فهرست مطالب

Caspian Journal of Internal Medicine - Volume:7 Issue:2, 2016
  • Volume:7 Issue:2, 2016
  • تاریخ انتشار: 1395/01/19
  • تعداد عناوین: 16
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  • Reza Karbasi, Afshar, Jafar Aslani, Mostafa Ghanei Pages 64-70
    Background
    Chronic obstructive pulmonary disease (COPD) is usually considered one of the leading causes of death worldwide, so finding proper therapeutic strategies for this disease is of high importance. In this meta-analysis, we reviewed the existing literature on the efficacy and safety of conventional long acting beta agonists (LABAs) in COPD patients.
    Methods
    We searched MEDLINE and Google scholar to identify relevant articles. We limited data to double-blinded randomized controlled trials (RCTs). Data of 14, 832 COPD subjects including 7540 patients under a β2 agonist (cases) and 7292 taking placebo (controls) retrieved from 20 randomized controlled trials and were enrolled into this meta-analysis. Evaluated outcomes included overall mortality, exacerbations and tolerance to the drug.
    Results
    The analysis of survival showed no significant difference between those taking LABAs or placebo (relative risk (RR): 0.945, 95% confidence interval (CI): 0.821-1.088, P=0.432). Exacerbation rate, however, was significantly lower among the cases than among the controls (RR: 0.859, 95%CI: 0.800-0.922, p
    Conclusion
    In conclusion, we found that the use of conventional LABA therapy in COPD patients is associated with a lower exacerbation rate of the disease as well as higher tolerance to the drug, but no survival advantage is expectable. Substitution of LABAs with new agents is recommended.
    Keywords: beta agonist, COPD, chronic obstructive pulmonary disease, meta analysis
  • Rasoul Mohammadi, Elham Foroughifar Pages 71-77
    Background
    Systemic candidiasis is a major complication in neutropenic cancer patients undergoing treatment. Most systemic fungal infections emerge from endogenous microflora so the aim of the present study was to identify Candida species isolated from the different regions of body in neutropenic patients in compare with the control group.
    Methods
    A total of 309 neutropenic cancer patients and 584 patients without cancer (control group) entered in the study. Molecular identification of clinical isolates was performed by PCR-RFLP technique.
    Results
    Twenty-two out of 309 patients had candidiasis (7.1%). Male to female ratio was 1/1 and age ranged from 23 to 66 years. Colorectal cancer and acute myeloid leukemia (AML) were the most common cancers. Candida albicans was the most prevalent Candida species among neutropenic patients (50%) and control group (57.9%). Mortality rate in cancer patients was 13.6% in comparison with control group (5.2%).
    Conclusion
    Since candidiasis is an important cause of morbidity and mortality in neutropenic patients, precise identification of Candida species by molecular techniques can be useful for the appropriate selection of antifungal drugs particularly in high risk patients.
    Keywords: Candidiasis, Neutropenic patients, Candida species, Identification
  • Mohammadreza Seyyedmajidi, Saba Homapoor, Elahe Zanganeh, Mohammad Dadjou, Shahab Eskandari, Nejad, Mohammad, Hadi Tajik, Galayeri, Jamshid Vafaeimanesh Pages 78-81
    Background
    Triple therapy with a proton pump inhibitor and two antibiotics in Helicobacter pylori (HP) eradication is widely accepted, but this combination fails in a considerable number of cases. The aim of this study was to assess the effect of clidinium-C addition on HP eradication and to investigate the efficacy and safety of clidinium-C in prevention of drug's side effects.
    Methods
    A total of 200 histopathologically confirmed HP positive peptic ulcer enrolled in this study which were randomly assigned to two treatment groups: OAC (20 mg omeprazole bid, 1000 mg amoxicillin bid and 500 mg clarithromycin bid) and OAC clidinium-C. The effect of treatment and adverse effects were compared 6 weeks after completion of treatment. A13C-urea breath test was performed to confirm HP eradication.
    Results
    A total of 184 patients (90 in group A and 94 in group B) completed the treatment protocols. HP eradication was achieved in 71.1% in OAC versus 72.3% in OCA牘鶊碮C, (P=0.73). The frequencies of abdominal pain and stool abnormality, among the side effects recorded during the therapy period, were significantly lower in group B (OCA牘鶊碮C) (P=0.01 and P=0.001, respectively).
    Conclusion
    Addition of clidinium-C to OCA triple therapy decreases abdominal pain and frequency of stool abnormalities without affecting HP eradication rate. Based on these findings addition of clidinium-C may increase patient's compliance.
    Keywords: Clidinium, C, Helicobacter pylori eradication, Peptic ulcer, Side effects
  • Seyed, Mohammad Alavi, Shokrollah Salmanzadeh, Hajar Abbasifar Pages 82-87
    Background
    Prompt diagnosis and treatment of latent tuberculosis (TB) infection (LTBI) are needed to control TB. The aim of the study was to compare the performance of Quanti FERON-TB test (QFT) with conventional TST for the diagnosis of LTBI.
    Methods
    In this analytical - comparison study, we enrolled 87 nurses working in teaching hospitals in Ahvaz. All study subjects were tested by TST. TST results were interpreted as positive if induration was more than 10 mm. If the level of QFT after stimulation was equal or greater than 0.35 IU/ml, test was considered as positive. Data were analyzed with SPSS program. QFT results compared with induration in TST and its relation to all variables were investigated.
    Results
    The rate of LTB diagnosis by TST and QFT was 31% and 35.6%, respectively. There was no significant difference between TST and QFT in LTB diagnosis (P=0.62). Among the 56 subjects who were TST- negative, 14 cases (approximately 25%) were QFT- positive and 42 (75%) were QFT- negative. Among the 31 cases (35.6%) that had TST- positive, 13 (42%) were QFT-positive and 18 (58%) were QFT- negative. The overall percent agreement was 63.2% (k=0.139, P=0.69), discordance %=15.9-20.7, sensitivity= 41.5% and specificity=75.5%.
    Conclusion
    Diagnostic value of QFT is similar to TST, when there is strong clinical and epidemiological evidence of LTB in a nurse with negative TST, adding QFT to diagnostic evaluation is associated with increased rate of LTB diagnosis.
    Keywords: Latent tuberculosis infection, Quanti FERON, TB test, tuberculin skin test, Health care workers
  • Ameneh Moslemnezhad, Soleiman Mahjoub, Mehdi Moghadasi Pages 88-92
    Background
    Recent studies have shown that oxidative stress (OS) is the most important indicator in the pathogenesis of Alzheimer's disease (AD), but the results in previous studies are conflicting. This study aimed to assess the plasma levels of 8-hydroxy-2'-deoxyguanosine (8-OHdG) as DNA oxidative damage marker and total antioxidant capacity (TAC) in patients with AD versus control group.
    Methods
    Thirty patients with AD and 30 sex-and age-matched healthy subjects were studied. Diagnosis of AD was based on National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's disease and Related Disorders Association (NINCDS/ADRDA) criteria. Also for the patients, Mini-Mental State Examination (MMSE), computed tomography (CT) scan and brain magnetic resonance imaging (MRI) were done. Plasma levels of 8-OHdG and TAC were measured by competitive ELISA method and ferric reducing antioxidant power (FRAP) assay, respectively.
    Results
    Plasma levels of 8-OHdG was significantly higher in AD compared to control group (p
    Conclusion
    Our results indicate a link between oxidative stress and AD indicating a possible contributive role of these markers in the development of AD and as an indicator in the discrimination of AD from healthy controls.
    Keywords: Alzheimer\'s disease, Oxidative stress, DNA damage, 8, OHdG, TAC
  • Mahboobeh Sheikhzadeh, Yones Lotfi, Abdollah Mousavi, Behzad Heidari, Mohsen Monadi, Enayatollah Bakhshi Pages 93-98
    Background
    Benign paroxysmal positional vertigo (BPPV) is linked to vitamin D deficiency. This clinical trial aimed to determine the influence of vitamin D supplementation on intensity of BPPV.
    Methods
    The study population was selected consecutively and the diagnosis of BPPV was made by history and clinical examination and exclusion of other conditions. Intensity of BPVV was assessed based on VAS score (0-10). Serum 25-hydroxyvitamin D (25-OHD) was measured using ELISA method and levels
    Results
    After two months of treatment, in both vitamin D treated and non-treated groups the intensity of BPPV decreased significantly as compared with control (P=0.001 for both groups) but at endpoint, the intensity of BPPV aggravated and regressed to the baseline value in vitamin D deficient non-treated group (P=0.001) whereas, in vitamin D treated group, improvement of BPPV remained stable and unchanged over the study period.
    Conclusion
    This study indicates that correction of vitamin D deficiency in BPPV provides additional benefit to rehabilitation therapy (Epley maneuver) regarding duration of improvement. These findings suggest serum 25-OHD measurement in recurrent BPPV.
    Keywords: Benign paroxysmal positional vertigo, Intensity, Vitamin D, Rehabilitation Therapy
  • Valiollah Amri, Maleh, Mahmood Monadi, Behzad Hidari, Parviz Amri, Maleh, Ali Bijani Pages 99-104
    Background
    Application noninvasive ventilation in the patients with exacerbation of chronic obstructive pulmonary disease (COPD) reduced mortality. This case-control study was designed to compare efficiency and outcome of non-invasive (NIV) versus invasive positive pressure ventilation (IPPV) in respiratory failure due to COPD
    Methods
    The patients were assigned to NIV or IPPV intermittantly.The clinical parameters, including RR (respiratory rate), BP (blood pressure), HR (heart rate) and PH, PaCO2, PaO2 before and 1, 4 and 24 h after treatment were measured. Demographic information such as age, sex, severity of disease based on APACHE score, length of stay and outcome were recorded
    Results
    Fifty patients were enrolled in the NIV group and 50 patients in IPPV. The mean age was 70.5 in NIV and 63.9 in invasive ventilation group (p>0.05). In IPPV group, the average values of PH: PCO2: and PO2, were 7.22±0.11, 69.64 24.25: and 68.86±24.41 .In NIV, the respective values were 7.30±0.07, 83.94±18.95, and 60.60±19.88. In NIV group, after 1, 4 and 24 h treatment, the clinical and ventilation parameters were stable. The mean APACHE score in was IPPV, 26.46±5.45 and in NIV was 12.26±5.54 (p
    Conclusion
    This study indicates that using NIPPV is a useful therapeutic mode of treatment for respiratory failure with acceptable success rate and lower mortality. The application of NIPPV reduces hospital stay, intubation and its consequent complications
    Keywords: Non, invasive ventilation, Invasive mechanical ventilation, acute respiratory failure, Mortality, Chronic obstructive pulmonary disease
  • Mozhgan Moazami, Goudarzi, Majid Farshdousti, Hagh, Abbasali Hoseinpour, Feizi, Mehdi Talebi, Ali, Akbar Movassaghpour, Akbari, Karim Shams, Asanjan, Jamal Eyvazi, Ziyaee Pages 105-113
    Background
    BCL-2 is the most important anti-apoptotic regulator and Bax is a pro-apoptotic protein. The status of these parameters or the ration of BCL-2 to BAX is important in malignant cell fate as well as normal cells.
    Methods
    Sixty-two ALL patients and 62 healthy sex-and age-matched controls were studied. After genotyping, the promoter region of the BAX and BCL-2 genes by RFLP-PCR method the patients were classified in nine prognostic groups, after that, the overall survival ratio of each score was compared with others pair-wise or between groups.
    Results
    The frequencies of the AA, AC, CC alleles of the BCL-2 C-938A polymorphism in patient group were 33 (53.23%), 18 (29.03%), 11 (17.74%), and in the control group were 13 (21.0%), 27 (43.5%), 22 (35.5%), respectively (P=0.003). Also, the frequencies of AA, AG, GG alleles of the BAX G-248A SNP were 15 (24.2%), 24 (38.7%), 23 (37.1%) in ALL group and 13 (21.0%), 25 (40.3%), 24 (38.7%) (p>0.05) in the control group. The survival time estimation and ratio were significantly different between different SNPs in BCL-2 (P=0.002).
    Conclusion
    These findings showed that the BCL-2 promoter region polymorphism is more reliable than BAX gene promoter polymorphism in any ALL scoring system. But the establishment of complete scoring system requires further more clinical and laboratory findings along with genetic polymorphisms is necessary
    Keywords: Acute Lymphoblastic Leukemia, BAX, BCL2, Prognostic Scoring, Survival, Single Nucleotide Polymorphism
  • Mohammad, Sadegh Rezai, Rostam Pourmousa, Roksana Dadashzadeh, Fatemeh Ahangarkani Pages 114-119
    Background
    Treatment of chronic sinusitis is complicated due to increase of antibiotic-resistant bacteria. The aim of this study was to determine the multidrug resistance (MDR) pattern of the bacteria causing chronic sinusitis in north of Iran.
    Methods
    This cross-sectional study was carried out on patients with chronic sinusitis. Bacterial susceptibility to antimicrobial agents was determined according to the CLSI 2013 standards. Double-disk synergy (DDS) test was performed for the detection of extended-spectrum beta-lactamase (ESBL) producing bacteria; also methicillin-resistant Staphylococcus (MRSA) strains were identified by MRSA screen agar. The MDR isolates were defined as resistant to 3 or more antibiotics. Data were analyzed using SPSS 17 software. Descriptive statistics was used to describe the features of the data in this study.
    Results
    The rate of ESBL-producing bacteria was 28.75-37.03% among enterobacteriaceae and the rate of MRSA was 42.75%-60% among Staphylococcus strains. The most detectable rate of the MDR bacterial isolates was Gram-negative bacteria 39 (76.47%) and Enterobacter spp. 19(70.37%) was the most multidrug resistant isolate among Gram negative bacteria. Also 36 (73.46%) of the gram positive bacterial isolated were multidrug resistance and Staphylococcus aureus 9(90%) was the most MDR among Gram positive bacteria.
    Conclusion
    Antimicrobial resistance is increasing in chronic bacterial sinusitis. The emergence of MRSA and ESBL bacteria causing chronic sinusitis is increasing
    Keywords: Chronic sinusitis, Bacteria, Antibiotic resistance, MRSA, ESBL, MDR
  • Alijan Ahmadiahangar, Seyyed, Reza Hoseyni, Farzan Kheyrkhah, Ali Bijani, Zahra Moghaddas Pages 120-125
    Background
    Headache and depression are prevalent among general population. The aim of this study was to determine the associated factors of headache in elderly subjects with emphasis to depression.
    Methods
    All cohort of elderly individuals of the Amirkola Health Study Project were included. Data regarding several clinical and demographic characteristics were provided via fill in quesstionnaire, interview and clinical examination. Presence and duration as well as severity of headache were collected through an interview based on self-reported data. Diagnosis of depression was confirmed according to standard Geriatric Depression Scale (GDS) criteria. In statistical analyses chi-square test with logistic regression analysis was used for association.
    Results
    A total of 832 men and 667 women aged >/= 60 years old were studied. Headache and depression were diagnosed in 42% and 42.4% respectively. In depressed subjects, headache was significantly higher by OR=3.1(95% CI, 2.5-3.83, P=0.001). Proportions of headache increased by severity of depression with a dose-response pattern of relationship from 53.3% in mild depression to 72.6% in severe depression. The magnitude of OR for headache increased from 2.59 (95% CI, 2.03-3.31) in patients with mild depression to 6.04 (95% CI, 3.54-10.3) in patients with severe depression. After adjustment for all covariates, headache was significantly associated with female gender and back pain as well as with depression with a significant dose-response relationship.
    Conclusion
    The findings of this study indicated an independent association between headache and psychological factors in elderly subjects, particularly in women
    Keywords: Depression, Elderly subjects, Headache, Pain
  • Simin Mouodi, Ali Bijani, Seyed Reza Hosseini, Karimollah Hajian, Tilaki Pages 126-132
    Background
    One of the factors that have impact on the health status of elderly people is living alone. This study was conducted to examine the living condition of elderly population in Babol and probable differences which this condition induced on the health disorders of elderly people.
    Methods
    This cross-sectional study was performed on 1544 elderly people aged 60 and over in Amirkola, Babol. Demographic characteristics, the incidence of falls, chronic diseases, polypharmacy, headache with uncertain cause, chronic pains and back pain were collected by the study questionnaire; social support, physical activity, depression and cognitive disorders were assessed with standard questionnaires.
    Results
    6.8% of elderly people were living alone. Lack of social support, cognitive disorders, depression, multiple chronic diseases, occurrence of falls and headache with uncertain cause were significantly higher among those elderly who live alone (p
    Conclusion
    Many disorders and disabilities are higher in the elderly people who live alone; also there is a difference in the health status of elderly people who live alone, according to their gender.
    Keywords: Living alone, Elderly, Health status, Iran
  • Ferigol Fallah, Abolhasan Hamidikenari, Seyed Navid Sajadi, Seyed Rohollah Sajadi, Mohammad Reza Shiran Pages 133-135
    Background
    Clopidogrel is a prodrug that converts in the liver to an active thiol metabolite, which irreversibly inhibits the platelet P2Y12 adenosine diphosphate receptor. It seems that methadone as CYP2C19 inhibitor affects ticlopidine activity in vivo. This study aimed to test the ability of methadone in changing ticlopidine pharmacokinetics.
    Methods
    We conducted a case–control study in 10 subjects. The cases (5 subjects) in our study were addicts who were receiving methadone maintenance treatment (MMT) for preventing opium withdrawal symptoms. The control group were opiate users before starting MMT. In both groups, the patients received clopidogrel (75mg/day) for 5 days. On the 6th day, the subjects returned to the clinic, blood samples were taken up to 12 hours following clopidogrel dosing in case and control groups. Plasma concentration of clopidogrel was measured by GC-MAS. Noncompartmental pharmacokinetic analysis was performed using Microsoft Excel software to estimate PK parameters.
    Results
    In this study, methadone decreased clopidogrel clearance by 25% and increased the AUC0-inf nearly 1.3 fold during the coadministration of clopidogrel as an antiplatelet drug.
    Conclusion
    A significant decrease in the clearance of clopidogrel during the coadministration of methadone consistent with a decrease in clopidogrel conversion to its active metabolite and this may decrease its efficacy and may have life-threatening consequences for the patients undergoing clopidogerel maintenance therapy
    Keywords: Clopidogrel, Methadone, Interaction
  • Shahram Agah, Hossein Khedmat, Mohammad Ebrahim Ghamar, Chehred, Reza Hadi, Aghdas Aghaei Pages 136-141
    Background
    Gastric cancer (GC) is one of the most common Cancers in the world and Helicobacter pylori (HP) infection is considered a causative factor. The aim of this study was to determine the characteristics and the associated factors of (GC) in a small cohort.
    Methods
    Overall, 54 patients with diagnosed gastric cancer were followed-up at the Department of Gastroenterology & Hepatology at Baqiyatallah University of Medical Sciences. 37 (68.5%) of them were positive for H pylori infection in histopathological evaluations. Univariate and multivariate regression analyses were used to determine the associations of demographic features and HP infection status with GC characteristics and prognosis.
    Results
    Univariate analysis showed female gender (odds ratio (OR): 6.53; 95% confidence interval (95%CI): 1.59-26.8; P=0.008), and illiteracy (compared to intermediate education; OR: 5.9, 95%CI: 1.37-25.43; p=0.05) were associated significantly with higher rate of HP infection. After a mean±SD follow-up duration of 254±329 months, only female gender was significantly associated with HP infection in GC (OR:4.56; 95% CI: 1.0-21.76; P=0.05). H pylori positive patients had significantly higher grade of GC (OR: 3.97; 95% CI: 1.0-16.16; P=0.05), and a trend toward greater GC stage (OR: 4.46, 95% CI: 9.39-21.23; p=0.06). There was no association between survival rate and H pylori infection.
    Conclusion
    In the current study, we found a significant association of female gender with GN and an association of higher grade of GC with female gender. These findings may indicate a sex disparity in susceptibility to HP infection regarding GC future studies of larger populations are recommended.
    Keywords: Helicobacter pylori, Gender, Female, Stomach cancer, Gastric carcinoma, Iran
  • Neha Agrawal, Tuhin Santra, Arnab Kar, Pradipta Guha, Mita Bar, Apu Adhikary, Sumana Datta Pages 142-145
    Background
    Deep vein thrombosis is an important cause of morbidity and mortality. However, its association with adenomatous polyposis coli is extremely rare. Here we present an interesting case of deep vein thrombosis associated with adenomatous polyposis coli.
    Case Presentation
    A 15 year old female who was having fever and diarrhea for 5 months developed bilateral asymmetric painful swelling of lower limbs for 1 month. Doppler ultrasound of lower limbs revealed presence of thrombosis from inferior vena cava up to popliteal vein. Colonoscopy and biopsy were suggestive of adenomatous polyposis coli. However, she could not tolerate anticoagulant therapy and was put on aspirin therapy for 6 months to which she responded well with the resolution of thrombus.
    Conclusion
    Role of aspirin therapy may be considered whenever a patient of venous thrombosis cannot tolerate anticoagulant therapy
    Keywords: Deep vein thrombosis, Adenomatous polyposis coli, Diarrhea, Aspirin
  • Bahman Farhangi, Arezo Farhangi, Alireza Firouzjahi, Babak Jahed Pages 146-149
    Background
    Splenic cysts are rare in all age groups and there are a few reports in the world literature. Primary cysts occur most frequently in children and young adults, comprising around 25% of all nonparasitic splenic cysts. Various techniques are suggested for the treatment of splenic cysts. In this case report, a huge epithelial splenic cyst in a 17-year-old female is presented and different treatment methods of splenic cysts are evaluated.
    Case Presentation
    A 17-year-old female presented with progressive abdominal mass in left upper quadrant associated with abdominal pain and food intolerance of duration of several months. There was no history of trauma. On physical examination, there was a huge mass located in the upper left side of abdomen. Computerized tomography scan revealed that a large cystic lesion had occupied the spleen with dimensions of 32x21xI5.6 cm. After patient preparation laparotomy was performed and complete cyst excision was done with splenectomy, patient was discharged after 2 days. This is a report of a case of epithelial splenic cyst of the spleen in a 17-year old female.
    Conclusion
    The management of splenic cysts continues to evolve and the optimum treatment of patients with nonparasitic splenic cysts is controversial, as a principle preservation technique of the spleen with minimally invasive methods such as laparoscopy is preferred to splenectomy with the exception of very large cysts and when splenic hilum is involved in cyst wall. However, significant cyst recurrences were encountered with these techniques. Recently open partial splenectomy has been proposed as a safe and effective method in the management of NPSCs it ensures complete cyst removal, lack of cyst recurrence, and preservation of the spleen functions
    Keywords: Cysts diagnosis, Cysts surgery, Splenic diseases diagnosis, Splenic diseases surgery
  • Dariush Moslemi, Mohammad Mohammadianpanah Pages 150-150