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Background and Purpose: Various abnormalities of the immune system have been demonstrated in patients with chronic kidney disease (CKD). Patients with CKD commonly present with abnormalities of immune function related with impaired kidney function and the accumulation of uremic toxins. Th1 and Th2 cells produce predominantly some cytokine profiles. The aim of the present study was the determination of the levels of IL-13 and IFN-g in sera of end-stage renal disease. The correlations of IL-13 and IFN-g levels with clinical presentation of the disease were assessed.
Materials and Methods: In this case-control study the serum levels of IL-13 and IFN-g were determined by a sandwich enzyme-linked immunosorbent assay in 30 patients on hemodialysis (HD), 30 patients with chronic renal failure (CRF), and 60 healthy individuals . Renal function was evaluated by measuring serum levels of creatinin, albumin and urea.
Results: The serum levels of IL-13 and IFN-g were differed significantly between patients and healthy controls. The serum levels of IL-13 was significantly increased in the HD group than in the CRF and control groups (13.7± 3.9, 6.7± 3.4, 4.5±3.3 pg/ml, respectively) (P=0.001). On the other hand, the IFN-g plasma levels were significantly higher in CRF patients than HD patients and controls (38.8±18.8, 17.4±8.78, 12.5±8.9 pg/ml, respectively).
Conclusion: In the HD patients, low production of IFN-g in line with upregulation of IL-13 indicates that Th1/Th2 balance may shift towards Th2 dominance. It is possible that this imbalance contributes to the abnormality of the immune system in HD patients.

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Background and purpose: Female nurses are exposed to many problems due to their working situation. This will make them vulnerable to stress, burnout, and emotional exhaustion. In this study we structurally analyzed burnout among nurses while considering acceptance, commitment, and emotion regulation. Material and Methods: This descriptive-correlational study was conducted in May 2013 and included 180 nurses working in a hospital located in city of Isfahan. A total of 119 cases was randomly selected using Morgan table. Maslach Burnout Inventory (MBI), Acceptance and Commitment Therapy (ACT), and Cognitive Emotion Regulation Questionnaire (CERQ) were used to collect the data. Data was then analyzed using SPSS and Lisrel program. Results: The results indicated a significant correlation between burnout, emotion regulation, and acceptance and commitment. Structural equation modeling showed direct relationships between burnout and ACT and emotion regulation and ACT. We also found ACT with a mediation effect in the relationship between burnout and emotion regulation. Conclusion: This study showed emotion regulation and ACT as the main indicators for burnout.

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Interferons (IFNs) are pleotropic cytokines with strong anti-viral and immunomodulatory properties. Their function is dependent to signaling pathway upon binding to IFN receptor. Both pro- and anti-inflammatory effects are seen in interferons-related immune responses. While, interferons are in direct correlation with autoantibodies production during autoimmunity, they have protective effects. This paradoxical role of interferons may impose on immunopathogenesis of autoimmune diseases and selecting appropriate medical strategies. Here, we will review the role of interferons in autoimmune diseases such as giant cell arteritis and describe a general overview on their dual role in autoimmune diseases including, systemic lupus erythematosus, multiple sclerosis, rheumatoid arthritis, and scleroderma.

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Background and purpose: Fibromyalgia (FM) is a chronic pain condition with non-articular origin that is defined by generalized pain, fatigue and sleep disturbance. The aim of this study was to evaluate the reliability and validity of Persian version of Revised Fibromyalgia Impact Question­naire (FIQR) in Iranian patients with FM.

Materials and methods: The FIQR was translated into Persian and adminis­tered to 44 female patients with primary FM. All patients filled out the questionnaire along with the Persian version of the Hospital Anxiety and Depression Scale (HADS) and short form-36 (SF-36). One week later, FM patients filled out the FIQR at their second visit. Reliability was analyzed by internal consistency Cronbach’s α coefficient and intra-class correlation coefficient. Construct validity was evalu­ated by Spearman’s and Pearson’s correlation coefficient. Statistical analysis was performed in SPSS ver. 19.

Results: From 69 female patients with primary FM who had HADS score less than 15, 44 were selected. The total scores of the FIQR in first and second visits were 52.85±20.2 and 53.62±18.3, respectively. Evaluation of construct validity with SF-36 and HADS showed a significant correlation at the 0.01 level. The intraclass correlation coefficient (ICC) was CI95%=0.929 (0.896-0.956) and Cronbach’s α was 0.93 for FIQR in the first visit. The correlation between first and second total scores was 0.82 (P=0.001).

Conclusion: The Persian version of FIQR showed adequate reliability and validity.

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Background and purpose: Evidence suggest high prevalence of trigger finger (TF) in diabetic patients. Corticosteroid injection in the area of tendon sheath thickening is the first-line treatment of choice for TF. However, some studies indicated low efficacy of this method in diabetic patients. This study aimed at investigating the effectiveness of oral corticosteroids in diabetic patients with TF.
Materials and methods: In a clinical trial, 50 diabetic patients with trigger finger (n=106 digits) enrolled. The patients were treated with oral prednisolone 5 mg, three times a day for 2 weeks. They were then followed up based on Quinnell grading at 3 and 6 weeks, and 3 months. Data analysis was done in SPSS V17 applying Repeated measures ANOVA.
Results: At the end of the three-month follow-up, 84 fingers (79.3%) of patients who took oral prednisolone improved. The reduction of Quinnell grading was significant after medication (p<0.001). Positive correlation was observed between symptoms duration and disease severity at third month (r=0.37, p<0.0001). In addition, there were positive correlations between the number of fingers affected and diabetes mellitus duration (r=0.425, p=0.002), HbA1C (r=0.319, p=0.024), and 2HPP (r=0.29, p=0.041).
Conclusion: Current study showed no local side effects of corticosteroids in patients receiving oral prednisolone. Therefore, it could be suggested as an influential treatment for trigger finger in diabetic patients, especially those with less than 6 months onset of symptoms, normal blood glucose control, less severity of the symptoms, and higher number of involved fingers.
 
(Clinical Trials Registry Number: IRCT2016060528266N1)

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Background and purpose: Nosocomial infections, especially in the intensive care unit (ICU), are critical medical problems worldwide, increasing the length of hospital stay, treatment costs, and mortality. The present study aimed to assess the prevalence of mortality caused by hospital infections in patients admitted to the ICU of Imam Khomeini Hospital, Sari.
Materials and methods: The cross-sectional descriptive study was conducted on 289
patients admitted to the ICU of Imam Khomeini Hospital, Sari, from 2019-2020. Culture reports (positive/negative), detected microorganisms, antibiotic sensitivity, and cases of mortality were recorded and evaluated in the checklist.
Results: Among 289 patients, 112 cases were female, and 177 subjects were male. The mean age of the deceased was 63.10±14.11 years. According to the data, 86% of patients recovered and 14% died. The most common cause of nosocomial infection was Enterobacter (17.3%), and the most common nosocomial infection was pneumonia (45.3%). The majority of patients who died had taken ceftriaxone.
Conclusion: Identification of factors related to increased mortality in patients with nosocomial infections can have a significant function in the management and control of hospital infections. In the present study, multiple drug resistance in pathogens was high. The highest mortality rate was related to Stenotrophomonas maltophilia infection.

 

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Background and purpose: Chronic obstructive pulmonary disease (COPD) is a progressive pulmonary ailment characterized by prolonged respiratory symptoms and airflow constriction. COPD stands as the third most prominent cause of mortality on a global scale. It is commonly linked to numerous extra-pulmonary conditions, such as cardiopulmonary disorders, musculoskeletal frailty, and anemia. Osteoporosis, regarded as one of the principal systemic complications arising from COPD, represents an elevated susceptibility to osteoporotic fractures and imposes a significant financial burden. Considering the clinical significance surrounding the emphysema phenotype in COPD, as well as the lack of investigation on this matter in the country, the objective of this study is to determine the comparative prevalence of osteoporosis and osteopenia in COPD patients, with and without emphysema, who receive medical attention at Tubi Sari Clinic and Imam Khomeini Hospital in Sari.
Materials and methods: This cross-sectional study was conducted in 2021 on patients referred to the rheumatology and lung clinic, and COPD patients admitted to Imam Khomeini Hospital in Sari. In this study, 50 patients with COPD with emphysema as a case group and 50 patients with COPD without emphysema as a control group were included in the study. Then, using densitometry and examining the bone mass density of all COPD patients, the patients were divided into two groups: with and without osteoporosis. Then, the patient's information was entered into SPSS software and analyzed.
Results: There was no significant difference in vitamin D serum levels, vertebral fracture score, or BMD between emphysema and non-emphysema patients (P=0.09, P=0.098). Multivariate analysis showed that (in a model including age, BMI, FEV1, PaO2, emphysema score, CRP, and dyspnea score) only BMI, FEV1, and PaO2 decreased as independent risk factors for low BMD.
Conclusion: Our findings showed that emphysema is an independent risk factor for osteoporosis according to the multivariate model. Low BMI, severity of COPD, and hypoxia play a dominant role in the development of osteoporosis.
 

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Background and purpose: Cardiovascular diseases are among the chronic diseases with a high mortality rate. Considering the importance of person-centered medicine and Iranian medicine, the concept of temperament has a great impact on the occurrence of diseases. The aim of this study is to investigate the temperament of patients with an acute heart attack.
Materials and methods: A descriptive cross-sectional study was conducted on 280 new patients, aged 20 to 60 years, diagnosed with their first acute heart attack, confirmed by a cardiologist based on clinical and laboratory findings, at the Mazandaran Heart Center from April to September 2024. The study population was selected using convenience sampling.
Results: The mean age of the patients was 51.81±5.98 years, and 70% were male. The frequency of hot temperament, both singly and in combination, differed significantly between the sexes (P= 0.011), as did wet temperament compared to other temperaments (P<0.001).
Conclusion: The results of this study indicate that most patients with acute heart attacks have a hot and humid temperament. Therefore, according to the principles of Iranian medicine, maintaining health and effectively treating these patients requires avoiding factors that increase hot and humid temperament, such as overeating, obesity, physical inactivity, and inadequate sleep. In other words, individuals with a hot and humid temperament are more susceptible to this disease and should adopt preventive measures that help reduce this temperament, including proper nutrition, regular exercise, and adequate sleep.