Reviews in Clinical Medicine
Volume:3 Issue: 2, Spring 2016

Weight gain and obesity are two important public health problems, which are associated with many diseases such as cardiovascular disorders. Various policies such as bariatric surgery have been proposed for the treatment of morbid obesity.
PubMed and Scopus were searched thoroughly with the following search terms (roux-en-y gastric bypass surgery) AND (ventricular function, OR cardiac risk factors OR heart)) AND (BMI OR body mass index) to find the articles in which the effect of roux-en-Y gastric bypass (RYGB) surgery had been evaluated in severely obese patients.
Out of 120 articles which were found in PubMed, and 28 records which were found in Scopus, only 18 articles fully met the inclusion criteria. Out of 2740 participants in the included studied, 1706 were patients with body mass index (BMI) over 40 kg/m2 who had undergone RYGB surgery, and 1034 were control participants. Results of the studies showed that RYGB surgery could reduce BMI, and cardiac risk factors, and improve diastolic function, systolic and diastolic blood pressures, and aortic function, postoperatively.
Obesity is associated with increased risk of cardiovascular diseases, impaired cardiac function, and hypertension. It is shown that RYGB surgery reduces the serum level of biochemical markers of cardiac diseases. Cardiac structure, parasympathetic indices of autonomic function, coronary circulatory function, hypertension, epicardial fat thickness, and ventricular performance improve after bariatric surgery.
It is concluded that RYGB surgery is an effective strategy to improve ventricular function and cardiac risk factors in morbid obese patients.

Oxygen therapy used for preterm infant disease might be associated with oxygen toxicity or oxidative stress. The exact oxygen concentration to control and maintain the arterial oxygen saturation balance is not certainly clear. We aimed to compare the efficacy of higher or lower oxygen saturations on the development of severe retinopathy of prematurity which is a major cause of blindness in preterm neonates.
PubMed was searched for obtaining the relevant articles. A total of seven articles were included after studying the titles, abstracts, and the full text of retrieved articles at initial search. Inclusion criteria were all the English language human clinical randomized controlled trials with no time limitation, which studied the efficacy of low versus high oxygen saturation measured by pulse oximetry in preterm infants.
It can be suggested that lower limits of oxygen saturations have higher efficacy at postmesetural age of ≤28 weeks in preterm neonates. This relation has been demonstrated in five large clinical trials including three Boost trials, COT, and Support.
Applying higher concentrations of oxygen supplementations at mesentural age ≥32 weeks reduced the development of retinopathy of prematurity. Lower concentrations of oxygen saturation decreased the incidence and the development of retinopathy of prematurity in preterm neonates while applied soon after the birth.
Targeting levels of oxygen saturation in the low or high range should be performed cautiously with attention to the postmesentural age in preterm infants at the time of starting the procedures.

Urolithiasis is a common and frequently occurring disease with high recurrence rate. Ureteroscopic lithotripsy (URSL) and extracorporeal shock wave lithotripsy (ESWL) are two most popular modalities in the treatment of urolithiasis. The efficacy of these two methods is reviewed on the treatment of ureteral stones in this systematic review.
PubMed was searched for the relevant randomized control trials (RCTs). Stone-free rate and retreatment rate were extracted from each article as the main outcomes, and Odds ratio was reported in each study.
Based on calculated odds ratio of each article, URSL has an odds ratio of 1 for the event of retreatment rate compared with ESWL.
Performing URSL in the treatment of urolithiasis could be associated with higher stone-free rate and lower retreatment rate; however duration of the surgery seems to be longer during URSL compared with ESWL.
There was high discrepancy between included RCTs regarding the study design, stone location, types of ureteroscope, intracorporeal lithotripsy devices, time to follow-up, and surgeon experience, which might affect the decision regarding type of surgery.

Atrial fibrillation (AF) is a common dysrhythmia postoperatively after coronary artery bypass grafting (CABG). Myocardial strain and strain-rate imaging is used for the assessment of postoperative atrial fibrillation (POAF) as a new echocardiographic method.
PubMed and Scopus were searched thoroughly using the following search terms: (strain and strain rate) AND (atrial fibrillation OR AF) on March 2015 to find English articles in which the strain and strain-rate echocardiographic imaging had been used for the evaluation of AF in patients undergone CABG. Full text of the relevant papers was fully reviewed for data extraction.
Of overall 6 articles found in PubMed, 10 records found in Scopus and 4 articles found through reference list search, only 6 papers fully met the inclusion criteria for further assessment and data extraction. The results of strain and strain-rate assessment showed that in total of 542 patients undergoing CABG, POAF occurred in 106 patients. Studies showed that the reduction of left atrial (LA) strain rate is correlated with AF. Consistently, the results of present review showed that LA strain and strain-rate in patients who developed AF postoperatively after CABG are significantly reduced, suggesting that strain and strain-rate could be a predictor of POAF.
Based on the obtained results, strain and strain-rate is a suitable and accurate echocardiographic technique in the assessment of left atrial function , and it might be helpful to detect the patients who are at high risk of POAF.

The importance of high-grade cervical intraepithelial neoplasia (CIN) as a precursor to invasive cervical cancer suggests a considerable need for accurate screening of the patients for the risk of these lesions. This systematic review aimed to study the diagnostic significance of endocervical curettage (ECC) at the time of colposcopy in the detection of CIN 2, 3, and preinvasive lesions.
PubMed was searched to obtain the relevant articles based on the following search term: (endocervical curettage OR ECC) AND colposcopy. The most relevant articles were included after studying the title, abstract, and full text of the obtained articles at initial search. Only English language articles published after 1992 with at least 500 patients were included in this study.
Among 300 articles identified by the first search, only seven articles were in line with the purpose of this systematic review. Majority of the included studies were retrospective observational studies.
Performing ECC has higher sensitivity in women older than 40 years and those with unsatisfactory colposcopy results. However exact diagnostic usefulness of ECC at the time of colposcopy needs to be investigated in further studies.

Bevacizumab (Avastin) is considered as an effective strategy in the treatment of various ocular diseases. As a vascular endothelial growth factor (VEGF) inhibitor, Avastin is used to control macular edema in patients with nonproliferative diabetic retinopathy (NPDR). Therefore, in this study, we systematically reviewed the effects of intravitreal bevacizumab injections on nonproliferative stage of diabetic retinopathy.
Scopus and PubMed were systematically searched to find articles in which the effect of Avastin (bevacizumab) had been evaluated in nonproliferative stage of diabetic retinopathy. Literature search was performed using “Avastin OR bevacizumab”, “nonproliferative stage” and “diabetic retinopathy” as keyterms in the title, keywords, and abstract.
All 47 articles were found in all databases, two additional records were found through reference list screening, and only 10 articles were relevant to the purpose of this study. According to the inclusion/exclusion criteria, 39 articles were excluded in several step processes of article selection. The results revealed that intravitreal injection of bevacizumab could be safely used to treat various ocular disease, particularly NPDR stage of diabetic retinopathy with macular edema.
Bevacizumab is considered as a novel and effective modality in the treatment of various ocular diseases such as retinal neovascularization, neovascular glaucoma, macular edema, and other ocular complications. Findings also suggested that bevacizumab is a suitable therapeutic approach in clinical use.
According to the results of included documents, intravitreal injection of bevacizumab could be considered as a promising treatment modality in the clinical management of NPDR stage of diabetic retinopathy.

Administration of methylene blue has been proposed as a therapeutic strategy in the treatment of vasopelgic shock following cardiac surgery. Major aims of this systematic review were to evaluate the effect of methylene blue on mortality rate, duration of vasoplegic syndrome, and further complications of patients with vasoplegic syndrome following cardiac surgery.
PubMed was searched to obtain the most relevant articles. All the randomized control trials and cohort studies were included.
A total of 54 articles were retrieved at the initial search. After studying the titles, abstracts, and full text of the articles, only five articles consisted of two randomized controlled trials (RCTs) and two observational studies were included.
Based on included RCTs, the mortality rate and duration of the disease decreased in patients applied methylene blue in the treatment of vasoplegic syndrome compared with those did not receive this medication.
Bbased on included articles, application of methylene blue could be suggested as a treatment for vasoplegic syndrome, but further large multicenter RCTs are needed to certainly evaluate the efficacy of methylene blue.

Echocardiography or cardiac imaging is proposed as a gold standard method for identifying high risk patients for cardiac arrest. In this systematic review, we studied the prognostic value of cardiac sonography in patients with cardiac arrest.
PubMed was searched for the relevant articles. Case reports were not included. Inclusion criteria were all the studies applied transthorasic echocardiography in patients with cardiac arrest arrived at emergency department that studied the efficacy of this modality on patients survived to emergency discharge and returned to spontaneous circulation.
Overall, 870 articles were obtained through initial search and only nine articles were included after the evaluation of the title, abstract, and the full text. Echocardiography has high sensitivity and specificity in predicting the return of spontaneous circulation.
Cardiac sonography is a fairly effective (not definitive) modality in predicting death in patients with lack of cardiac activity during resuscitation. Echocardiography should not be the sole basis for the decision to cease resuscitative efforts.

Bevacizumab (Avastin), as an effectiveness treatment modality, is currently used in patients with various ocular disease. However the results have been promising, the use of bevacizumab in the treatment of ocular disease is an off-label application. Hence, the aim of this study was to systematically review the effectiveness of intravitreal injection of bevacizumab on various ocular tissues, especially corneal endothelial cells.
The articles related to the effect of application of Avastin in the treatment of ophthalmic diseases and especially its effect on corneal endothelial cells were collected and reviewed. We searched PubMed, Google scholar, and Scopus databases and used Avastin, ocular diseases and corneal endothelial cells as search keywords.
Of all 55 articles found in all databases, only 10 were relevant to the purpose of this study, and 45 articles were excluded in several step by step process of article selection according to the inclusion/exclusion criteria. The results revealed that intracameral bevacizumab injection caused no changes in specular microscopy and corneal pachymetry. Moreover, it had no significant toxicity on corneal endothelial cells.
Effectiveness of bevacizumab as a new modality in the treatment of different ophthalmic diseases have been suggested. Recent data on both human and animal models showed that intravitreal injection of bevacizumab resulted in no significant toxicity on various ocular cells, and it could be considered as a suitable therapeutic approach in clinical use.
According to the results of included documents, bevacizumab was not toxic to corneal endothelial cells at various clinically relevant doses.

The most common disease in the aged population is osteoarthritis (OA) that is resulting in progressive dysfunction following isolated cartilage injuries, subchondral bone remodeling, tissue loss, marginal osteophytes, and loss of joint space. Mesenchymal stem cells (MSCs) are multipotent stem cells; they are able to produce many or all joint tissues. Bone marrow and adipose tissue are rich sources of mesenchymal cells that are useful for the reconstruction of injured tissues such as bone, cartilage, or cardiac muscle. Recently, some studies have been performed on the use of the direct intra-articular injection of mononuclear cells (MNCs) and MSCs as potential therapeutic targets in OA. In this review, the history of MSCs in the treatment of OA are explained. Injection of Bone Marrow Aspirates Concentrate (BMAC) has significantly improved both joint pain and function in radiologic findings; some studies suggested that the injection would be even more effective in early to moderate phases of OA. Injection of MSCs in combination with growth factors may be better solution for the treatment.