فهرست مطالب

Caspian Journal of Internal Medicine - Volume:8 Issue: 1, Winter 2017
  • Volume:8 Issue: 1, Winter 2017
  • تاریخ انتشار: 1395/12/10
  • تعداد عناوین: 12
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  • Kourosh Sayemiri, Milad Azami *, Ali Sharifi Pages 1-15
    Background
    This study aimed to investigate the prevalence of diabetes, impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) in Iranian patients with thalassemia major.
    Methods
    The current study has been conducted based on PRISMA guideline. To obtain the documents, Persian and English scientific databases such as Magiran, Iranmedex, SID, Medlib, IranDoc, Scopus, PubMed, ScienceDirect, Cochrane, Web of Science, Springer, Wiley Online Library as well as Google Scholar were searched until December 2015. All steps of the study were conducted by two authors independently. To the high heterogeneity of the studies, the random effect model was used to combine studies. Data were analyzed using STATA Version 11.1 software.
    Results
    Thirty-two studies involving 3959 major thalassemia patients with mean age of 16.83 years were included in the meta-analysis. The prevalence of diabetes in Iranian patients with thalassemia major was estimated as 9% (95% CI: 6.8-10.5) and estimated rate was 12.6% (95% CI: 6.1-19.1) for males and 10.8% (95% CI: 8.2-14.5) for females. The prevalence of IFG and IGT were 12.9% (95% CI: 7-18.8) and 9.6% (95% CI: 6.6-12.5) respectively. No relationship between serum ferritin and development of diabetes was noted.
    Conclusion
    The prevalence of diabetes, IFG, and IGT in patients with thalassemia major in Iran is high and accordingly requires new management strategies and policies to minimize endocrine disorders in Iranian patients with thalassemia major. Screening of patients for the early diagnosis of endocrine disorders particularly diabetes, IFG, and IGT is recommended.
    Keywords: Diabetes, Impaired Fasting Glucose, Impaired Glucose Tolerance, Ferritin Thalassemia Major, Iran, Meta-analysis
  • Mohammad Sadegh Rezai, Javad Ghaffari *, Mohammadreza Mahdavi, Amir Bahari, Shahram Ala Pages 16-22
    Background
    Pneumococcal vaccine provides protection against invasive pneumococcal disease in population at risk. This study was conducted to compare the antibody response to 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine in patients with thalassemia major.
    Methods
    A randomized cross-over clinical trial was performed on 50 asplenic patients with thalassemia major who referred to thalassemia center at Bouali Sina Hospital, Sari, Iran from 2013 to 2014. Patients were divided into two equal groups. The first group received 13-valent pneumococcal conjugate vaccine (PCV) injected into the deltoid muscle at first and received 23-valent polysaccharide vaccine (PPV) by the same way two months later. The second group received PPV vaccine at first and PCV13 two months later. Levels of serum antibody were checked and measured by enzyme-linked immunosorbent assay (ELISA) before vaccination, and then 8 weeks after the first injection and 2 months after the second injection in all patients. Each time 0.5-ml dose of the vaccine was injected.
    Results
    Of the 50 patients, three cases were excluded due to lack of cooperation and avoidance of vaccination. From 47 patient participants, 28 (59.6%) were males and 19 (40.4%) were females with age ranged between 20 to 44 years (average age of 29.6±1.4 years). Pneumococcal IgG levels in a group that used PCV before PPV (Group A) increased from 114.5±87.7 to 1049±720 U/ml (p=0.0001) and in another group that used PPV before PCV (Group B) increased from 115±182.2 to 1497.3±920.3 U/ml (P=0.0001).
    Conclusion
    It can be concluded that PCV vaccine before PPV can be more effective in asplenic thalassemia major patients as a booster dose.
    Keywords: PPV-23, PCV-13, Thalassemia Major, Asplenia
  • Mostafa Javanian *, Arefeh Babazadeh, Farshid Oliaei, Roghayeh Akbari, Abazar Akbarzadepasha, Ali Bijani, Mahmoud Sadeghi Pages 23-29
    Background
    Cytomegalovirus (CMV) disease is an important cause of death and possibly transplant rejection in kidney transplant (KT) patients. This study was conducted to investigate the incidence and risk factors of CMV disease in kidney transplant patients.
    Methods
    All end-stage renal disease (ESRD) patients who underwent kidney transplantation during 1998-2014 and their donors were assessed. All samples were followed-up for approximately 70 months. CMV was identified by polymerase chain reaction (PCR) and/or PP65 antigen in peripheral blood leukocytes along with clinical manifestations.
    Results
    A total of 1450 cases participated in the current study. CMV was diagnosed in 178 out of 725 (24.6%) kidney recipients. The annual incidence of CMV disease was 4.2%. Patients older than 40 years had a higher incidence of CMV disease. The level of CMV disease incidence in the 41-60 age group was 4 fold compared to those under 20 of age group (P=0.001).
    Conclusion
    This study demonstrated that the incidence of CMV disease in our region is relatively low and also age more than 40 years and EBV infection are the important risk factors in kidney transplant patients. So care and monitoring of these patients are crucial in the first 5 months.
    Keywords: Cytomegalovirus, Incidence, Renal transplantation
  • Novin Nikbakhsh, Mohammad Zamani, Askari Noorbaran *, Ali Naghshineh, Danial Rastergar Nejad Pages 30-34
    Background
    Chylothorax results from leakage of lymph in the pleural cavity because of thoracic duct injury which is associated with severe metabolic disorders. The aim of this study was to evaluate the rate of chylothorax and its causes among hospitalized patients in Shahid Beheshti Hospital of Babol city, North of Iran.
    Methods
    In this cross-sectional study, all patients with chylothorax admitted to the surgery department of Shahid Beheshti Hospital during 2002-2015 were included. Information including gender, age, duration of symptoms, laboratory findings, causes of disease and the type of treatment were extracted from the patient's records.
    Results
    Of the 42 patients, 27 (64.3%) were men and 15 (35.7%) were women. The mean age of the study population was 51.03±16.95. The most common clinical symptoms were dyspnea (66.7%) and dyspnea with cough (21.4%), respectively. In all patients, the pleural fluid triglyceride level was greater than 110 mg/dl, whereas the presence of lymphatic in pleural fluid was eventful in 18 (42.8%) patients. The causes of the disease were traumatic (54.8%), non-traumatic (38.1%) and unknown (7.1%), which were not significantly correlated with gender. Nineteen (45.2%) patients were operated, 16 (38.1%) patients received supportive therapy, and 7 (16.7%) patients had the treatment of the underlying conditions and then supportive therapy.
    Conclusion
    According to the results, trauma was the most common cause of chylothorax. Therefore, identification and control of the traumatic factors seem to be the steps to prevent and reduce the chylothorax incidence and its complications.
    Keywords: Chylothorax, Lymph, Thoracic duct, Trauma, Surgery
  • Alieh Pourdast, Maryam Sanaie, Sirous Jafari, Mostafa Mohammadi, Hossein Khalili, Gita Shafiee, Zeinab Ahadi, Mahsa Rostami, Saba Alizad, Ramin Heshmat *, Minoo Mohraz Pages 35-43
    Background
    Septimeb as a herbal medicine has regulatory effects on inflammation. This study set to evaluate the effects of Septimeb among patients with sepsis on inflammatory biomarkers and survival rate.
    Methods
    In this randomized clinical trial, 51 patients with sepsis from the ICU and medical ward of Imam Khomeini Hospital were divided into two groups: Septimeb (n=25) and control group (n=26). In the control group, the patients received a standard treatment only for 7 days, while Septimeb group received Septimeb (6cc vial with 500cc serum glucose infusion 5% daily for one to two hours) plus standard treatment of sepsis for 7 days. Then, blood samples were analyzed. APACHE (Acute Physiologic and Chronic Health Evaluation), SOFA (Sequential Organ Failure Assessment), and GCS (Glasgow Coma Score) values were calculated daily.
    Results
    Treatment with Septimeb showed a significant decrease in SOFA value (1.54±0.83) compared to the control group (2.39±0.88) (P
    Conclusion
    Septimeb has positive effects on reduction of the severity of sepsis which leads to reduction of patients’ mortality rates.
    Keywords: Sepsis, Septimeb, Infection, Inflammatory
  • Soheil Ebrahimpour, Masomeh Bayani, Mohammad Reza Hasanjani Roushan * Pages 44-48
    Background
    Skeletal complication of brucellosis is common in endemic region of brucellosis, but its frequency has not been clearly determined. The aim of this study was to determine the frequency of skeletal complication in brucellosis patients in Babol, north of Iran.
    Methods
    From 2005-2015, 1252 cases of brucellosis were diagnosed at the Department of Infectious Diseases, Ayatollah Rouhani Teaching Hospital, in Babol, North of Iran. The diagnosis of brucellosis was established using serum agglutination test (SAT≥1/160), and 2-mercaptoethanol (2ME≥ 1/80) with clinical and epidemiological findings compatible with brucellosis. Among them, 464 (37.1%) cases demonstrated skeletal complication. The diagnosis of skeletal involvement was established with appropriate diagnostic facilities. The data were collected and analyzed.
    Results
    The mean age of these patients (299 males, 165 females) was 33.2±17.6 years. Three hundred-thirty four (72%) cases were from rural areas. In 350 (75.4%) patients with peripheral arthritis, 242 (52.1%) cases were monoarthritis. Furthermore the knee arthritis was seen in 148 (31.9%) patients and hip in 54 (11.6) cases. Sacroiliitis was seen in 59 (12.7%) patients and spondylitis in 55 (11.9%) cases. There were no significant differences regarding the occurrence of these focal lesions in both sexes.
    Conclusion
    The results show that about one-third of brucellosis in human is associated with skeletal complication. Peripheral arthritis, sacroiliitis and spondylitis are the frequent skeletal complications of human brucellosis.
    Keywords: Brucellosis, Skeletal complication, Sacroiliitis, Spondylitis, Arthritis
  • Ulas Aday, Cuneyt Kayaalp *, Murat Kapan Pages 49-51
    Background
    Rupture into the biliary ducts is the most frequent complication of hydatid liver disease. In endemic areas of Echinococcus granulosus, development of jaundice in a patient with liver cyst is initially suspected to have hydatid cyst.
    Case Presentation
    A 48 year-old woman with history of asymptomatic hydatid liver cysts was admitted to the emergency department with right upper quadrant abdominal pain, increased levels of liver enzymes, bilirubin and alkaline phosphatase and the initial clinical diagnosis was the hydatid cyst rupture into the bile ducts. Surgery was planned but radiological evaluation (MRI) revealed non-dilated intra-extra biliary ducts. High suspicion of hydatid rupture required diagnostic ERCP that was normal and surgery was cancelled then. A possible diagnosis of coexistent hepatitis was suspected. Liver function tests normalized gradually and no cyst rupture was determined during surgery.
    Conclusion
    These findings suggest considering the possible development of cryptogenic hepatitis in patients with preexisting hydatid cyst.
    Keywords: hydatid liver disease, surgery, jaundice, cryptognic hepatitis
  • Ghodratollah Maddah, Abbas Abdollahi *, Omid Rouhbakhshfar, Shirin Taraz Jamshidi, Masoumeh Hassanpour Pages 52-55
    Background
    Arteriovenous malformations are one of the most common vascular disorders of the colon. Vascular disorders present as painless, high-volume rectal bleeding.
    Case Presentation
    This study elucidates two rare cases of vascular disorders that are diagnosed as angiodysplasia of the left colon and cavernous hemangioma of the colon and rectum. The chief complaint in two patients was rectorrhagia. The patients who were diagnosed of ulcerative colitis were treated with sulfadiazine and prednisone. Due to continuous bleeding, the patients were referred to the surgery department for operation. The patients underwent total proctocolectomy.
    Conclusion
    We discuss the faults in the diagnosis and management of vascular disorders of the intestine.
    Keywords: Gastrointestinal Hemorrhage, Rectorrhagia, Arteriovenous malformation, Angiodisplasia
  • Payam Saadat *, Reza Mohseni Ahangar Pages 56-58
    Background
    Cerebral venous sinus thrombosis is a rare and potentially life-threatening neurologic manifestation of antiphospholipid syndrome. Oral contraceptive pills (OCP) may increase the risk of vascular events, even in people without family history of venous thrombosis.
    Case Presentation
    A 31-year-old woman with four weeks of constant headache and history of taking OCP for one year has been selected for this study. The results of magnetic resonance imaging (MRI) of brain and venography confirmed a diagnosis of cerebral venous sinus thrombosis. The serum anticardiolipin and antiphospholipid antibodies were elevated and a definitive diagnosis of antiphospholipid syndrome was made.
    Conclusion
    The present report demonstrates the importance of screening for antiphospholipid antibodies in patients presenting with cerebral venous sinus thrombosis despite history of taking OCP.
    Keywords: Oral Contraceptive Agents, Cerebral venous sinus thrombosis, Antiphospholipid syndrome, Anticardiolipin antibody, Antiphospholipid antibody
  • Fulminant hepatic failure due to metastatic choroidal melanoma
    Emmanuel Escobar Valdivia, Roberto Monreal Robles *, Guillermo Delgado Garc, Iacutea., Badir Hern, Aacute, Ndez Velazquez Pages 59-62
    Background
    Acute liver failure (ALF) as a consequence of metastatic disease is extremely uncommon. The liver is the most commonly affected organ by metastatic disease, but only a few cases of ALF in the setting of metastatic choroidal melanoma have been reported.
    Case Presentation: We describe the case of a 47-year-old man with right upper quadrant pain, progressive jaundice, and unintentional weight loss. He also reported tha the had experienced reduced left visual acuity which progressed to blindness over 2 months. On physical examination, we found a pigmented scleral lesion in the left eye. He had a coagulopathy and,during his hospital stay, healsodeveloped encephalopathy. The diagnosis of ALF was therefore established and was later attributed to metastatic uveal melanoma. In addition, we briefly review the relevant literature.
    Conclusion
    Liver metastasis should be kept in mind when assessing abnormal liver function tests in patients with uveal malignant melanoma.
    Keywords: Fulminant liver failure, Acute liver failure, Melanoma, Metastatic melanoma, Choroidal melanoma
  • Nader Aghakhani, Mehdi Azami, Mohsen Ghomashlooyan, Alireza Nikoonejad * Pages 63-64
  • Toba Kazemi *, Gholam, Reza Sharifzadeh, Nahid Borna Pages 65-66