Grape Seed Extract to Improve Liver Function in Patients with Nonalcoholic Fatty Liver Change

Background/Aim:

Therapeutic interventions in nonalcoholic fatty liver disease are limited, while antioxidative materials have shown benefi ts in animal models. This study aimed to evaluate grape seed extract as an anti-oxidative material in this process. Therapeutic effects of grape seed extract were evaluated in comparison to vitamin C in a double-blind setting.

Materials and Methods:

Fifteen patients were enrolled in each group. Liver function tests were done; also, grade of steatosis and pattern of echogenicity of the liver were determined. Patients were followed up by the same evaluation repeated in first, second and third months.

Results:

Mean age ± standard deviation was 43.2 ± 10.3 years. Grape seed extract (GSE) significantly improved the grade of fatty liver change; and resulted in significant decrease in alanine aminotransferase in patients receiving the concentrate compared to those receiving vitamin C independently, from the initial grade of steatosis.

Conclusions:

This study describes the beneficial effect of using grape seed extract for three months in patients with nonalcoholic fatty liver disease. These results may improve with a longer period of follow-up.     

Personality factors and profiles in variants of irritable bowel syndrome

AIM: To study the association between irritable bowel syndrome (IBS) variants (constipation,diarrhea,or both) and personality traits in non-psychiatric patients. METHODS: IBS was diagnosed using the Rome Ⅱ diagnostic criteria after exclusion of organic bowel pathology. The entry of each patient was confirmed following a psychiatric interview. Personality traits and the score of each factor were evaluated using the NEO Five Factor Inventory. RESULTS: One hundred and fifty patients were studied. The mean age (± SD) was 33.4 (± 11.0) year (62% female). Subjects scored higher in neuroticism (26.25 ± 7.80 vs 22.92 ± 9.54,P < 0.0005),openness (26.25 ± 5.22 vs 27.94 ± 4.87,P < 0.0005) and conscientiousness (32.90 ± 7.80 vs 31.62 ± 5.64,P < 0.01) compared to our general population derived from universities of Iran. Our studied population consisted of 71 patients with Diarrhea dominant-IBS,33 with Constipation dominant-IBS and 46 with Altering type-IBS. Scores of conscientiousness and neuroticism were significantly higher in C-IBS compared to D-IBS and A-IBS (35.79 ± 5.65 vs 31.95 ± 6.80,P = 0.035 and 31.97 ± 9.87,P = 0.043,respectively). Conscientiousness was the highest dimension of personality in each of the variants. Patients with C-IBS had almost similar personality profiles,composed of higher scores for neuroticism and conscientiousness,with low levels of agreeableness,openness and extraversion that were close to those of the general population. CONCLUSION: Differences were observed between IBS patients and the general population,as well as between IBS subtypes,in terms of personality factors. Patients with constipation-predominant IBS showed similar personality profiles. Patients with each subtype of IBS may benefit from psychological interventions,which can be focused considering the characteristics of each subtype.     

Validity and reliability of a Persian translation of the Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS)

Cognitive dysfunction is common in multiple sclerosis (MS) and validated batteries are limited in languages other than English. We aimed to translate, cross-culturally adapt, validate, and assess reliability of Minimal Assessment of Cognitive Function in MS (MACFIMS) in Persian. The MACFIMS is a well-constructed battery in the MS literature. The battery was adapted to Persian in accordance with available guidelines. A total of 158 MS patients and 90 controls underwent neuropsychological assessment. For reliability assessment the battery was re-administered in a subset of 41 patients after a short interval using alternate forms to mitigate practice effects (approximately 10 days). Patients performed significantly worse than controls in all cognitive tests, supporting discriminant validity of our adapted battery. Approximately half of patients (46.2%) showed cognitive impairment as defined by the impairment in two or more tests. The Symbol Digit Modalities Test was the most robust test by ROC analysis. All tests showed acceptable to good level of reliability. This is the first validation of gold-standard cognitive testing in Persian. The Persian MACFIMS shows nearly the same psychometrics as its English counterpart.     

ENDOSCOPIC RETROGRADE CHOLANGIOGRAPHY FOR INTRABILIARY RUPTURE OF HYDATID CYST

The most common complication of hydatid cysts of the liver is cholestasis due to rupture of hepatic cysts into the biliary tree. Such a complicated cyst is usually managed by surgical cyst resection. Endoscopic retrograde cholangiogram with sphincterotomy is a well‐established method for preoperative and postoperative extraction of cyst material from the biliary tree. Successful nonsurgical treatments of complicated hydatid cyst are reported with a combination of pharmaceutical therapy and endoscopic techniques consisting of endoscopic sphincterotomy and instillation of hypertonic saline solutions. We report feasibility and outcome of the endoscopic method for treatment of ruptured hepatic hydatid cyst into the biliary tract that also benefited from drainage of the whole cyst and membranes into the major biliary duct.     

Is cardiac biomarkers and left ventricular function affected by chronic kidney disease?

BackgroundCardiovascular disease is the leading cause of death in patients with chronic kidney disease (CKD). These patients may have high level of cardiac troponins in their serum irrelevant to acute coronary syndrome (ACS) that could have profound impact on patient's morbidity and mortality.ObjectivesThe aim of this study was to assess the relation between level of serum creatinine (Cr) and cardiac troponins T and I, and left ventricular (LV) function (as defined by LV ejection fraction) in non-dialysis and non-acute coronary syndrome CKD patients.Materials and MethodsThis is a prospective cross sectional study that includes 150 non-dialysis CKD patients without history of ACS in at least 1 month before the beginning of the study. Patients with history of CKD (serum Cr ≥1.5 mg/dl) of more than 6 months were selected. Patients with advanced multi-organ disease (lung disease, liver disease, cerebrovascular disease and peripheral vascular disease) and history of dialysis were excluded from the study. In each patient blood sample was obtained for analyzing serum Cr and cardiac troponin T and I (cTnT and cTnI). Also LV ejection fraction (LVEF) was measured by echocardiography in the same session.ResultThere was a positive non-parametric relation between serum Cr and cTnT (p = 0.028). However there were no relation between serum Cr, cTnI (p = 0.57) and LVEF (p = 0.188).ConclusionIn patients with CKD, serum Cr level has an impact on cTnT, but has no impact on cTnI and LVEF.     

Characteristics of anatomical landmarks in the mandibular interforaminal region: a cone-beam computed tomography study

Objectives: This study was conducted to assess appearance, visibility, location and course of anatomical landmarks in mandibular interforaminal region using cone-beam computed tomography (CBCT). Study design: A total of 96 CBCT examinations was re-evaluated to exploit anatomical landmarks. The examinations used the Promax 3D CBCT unit. A sole examiner carried out all the measurements. Visibilities of the anatomical landmarks were scored using a four-point rating scale. Results: The mandibular foramen, anterior loop, incisive canal and lingual foramen were observed in 100,84,83,49 % of the images, respectively. The mean size, diameter and width of anterior loop, incisive canal and lingual foramen were obtained 3.54± 1.41, 1.47±0.50 and 0.8 ± 0.09mm, respectively. Conclusion: It is not safe to recommend any definite distance mesially from the mental foramen. The diameter of the canals and foramens should be determined on a case-by-case basis to exploit the appropriate location for each individual. Key words:Anatomical landmarks, cone-beam computed tomography, implant surgery, radiographic evaluation, surgical complications.     

Full-mouth rehabilitation of a patient with severely worn dentition and uneven occlusal plane: a clinical report

Severe tooth wear is frequently multifactorial and variable. Successful management is a subject of interest in dentistry. A critical aspect is to determine the occlusal vertical dimension (OVD) and a systematic approach that can lead to a predictable and favorable treatment prognosis. Management of patients with worn dentition is complex and difficult. Accurate clinical and radiographic examinations, a diagnostic wax-up, and determining OVD are crucial. Using mini-implants as orthodontic anchorage may facilitate orthodontic movement of teeth to improve their position, which is necessary for favorable prosthetic treatment. A 46-year-old man was referred for restoration of his worn and missing teeth. After diagnostic work-up, provisional removable prostheses were fabricated for both jaws, evaluated clinically, and adjusted according to esthetic, phonetic, and vertical dimension criteria. Clinical crown lengthening and free gingival graft procedures were performed in appropriate areas. Drifting of the left posterior mandibular teeth was corrected using mini-implants as orthodontic anchorage. Two conventional implants were inserted in the right mandibular edentulous area. After endodontic therapy of worn teeth, custom-cast gold dowels and cores were fabricated, and provisional removable prostheses were replaced with fixed provisional restorations. Metal-ceramic restorations were fabricated, and a removable partial denture with attachments was fabricated for maxillary edentulous areas. An occlusal splint was used to protect the restorations. Full-mouth rehabilitation of the patient with severely worn dentition and an uneven occlusal plane was found to be successful after 3 years of follow-up. This result can encourage clinicians to seek accurate diagnosis and treatment planning to treat such patients.     

Comparison of pulmonary function and respiratory symptoms in water pipe and cigarette smokers

Background and objective: A major type of smoking in Middle Eastern countries is water pipe (WP) smoking. In the present study, pulmonary function tests (PFT) and respiratory symptoms (RS) were compared in WP smokers and deep inspiration (S‐DI) or normal inspiration (S‐NI) cigarette smokers. Methods: Pulmonary function and RS were compared among WP smokers, deep or normal inspiration cigarette smokers, and non‐smokers. Results: All PFT values in WP smokers and S‐DI, but only some values in S‐NI, were lower than those of non‐smokers (P < 0.05 to P < 0.001). In addition, all PFT values in WP smokers and S‐DI were lower than the corresponding values in S‐NI, except for forced expiratory volume in 1 s and maximal expiratory flow at 25% of forced vital capacity (P < 0.05 to P < 0.001). The prevalence of RS, except for sputum production, was greater in all three groups of smokers than in non‐smokers (P < 0.05 to P < 0.001). However, the severity of most RS in WP smokers and S‐DI, but only the severity of wheezing in S‐NI, was greater than that in non‐smokers (P < 0.05 to P < 0.01). There were inverse correlations for PFT values and positive correlations for RS, with duration and total amount of smoking (P < 0.05 to P < 0.001). Conclusions: The results from this study showed that there was a profound effect of WP smoking on PFT values and RS, which were similar to the effects of deep inspiration cigarette smoking.     

Right bundle branch block is not a predictor of coronary artery disease

Right bundle branch block (RBBB) is considered as an important predictor of poor outcome in patients with acute myocardial infarction, but the prognostic implication of RBBB in patients with suspected coronary artery disease (CAD) is unclear. Furthermore, the association between RBBB and incidence of CAD also its influence on the severity of stenosis in coronary arteries has not been established. This study was designed to assess the relationship between RBBB and the presence and the severity of CAD in patients with suspected CAD. The study population consisted of 172 patients with RBBB and 174 patients with normal resting electrocardiography (ECG). Severity of CAD was defined as estimated Gensini score according to the degree, quantity and distribution of lesions in angiographic study. According to our study based on angiographic investigations, in patients with RBBB the prevalence of CAD was 77.3 percent versus 70.1 percent in patients with normal resting ECG (P=0.13). Also, there was no significant association between the presence of RBBB and magnitude of Gensini score (OR=0.87, P=0.62). However, male gender and history of diabetes mellitus were associated with higher Gensini score (OR=3.41; 95% CI: 1.96-5.93, P<0.0001 and OR=3.22; 95% CI: 1.77-5.87, P<0.0001 respectively). This study suggests that although RBBB was associated with more severity of stenosis in left coronary system (LAD&LCX), but as a whole there was no association between RBBB and the presence and severity of CAD.