Caspian Journal of Internal Medicine
Volume:9 Issue: 2, Spring 2018

Cryptosporidiosis is an important cause of diarrhea in children and immunosuppressive patients. The current study was intended to evaluate the prevalence rate of Cryptosporidium infection and clarify the epidemiological characteristics of the infection in both children and immunosuppressive patients in Iran.
Five English electronic databases including PubMed, Google Scholar, Science Direct, Scopus and Cochrane, and two Persian language databases Magiran and Scientific Information Database were searched. Additionally, reports from the Iranian congresses of parasitology and graduate student thesis dissertations were assessed manually.
Out of 1856 studies from the literature search, our search resulted in a total of 27 articles published from 1991 to 2016. These include 14 reports on cryptosporidiosis in children and 13 papers regarding immunosuppressive patients. 8520 children and 2015 immunosuppressed cases were evaluated. Oocysts of Cryptosporidium were found in 3.8% and 8% children cases and immunosuppressed patients, respectively. There was a relatively high variation in the prevalence estimates among different studies, and the Q statistics was high among articles regarding children (p In summary, the present study provides a comprehensive view of the epidemiology of Cryptosporidium in children and immunosuppressive patients in Iran. Furthermore, a multidisciplinary and multicenter study to evaluate the real prevalence of Cryptosporidium infection and to determine its risk factors using an adequate sample size and standardized methods is highly recommended.

Metabolic syndrome (MetS) is a collection of various interrelated risk factors that appear to have an impact as development of atherosclerotic cardiovascular disease (CVDs). Epidemic of childhood and adolescent’s obesity has increased interest in the metabolic syndrome (MS) due to the potential projection into adulthood. The prevalence of MS in adolescents has been estimated to be 6.7% in young adults and 4.2% in adolescents. We aimed to study the MetS in children and adolescents with respect to metabolic changes.
The international Diabetes Federation criteria were used for the selection of cases. Serum paraoxonase 1 (PON1) activities were measured using spectrophotometer. Statistical analysis was done using MyStat statistical software.
Serum PON1 arylesterase (ARE) and lactonase (LACT) activities were found to be reduced significantly in patients with MetS than in controls. Regression analysis showed a significant correlation between PON1 activities and body mass index. Area under curve (AUC) found to increase from HDL to PON1 ARE to PON1 LACT.
From the present study, it is clear that in children and adolescents, reduction in PON1 activities in MetS is mainly due either to abnormalities with synthesis or secretion of HDL cholesterol or oxidative stress as a consequence of excess production of the free radicals. This study also iterates that it is the quality and not the quantity of HDL cholesterol which is important while studying the pathophysiology of MetS.

Cardiovascular diseases are the most common causes of death in the world and type 2 diabetes is one of them because it is highly prevalent and doubles heart disease risk. Some studies suggest that insulin resistance is associated with coronary artery disease in non-diabetics. The aim of this study was to evaluate the association of insulin resistance (IR) and coronary artery disease (CAD) in non-diabetic patients.
In this cross-sectional study, from September 2014 to July 2015, 120 patients referring to Shahid Beheshti Hospital of Qom were evaluated. Their medical history, baseline laboratory studies, BMI and GFR were recorded. After 8 hours of fasting, blood samples were taken from the patients at 8 am, including fasting glucose and insulin level. We estimated insulin resistance using the homeostatic model assessment index of IR (HOMA-IR). Finally, we evaluated the association between IR and CAD.
Totally, 120 patients were assigned to participate in this study, among them, 50 patients without CAD and 70 with coronary artery stenosis. Insulin resistance (HOMA-IR> 2.5) was positive in 59 (49.3%) patients and negative in 61 (50.7%) patients. Hence, the correlation between IR and CAD was not statistically significant (P=0.9).
In this study, although the correlation was not found between insulin resistance and coronary heart disease, among men, we found a significant association between coronary heart disease and insulin resistance.

Chronic oral mucosal disease questionnaire (COMDQ) is used to evaluate the quality of life in patients with chronic conditions of the oral mucosa. The aim of the present study was to evaluate the validity and reliability of the Persian version of this questionnaire.
A total of 135 subjects were selected in two groups; group 1 consisted of 95 patients with chronic oral mucosal conditions, including recurrent aphthous stomatitis, oral lichen planus and pemphigus and mucous membrane pemphigoid and group 2 consisted of 40 patients with other oral diseases. The subjects completed the demographic data sheets and COMDQ and then underwent examinations to determine disease severity. After 14 days, the questionnaire was completed again by the group 1subjects only.
Cronbach’s α coefficient for COMDQ was estimated at 0.969 and the interclass correlation coefficient was estimated at 0.997. There was a significant relationship between the mean COMDQ scores and disease and pain severity. There was a clear correlation between the patients’ self-report about their general health and mean COMDQ scores and also between their opinions about their oral health and the mean COMDQ scores.
The Persian version of COMDQ exhibited proper levels of reliability and validity. It is suggested that this questionnaire be used for the evaluation of the effect of treatment on the oral health-related quality of life (OHQoL).

Breast cancer is the most common serious disease around the world. The trace elements have a vital role in the metabolism and chemotherapy may change the level of metal ions. Due to the ambiguity of the existence in this regard, the study examined the trace element serum levels in women with breast cancer before and after chemotherapy .
Sixty patients were studied undergoing specialist. First sampling was taken before chemotherapy (after 4 weeks of surgery) and second sampling was taken after the completion of 3 courses of chemotherapy, approximately 9 weeks after the first chemotherapy. The patients took Adriamycin 60mg/m2 Cytoxan 600mg/m2. Serum zinc and iron levels were measured using standard spectrophotometric method. Measurement of serum copper was done by atomic absorption spectroscopy.
Serum zinc and iron levels in women after chemotherapy significantly decreased (p Our findings demonstrate significant decrease in zinc and iron levels in breast cancer patients after 3 courses of Adriamycin and Cytoxan chemotherapy. Prescribing zinc supplements can be useful after chemotherapy.

Bone lesion in multiple myeloma (MM) is most commonly presented as a lytic lesion in this disease. Determination of extent of bone lesions in MM is necessary to follow-up the patients. Whole body bone scan with 99m, Tc-methylene diphosphonate (MDP) has a lower sensitivity than other modalities.
From the patients with MM admitted to Ayatollah Rouhani Hospital of Babol-Iran from 2009 to 2015, who had undergone whole body bone scan during diagnostic process, were entered into the study. Findings of bone scan were compared with MRI.
Of the 19 patients, sixteen (84.2%) of them had positive finding in bone scan, fifteen (78.9%) had MRI of the spine. While of the thirteen patients who had positive finding in MRI, seven (53.8%) had more positive finding in thorcolumbosacral MRI than in bone scan.
99m-Tc MDP bone scan is a sensitive but insufficient method for detecting bone lesions in MM.

Diabetes is a prevalent chronic disease around the world. To evaluate risk of diabetes comprehensively, we developed a score model for the risk prediction with HDL-C as a protective factor.
We extracted physical examination data of 2728 individuals. The data contain 18 demographic and clinical variables. To identify the statistical significant feature variables, the backward stepwise logistic regression was used based on the data of the “exploratory population”. To ascertain the cutoff value of the selected variables, we used the Youden index. Then we assigned each variable level a score according to the estimated regression model coefficients and then calculated the individual’s total score. We gained the cutoff value for the total score through the Youden Index and stratified the total score into four levels. We employed the data of “validation population” to test the performance of the score model based on the area under the ROC curve.
Age, LDL-C, HDL-C, BMI, family history of diabetes, diastolic blood pressure and TCHO were selected as statistically significant variables. The diabetes risk score range varied from 0 to 17. The risk level categorized by the total score was low, middle, high and extremely high, with a score range of 0-2, 3-7, 8-12 and 13-17, respectively.
The score model based on physical examination data is an efficient and valuable tool to evaluate and monitor the potential diabetes risk for both healthy and unhealthy people at an individual level.

Pain and shivering are two unpleasant problems in postoperative period. Various techniques are used to alleviate the postoperative shivering and pain. We compared the preemptive prescription of a single dose of intravenous meperidine and ketorolac on postoperative pain and shivering in patients undergoing cesarean section with spinal anesthesia.
One hundred and fifty patients who were scheduled for elective cesarean section under spinal anesthesia were randomly allocated to one of three study groups to receive either intravenous ketorolac (group K), meperidine (group M) or normal saline (group P). Time to first analgesic request, analgesic requirement in the first 24 hours after surgery, body tympanic temperature, hemodynamic variables and incidence of shivering were assessed as outcome variables.
There was no significant difference between meperidine and ketorolac groups in terms of prevalence of shivering, although both groups were different from the placebo group (p The preemptive prescription of a single dose of intravenous meperidine and ketorolac can provide a satisfying analgesia immediately after surgery and decrease shivering prevalence without any serious side effects.

Tobacco contains carcinogens such as NNK (nicotine-derived nitrosamine ketone) that makes induction of lung cancer by changing the stimulation of IL-10 expression. The aim of this study was to investigate changes in resting levels of IL-10 in lung tissues of rats exposed to NNK after a 12-week aerobic submaximal swimming training.
For this purpose, 46 Wistar rats were randomly divided into five groups consisting training, training NNK, NNK, saline and control. NNK-induced groups received NNK subcutaneously one day per week at a rate of 12/5 mg per kg body weight and the training groups performed submaximal swimming training for 12 weeks. The levels of IL-10 in homogenized lung tissue were measured by ELISA.
Findings indicated that a period of swimming training increased the IL-10 levels significantly in lung tissue of training group when compared to control (P=0.00) and NNK groups (P=0.00). Also, a significant increase of IL-10 level was observed in exercise NNK group when compared to NNK group (p≤0/02). Furthermore, it was observed that IL-10 levels of NNK group had a significant decrease when compared to training group (P=0/00), training NNK group (p≤0/02), but had insignificant increase when compared to saline group (p≤0/85).
Generally, it could be confirmed that regular submaximal aerobic training plays an important role in the inhibition of the effects of lung inflammation induced by NNK via increasing IL-10 activity.

Chronotropic incompetence has prognostic value of all-cause and cardiovascular mortality in both patients with asymptomatic and symptomatic ischemic heart disease (IHD), regardless of traditional risk factors. The aim of this study was to investigate the relationship between chronotropic response during exercise test and the development of ventricular arrhythmias.
153 patients with stable ischemic heart disease were screened and observed during the 24 months since October 2014 in a university hospital in Astana Kazakhstan. They underwent bedside electrocardiography, 24h heart rate Holter monitoring, echocardiography, exercise stress test (treadmill) for assessment of chronotropic index calculating at first contact. Holter- electrocardiography was repeated three times (at 3, 6, 12 months of follow-up period) to reveal life-threatening ventricular arrhythmias.
The quantity of the ventricular extrasystoles was higher in the group with low chronotropic index. Low chronotropic index increased the risk of high grade ventricular extrasystoles more than two times (P=0.015); episodes of non-sustained VT more than three times (p Chronotropic index less than 35.6 increases the risk for life-threatening ventricular arrhythmias in patients with stable chronicle ischemic heart disease irrespectively of severe left ventricle systolic dysfunction.

Long-term treatment of rheumatoid arthritis (RA) with prednisolone (PRED) is associated with bone mineral density (BMD) loss. This study aimed to determine the status of BMD in non-compliant women who used PRED alone for RA.
Non-adherent RA taking 6 months, and RA patients taking methotrexate 㴑 (RA control) were compared with age-matched non-RA controls. BMD was measured by dual energy x-ray absorptiometry (DXA) method and osteoporosis (OP) was diagnosed by WHO criteria. Influence of PRED on RA bone mass, and the risk of OP in RA was assessed by comparing PRED users RA and RA control,versus non-RA controls.
Sixty-four PRED user RA, 39 RA controls and 111 non RA-controls, with respective mean (±SD) age of 52±11; 8, 51±11; and 52±7.5 years (p=0.91) were studied. Median duration of treatment in PRED users and RA control was 2.5 and 4 years, respectively. BMD g/cm2 at the femoral neck (FN-BMD) and lumber spine (LS-BMD) in PRED users and RA control was significantly lower than non-RA control (P=0.001). The prevalence of OP at either FN or LS in both RA groups was significantly higher than controls (P=0.001). In PRED users, the risk of OP increased by OR=4.9, P=0.001) and in RA controls by OR=1.7 (P=0.20). The risk of OP in PRED user RA was 2.89 times (P=0.014) greater than RA controls.
These findings indicate significantly lower BMD, and higher prevalence of osteoporosis in non-compliant women with RA taking low-dose PRED alone for a median period of 2.5 years, as compared with patients taking standard treatment comprising methotrexate 㴑.

Thyroid-associated eye disease (TED), previously known as Graves’ ophthalmopathy is a cosmetically and functionally debilitating disease that is seen worldwide. The aim of this study was to evaluate the prevalence and clinical severity of ocular manifestations of Graves’ disease according to sex, age and duration in northern Iran.
Between April 2011 and March 2012, 105 patients with Graves’ disease, underwent ophthalmic examination, including ocular motility, exophthalmometry, intraocular pressure (IOP), slit lamp and fundoscopy. Patients received scores according to modified Werner’s NO SPECS classification.
Ocular involvement was found in 70 patients with established Graves’s disease. The mean age was 35.0 years, (SD 13.0, range 15 to 69). The most common ocular findings were exophthalmometric proptosis of more than 20 mm (63.8%), lid lag (55.7%), lid retraction (52.8%) and tearing (38.6%). Almost 70% of patients had bilateral involvement. Elevated IOP was seen in 15 (25.4%) patients, and was significantly related to proptosis (P=0.007). More than half of the patients (n=36, 52.2%) had a modified Werner’s NO SPECS score of 3.00. Clinical severity as shown by the increasing number of signs and symptoms per patient was correlated to increasing age (r=0.31, P=0.01) but not to gender (P=0.17).
Both functional (ocular motility disorders, increased IOP) and cosmetic (proptosis, periorbital edema) sequels are common ocular presentations in patients with Grave's disease. Proptosis was the most common finding in this study and was associated with elevated IOP. Clinical severity was found to correlate to increasing age.

In Iran scince 1992, hepatitis B vaccination was a part of the national vaccination program. Hepatitis B vaccination is effective in the epidemiology of hepatitis B. The aim ofthis study was to evaluate the long – term persistence of immunity.
This cross-sectional analytical study was conducted on children and adolescents aged between 6-18 years in Birjand, who received a three – dose hepatitis B vaccination in accordance with the national immunization program. No students were infected with hepatitis B. Antibody titer higher than10 IU/L was considered positive.
A total of 530 patients (307 boys and 223 girls) were recruited for the study of which 44% had positive antibody titer (≥10 IU / L). The geometric concentration mean (GMCs) of antibody in subjects was 64.9±34.2, HBS antibody titer was positive in 40.4% of the boys and 59.6% of the girls. A significant difference in antibody titers was observed in terms of gender and according to the time elapsed since the last vaccination. Antibody titer in children older than 13 years had passed since their last vaccination and was significantly less than those children younger than thirteen years old had passed since their vaccination logistic regression analysis showed that the only predictive factor of anti-HBS low titer (

We aimed to investigate the etiologic causes and the existence of Janus kinase 2 mutation (JAK2) in cases with thrombocytosis.
In this retrospective study, patients, who were admitted to hematology clinic with thrombocytosis between 2013 and 2015, were investigated in terms of the etiological causes of thrombocytosis and the existence of JAK2 mutation.
We retrospectively evaluated 136 cases that underwent JAK2 mutation analysis due to ET preliminary diagnosis in our hematology clinic. The mean age of the patients was 56.7±15.3 years (range: 22-86 years) and 71 (52%) were males. JAK2 mutation was found to be positive in 58 (42%) of cases. The mean platelet counts of the cases were 860.25×109 / L (range: 455-1,105 109 /L) and the mean spleen vertical length was 135.1±21.6 mm (range: 110-220 mm).
JAK2 mutation analysis and bone marrow biopsy are the two main procedures to diagnose primary thrombocytosis in adults with persistent thrombocytosis after excluding the causes of secondary thrombocytosis. Myeloproliferative neoplasms and essential thrombocytosis are the common causes of primary thrombocytosis in adults with persistent thrombocytosis, as myelodysplastic syndrome rarely causes primary thrombocytosis.

Botulism is an acute and rapidly progressive descending paralytic disease caused by a neurotoxin of clostridium botulinum.
A 28-year-old woman presented with severe generalized ascending symmetrical muscle paralysis. The patient was intubated and transferred to the medical intensive care unit with several symptoms including: severe headache, dysphagia, dyspnea, ptosis, diplopia, and dry mouth. Despite being alert, pupils were bilaterally midriatic and had absent corneal reflux. Pansinusitis was seen in the paranasal sinus scan. At first, the movement of eyelids, head and neck were restored. The movement of the upper limbs (15th day) and chest wall (20th day), abdomen (25th day) and the lower extremities (32nd day) were then gradually restored. On 41st day, the patient was completely disconnected from the ventilator.
Botulism should be a diagnosis in any patient with an acute progressive symmetrical descending paralysis. Sinus mucosal injury (acute sinusitis) can be inoculated with spores of botulinum.

Biloma is a rare abnormal localized accumulation of bile out of biliary tree due to an injury that occurs usually postoperatively from an injured cystic or bile duct. While most bilomas collect in the subhepatic space, we describe a rare case of hepatic subcapsular biloma after laparoscopic cholecystectomy and ERCP which was done one week after surgery successfully treated by percutaneous drainage and placement of plastic stents in CBD.
A 30-year-old woman with right upper quadrant pain referred to our center. Four weeks ago, she had a history of laparoscopic cholecystectomy and two weeks ago she had a history of ERCP. Abdominal ultrasonography showed a mass in her right liver lobe. The patient underwent the fluid aspiration under ultrasonography guidelines. Chemical analysis of aspirated fluid proved that the liquid was bile. A drainage catheter was placed in site of bile accumulation to drain the liquid. The next follow up ultrasonography showed that the mass disappeared and no recurrence was detected.
Diagnosis of biloma in a patient with the history of laparoscopic cholecystectomy or ERCP should be considered for proper interventional treatment to reduce morbidity and mortality,

Darier disease (DD) is an autosomal dominant genetic disorder which develops from a mutation in the ATP2A2 gene. Inflammatory myopathies (IM) are the largest group of potentially treatable myopathies. In this case, we report development of IM in a patient with DD for the second time in the literature.
The patient is a 59-year-old female, a known case of DD, who developed proximal muscle weakness 2 weeks prior to admission. Elevated muscle-enzymes, as well as typical electromyographic and radiologic confirmed the diagnosis of IM.
Abnormalities in intracellular calcium homeostasis may explain the association between DM and DD, therefore it is noteworthy to keep this association in mind and conduct more research regarding this issue.