Caspian Journal of Internal Medicine
Volume:8 Issue: 4, Autumn 2017

Immunotherapy has been used for years in many types of cancer therapy. Recently, cancer immunotherapy has focused on mechanisms which can enhance the development of cell-mediated immunity. Anticancer medications are administered to inhibit immunosuppressive factors such as nagalase enzyme, which is produced by neoplastic cells and destroys macrophage activating factor (Gc-MAF). Anti-neoplastics medications can also enhance immune-cell activity against tumors. Such medications show great potential in cancer immunotherapy using natural human mechanisms against neoplasms.

Hearing disorders are reported in thalassemia patients treated with deferoxamine. This study aimed to assess hearing loss in Iranian thalassemia major patients treated with deferoxamine.
This review article was designed based on PRISMA guidelines. To review the literature, two researchers studied national and international databases including Iranmedex, Magiran, Medlib, SID, Scopus, PubMed, Science Direct, Web of Science and Google Scholar without time limit until May 2017. Cochran's Q test and I2 index were used to assess the heterogeneity of the studies. The data were analyzed using Comprehensive Meta-Analysis software version 2 and p A total of 17 articles involving 1,835 Iranian thalassemia major patients treated with deferoxamine were included in the meta-analysis. The overall prevalence of hearing loss was estimated 27.3% (95% confidence intervals (CI): 19-37.6). The prevalence of sensorineural, conductive and mixed hearing loss was estimated 10.6% (95% CI: 5.7-18.8), 14.6% (95% CI: 10.5-20.6) and 9.1% (95% CI: 5.6-14.6), respectively. No significant differences were noted regarding the relationship hearing loss and mean serum ferritin (P=0.29) and average daily deferoxamine (P=0.30). Meta-regression model showed an increased significance in the prevalence of hearing loss based on the year of studies (p There is a high prevalence of hearing loss in Iranian thalassemia major patients treated with deferoxamine. Therefore, periodic hearing assessments and regular check-ups after the initiation of chelation therapy are necessary.

Hepatitis B (HB) vaccination is a recommended procedure in all dialysis patients, but its efficacy has not been perfect. In the current study, we aimed to conduct a comprehensive review of the literature to find and pool data of the randomized trials evaluating the impact of serum albumin levels on the immunogenicity of HB vaccination in dialysis patients.
Literature searches were conducted by the Medline and Google Scholar. The key words used included ‘Hepatitis B’, ‘Vaccine’, ‘Dialysis’, ‘Hemodialysis’, and ‘Albumin’. Data of serum albumin levels regarding seroresponse to HB vaccine in clinical trials have been achieved and analyzed. Finally, data from 17 clinical trials have been pooled and analyzed.
One thousand six hundred eighty-two dialysis patients (1212 seroconverted) were included in the meta-analysis. Analysis of response to HB vaccination in our dialysis population showed a significant relationship to their serum albumin levels (p The data showed a significant effect for the levels of serum albumin on the immunogenicity of HB vaccine in dialysis patients. Moreover, stratification of data upon dialysis mode showed that this association is only available for hemodialysis patients, and not those on peritoneal dialysis.

Due to the rate increase in cancer incidence, many researchers in different fields have been conducting studies on cancer-related phenomena. Most studies are conducted to focus on cellular and molecular aspects of cancerous diseases and treatment strategies. Physicists have been using mathematical modeling and simulation to explain the growth pattern of tumors. Although most published studies in this area still have not gained the needed maturity for “treating cancer”, research has helped with the statistical laws of growth, predation and proliferation of cancer cells. In this review, a brief explanation of mathematical models for tumor growth is presented, followed by a discussion on treatment simulations, introducing white noise as one of the clinical remedies in the original model.

Recent studies have suggested the importance of oxidant/antioxidant status in initiation and progression of breast cancer. The aim of this study was to evaluate oxidative stress markers in breast cancer patients before and after 3 cycles of chemotherapy with adriamycin and cytoxan (AC). Also, in this study the effect of age and the stage of disease on oxidative stress markers were compared and evaluated.
This study included 60 women with newly diagnosed stage II-III breast cancer who underwent chemotherapy with AC as the therapy-first strategy after surgery. Serum samples were obtained before treatment and after the third chemotherapy. Then, serum total antioxidant status (TAS) and malondialdehyde (MDA) as lipid peroxidation marker were analyzed. Moreover, the effects of the subject’s age and clinical disease stage were investigated.
A concurrent significant increase in MDA (p Our data indicated that chemotherapy with AC increase the oxidative stress in breast cancer patients. The present study indicated that higher stages of the breast cancer are associated with significant increases of oxidative stress markers.

Microvascular changes are one of the first obvious steps in numerous inflammatory diseases such as rheumatoid arthritis (RA). Nailfold video capillaroscopy (NFC) is an easy, reliable and safe method for evaluating peripheral microangiopathy. The objective of this study was to examine nailfold microcirculation in RA patients, assess morphological and structural changes quantitatively and qualitatively, and recognize useful changes.
A total of 430 patients diagnosed with RA were examined in a period of 4 years. NFC was performed on all fingers of both hands in each patient. Different parameters indicating microvascular changes were detected and analyzed; such as microvascular architecture, capillary distribution disturbances, capillary morphology, capillary density, efferent/afferent limb ratio, subpapillary venular plexus and morphological abnormalities. The obtained results were categorized into normal pattern, nonspecific morphological abnormality and scleroderma pattern.
The mean age of participants was 51.03±14.54 (19-87 years) that consisted of 359 females and 71 males. Based on the findings, angiogenesis (74.7%) was the most pathological condition observed after tortuosity (99.5%). 7.2% and 20.9% of patients were categorized into normal and scleroderma pattern group, respectively. Among morphological abnormalities, angiogenesis, isolated enlarged loop, irregular enlarged loop and architectural derangement were significantly more frequent in scleroderma than normal pattern (p NFC may play an important role in monitoring RA disease and patients’ follow-up. Therefore, in our opinion it could be considered in the course and follow-up of rheumatoid arthritis.

Most frequently, empirical antibiotic therapy is immediately administered for patients with febrile neutropenia (FN). In this study, its aim was to assess the antibiotic resistance status and the cost of antibacterial agents in FN patients associated with hematological malignancies.
The cost of antibacterial agents used in FN episodes in patients with hematologic neoplasms followed-up at the Department of Hematology from November 2010 to November 2012 were analyzed retrospectively.
In the study period, 15 of 141 patients who were admitted to the hematology ward and ineligible for the study criteria were excluded. In total, 282 febrile episodes of 126 consecutive patients with neutropenia were retrospectively investigated. Imipenem was found to be the most commonly used among the antibacterial drugs as 1.16 patient daily dose (PDD)/100 patient-days, 117.16 is the mean defined daily dose (DDD) per month and US $73264.66 total cost per year, followed by meropenem, cefoperazone-sulbactam, and linezolid.
Choosing noncarbapenem-based antibacterial therapy for empirical treatment of FN until the growth of microorganisms and switching to carbapenem therapy subsequent to new radiological, or microbiological, or/ and clinical findings, the appropriate vancomycin use may decrease the cost of antibacterial agents in the treatment of FN episodes in patients with hematologic malignancies contributing to antimicrobial stewardship.

Drug-drug interactions (DDIs) may often lead to preventable adverse drug events and health damage. Particularly in hospitals, this might be an important factor as multiple drug therapies are common. The objective of this study was to identify the frequency and levels of potential DDIs in internal medicine wards in an Iranian university hospital.
A cross-sectional study was conducted by reviewing charts of 448 hospitalized patients in internal medicine wards of a teaching hospital, from November 2014 to May 2015. “Lexicomp drug interaction software” and Micromedex Drug-Reax system were used for screening the potential DDIs. The identified DDIs were categorized by level of severity. Logistic regression was applied to determine the odds ratio for specific risk factors of potential DDIs e.g., age, gender, hospital stay and number of medications.
The mean age of patients was 61 years, the length of hospital stay for patients was 9 days and the number of drugs per patient was 9. Potential interactions were detected in 386 patients. The most common types of interactions were type C (78.6%), moderate (60.9%) and delayed onset (56.5%). There was a significant association of the occurrence of potential DDIs with seven or more numbers of prescribed medications (OR: 0.048, 95% CI:0.02-0.12, p The present study has recorded a high prevalence of potential DDIs in internal medicine wards. Patients with polypharmacy were at high risk for DDIs. Education, computerized prescribing systems, drug information, and pharmaceutical care are important measures that were recommended to minimize harm associated with DDIs.

The low density lipoprotein cholestrol (LDL-C) has an important role in the pathogenesis of cardiovascular disease but its association and predictive accuracy with metabolic syndrome (MetS) remains controversial. The objective of this study was to investigate the association and predictive ability of LDL-C with MetS.
We analyzed the data from a population-based cross-sectional study conducted on representative samples of an Iranian adult population. The demographic data, anthropometric measures and the lipid profiles were measured with standard methods, and MetS was diagnosed by ATP III criteria. Logistic regression model and ROC analysis were used to estimate the predictive accuracy of LDL-C and its association with MetS.
The mean age (±SD) of participants with and without MetS was 47.6±12.5 years and 39.1±12.9 years, respectively (p=0.001). All anthropometric measures (body mass index, waist circumference, waist to hip ratio, waist to height ratio), systolic blood pressure, total cholesterol, triglycerides and fasting blood glucose were significantly higher in MetS, but a significantly higher difference in LDL-C was observed only in women. Accuracy of LDL-C in predicting MetS for men and women was 0.48 (95% CI: 0.43-0.54) and 0.55 (95% CI: 0.51-0.60), respectively. The unadjusted and adjusted odds ratios of different quartiles of LDL-C compared with 1st quartile did not reach to a significant level.
Serum LDL-C level is not significantly associated with MetS but exhibits a weak ability in predicting MetS in women.

According to high prevalence of renal stone in children, we evaluated the efficacy of treatment with potassium citrate and its correlation with metabolic disorders in children less than two years of age with renal stone and microlithiasis.
In this cross- sectionaly study, 100 patients (less than 2 years old) with renal stone or microlitiasis were evaluated for metabolic disorders. They were treated with potassium citrate and followed-up by ultrasonography every 3 months. Then response to treatment was evaluated according to the fresence metabolic disorders (A p-alue According to this study, hyperuricosuria and hypercalciuria were the two major metabolic disorders (40-33%). Seventy three patients had complete response, and also there as not a significant difference (p Based on our results the use of potassium citrate in all children less than 2 years with renal stone or microlithiasis especially those with metabolic disorders, are recommended.

Fine needle aspiration (FNA) is the most important method in the diagnosis of thyroid nodules before surgery. Recently, the efficiency of FNA in thyroid nodule management has been debatable. On the other hand, intraoperative frozen section (FS) has been used to confirm the diagnosis of FNA and select the proper surgical approach. In this regard, the present study aimed to assess the diagnostic value of FNA as compared to FS in the diagnosis of thyroid nodules.
This retrospective study was performed on 69 patients with FNA and FS and histopathological examination from 1993 to 2014 in Babol, northern Iran. FNA was classified into 5 groups: benign (colloid goiter), lymphocytic thyroiditis, follicular lesions, suspicious and malignant, and FS was classified as after benign or malignant. The results of both methods were compared with each other.
This retrospective study was performed on 69 patients with FNA and FS and histopathological examination from 1993 to 2014 in Babol, northern Iran. FNA was classified into 5 groups: benign (colloid goiter), lymphocytic thyroiditis, follicular lesions, suspicious and malignant, and FS was classified as after benign or malignant. The results of both methods were compared with each other.
FNA was considered as a simple, less invasive and cost effective method with fewer side effects for evaluation of thyroid nodules. Particulary it had a high sensitivity and specificity in experienced and skilled hands.

There is some evidence that shows the symptoms of anemia are fewere in overweight and obese people, so, the purpose of this research was to study the relationship between anemia and iron deficiency anemia (IDA) with lipid profile status of the elderly.
This cross-sectional study came from the Amirkola Health and Ageing Project (AHAP). A demographic questionnaire was given to the older people and a blood sample was obtained to assay their lipid indexes (triglyceride, cholesterol, HDL and LDL) and the parameters related to anemia after 12 hours fasting. The data were analyzed by chi-square test, t-test and Pearson correlation using SPSS. A p The average age of the people was 68.95±7.43 years old. In this study, the prevalence of anemia and IDA was 31% and 9%, respectively. The mean concentration of serum triglyceride, cholesterol and LDL in the anemia group and the IDA group was less than the control groups. The amount of HDL in different groups was almost the same, although the difference was statistically significant with respect to variables like age and obesity (P=0.001).
The study showed that the amount of lipid profile (triglyceride and cholesterol) in the elderly with anemia and IDA was less compared to other people. This result was achieved in some other research studies too, but further research is suggested to find possible mechanisms.

Staphylococcus aureus (s. aureus) nasal carriers, particularly the healthcare staff can be considered as a potential source for the spread of resistant strains. The aim of this study was to determine the molecular characterization of S. aureus strains isolated among the staff nasal carriers in one of the teaching hospitals in Babol.
A total of 120 nasal swabs were taken from the staff of Ayatollah Rouhani Hospital Babol during 2016. The antibiotic resistance pattern was performed by disc diffusion method for 13 antibiotics, including cefoxitin, cephalothin, teicoplanin, vancomycin, daptomycin, oxacillin, amoxicillin, amikacin, linezolid, ciprofloxacin, levofloxacin, erythromycin, rifampin, according to the CLSI 2015. Polymerase chain reaction (PCR) was used to detect mecA and pvl genes. Finally, the different SCCmec types were determined by multiplex- PCR method.
Among the 120 collected specimens, 40(33.3%) S. aureus isolates were approved. 28(70%) of strains were identified as methicillin-resistant Staphylococcus aureus (MRSA) and the frequency of pvl gene was confirmed 2(5%). Based on the multiplex PCR assay, four different SCCmec types were detected as 35.7% type I, 14.2% type III, 7.1% type II and 3.5% type IV. By a disc diffusion method, no resistance pattern was observed to vancomycin, while 100% of strains were resistant to amoxicillin.
Consequently our results illustrated that isolated S. aureus strains among the staff nasal carriers via mentioned molecular characterization may lead to increase the nosocomial persistent infections in hospitalized patients and also health care workers.

Limited information exists between the associations of diabetes mellitus (DM) and solar lentigo (SL); a benign, common skin lesion characterized by hyperpigmented macules.
This study was conducted on 90 patients diagnosed with DM and their age and sex matched controls who were referred to the Departments of Endocrinology at Babol University of Medical Science in Northern of Iran from January 2013 to December 2015. All demographic data including age, gender, occupation, family history of DM, estimated average sun exposure and presence of skin lesions were collected and analyzed.
Presence of SL was significantly higher among patients with DM compared to controls (61.9% vs 33.6%, P The findings of the present study indicate that DM is an independent risk factor for the occurrence of SL lesions. These findings could represent a novel association between DM as a chronic oxidation state and SL as an early sign of aging.

Multiple sclerosis and other demyelinating processes are sometimes difficult to differentiate from the neurological involvement in autoimmune diseases. Distinguishing multiple sclerosis from other lesions due to autoimmune diseases is crucial to avoid unsuitable or delayed treatments.
Charts of 6 patients diagnosed with mimicking multiple sclerosis between 1996 and 2014 were retrospectively assessed.
The mean age at diagnosis was 35±7 years. The most commonly neurological manifestation at onset was paraparesis due to transverse myelopathy and uni/bilateral optic neuropathy. All our patients suffered from recurrent episodes of optic neuritis with a mean lag time of 12 months. Other initial presenting neurological manifestations in our patients included ataxic gait and pyramidal syndrome. Systemic symptoms occurred a long time before or after their initial neurological presentation. All patients had numerous T2 hyperintense lesions in the periventricular white matter and spinal cord with contrast enhancement. The antibodies tests revealed the presence of significant amounts of anti-nuclear antibodies. The anti-phospholipid antibodies were negative in all patients. All patients were treated with corticosteroid therapy and neurological features were cleared in all cases.
Multiple sclerosis, other myelitis and optic neuritis, are sometimes difficult to differentiate from CNS involvement in autoimmune disease. Indeed, the clinical presentation, immunological profile and MRI lesions may be similar.

Stiff person syndrome (SPS) is a rare neurological disease resulting in stiffness and spasm of muscles. It initially affects the axial muscles and then spread to limb muscles. Emotional stress exacerbated the symptoms and signs of the disease. The pathophysiology of the disease is caused by the decreased level of the glutamic acid decarboxylase (GAD) activity due to an autoantibody against GAD that decreases the level of gamma-aminobutyric acid (GABA). In this paper, we present a case of atypical presentation of SPS with lower limb stiffness misdiagnosed as conversion disorder.
We report a patient with atypical presentation of SPS with lower limb stiffness and gait disorder misdiagnosed as conversion disorder for a year. Her antithyroid peroxidase antibody (anti-TPO Ab) level was 75 IU (normal value: 0–34 IU). Intravenous immunoglobulin (IVIG) was administered (2gr/kg, 5 days) for the patient that showed significant improvement in the follow-up visit.
It is essential that in any patient with bizarre gait disorder and suspicious to conversion disorder due to the reversibility of symptoms, SPS and other movement disorder should be considered.

Hughes-Stovin Syndrome (HSS) is a rare clinical disorder characterized by deep venous thrombosis and multiple pulmonary and/or bronchial aneurysms. Aneurysms in systemic circulation can also be seen.
We report the first case of HSS with aortic aneurysm in a 55-year-old man who initially presented with deep venous thrombosis. The diagnosis of HSS revealing Behçet’s disease was made given the history of recurrent oral and genital ulcers. Treatment consisted of 3 daily pulses of methylprednisolone (1g) followed by oral prednisone (1mg/kg daily) and 6 monthly pulses of cyclophosphamide. Oral anticoagulation treatment was held 3 months and then was stopped with good outcome.
Systemic aneurysms in Hughes Stovin is a worth knowing complication which may reveal Behçet’s disease.