فهرست مطالب

Caspian Journal of Internal Medicine - Volume:7 Issue:3, 2016
  • Volume:7 Issue:3, 2016
  • تاریخ انتشار: 1395/05/16
  • تعداد عناوین: 17
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  • Alijan Ahmadi, Ahangar Pages 151-152
  • Behzad Heidari, Karimollah Hajian, Tilaki, Mansour Babaei * Pages 153-161
    Background
    Several factors are associated with the development or exacerbation of pain in knee osteoarthritis (KOA). In this study, we reviewed this context based on relevant studies.
    Methods
    Recent published studies which have addressed the relationship between pain and KOA were summarized.
    Results
    Correlates of the clinical, demographic features, laboratory tests and abnormalities on radiographic as well as magnetic resonance imaging (MRI) with the knee pain have been discussed. The results indicated that many factors such as synovitis, synovial effusion, obesity, as well as structural lesions determined by MRI or radiographic examination, serum cytokines, inflammatory markers are determinants of pain in KOA.
    Conclusion
    This context requires further investigations for identification of additional factors which initiate pain in asymptomatic KOA
    Keywords: Knee osteoarthritis, Pain, Determinants, Synovitis, C, reactive protein, Structural lesions
  • Moharam Mafi, Massoud Hajia *, Mohamad, Mahdi Goya Pages 162-167
    Background
    Cholera is considered a key indicator of social development but still is reported in various cities of Iran. The present study aimed to analyze the available information regarding cholera outbreaks since 2010 in Iran.
    Methods
    All cases reported to the Center for Disease Control and Prevention of Ministry of Health and Education who had been confirmed as cholera cases by the Health Reference Laboratory, were entered into this study since 2010. A specific spreadsheet was designed to ensure the safe keeping of the patient records.
    Results
    A total of 1522 patients were clinically diagnosed as cholera with laboratory confirmation over the study period. Cholera was detected in 26 Provinces and 115 cities during this period. Mean age of the patients was 35.1±17, both the Inaba and Ogawa strains were isolated. The highest mortality and the morbidity rate was 1.98% in 2013. The most cholera prevalent provinces in order of frequency were Baluchistan, Alborz, Gilan, Golestan and Qom, as well as Tehran. Inaba serotype was the most common cause of mortality and morbidity in 2013.
    Conclusion
    These findings indicate significant outbreaks of cholera in some of the provinces of Iran and warrant appropriate treatment and preventive measures.
    Keywords: Epidemiology, Risk factor, Cholera
  • Roghayeh Akbari, Bahram Adelani, Reza Ghadimi * Pages 168-172
    Background
    Both vitamin D deficiency and hypertension are prevalent in the general population. Several observations indicate an association between vitamin D deficiency and high blood pressure. The present case-control study aimed to compare serum 25-hydroxyvitamin D (25-OHD) in hypertensive patients versus healthy controls.
    Methods
    One hundred patients aged 30-60 years with hypertension (HTN) and 100 healthy controls without history of hypertention were compared regarding serum 25-OHD. Blood pressure was measured using standard method and the systolic and diastolic blood pressure more than140 mmHg and 90 mmHg respectively were considered as HTN. Patients and controls with coexistent morbidities, vitamin D supplementation were excluded. The serum levels of 25-OHD, PTH and calcium were measured after obtaining a written informed consent from the patients and taking their blood pressure under standard conditions. In statistical analysis, the two groups were compared using independent t test and chi-square test using SPSS Version 18.
    Results
    The mean age of patients and controls was comparable (53.7±6.4 vs 52.3±7.54 years, P=0.17). Serum 25-OHD in HTN was significantly higher than controls (P=0.001).
    Conclusion
    In the present study, serum 25-OHD level in hypertension was higher than controls. The results contradict with earlier studies indicating an association of HTN with vitamin D deficiency. This issue warrants further investigations in particular the follow-up of serum 25-OHD deficient and sufficient subjects with regard to the development of HTN.
    Keywords: blood pressure, hypertension, vitamin D, calcium, PTH
  • Mahboobeh Sheikhzadeh, Yones Lotfi *, Abdollah Mousavi, Behzad Heidari, Enayatollah Bakhshi Pages 173-177
    Background
    Benign paroxysmal positional vertigo (BPPV) is a condition with recurrent attacks in a significant proportion of patients. The present case- control study was conducted to assess the influence of serum vitamin D normalization on recurrent attacks of vitamin D deficient patients.
    Methods
    Diagnosis of BPPV was made based on history and clinical examination and exclusion of other conditions. Serum 25-hydroxy vitamin D (25-OHD) was measured using ELISA method and a levels of
    Results
    Twenty-seven patients were allocated to each group. At baseline, serum 25-OHD was similar (10.7±2.3 vs 11.41±1.9, P=0.23). At month 2, serum 25-OHD in the treatment group increased significantly to ≥ 30 ng/ ml, whereas serum 25-OHD in the control group remained unchanged (34.2±3.3 vs 10.6 10.6±2.2 ng/ml, P=0.001). During the follow-up period, attacks of BPPV in the treatment group decreased significantly compared with the control group (14.8% vs 96.3% OR= 0.18, P=0.001).
    Conclusion
    The findings of this study indicate that the normalization of serum vitamin D significantly reduces BPPV recurrences.
    Keywords: BPPV, 25, hydroxy vitamin D, Epley Therapy, Recurrent vertigo
  • Saeide, Sadat Shobeiri, Saeid Abediankenari *, Bahareh Lashtoo Aghaee, Zahra Rahmani, Bahareh Esmaeili, Gorji Pages 178-182
    Background
    Research says that diabetes may develop in over 10% of non-diabetic pregnant women. Diabetes which generally occurs late in second trimester and third trimester of pregnancy, it is called gestational diabetes. Overweight or suffering from obesity before pregnancy is type 2 diabetes risk factor. In most cases, diabetic symptoms disappear after delivery. HLA-G has an important role both in mother and fetus tolerance during pregnancy, it may also be effective in the protection of pancreatic islet cells. In this study, concentration of these molecules in pregnant women with gestational diabetes in comparison with normal pregnant women was investigated.
    Methods
    In this case-control study, we measured serum HLA-G levels in 24 pregnant women with gestational diabetes compared with 30 normal pregnant women using sandwich ELISA.
    Results
    HLA-G levels were significantly low in pregnant women with gestational diabetes in contrast to normal pregnant women (P=0.001).
    Conclusion
    In this study, we found that HLA-G levels were reduced in women with gestational diabetes compared with control group. Therefore, it is suggested that measurement of HLA-G in pregnant women can be considered as an indicator in prognosis of gestational diabetes.
    Keywords: HLA, G, gestational diabetes, pregnancy
  • Mohammadreza Jalali, Nadoushan, Reza Amirtouri, Ali Davati, Samaneh Askari, Sepideh Siadati * Pages 183-187
    Background
    Papillary thyroid carcinoma (PTC), occurs mostly in women and sex hormones may play a role in the pathogenesis and clinical course. The objective of this study was to determine the status and prevalence of estrogen and progesterone receptors in PTC with regard to age, gender, tumor size and lymph node involvement.
    Methods
    Immunohistochemical stains were performed on 92 tissue blocks of PTC for estrogen receptor (ER) and progesterone receptor (PR) expression in tumor cells. Chi-square test and Mann-Whitney U test were used to determine statistical difference using statistical software SPSS.
    Results
    The mean age of patients was 39.32±1.7 years (range 13-80) with 79(85.9%) women and 13 (14.1%) men. Lymph node involvement was seen in 76.1% of patients. The average tumor size was 3.6±2.21 cm. The rate of ER and PR expression were 46.75% and 5.6%, respectively. ER expression for females was higher than males (P=0.014), but no relation was found between males and females in PR expression (P=0.7). Also there was no statistical difference between ER and PR expression with respect to age, lymph node involvement and tumor size.
    Conclusion
    Our study showed higher ER expression in females than males with PTC. No relation was found between the expression of these receptors and age of presentation, lymph node involvement and tumor size. Further investigation is required to determine the prognostic importance of ER and PR in PTC.
    Keywords: Papillary thyroid carcinoma, Estrogen receptor, progesterone receptor, Prognosis
  • Hourolein Arab, Soleiman Mahjoub *, Karimollah Hajian, Tilaki, Mehdi Moghadasi Pages 188-194
    Background
    Alzheimer’s disease (AD) is the most prevalent degenerative disorder of the brain among elderly individuals. Many studies indicate that oxidative stress is an important pathogenic factor which involves oxidizing macromolecules such as DNA, lipids, and proteins in AD. Green tea is a rich source of antioxidant compounds that can remove radical oxygen species. The purpose of this study was to investigate the influence of green tea consumption on markers of oxidative stress in AD.
    Methods
    In this prospective intervention study, 30 patients with severe AD were recruited. The diagnosis of AD was made based on the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer’s disease and Related Disorders Association (NINCDS/ADRDA) criteria. Brain magnetic resonance imaging (MRI) and computed tomography (CT) scan as well as Mini-Mental State Examination (MMSE) were performed for all participants in which four green tea pills were administered daily for 2 months (2 g/day in 2 divided doses). The plasma total antioxidant capacity, 8-hydroxy-2’-deoxyguanosine levels (8-OHdG), malondialdehyde (MDA), carbonyl content, and MMSE scores were measured at baseline and at the end of the study period.
    Results
    The levels of MDA, 8-OHdG and carbonyl decreased significantly as compared to baseline values (P=0.002, P=0.001 and P=0.037, respectively). Whereas, the total antioxidant capacity of plasma and MMSE scores significantly increased at end point (P=0.000, P=0.043, respectively).
    Conclusion
    The findings indicate that consumption of green tea for two months by with the improvement of antioxidant system exerts beneficial effect on cognitive function.
    Keywords: Alzheimer's disease, Antioxidants, Green tea, Oxidative stress, Cognitive function
  • Mohammad Reza Hatef, Fard, Mina Khodabandeh, Maryam Sahebari *, Majid Ghayour, Mobarhan, Zahra Rezaieyazdi Pages 195-200
    Background
    Systemic lupus erythematous is an autoimmune disease associated with atherosclerotic manifestations or metabolic disturbance due to inflammation. The aim of this study was to determine frequency of metabolic syndrome (MetS) in SLE compared to healthy controls.
    Methods
    In this cross-sectional study, 150 SLE patients and 220 healthy volunteers were enrolled. MetS was diagnosed according to ATPIII criteria. Patients and controls were compared according to prevalence of MetS. In addition, SLE patients with and without MetS were compared according to laboratory parameters. Each patient also fulfilled a checklist about routine daily activities and diet program. Data were analyzed by SPSS-11 software.
    Results
    MetS was significantly lower in SLE than healthy controls (18% vs 29.1%, P=0.015). Disease manifestations, major organ involvement, serum values of complements and anti-DNA antibody and pharmacological therapy did not correlate with MetS occurrence in patients. The mean TG, FBS, systolic and diastolic BP were statistically higher in lupus patients compared to healthy volunteers in contrast to waist circumference. HDL-cholesterol serum values did not show any significant difference between two groups.
    Conclusion
    It seems that despite higher values of blood pressure, serum lipids and glucose in lupus patients, the cumulative metabolic components were in a manner to make MetS more prevalent in healthy volunteers. As far as life habits are concerned, lupus patients in general did not exercise enough and did not go on a healthy diet despite of glucocorticoid therapy and hypertension.
    Keywords: systemic lupus erythematosus, SLE, lupus, metabolic syndrome, Diet, exercise, life style
  • Nasrin Rafieian, Hamidreza Abdolsamadi, Aliakbar Moghadamnia, Mina Jazayeri, Mohammadali Seif, Rabiee, Mina Salmanzadeh, Shahrbanoo Radi * Pages 201-205
    Background
    Recurrent aphthous stomatitis (RAS) is the most common painful ulcers of oral mucosal which can cause many sufferings. Treatment of RAS often includes administration of corticosteroids, analgesics and regulators of the immune system. However, considering the side effects of these medications, even their topical application must be done with caution. Alum is used in traditional medicine for treatment of oral ulcers without significant side effect. This study sought to assess the effect of topical application of alum on aphthous ulcers.
    Methods
    This clinical randomized double-blind placebo-controlled study was conducted on 50 females aged 21 to 27 years. Mucosal adhesive patches were prepared in two forms of basic and 7% alum-containing patches. Subjects in two groups of case and control randomly received the mucosal adhesive patches containing alum and the basic patches, respectively three times in five days. Duration of recovery, changes in size of lesion and severity of pain were recorded. Data were entered into SPSS Version 16 and analyzed using t-test.
    Results
    The average period of full recovery was 7.52 days in the case and 12.2 days in the control groups; which was significantly different (p
    Conclusion
    Alum can significantly decrease the size of aphthous lesions, severity of pain and expedite the recovery of patients with RAS.
    Keywords: aphthous, stomatitis, Alum Compounds
  • Babak Bakhshayesh, Eghbali, Seyed, Ali Roudbary, Seddigheh Basir, Jafari, Seyedeh, Parand Nabizadeh, Naghmeh Naderi, Asrami, Reza Sohrabnejad* Pages 206-210
    Background
    Stroke is one of the leading causes of mortality and long-term morbidity. The aim of the present study was to determine the ability of baseline serum C-reactive protein (CRP) and white blood cell count (WBC) values in predicting the outcome of acute ischemic stroke (AIS).
    Methods
    This study consisted of patients with first AIS referred to Poursina Hospital, Rasht, Iran. Severity of stroke was determined according to the National Institute of Health (NIH) Stroke Scale at the time of admission. Serum CRP levels and WBC count were measured at the time of admission. All patients were followed-up for 90 days after discharge and the severity of stroke was assessed using modified Rankin Scale. Receiver operating characteristic curve analysis was used for calculating the most appropriate cutoff point of CRP and WBC count for differentiating patients with and without poor outcome at the end of the study period.
    Results
    A total of 53 out of 102 patients (52%) had poor outcome. The most appropriate cutoff value for CRP in differentiating patients with and without poor outcome was 8.5mg/l (sensitivity: 73.1%, specificity: 69.4%) and for WBC the difference did not reach to a significant level. The cutoff points of CRP > 10.5 mg/ml yielded a predictive ability at sensitivity: 75%, specificity: 63.8% whereas predictive ability of WBC for mortality was at a borderline level.
    Conclusion
    These findings indicate that high levels of serum CRP in AIS at the time of admission is associated with poor prognosis. However, this study found no ability for WBC in predicting AIS outcome
    Keywords: C reactive protein, Leukocytosis, Ischemic Stroke, Prognosis, National institutes of health stroke scale
  • Iraj Mohammadzadeh*, Alireza Nouroozi, Kazem Babazadeh, Hassan Zamani, Rahim Barari, Savadkoohi, Reza Alizadeh, Navaei Pages 211-216
    Background
    Cardiac involvement was the major leading cause of death in patients with Kawasaki and IVIG administration reduces cardiac complications. The objective of this study was to determine the frequency of cardiovascular complications and duration of fever with regard to the time of intravenous immunoglobulin (IVIG) administration of patients with Kawasaki disease.
    Methods
    This follow-up study was done on all patients with Kawasaki disease who were hospitalized at Amirkola Children’s Hospital between 2006 and 2011. Diagnosis of Kawasaki was clinical and included fever more than 5 days with 4 of 5 signs containing mucosal changes, scaling and skin rash, bilateral nonexudative conjunctivitis, cervical lymph adenopathy and edema in lower extremities. After diagnosis of Kawasaki, all patients received standard treatment (intravenous immunoglobulins and aspirin) and undergoing cardiac echocardiography in 2 weeks, 2 months and 6 months. Information including age, sex, sign of diseases, laboratory findings, and cardiac complications in echocardiography were recorded.
    Results
    This study was performed on 100 patients (61 boys and 39 girls) with Kawasaki disease. The mean age of children was 2.8±2.6 years. Cardiac complication rate was 47% at the onset of the disease and had reached to 7% at the end of the sixth month (P=0.000). Distribution of cardiovascular complications in the second week, the second month and the sixth month after treatment was not significantly different according to the start of time of treatment (p>0.05). Duration of fever in patients who received treatment before 10th day (1.5±1.3) did not have significant difference (P=0.78) with patients who received after 10th day (1.6±0.9).
    Conclusion
    Result shows that most of patients (99%) responded to the treatment with IVIG and ASA and cardiovascular complication ratio decreased. There was not significant relationship between duration of fever and time of IVIG treatment initiation.
    Keywords: Kawasaki, Cardiac complications, Children, IVIG
  • Hamed Golmohammadzadeh, Ghodratollah Maddah *, Yavar Shams Hojjati, Abbas Abdollahi, Hossein Shabahang Pages 217-221
    Background
    Splenic cysts are known as rare clinical encounter. Classifying into primary (true) and secondary cysts (pseudocysts), true cysts contain cellular epithelial lining and subdivided into parasitic and non-parasitic cysts. This study aimed to determine the outcome of treatment in patients with splenic cyst.
    Methods
    All patients with splenic cyst who had been treated in Department of General Surgery of Ghaem and Omid teaching hospitals over a 24-year period were identified. The medical records of these 16 patients were reviewed.
    Results
    The study patients included 11 females (68.75%) and 5 males (31.25%) with average age of 39.8 years. Fifteen cases had true cyst including 11 parasitic cysts (hydatid) and only one pseudocyst. 37.5% of the splenic cysts had coexistent cysts in liver, pelvis, omentum and paracolic regions. Nine patients underwent total splenectomy and 5 cases partial splenectomy and 2 remaining cases received conservative medical treatment. The size of the cysts varied from 6 to 25 centimeter with average size of 14.3 centimeter. All patients with hydatid cysts received albendazole postoperative medical treatment with albendazole for 6 months. All patients recovered after treatment.
    Conclusion
    Open splenectomy whether total or partial is effective and safe in patients with splenec cysts with or without hydatidosis. The outcome of treatment is good without recurrences.
    Keywords: splenic cysts, Open splenectomy, management
  • Khalid Hamid Changal *, Shoaib Altaf Sheikh, Adnan Raina Pages 222-224
    Background
    The clinical presentation of non-Hodgkin lymphoma (NHL) varies tremendously depending upon the type of lymphoma and the areas of involvement. NHL can rarely present as an abdominal mass compressing the inferior vena cava. The clinical presentation due to obstruction of inferior vena cava has often been called the inferior vena cava syndrome (IVCS). It can present acutely or chronically.
    Case Presentation
    A 35-year-old male presented with 3 months history of fever, anorexia, weight loss and abdominal discomfort. His abdominal examination showed dilated superficial veins with blood flowing rostrally. CECT abdomen revealed multiple enlarged some necrotic, retroperitoneal lymph nodes. The inferior vena cava was noted to be compressed by the lymph nodes. The lymph node biopsy revealed non- Hodgkin lymphoma, precursor B cell.
    Conclusion
    An abdominal mass compressing the inferior vena cava is a rare but possible cause for appearance of dilated superficial abdominal veins and should be looked for.
    Keywords: NHL, Inferior vena cava, Oncology
  • Payam Saadat *, Marzie Adabi Pages 225-227
    Background
    Spinal dural AVF is the most common type of spinal vascular malformation. However, presenting symptoms differ according to site of spinal involvement. This study described a case of arteriovenous malformation with paraparesis and incontinence.
    Case Presentation
    Diagnosis of patient was confirmed by clinical and imaging examination using magnetic resonance image and ruling out other possibilities
    Result
    A definitive diagnosis of arterio venous fistula was confirmed by clinical and MRI examination and demonstrated abnormalities compatible with dural arteriovenous fistula.
    Conclusion
    Dural arteriovenous fistula should be considered in patients with paresis in both lower extremities.
    Keywords: Spinal dural AVF, Myelopathy, weakness
  • Mahdieh Rajabi, Moghaddam*, Mohammad Ranaee, Shahla Yazdani, Seyyed Reza Modarres Pages 228-231
    Background
    Ovarian cancer is the most common cause of cancer death worldwide. Incidence of ovarian cancer is more common in postmenopausal women. Premenopausal onset is rare and the present study described two cases of ovarian clear cell tumors in young women.
    Case Presentation
    The patients presented with pelvic mass which was confirmed by sonography and laparotomy and final diagnosis was made according to histologic examination. Both patients showed a solid mass with cystic components in adnexal areas and explorative laparotomy demonstrated extension of tumors to abdomen in both patients. The level of CA 125 increased in both patients. For both tumors, immunohistochemical stainings were positive for CK7 and CD15, but CK20 was negative.
    Conclusion
    Although ovarian clear cell tumor is usually diagnosed in postmenopausal women but its diagnosis should be suspected in young women with pelvic mass.
    Keywords: ovarian neoplasms, clear cell carcinoma, young adult
  • Viroj Wiwanitkit* Page 232