interval (95% CI) was used to estimate the overall prevalence of vitamin B12 deficiency. RESULTS: Fourteen studies, including 2627 GC patients who underwent surgery, were included in the study. The mean age of the patients in this study was 61.2 ±â€…4.93 years. The pooled estimate of meta-analysis results showed that the prevalence of vitamin B12 deficiency after gastrectomy in patients with GC was 48.8% (95% CI:32.4, 65.2%, I 2 : 98.85, τ 2  = 0.05, Q (13) = 1127.8, P  < 0.001). The most important symptoms were anemia, fatigability, cold feet or legs, numbness, and dizziness. CONCLUSION AND RECOMMENDATION: Vitamin B12 deficiency has a high prevalence among patients who have undergone gastrectomy, and it is necessary to pay enough attention to treating these patients after surgery to prevent its complications.

Efficacy of a mobile phone application for the improvement of oral hygiene of patients undergoing fixed orthodontic treatment : A randomized controlled clinical trial.

OBJECTIVES: This study aimed to assess the efficacy of a mobile phone application (app) to improve oral hygiene of patients undergoing fixed orthodontic treatment. MATERIALS AND METHODS: This randomized controlled clinical trial was conducted with a total of 60 patients undergoing fixed orthodontic treatment in two groups: intervention and control (n = 30 each). A previously designed mobile app (Labkhand) was used by patients in the intervention group. Orthodontic plaque index (OPI) and modified gingival index (MGI) were recorded in the two groups at baseline (first session or T0), and after 1 (T1) and 3 (T2) months. The number of debonded/broken brackets was also recorded, and pain score of the patients was assessed at nine time points. Data were analyzed using the χ2 test, paired t­test, and repeated measures analysis of variance (ANOVA; α = 0.05). RESULTS: The two groups demonstrated no significant difference in OPI and MGI at T0 (P > 0.05). OPI and MGI at T1 and T2 were significantly lower in the intervention group than in the control group (P < 0.05). The number of patients with broken brackets in the intervention group was significantly lower than that in the control group (P = 0.017). The two groups reported no significant difference in pain score (P > 0.05). CONCLUSION: The Labkhand mobile app successfully improved oral hygiene indices of patients undergoing fixed orthodontic treatment, and decreased the frequency of broken brackets after 1 and 3 months of use.

Effect of Metformin Use on Survival and Recurrence Rate of Gastric Cancer After Gastrectomy in Diabetic Patients: A Systematic Review and Meta-analysis of Observational Studies.

BACKGROUND: Gastric cancer (GC) is one of the most common worldwide cancers and causes of death. Various studies have investigated the effect of metformin on overall survival (OS), cancer-specific survival (CSS), recurrence-free survival (RFS), and recurrence rate in diabetic patients after gastrectomy, and their results have been contradictory. This meta-analysis aimed to evaluate the effect of metformin use compared to sulfonylurea compounds with OS, CSS, RFS, and recurrence rate after gastrectomy in diabetic patients. METHODS: We reviewed the Scopus, Google Scholar, PubMed, Web of Science, and Embassy databases until September 2022 based on appropriate MESH terms. All observational studies that evaluated the effect of metformin on survival in diabetic patients who underwent surgery for GC were included. The hazard ratio (HR) with a 95% confidence interval was used to estimate the effect size. The Egger test was used to evaluate publication bias. RESULTS: Overall, nine studies, including 245,387 GC patients who underwent surgery, were included. The use of metformin significantly increased the OS rate (HR: 0.81, 95% CI: 0.78, 0.86, P: 0.001, I2: 4.5%), CSS rate (HR: 0.72, 95% CI: 0.63, 0.81, P: 0.011, I2 = 0%), and RFS rate (HR: 719, 95% CI: 0.524, 0.986, P: 0.001) and decreased the recurrence rate after gastrectomy (HR: 0.83, 95% CI: 0.77, 0.87, P: 0.001, I2: 0%). The use of metformin was significantly associated with a greater increase in OS and CSS rate and a greater decrease in recurrence rate in the Asian population than in the Western population. CONCLUSION: The use of metformin in diabetic patients with GC can be associated with improved OS, CSS, RFS, and reduced recurrence rate after gastrectomy, especially in the Asian population.

The Association between ABO Blood Group and the Risk of Colorectal Cancer: A Systematic Literature Review and Meta-Analysis.

INTRODUCTION: Recently, studies have investigated the relationship between blood types and cancers. Contradictory results regarding the relationship between blood group type and colorectal cancer(CC) have been reported. The purpose of this study was to systematically investigate the distribution of ABO blood group frequency and evaluate its relationship with CC. MATERIAL AND METHODS: To conduct this systematic meta-analysis, we searched PubMed, Scopus, Web of Science, and Google Scholar databases using appropriate MESH terms until July 2022. All observational studies which assessed the ABO blood group frequency distribution and the association between ABO and CC were included. The Risk of Bias Assessment tool was used to assess the quality of studies. A random model was used to estimate the odds ratio (OR). The Egger test was used to assess the publication bias. RESULTS: Overall,14 studies (413,132 patients) were included. According to the pooled estimation, blood groups A, B, AB, and O frequency in patients with CC were 37%,18%,9%, and 31%, respectively. The OR of CC in people with the A blood group was higher than in the other groups (OR: 1.11, 95% CI:1.03,1.19, P:0.001). In contrast, the OR of CC in people with the O blood group was significantly lower than in other blood groups (OR: 0.93, 95% CI:0.83,0.97, P:0.001). No significant relationship was observed for B and AB blood groups with CC. CONCLUSIONS: This Meta-analysis showed that blood group type A has a greater risk of developing CC, while blood group type O was associated with lower chances of CC.

Mobile app for comprehensive management of orthodontic patients with fixed appliances : Design and use.

OBJECTIVES: This study aimed to design and implement a mobile phone application (app) aiming to enhance the cooperation and oral hygiene of orthodontic patients. METHODS: An orthodontic app named "Labkhand" was designed by a team of orthodontists and programmers according to the needs and scheduled interventions for patients. The aim of this app was to obviate the orthodontic needs of patients by providing educational content in the form of texts and videos, oral hygiene reminders, appointment reminders, and nutrition reminders. It also enabled instant messaging and chatting between patients and dental personnel. In this study, 61 patients were monitored during their orthodontic treatment procedure. All patients were evaluated using a questionnaire with 7 questions before and after a 6-month treatment period. A total of 31 patients were instructed to use the app, while the other 30 patients received treatment without the app. The collected data were analyzed using paired t­test and analysis of covariance (ANCOVA) test. RESULTS: While the control group's questionnaire score remained almost the same (P > 0.05), the mean questionnaire score of patients in the intervention group significantly increased after using the app compared to the baseline scores acquired before using the app (P < 0.001). The greatest improvement was noted in topics related to "reminding of appointments", "general information about orthodontic treatment", and "oral hygiene maintenance and instructions". "Quality of services" and "patient-orthodontist communication" showed the least improvement in patient satisfaction. CONCLUSIONS: The Labkhand orthodontic app has multiple functions and can obviate the needs of orthodontic patients easily and at a low cost.

Histopathologic Changes of Appendicitis Stage During the COVID-19 Pandemic.

Background: We decided to compare the pathology stage of appendicitis in patients referred to Firoozabadi Medical Center before and after the official announcement of the coronavirus outbreak in Iran because we believe that people's fears of COVID-19 are keeping them away from hospitals and it likely causes them to come in later stages of the disease. Therefore, this study aims at investigating the effect of the COVID-19 pandemic on the stage of appendicitis at presentation. Methods: In this retrospective study, histopathology records of all acute appendicitis patients who underwent an emergency appendectomy in the surgical unit in our institute between December 2019 and April 2020 were reviewed retrospectively. The study period was designed to include 2 months before and 2 months after the officially announced onset of the COVID-19 outbreak in Iran on February 20, 2020. All cases of complicated appendicitis (perforated appendicitis, phlegmonous appendix, itis or abscess) were excluded. Descriptive statistics were used to describe our study variables. Furthermore, ordinal logistic regression was used to investigate the effect of the COVID-19 pandemic and demographic variables on the stage of appendicitis at presentation. Data were analyzed using SPSS Statistics Version 22. Results: The study was conducted on 170 clinically diagnosed acute appendicitis patients. The odds ratio for gender was equal to 0.45 (0.23, 0.86), which means that women presented at an earlier pathological stage than men ( p = 0.016). Also, patients who had health insurance were 50% less likely to present in later pathological stages than those who did not ( p = 0.024). The COVID-19 outback did not have a significant role in the pathological stage at presentation ( p = 0.235). Conclusion: The number of appendicitis patients was down by about 50% following the outbreak announcement in Iran. Surprisingly, we did not find any significant changes in the distribution pattern of appendicitis pathological staging after the outbreak. Being uninsured and male sex were found to have the most significant roles in delayed hospital presentation and higher pathological stages in patients with acute appendicitis.

Amyand's hernia: non incarcerated, inflamed appendix in inguinal sac case report.

Inguinal hernia is described as protrusion of abdominal structures into inguinal canal, such as intestinal loop and abdominal fascia. Appendix rarely bulges into inguinal canal which is called Amyand's hernia. A 55-year-old diabetic male presented to an outpatient clinic with right inguinal bulging since 2 years ago which was non-tender, without erythema and became non reducible since 2 days ago. Also bulging worsened by physical activity. The patient went through operation and an inflamed appendix was found stuck in hernia sac. Non incarcerated inguinal hernia can be diagnosed with physical examination and there is no need of further imaging which makes it hard to diagnose the nature of protrusion. Amyand's hernia usually presents with pain due to appendicitis which mimics incarcerated hernia and makes it easier to suspect the etiology and request for further investigation. However in this case, pain was suppressed and this patient was candidate for elective inguinal herniotomy.

Design and implementation of a follow-up and training program of health-promoting lifestyle after the coronary artery bypass graft.

BACKGROUND: Coronary artery bypass graft (CABG) plays an important role in reducing coronary heart disease mortality, but patients are still at risk after surgery. Consequences can be avoided if threatening behaviors are soon detected and lifestyles are promoted. Therefore, the present study aimed to evaluate, follow-up, and promote a healthy lifestyle in the patients. MATERIALS AND METHODS: The present research was a quasi-experimental pre- and postintervention single-group study on 35 patients under the CABG at two hospitals affiliated to the Baqiyatallah University of Medical Sciences in Tehran from August 2020 to April 2021. The samples were selected using the purposive sampling method and the educational content was determined by creating an expert panel. We utilized the Health-promoting Lifestyle Profile II to collect data, and SPSS 22 to analyze them. RESULTS: There was a significant difference between mean total scores of health-promoting lifestyle before and after the intervention and they reached from 138.7 ± 20 to 157.2 ± 18 (P < 0.0001). There was also a statistically significant difference between mean scores of nutrition (P < 0.003), physical activity (P < 0.0001), health responsibility (P < 0.0001), and stress management (P < 0.0001) before and after the intervention, but there was no statistically significant difference between mean scores of interpersonal relationships, and spiritual growth before and after the intervention. CONCLUSIONS: The program had a positive effect on the health-promoting lifestyle scores of patients after CABG. It is possible to increase scores of healthy lifestyles in the patients by combining face-to-face and virtual training methods as well as involving family members and relatives of patients in training and follow-up programs.

Primary and metastatic primitive neuroectodermal tumor of the heart: A systematic review.

OBJECTIVE: Primary and metastatic primitive neuroectodermal tumors of the pericardium are uncommon. Two cases are presented and discussed. METHODS: The cases of a 17- and 38-year-old male patients with neuroectodermal tumors of the pericardium are presented. In addition, a systematic review was performed according to the Preferred Reporting Items and checklist for Systematic reviews and Meta-Analyses (PRISMA). All selected articles' quality assessment was done using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Reports. RESULTS: The systematic review yielded 29 patients with primary or metastatic PNET. Two patients underwent cardiac transplantation. It seems that unlike considering total resection in other organs, pericardiectomy in PNET patients with pericardial origin may lead to further invasion of the lesions, and it is not recommended. The average disease-free follow-up was 10 months. The combination of neoadjuvant and adjuvant chemotherapy along with surgery and radiotherapy offered the best disease-free outcomes. CONCLUSION: Neuroectodermal heart tumors are rare, aggressive tumors requiring chemotherapy and radiotherapy in association with tumor resection surgery to have the best disease-free duration.

The impact of socially accountable health professional education: Systematic review.

Medical education is socially responsible for a global educational movement that transforms the development and presentation of medical schools in higher education. Therefore, in the present systematic review, we aimed to evaluate the impact of socially accountable health professional education. Published research articles were reviewed by searching the relevant terms invalid databases. In the initial search, 2340 records were obtained. At this stage, 1482 records were deleted due to duplication, and 773 records were removed due to indirect connection with the subject. Then, 85 articles were retrieved for full-text review. Finally, the complete review led to the selection of nine studies that met all inclusion criteria. Based on the results of the present systematic review, among the nine reviewed articles, four studies (44.44%) evaluated the effectiveness of social accountability on increasing the sense of empowerment, self-confidence, competencies such as teamwork, communication skills, and readiness for work. Three studies (33.333%) assessed the effectiveness of social accountability on providing further and better medical services and reducing infant mortality. Also, in two articles (22.22%), students' lack of knowledge about social accountability was studied. Social accountability can help cultivate a healthy and skilled medical workforce and be effective in improving health services provided to the people. On the other hand, there are different perceptions and views on what social responsibility really is and how its effectiveness can be measured. Also, it is highly important to provide awareness in this regard for students.

Non-adherence to Treatment Among Iranian Dialysis Patients, A Systematic Review.

Non-adherence to treatment is a common problem among hemodialysis (HD) patients and was considered as a reliable factor in patients deteriorating, increasing admission chance and inappropriate responding to HD treatment. According to multiple factors related to Non-adherence with HD treatment and its importance in patients' quality of life, this study aims at a systematic reviewing of Non-adherence to treatment among Iranian dialysis patients. Treatment with adherence status is one of the problems that patients encounter during dialysis. This study aims at detecting the most important causes of Non-adherence in patients on dialysis according to previous studies. First, all of the studies related to our title were searched using main keywords (dialysis, hemodialysis, adherence, and non-adherence) for English and Persian databases; Iranmedex, Magi ran, SID, Iran doc, Google, Google scholar, PubMed, Embase, CINAHL, PsycInfo, and Cochrane Database of Systematic that covering the period from 2010 to 2018 was reviewing following a predefined inclusion and exclusion criteria. As a result, 40 papers related to inclusion and exclusion criteria were identified and analyzed. Data were collected according to study features, measures of Non-adherence, prevalence rates and factors related to Non-adherence. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to conduct this systematic review. According to the results of present study six main categories were found. The main reasons for Non-adherence with treatment in dialysis patients listed in the papers included: Patient related factors, socioeconomic factors, psychological factors, health care related factors, therapy related factors and disease-related factors.Trying to improve adherence is very important and can play a significant role in increaseing the health status among patients on dialysis.

The relationship of mandibular radiomorphometric indices to skeletal age, chronological age and skeletal malocclusion type.

BACKGROUND: The present study was performed with the following aims: (1) to assess the relationship between skeletal age, measured using the cervical vertebral maturity (CVM) method, and chronological age; (2) to determine the correlation of skeletal and chronological age to the cortical thickness of the lower border of the mandible using the linear radiomorphometric; and (3) to explore the relationship between these indices and skeletal malocclusion type. MATERIAL AND METHODS: The data were collected from the records of 180 patients, including 57 males (31.7%) and 123 females (68.3%). The data were based on the panoramic and lateral cephalograms of each patient. The CVM stages were determined on the basis of the patients' lateral cephalograms. Three radiomorphometric indices were measured: AI, MI and GI. The patients were divided up into three groups of skeletal malocclusion: Class I, II, and III. For all the tests, statistical significance was set at P<0.05. RESULTS: The relationship between chronological age and skeletal age was 0.496. Furthermore, with an increase in chronological and skeletal age, the cortical thickness of the lower border of the mandible and consequently the radiomorphometric indices increase, except for the GI (P > 0.05). Lastly, the relationship between GI and skeletal malocclusion type proved significant. CONCLUSIONS: AI and MI were found to increase significantly with increasing age, so the assessment of mandibular radiomorphometric indices could be clinically useful in estimating of the growth and maturation of the mandible. Key words:Orthodontics, Radiomorphometric indices, Skeletal age, Skeletal malocclusion.

Shear bond strength of orthodontic metal brackets to aged composite using three primers.

BACKGROUND: This study aimed to assess the effect of surface preparation with sandblasting and diamond bur along with the use of three primers on shear bond strength (SBS) of metal brackets to aged composite. MATERIAL AND METHODS: In this in vitro, experimental study, 60 Filtek Z250 composite discs were fabricated (10×2mm), immersed in distilled water for 24 hours and subjected to 5000 thermal cycles. They were randomly divided into two groups (n=30) of sandblasting with aluminum oxide particles for 10 seconds and surface roughening with bur. Each group was randomly divided into three subgroups (n=10) for use of Transbond XT, Assure Plus and Composite Primer. Metal brackets were bonded and the samples were stored in distilled water for 24 hours followed by 2000 thermal cycles. The SBS of brackets was measured and the adhesive remnant index (ARI) score was calculated. The data were analyzed by one-way ANOVA, t-test and Chi square test. RESULTS: The difference in the mean SBS was not significant among the six subgroups. CONCLUSIONS: All combinations of primers and surface preparation methods provided adequately high SBS between brackets and aged composite surfaces. Considering the ARI scores, surface roughening by bur is superior to sandblasting. Key words:Shear strength, composite resins, orthodontic brackets, aged composite, surface preparation.

The Effect of BCAA and ISO-WHEY Oral Nutritional Supplements on Dialysis Adequacy.

BACKGROUND: Protein-energy malnutrition is a common problem in hemodialysis patients and has different outcomes such as reduced quality of life, longer hospitalization time, lower dialysis adequacy, and higher mortality rate. Investigation of dialysis adequacy is an important method for assessing hemodialysis patients, and improving the dialysis adequacy is an important healthcare team goal. OBJECTIVES: The present study aims to investigate and compare the effects of BCAA and ISO-WHEY oral nutritional supplements on dialysis adequacy. METHODS: In a clinical trial study, 66 hemodialysis patients were randomly divided into three groups: Group A (n = 22), Group B (n = 22), and Group C or the control group (n = 22). In Groups A and B, as prescribed and controlled by nutritionists and nephrologists, respectively, ISO-WHEY and BCAA protein powder were used for 2 months on a daily basis. For all groups, before intervention and 1 and 2 months after intervention, the dialysis adequacy was measured using URR and Kt/V. Finally, the data were analyzed using IBM SPSS Statistics Base 21.0 software. RESULTS: Out of 66 patients, 61 (19 in Group A, 20 in Group B, and 22 in Group C) completed the study period, and before intervention, all groups were equal in terms of quality and quantity variables (P > 0.05). After intervention, there was a significant difference between the three groups with regard to the variables of dialysis adequacy based on Kt/V and URR to independent-t test and repeated measures ANOVA (P < 0.05). CONCLUSIONS: Results show that the intake of oral nutritional supplements leads to an improvement in the dialysis adequacy of hemodialysis patients. Therefore, the use of nutritional supplements along with patients' training and regular consultation will be helpful in improving the nutritional status, dialysis adequacy, and eventually the quality of life.

The Effect of Continuous Care Model on the Sleep Quality of Hemodialysis Patients.

BACKGROUND: One of the most prevalent problems in hemodialysis patients is sleep disturbance. Poor sleep quality has unpleasant bio-psycho-social outcomes. The positive effects of implementing the continuous care model (CCM) were verified with different variables, including sleep quality. This study was done with different populations, using two groups. OBJECTIVES: This study aims to identify the sleep quality of hemodialysis patients in the city of Ilam and determine the effects of CCM on sleep quality. PATIENTS AND METHODS: We performed a quasi-experimental research study with 56 hemodialysis patients at the Shahid Mostafa Hospital in Ilam during 2014 and 2015. Pretests and posttests were conducted with the study groups and the control groups. Pretests were conducted over a one-month period, then repeated immediately before the study. Posttests were conducted immediately after the study and then repeated one month later. Participants were selected by census method and randomly divided into two groups. Ethical considerations were observed. Based on the continuous care model, interventions were performed through educational sessions over a three-week period. Consultations for continuous sleep monitoring, controls, and evaluations were conducted with the study group over the next nine weeks. Data were gathered from patient demographics questionnaires and PQSI, then introduced in SPSS 22 and analyzed with descriptive and analytic statistics (t-paired, ANOVA with repeated measures, follow-up tests such as S-N-K, Duncan, Sheffe and Tukey). RESULTS: One month prior to the study, 94.6% of the participants suffered from poor sleep quality. Immediately before and after the study, 91% complained of poor sleep quality. And one month after intervention, the figure dropped to 82%. Applying the CCM positively affected the sleep quality of hemodialysis patients in Ilam, and was statistically meaningful one month after intervention (P = 0.001). CONCLUSIONS: Hemodialysis patients need a consistent care plan to manage poor sleep quality. This research has proven the effectiveness of implementing CCM as an intervention for improving the sleep quality of hemodialysis patients. CCM provides a comprehensive model for caring for hemodialysis patients, and its executive stages are congruent with the many stages of the nursing process. Practitioners in different domains of nursing care, education, and management can derive great benefit from this valuable care model.

Effect of Vitamin B12 supplementation on serum homocysteine in patients undergoing hemodialysis: A randomized controlled trial.

Clinical studies have shown that hyper-homocysteinemia is a potent independent risk factor for cardiovascular diseases, and many different methods have been investigated for lowering it in hemodialysis (HD) patients. Our study investigated the effect of Vitamin B 12 supplementation on serum homocysteine levels in these patients. This randomized trial was conducted on 140 HD patients. They were randomly distributed by lottery method into two groups: intervention and control. In the intervention group, 100 µg/mL of Vitamin B 12 was intravenously injected two times a week, for eight weeks. No intervention was performed in the control group. Serum levels of homocysteine, hemoglobin (Hb), and hematocrit (Hct) were measured at the beginning and again after eight weeks (2 months) of treatment. About 91% of the patients had hyperhomocysteinemia (serum homocysteine >15 µmol/L). The median baseline levels of serum homocysteine in the intervention and control groups were 31.9 and 26.9 µmol/L, respectively (P = 0.1). After eight weeks, the median homocysteine level reduced significantly in the Vitamin B 12 group to 22.2 versus 28.4 µmol/L in control group (P = 0.006). The mean Hb and Hct also changed significantly during our study (12.3 vs. 11.4 g/dL; P = 0.003 and 37.9 vs. 35.3%; P = 0.02, respectively). Our results demonstrated the existence of a statistical negative relationship between Vitamin B 12 and serum levels of homocysteine. Detailed investigations with larger sample sizes and longer-term use of Vitamin B 12 are recommended.

Effect of vitamin C supplementation on marital satisfaction in patients undergoing hemodialysis: A randomized, double-blind and placebo-controlled trial.

One of the common problems in patients on hemodialysis (HD) is marital dissatisfaction. Because anemia and fatigue are two important factors for marital dissatisfaction, and vitamin C can ameliorate both of them, we carried out this study to evaluate the effect of vitamin C on marital satisfaction among HD patients. This randomized, placebo-controlled, double-blind and parallel-group trial was conducted on 62 HD patients. The MFI-20 and ENRICH questionnaires were completed at the start and end of study. Required laboratory parameters including serum levels of hemoglobin (Hb), hematocrit (Hct) and ferritin were also measured at the start and at the end of the study. In the intervention group, 250 mg of vitamin C was injected intravenously immediately at the end of each HD session three times a week for eight consequent weeks. In the control group, placebo saline was injected. There was a significant change in the level of fatigue (P = 0.01) and the serum levels of Hb (P = 0.006) and Hct (P = 0.02). The mean of the marital satisfaction score increased significantly in the intervention group (P = 0.001): Baseline score of 35.7 ± 5.10 versus a final score of 38.0 ± 5.30. However, the mean of marital satisfaction score decreased in the control group: Baseline 37.1 ± 7.10 versus a final score of 34.7 ± 7.40. Our findings suggest that vitamin C supplementation can modify the marital satisfaction. Further studies are recommended.

Effect of vitamin C supplementation on serum uric acid in patients undergoing hemodialysis: a randomized controlled trial.

INTRODUCTION: Clinical studies of recent years have shown that hyperuricemia is associated with poor outcomes such as cardiovascular mortality and dialysis inadequacy in patients undergoing hemodialysis. Our study investigated the effect of vitamin C supplementation on serum uric acid levels in hemodialysis patients. MATERIALS AND METHODS: This randomized placebo-controlled trial was conducted on 172 hemodialysis patients. They were randomly divided into the intervention group, to receive 250 mg of vitamin C, three times per week, for 8 weeks, and control groups 1 and 2, to receive placebo injection (saline) and no intervention, respectively. Serum levels of uric acid and creatinine were measured at the start of the study and also after 8 weeks. RESULTS: The mean of serum levels of uric acid was 6.02 ± 1.08 mg/dL (reference range, 2.6 mg/dL to 6 mg/dL). Nearly, half of the patients (46.7%) had a serum level of uric acid greater than 6 mg/dL. The median baseline serum levels of uric acid were 6.2 mg/dL, 5.9 mg/dL, and 6 mg/dL in the intervention, control 1, and control 2 groups, respectively (P = .19). After 2 months, median levels reduced significantly in the vitamin C group to 5.8 mg/dL as compared to 6.4 mg/dL and 6.3 mg/dL in control groups (P = .02). The mean serum creatinine level had no significant changes during the study. CONCLUSIONS: Our results demonstrated the existence of a significant negative relationship between vitamin C and serum uric acid levels. Detailed investigations with larger sample sizes and longer-term use of vitamin C are recommended.

Effect of Vitamin C Supplementation on C-reactive Protein Levels in Patients Undergoing Hemodialysis: A Randomized, Double Blind, Placebo-Controlled Study.

BACKGROUND: Chronic inflammation is the most important cause of cardiovascular disease in patients undergoing hemodialysis, and vitamin C as a major antioxidant which could be effective to suppress inflammation. OBJECTIVES: This study was performed to evaluate the effect of vitamin C supplementation on C-reactive protein levels in patients undergoing hemodialysis. PATIENTS AND METHODS: This randomized, placebo-controlled and double-blind trial was conducted on 151 patients on hemodialysis who were divided randomly by lottery method to three identical groups. In the intervention group, 250 mg of vitamin C was injected intravenously immediately at the end of each hemodialysis session three times a week for 8 weeks in a row. In the control group 1, same term of placebo saline was injected, and in the control group 2, no intervention was performed. RESULTS: A total of 86 (61%) male and 55 female patients with mean hemodialysis duration of 39.74 ± 45.5 months, and a mean age of 61.36 ± 11.46 years-old, participated in this study. Hypertension and diabetes were the most common underlying diseases (79.4%). Median baseline CRP in the intervention, control 1 and control 2 groups were 16.8, 17.8, and 19.4 mg/L respectively. After 2 months, median CRP reduced significantly in the vitamin C group to 10.7 (P = 0.04) vs. 22.6, and 30.6 mg/L in control groups. CONCLUSIONS: Our findings demonstrated that vitamin C supplementation modifies the levels of CRP in patients on hemodialysis.

Effect of applying continuous care model on quality of life among kidney transplant patients: a randomized clinical trial.

INTRODUCTION: The aim of this study was to compare the effect of continuous care model with routine care on the quality of life among patients who receive a kidney transplant. MATERIALS AND METHODS: In a randomized clinical trial, 90 kidney transplant patients were selected from 4 hospitals in Tehran, Iran, and were randomly assigned to 2 group. In the experimental group, continuous care model was applied for 3 months and the control group received routine care. The scale scores of the Kidney Transplant Questionnaire concerning quality of life were monthly compared between the two groups. RESULTS: Of 90 patients, 4 in the experimental and 8 in the control group were excluded from the study. Final analysis was performed on 41 in the experimental and 37 in the control groups. No significant difference was found between the two groups in terms of demographic variables. Although the quality of life scores increased in both groups, the mean scores of the experimental group were significantly higher than those in the control group at 1, 2, and 3 months. CONCLUSIONS: Continuous care model may improve the kidney transplant patients' quality of life.