Caspian Journal of Internal Medicine
Volume:9 Issue: 4, Autumn 2018

According to epidemiological studies, leukemia is among the five most common cancers in Iran. Keeping efforts to estimate survival is critical to monitoring and improving patients’ quality of life with leukemia. The purpose of this study was to evaluate the 5-year survival rate of leukemia patients in Iran using meta-analysis method. This meta-analysis was carried out according to studies that adhere to inclusion and exclusion criteria during enrolment. The valid Iranian databases included: Medex, Magiran, SID, and Medlib, along with international data bases, namely, Scopus, Pubmed, and ISI were searched to find relevant articles. After determining the heterogeneity between studies, the random effects models were used to estimate pooled survival in leukemia patients. In total, 18 studies involving 2517 participants were included in this meta-analysis. The pooled 5-year survival rate was 0.56 % (95% CI, 0.54 to 0.58). According to types AML and ALL, the 5-year survival rates in Iran were 35.0 % (95% CI: 32.0-38.0) and 57.0 % (95% CI: 54.0-60.0), respectively. Based on our findings, slightly less than 50% of leukemia deaths happened in the first 5 years after diagnosis, which is lower than the global average.

Behcet’s syndrome is a disease with different aspects in its clinical manifestations. The purpose of this study was to evaluate the simultaneous presence of oral mucosal and ophthalmologic lesions in patients with Behcet’s syndrome. From April 2012 to December 2014, 50 cases of Behcet’s syndrome who referred to the Departments of Ophtalmology, Oral Diseases and Infectious Diseases of Babol University Medical Sciences were entered into the study. The diagnosis of the disease was performed using the Iranian criteria for the diagnosis of Behcet’s syndrome. The demographic findings as well as clinical manifestations were recorded. Thirt-six (72%) were males and 14 (28%) were females. The mean age of the patients was 35.6±9 years. Oral aphthous (94%), ocular lesion (76%) and genital ulcers (70%) were the most clinical findings. The clinical onset of the disease in 43 (86%) was oral lesions and in 5 (10%) was ocular lesions. Among the forty-eight cases with oral lesions, 77% had ocular lesions concurrently. HLA-B5 was positive in 35 (70%) cases. Ocular lesion was seen in 33 of 35 (91.4%) cases versus 6 of 15 (40%) with HLA-B5 positive and negative cases, respectively (p<0.05). Oral lesion was seen in 94.3% cases with positive HLA-B5 and in 100% cases with negative HLA-B5 (p>0.05). The results show that concurrent ophthalmic and oral lesions in Behcet’s syndrome are relatively high. HLA-B5 positive cases are associated with more ophthalmologic lesions.

Concomitant hepatitis B and HIV infections are common. In some of these patients, HBcAb is the only serologic marker of hepatitis B. This study was conducted to elucidate the cause of isolated HBcAb in HIV-infected patients via hepatitis B vaccination. In this interventional study during 2014-15 in the HIV Clinic in Hamadan, thirty four patients with HIV infection and isolated HBcAb positive isolate, received hepatitis B vaccine and their responses to vaccination were investigated. Demographic data, stage of disease, and status of CD4 and HCV Ab were extracted from the patients' medical records and were entered in a checklist. Of the 103 HIV positive patients, the prevalence of HBs Ag, and HBc Ab isolates were 6.79% (n=7) and 46.6% (n=48), respectively. All of the patients with isolated HBcAb were positive for HCV Ab. Among the 48 patients with isolated HBc Ab, 34 (70.8%) were available and examined for HBV DNA in serum samples. The result of PCR was negative in all. After the first round of hepatitis B vaccination, HBs Ab titer exceeded 10 International Units Per Liter (IU/L) in 58.8% of patients with isolated HBc Ab. With the completion of the three-dose of vaccine, this titer was observed in 97% of patients. Significant correlation was observed between titer of antibodies and values of CD4 cells. Due to favorable response to hepatitis B vaccination in HIV positive patients with isolated HBc Ab, false positive HBc Ab and recovery from previous infection were more probable than hidden hepatitis B.

Dengue is endemic and prevalent in tropical and sub-tropical countries including India and can cause significant mortality and morbidity. There are limited studies available on factors associated with severe dengue from India, to investigate the predictors of severe dengue in south Indian patients. We recruited 334 patients with dengue admitted in Yashoda Hospital, Hyderabad. Study period was between March 2015 and February 2017. Based on clinical symptoms, we divided patients into severe dengue and non-severe dengue. Univariate and multivariate analysis was performed for prognostic factors of severe dengue. Out of 334 patients, there were 186(55.6%) males with mean age 30.3±14.3 39 years (age range: 10-73 years), severe dengue was seen in 117(35%) and non-severe dengue in 217(65%). Clinical symptoms of diabetes, low platelet count (<50,000mm3), melena, skin rash, delayed admission (>5days after onset) elevated hematocrit, lymphadenopathy, hepatomegaly, splenomegaly, convulsions and mortality were significantly associated with severe dengue. After multivariate analysis, diabetes (OR: 2.12; 95% CI:1.34-4.65) (<0.0001), elevated hematocrit (OR: 3.14; 95% CI:2.17-6.14) (<0.0001), skin rashes (OR: 1.99; 95% CI: 1.11-3.55) (<0.0001), melena (OR: 2.59; 95% CI:1.40-4.93) (<0.0001), low platelet count (OR: 6.71; 95% CI:4.12-13.6) (<0.0001), lymphadenopathy (OR: 3.12 95% CI: 1.91-7.85) (<0.0001) and delayed admission (OR: 2.40; 95% CI:1.31-3.41) (<0.0001) were significantly associated with severe dengue disease. In our study, it was established that low platelet count, elevated hematocrit, diabetes, skin rash, melena, lymphadenopathy and delayed in admission (>5days) were independently associated with severe dengue.

According to the side effects of the usual treatment of burns, in improving the patients’ prognosis, there is a need to introduce faster and more effective adjuvant therapies to treat wounds, thus to improve the prognosis of patients. The aim of this study was to investigate the effect of adjuvant treatment with oral silymarin on wound healing process caused by second degree-burns among the patients admitted to Valiasr Hospital of Arak. This randomized, double-blind clinical trial study was carried out on 80 patients with second-degree burns covering 20 to 30 percent of the body with flame. Patients were randomized into 2 groups with an equal number: The intervention group (treated daily with oral 140-mg silymarin) and control (under the administration of placebo). Patients were treated for 8 weeks and at the end of weeks 1, 2, 3 and 4 according to the degree of wound healing (grade 1, 2 and 3) were followed during 2016-2017. Changes in degrees of burn wound healing in both the intervention and placebo groups during the 4 weeks of treatment, significantly improved grade 3 completely. Based on the results, the complete remission in all four follow-up stages was significantly higher in silymarin group than the placebo group: Week 1 (intervention: 9 (22.5%), control: 0 (0%), (p=0.011), week 2 (intervention group: 18 (45%), placebo: 7 (17.5%), (p=0.000), week 3 (intervention: 24 (60%), placebo: 11 ( 27.5%), (p=0.051); week 4 (intervention: 27 (67.5%), control: 19 (47.5%), (p=0.003). According to our results, the 4-week adjuvant treatment with oral silymarin resulted in the full and faster wound recovery in patients with second degree-burn. So, it is recommended to use adjuvant treatments to obtain effective results.

There are some uncertainties among the risk factors of vascular calcification in the hemodialysis patients. This study was planned to examine the association between abdominal aortic calcification and concerned biochemical parameters in hemodialysis patients. In this cross- sectional study, 84 stable hemodialysis patients admitted on hemodialysis section of Shahid Beheshti Hospital in 2013 were enrolled after obtaining informed consent. Pre-dialysis venous blood samples were taken from patients to determine the amount of intact parathyroid hormone (iPTH), alkaline phosphatase (Alk.P), C - reactive protein (CRP), calcium (Ca) and phosphorus (P). Patients underwent abdominal CT scanning and ACI (ACI) was calculated. Statistical analysis was performed using SPSS Version 20. Chi-square, Kruskal Wallis and One Way ANOVA tests were used. P-values < 0.05 were considered significant. The average age of participants was 50.15±17.03 years (18-83 y/o).A statistically significant correlation was observed between ACI and ALK-P serum levels (p=0.01). It was found that ACI had a significant relationship with phosphorus in women (p=0.01). ALK-P serum levels in men also had a significant relationship with ACI (p=0.02). In addition, there was a significant correlation between ACI and history of cerebro-cardiovascular disease and also duration of dialysis (p=0.004 and 0.0001, respectively). In patients with longer duration of dialysis, and patients with a history of cardiovascular and cerebrovascular events, ACI levels were significantly higher. ALK-P and phosphorus were correlated with aortic calcification in males and females respectively. No significant correlation was found between iPTH serum levels and aortic calcification.

Studies concerning on esophageal squamous cell carcinoma (ESCC) etiological factors have been done for several decades, however, results reported from various investigations were not consistent. The present investigation aimed to explore the presence of 3 oncogenic viruses, human papilloma virus (HPV), Epstein-Barr virus (EBV) and Merkel cell polyomavirus (MCPyV) in the neoplastic and non- neoplastic esophageal lesions collected from Mazandaran, a high risk area of Iran. In total, 168 esophageal specimens (100 with ESCC confirmed diagnosis and 68 without esophageal malignancy) were analyzed for HPV, EBV and MCPyV by Real Time PCR. HPV DNA was detected in 27 out of the 100 neoplastic esophageal lesions (27.0%) and 28 out of the 68 samples from non-neoplastic group (41.2%). EBV DNA was detected in esophageal specimens of 10 out of the 100 neoplastic cases (10%) and 3 out of the 68 samples in non- neoplastic group (4.4%). MCPyV DNA was detected in esophageal specimens of 30 out of the 100 neoplastic cases (30.0%) and 24 out of the 68 samples in non- neoplastic group (35.3%). There was no statistically significant difference in HPV (p=0.066), EBV (p=0.143) and MCPyV (p=0.471) DNA positivity between neoplastic and non-neoplastic groups. This study showed that HPV, EBV and MCPyV can be detected in both neoplastic and non-neoplastic esophageal tissues and weakens the hypothesis of the pathogenic role of these viruses in esophageal malignant transformation.

Coronary artery disease (CAD) is one of the most progressive and life-threatening diseases and is the first leading cause of death affecting both genders in Iran. The present study aimed to determine the extent of coronary vessel involvement and relevant relationship with several underlying risk factors. In this cross-sectional study, 1452 patients undergoing angiography who met the inclusion criteria were recruited consecutively in Babol, Iran during 2016. Data collection was performed through a questionnaire including demographic and clinical characteristics and information on underlying diseases via an interview with the patient and looking into the patients’ records. Of these patients, 459 (31.6%) had normal coronary arteries, 220 (15.1%) suffered from non-obstructive CAD and 773 (53.3%) had one, two or three-vessel obstructive involvement. The results of multiple logistic regression showed that the chances of having coronary artery involvement in patients with diabetes (OR=1.55, p=0.012), age> 60 years old (OR=3.52, P=0.001), male gender (OR=2.54, P=0.001), history of heart attack (OR=3.16, P=0.001), and history of hospitalization because of cardiac problem (OR=1.51, P=0.021) significantly increased. Diabetes, male gender, age over 60 years old, history of myocardial infarction and history of hospitalization due to cardiac problem were related to the extent of coronary vessels involvement. Therefore, it is recommended to practice preventive measures more extensively in this regard.

Using oral glucose for glucose challenge test (GCT) and glucose tolerance test (GTT) is problematic, especially in early pregnancy when the pregnant woman is experiencing gastrointestinal complications. This research seeks to investigate the relationship between the ratio of Triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) and the risk of gestational diabetes and large for gestational age (LGA) fetus for suggesting a more appropriate index for diagnosis of gestational diabetes. The present cross-sectional study investigated pregnant women visiting the Perinatal Clinic of Ayatollah Rouhani Hospital in Babol for prenatal care from September 2015-2016. The GCT was performed on these pregnant women at 24-28 weeks as a screening test and their lipid profile, including HDL-C and TG, was simultaneously assessed after eight to 14 hours of fasting. Significant differences were observed between women with and without gestational diabetes in terms of mean triglyceride, HDL, LDL/HDL ratio, triglyceride/LDL ratio and triglyceride/HDL ratio. The cut-off point of TG/HDL in the GTT was 4.254 with a sensitivity of 79.07% and specificity of 78%. According to the results obtained, lipid profile can help predict the risk of gestational diabetes, especially TG/HDL ratio that has a high sensitivity to diagnose gestational diabetes, while, lipid indices could not predict birth of a LGA neonate.

Metabolic syndrome is a prevalent condition with dramatic rising trend worldwide. Single dietary factors, such as omega-3 fatty acids consumption protect body against oxidative damage by reinforcement of dietary total antioxidant capacity but the combination of all dietary components may be more effective when studied as integrated dietary patterns. This present study was designed to assess the association between different dietary patterns and oxidative stress in a population of Tehranian adults suffering from metabolic syndrome. Dietary data were collected using a validated 147-item semi-quantitative FFQ with a standard serving size. Factor analysis method was used to derive dietary patterns. Blood analysis and anthropometric measurements were also obtained. Oxidative stress was assesses using serum levels of Malondialdehyde (MDA) and total antioxidant capacity (TAC). The regression coefficient for TAC and MDA with different quintiles of dietary patterns, adjusted for potential confounder in model 3 reveal a significant positive association between healthy pattern and serum TAC levels (β=0.244, p=0.008) and also between serum MDA levels and the unhealthy pattern (β=0.387, p=0.0001). On the other hand, a significant negative association found between serum TAC levels (β=-0.289, p=0.001) and the unhealthy pattern, a relationship also noted between serum MDA levels and the healthy dietary pattern (β=-0.273, p=0.002). Our findings suggest that following a healthy pattern filled with fruits and vegetables ameliorates oxidative stress status and on the contrary, attachment to an unhealthy pattern, characterized by higher intakes of fast foods and processed foods, aggravated the oxidative stress levels in Tehranian individuals suffering from metabolic syndrome.

Cataract induced vision impairment can lead to loss of older people’s independence and self-esteem and limit their daily activities. Moreover it has comorbid cognitive impairment and depression. Cataract surgery may be one way to attenuate these comorbidities. The aim of this study was to compare pre-operative and postoperative depressive symptoms and cognitive impairments of patients who underwent cataract surgery. This study was a before - after clinical trial. Participants completed the following validated surveys one day before and again three months after surgery. Dependent variables were preoperative to postoperative within-patient difference in Geriatric Depression Scale (GDS) and Mini-Mental State Examination (MMSE) scores. Independent variable was improvement of visual acuity. Mean age was 71.77±8.08, 54% were females. Mean postoperative visual acuity improvement was 0.7720±0.1758, mean GDS score difference was -1.49±1.72 and mean MMSE score difference was 0.28±0.88. Postoperative improvement of visual acuity, GDS and MMSE scores were statistically significant (p=0.001). The mean visual acuity improvement in the participants with age over 80 years was lower than the younger subjects; while improvement in MMSE scores in this age group was significantly higher than them. There were no significant relationship between visual acuity, GDS and MMSE scores before and after surgery based on BMI and educational level. It was concluded that cataract surgery is effective for relieving depressive symptoms in the elderly. Improved visual acuity at older ages has far more effects on reducing cognitive impairment.

Chronic hepatitis B virus infection (HBV) may reactivate during the course of the disease and is called spontaneous relapse. The purpose of this study was to evaluate the incidence of relapse of hepatitis in subjects with inactive HBV carriers. This follow-up study was performed on 785 patients with inactive HBV carriers that were followed-up at six month intervals. The presence of serum HBsAg and anti-HBe, without HBeAg, HBV DNA levels <2000 IU/ml with normal alanine aminotransferase (ALT) levels was defined as inactive carriers. Patients who developed ALT ≥80 IU/L with HBV DNA levels ≥2000 IU/ml were considered as spontaneous relapse. Seven hundred- eighty five cases (441 males, 344 females) of chronic HBV infected individuals were followed-up. The mean age at the entrance of the study was 30.5±11.8 years. The mean follow-up duration was 5.9±5 years. Relapse was seen in 35 (4.5%) cases, in 27 out of 441 (6.1%) males and in 8 out of 344 (2.3%) females and in 4.2% subjects ≥ 30 years versus in 4.7% cases of under 30 years (p>0.05). The development of relapse in males was higher than females (hazard ratio 2.53, 95% CI 1.2-5.6, p=0.021), but age ≥30 or < 30 years did not have effect (hazard ratio1.21, 95% CI 0.62-2.36, p=0.58). The results show that spontaneous relapse of hepatitis may develop during the course of chronic HBV infection. We suggest that all patients with chronic hepatitis B, regardless of their age, be examined for the possibility of relapse.

Neisseria gonorrhea and Treponema pallidum as an obligate human pathogen are two common causes of sexually transmitted diseases (STDs). The present study aimed to determine the prevalence of N. gonorrhoeae and T. pallidum among human immunodeficiency virus (HIV) patients in the southwest Iran. This retrospective study was performed from 2004 to 2013, on HIV patients who were tested for detection of gonorrhea and syphilis infection at Shiraz HIV/AIDS Research Center. ELISA technique was used for preliminary detection of HIV and confirmed by a Western Blotting test. Gonorrhea was routinely diagnosed using direct Gram-staining and culturing on selective agar. Syphilis was routinely diagnosed by RPR test. Of the 806 HIV patients, 39 (2.6%) cases had co-infection with gonor rhea. Compared with mono-HIV infected patients, gonor rhea was significantly more likely among the males (69.4% vs. 92.3%, P=0.002). History of addiction and prison seems to be a significant risk factor for gonor rhea infection (P<0.05). Also, the mean of CD4+lymphocyte was higher among gonor rhea infected patients (368±238 vs. 415±328). Logistic regression analysis showed that sexual contact increased risk of gonococcal infection about 4 fold (OR: 4, CI: 1.7-9.39, P=0.001). None of the HIV patients had syphilis co-infection. As a preliminary survey, our findings provided unique information on the prevalence of gonorrhea and syphilis co-infections among HIV patients. Moreover, we introduced the main risk factors associated with gonorrhea co-infection in HIV patients in our region including gender, history of addiction and prison, CD4+lymphocyte count, and transmission routes for effective management of STDs.

Persistent hiccups can be a debilitating symptom and many such patients present to the emergency department seeking relief. A variety of serious conditions have been associated with persistent hiccups. Cases of pneumonia as a cause of hiccups have been rarely described. A 79-year-old male patient presented to the hospital due to persistent hiccups for 4 days. Despite lack of new respiratory symptoms or fever, a chest x-ray demonstrated a left lower lobe consolidation, which was also confirmed with a chest CT. The patient was treated with levofloxacin and at 1-month follow-up hiccups had completely resolved, while a repeat chest CT demonstrated resolution of the consolidation. The presentation of pneumonia in elderly patients may be atypical and may lack the symptoms and signs observed in younger patients. Hiccups may be the main presenting symptom of pneumonia.

Pulmonary arteriovenous malformations (PAVM) are rare pulmonary vascular anomalies and hemothorax as a presenting feature of PAVM is a very rare occurrence. A 45-year old woman presented with chest pain and breathlessness. A chest x-ray showed left-sided pleural effusion. An emergency MSCT scan with contrast showed no signs of pulmonary embolism but instead a probable AV malformation was shown. Diagnostic thoracocentesis revealed hemorrhagic exudate with negative cytology and microbiology findings. Thoracic drainage was performed resulting with complete regression of hemothorax. Three months later, patient was treated with transcatheter embolization of PAVM with good clinical outcome. We have shown that management of PAVM related hemothorax initially by thoracic drainage followed by later on performed catheter embolization of the PAVM could lead to a successful outcome.

The prevalence of using anabolic steroids such as oxymetholone is increasing. This highlights the need for closely monitoring side effects of this drug. Acute renal failure (ARF) has been reported as a complication of rhabdomyolysis in anabolic steroids users. We present one 33-year-old man complaining of decreased urine volume, urine color change, and lower abdominal pain. He is engaged with a rare side effect of oxymetholone abuse. During assessments of potential medical issues associated with the intake of anabolic steroids, known side effects are known to be transient, but the need for appropriate interventions remains essential. Rhabdomyolysis due to drug use and the consequent acute kidney injury are among the lethal risks associated with anabolic steroid abuse. In most cases, the symptoms are extensive and often misleading. Therefore, detailed history taking, physical scrutiny, paraclinical testing, and early diagnosis are crucial for rhabdomyolysis patients.

Generally, it is very rare for clinically significant hypermagnesemia to develop in an individual with normal renal functions as the renal handling of serum magnesium is a very potent process and it has the capacity, under conditions of hypermagnesemia, to completely block Mg (magnesium) reabsorption from the thick ascending limb of Henle. Therefore, hypermagnesemia usually arises in the setting of renal failure. We present a very rare case of a 40-year-old African American obese female with prior normal renal functions, who presented post-cardiac arrest following accidental overdose of Epsom salt. The patient was initially given supportive therapy and was later considered for the dialysis despite normal renal functions, as serum Mg levels kept on creeping up and clinical status kept on deteriorating continuously. Seemingly harmless magnesium containing (over-the-counter) (OTC) can potentially be lethal, and such consequences must always be taken into account when using such medications for a prolonged period of time.