Caspian Journal of Internal Medicine
Volume:7 Issue: 1, Winter 2016

Urolithiasis has become a worldwide problem with the prevalence of the disease increasing over the past few decades. While various treatment modalities have evolved over the years, discrepancies exist regarding the clinical indications and the efficacy of each of these treatment options. In the present review, we aim to review the current treatment modalities for urinary tract stones to provide a better understanding on the therapeutic approaches as well as their clinical indications.

Renal complication of leptospirosis is common and its clinical manifestations vary from urinary sediment changes to acute renal failure. The aim of this study was to determine the final outcome of renal involvement in leptospirosis. This longitudinal prospective study included all serologically confirmed cases of leptospirosis with evidence of renal failure. All patients were followed for three months while all patients with renal failure were followed-up for one year. Fifty-one patients, 53.5±14.8 years (82.4% males) with acute renal failure were studied. Over the hospitalization period, 28 patients recovered, and seven (13.72%) patients died of multiple organ failure. At the time of discharge, 16 patients had mild renal failure. Over the follow-up period, all patients recovered but in two patients renal failure persisted at creatinine level of 1.5 mg/dl. Development of renal failure in leptospirosis is not rare. Recovery of renal function may last several months. However, most patients recover completely at least after one year.

Recurrent aphthous stomatitis (RAS) is the most common inflammatory ulcerative condition of oral cavity. The aim of this study was to compare the levels of the salivary Malondialdehyde (MDA) and total antioxidant capacity (TAC) and blood parameter in RAS versus healthy controls. This case-control study consisted of 28 patients with RAS and 28 age and sex -matched control without RAS. Cell blood count was assessed by sysmex system, serum iron and total iron binding capacity was measured by standard laboratory kit and for ferritin ELISA kit was utilized. Salivary TAC and MDA level determined using FRAP and TBARS method respectively. Statistical analysis was performed using SPSS Version 21, chi-square test was used to compare proportions, and student’s t-test and Mann Whitney U-test were used for the comparison of quantitative variables Salivary MDA level was significantly higher (p<0.001) and TAC level was significantly lower (p<0.042) in RAS as compared with the control group. Also, serum ferritin level was significantly higher in RAS patients (p<0.008). These findings indicate the alteration of oxidant/antioxidant status was observed in recurrent aphthous stomatitis, may be also associated with changing several hematinic parameters in this study. The finding maybe helpful to clarify the etiologies of RAS and possibely to improve the management or preventive options.

Treatment of chronic constipation is creating one of the major problems for doctors and patients. Pyridostigmine increases the gastrointestinal motility through the effects on cholinesterase. It seems that this mechanism can reduce chronic constipation. The aim of this study was to compare the effects of pyridostigmine and bisacodyl on chronic constipation. This study was conducted on 68 patients who suffered from chronic constipation. Patients were randomly divided into two groups of Pyridostigmine and bisacodyl in which each consisted of 34 patients, respectively. Bristol stool form score, straining defecation, the time of defecation, the number of defecation per week, sense of incomplete evacuation and self-digitation were collected by means of questionnaires and the data were compared. Sixty-eight patients with the mean age of 68.12±84.49 were studied. The mean difference in the frequency of defecation per week, VAS score, the time to defecation and the Bristol Stool form Scale in pre and post-treatment were 4.33±1.88, 5.96±2.29, 12.30±7.95 min and 2.10±0.95 in pyridostigmine group and 2.96±1.81, 4.06±2.22, 6.67±5.23 min and 1.41±0.84 in bisacodyl group, respectively. The significant difference was observed in both pyridostigmine and bisacodyl groups (P=0.005, P=0.002, P=0.002 and P=0.005, respectively). 60% and 32.3 of patients in pyridostigmine and bisacodyl groups recovered from self-digitations, respectively. In pyridostigmine and bisacodyl groups, 66.7% and 32.3 of them had improvement in the sense of incomplete defecation, respectively. Pyridostigmine and bisacodyl significantly improved the symptoms of chronic constipation similarly.

Cancer is a major public health problem in the world. In Iran especially after a transition to a dynamic and urban community, the pattern of cancer has changed significantly. An important change occurred regarding the incidence of cancer at the southern shores of the Caspian Sea, including Gilan, Mazandaran and Golestan province. This study was designed it investigate the epidemiology and changes in trend of cancer incidence in the geographic region of the Caspian Sea (North of Iran). Data were collected from Cancer Registry Center report of Iran health deputy. Trends of incidence were analyzed by joinpoint regression analysis. During the study period year (2004-2009), 33,807 cases of cancer had been recorded in three provinces of Gilan, Mazandran and Golstan. Joinpoint analysis indicated a significant increase in age-standardized incidence rates (ASR) with an average annual percentage change (AAPC) 10.3, 8.5 and 5.2 in Gilan, Mazandaran and Golestan, respectively. The most common cancer in these provinces were correspondingly cancer of stomach, breast, skin, colorectal and bladder, respectively. The incidence of cancer tends to be increasing in North of Iran. These findings warrant the epidemiologic studies are helpful in planning preventive programs and recognition of risk factors.

There are studies that indicated dyshomeostasis of oxidant/antioxidant and trace elements in breast cancer patients, but the data regarding the status of these parameters in various stages of breast cancer are limited. The aim of this study was to highlight the status of these biochemical factors in various stages of breast cancer. Fifty-eight breast cancers patients participated in this study and underwent staging work up for the assessment of disease stage. Serum total antioxidant capacity and lipid peroxidation were determined spectrophotometically. Glutathione peroxidase (GPX), catalase (CAT) and superoxide dismutase (SOD) levels were analyzed by ELISA method. The serum level of Cu, Mn and Zn was measured by atomic absorption spectrophotometer. Student t-test and one-way analysis of variance (ANOVA) were used to compare group means. All the patients included in the study classified as mild (stages I+II) and advanced stages (stages III+IV). Patients in advanced stage had lower serum antioxidant capacity and higher lipid peroxidation levels, but the differences were not statistically differet (P=0.690 and 0.666, respectively). Patients in advanced stage had higher, but not statistically different serum levels of CAT, GPX and SOD levels (p>0.05). Patients in both groups had to some extent similar serum Cu, Mn and Zn levels. There was no evidence of remarkable discrepancy in the status of analyzed factors in various stages of breast cancer. It seems that the severity of oxidative stress in different stages of breast cancer is similar to some extent.

Increased serum high sensitive C-reactive protein (hs-CRP) in asthma and its association with disease severity has been investigated in many studies. This study aimed to determine serum hs-CRP status in asthma versus healthy controls and to examine its ability in predicting asthma control. Serum CRP was measured by ELISA method using a high sensitive CRP kit. Severity of asthma was determined using Asthma Control Test. Spearman and chi square tests were used for association and correlation respectively. The predictive ability was determined by receiver operating characteristics (ROC) analysis. Accuracy was determined by determination of area under the ROC curve (AUC). A total of 120 patients and 115 controls were studied. Median serum hs-CRP in asthma was higher than control (P=0.001. In well controlled asthma the hs-CRP decreased significantly compared with poorly controlled (P=0.024) but still was higher than control (P=0.017). Serum hs-CRP at cutoff level of 1.45 mg/L differentiated the patients and controls with accuracy of 63.5 % (AUC= 0.635±0.037, P=0.001). Serum hs-CRP &le 2.15 mg/L predicted well controlled asthma with accuracy of 62.5% (AUC= 0.625±0.056, p=0.025). After adjusting for age, sex, weight and smoking, there was an independent association between serum hs-CRP >1.45 mg/L and asthma by adjusted OR=2.49, p=0.018). These findings indicate that serum hs-CRP in asthma is higher than healthy control and increases with severity of asthma and decreases with. Thus, serum hs-CRP measurement can be helpful in predicting asthma control and treatment response.

Similar to inflammatory cells, peripheral blood mononuclear cells (PBMCs) can also infiltrate in to kidney and urinary tracts and subsequently excreted by urine. In this study we determined the viability rate and response to phytohemagglutinin-A (PHA) of human PBMCs in normal urine. A number of 1×106 ficoll-hypaque isolated PBMCs were dispensed in 1 ml normal urine and 6 molar urea and RPMI-1640+FBS10 % were considered as negative and positive control, respectively. After 20, 60 and 120 minutes the viability of these cells was measured by trypan blue dye exclusion assay. 1×105 of PBMCs were isolated from urine and cultured as triplicate in RPMI-1640`supplemented with FBS 10% and PHA for 96hr. MTT assay was performed to determine the PBMCs response to PHA. These experiments were repeated three times independently. There was no significant difference between the viability rates of the PBMCs incubated in urine and positive control after 20, 60 and 120 minutes while after 60 minutes they exhibited 75.6% of reactivity to PHA versus positive control. Overall, there was a significant difference in trends of viability rate across the three groups (p<0.05). Our results showed that not only PBMCs remained alive in urine after 120 minutes, but can also respond to PHA up to 60 minutes at a remarkable level. These data open a new avenue in the designation for cell culture-based techniques in urine cell analysis.

BCG vaccination which is administered to prevent tuberculosis is sometimes associated with serious complications. This study aimed to determine the incidence of complications of BCG vaccination in Babol. All infants who received BCG vaccination between 2011-2013 in health centers of Babol entered the study. Data regarding complications of vaccine were extracted according to the National Inventory of babies. All complicated cases were confirmed by the Academic Committee to review the adverse consequences of the vaccine. Among the 15984 vaccinated neonates, 150 (0.93%) cases presented lymphadenitis. 46.5% were females and 53.5% were males 43% were rural residents and 57% were urban residents. No cases of lymphadenitis including 1% of lymphadenitis with abscess formation were recovered without treatment. Disseminated infection occurred in 3 cases of immune deficient patients who responded to the treatment. Most complications occurred during 4 months after vaccination. According to the results of this study, the prevalence of lymphadenitis in Babol was higher than the standard of WHO. This may be attributed to type and vaccine storage and injection technique. These findings justify further training of health-center workers.

Alveolar echinococcosis (AE) is a chronic, rare and sometimes lethal parasitic infection in humans, caused by the larval stage of the fox tapeworm Echinococcus multilocularis. This study aimed to investigate the clinical aspects and treatment outcomes of patients with alveolar hydatid disease. The medical records of patients with alveolar echinococcosis admitted between 1997 and 2012 were reviewed. Diagnosis was confirmed by physical examination, ultrasonography and CT scanning and MRI. Various treatment techniques were used such as complete liver resection in seven (38.89%) patients, biliary bypass in two (11.11%) patients, laparotomy and tumor biopsy in eight (44.44%) patients and long term medical treatment in one (5.56%) patient. After discharge, all patients were followed to determine the effect of treatment, complications, recurrences and survival. A total of 18 patients with mean age of 46.11±15.14 years (range 23-74 years) were studied. The disease was more prevalent in women than men (78.9% vs 4, 21.1%, P=0.021). Fourteen (77.78%) patients live in Chenaran, a town located in Khorasan, Iran). Death occurred in (22.22%) patients after an average period of 45.70±7.50 months after disease onset. 14 remaining patients survived after a mean follow-up duration of 54.60±29.17 months. Diagnosis of alveolar echinococcosis should be considered in endemic area. Early diagnosis and treatment is associated with excellent outcome.

Calciphylaxis is a serious disorder often observed in dialysis patients and less frequently in chronic renal failure patients with secondary hyperparathyroidism. Mortality rate increases following the development of calciphylaxis, immediate application of parathyroidectomy along with other treatment options may be lifesaving. A 44-year-old male patient had been on regular hemodialysis three times per week, with 4-hour sessions since December 2003. The etiology of his renal failure was unknown and the patient had no systemic disease when hemodialysis was started, painful, erythematous skin lesions were detected over and around the external malleolus of the right foot. In the next two months, erythematous skin lesions gained a necrosed character and spread into the malleolar and posterior tibial region and back of the ankle in both extremities. The patient showed no clinical signs of recovery and despite anti-biotherapy, debridement and protective measures, the skin lesions got infected and presented as intolerable, painful wounds. The patient was diagnosed with calcific uremic arteriolopathy (CUA) and hospitalized for parathyroidectomy. All parathyroid glands were removed after having checked quick PTH intraoperatively. A small amount of parathyroid tissue was intramuscularly auto-implanted into the right forearm. Skin lesions showed fast improvement in further follow-ups. Three months after parathyroidectomy, iPTH value was measured as 1197 pg/ml. After 6 months of medical treatment, iPTH was found as 970 ng/L and we decided to remove the implanted parathyroid tissue from the right forearm. In this article, we present a case of calciphylaxis accompanied by severe secondary hyperparathyroidism.

Peritoneal tuberculosis accounts 1-2% of all forms of tuberculosis. Peritoneal tuberculosis is an important differential diagnosis for ovarian cancer in women with ascites, adnexal mass and elevated cancer antigen 125 (CA125) levels. We report a case of a 32- year -old woman with multiple miliary peritoneal deposits mimicking advanced ovarian carcinoma. A 32-year-old drug addicted woman presented with menometrorrhagia, fever and shivering, ascites and pelvis mass. Ultrasonography revealed a 53×65 mm cyst in left ovary and ascites. Multiple miliary peritoneal deposits were observed during laparatomy without any mass, histologic examination confirmed tuberculosis of uterus, tubes, omentum, liver and external surfaces of small intestine. Finally, the patient recovered with anti-tuberculosis treatment. These findings highlight considering tuberculosis in the differential diagnosis of any patients with adnexal mass, ascitis and elevated serum CA125 even with negative cytology and bacteriology test results.