مجله پزشکی بالینی ابن سینا
سال بیست و ششم شماره 2 (پیاپی 92، تابستان 1398)

Seborrheic dermatitis is a common inflammatory skin disease characterized by erythema, scaling, and pruritus. Antifungals are among the most commonly prescribed drugs for the treatment of this disease. In this regard, the present study investigated the efficacy of two medications including clotrimazole 1% and sertaconazole 2% in the treatment of adult seborrheic dermatitis.

This double-blinded randomized clinical trial was performed on 100 patients over the age of 18 with seborrheic dermatitis referring to Farshchian hospital, Hamadan, Iran. Patients were randomly assigned to two groups. The participants in one group received sertaconazole twice a day for four weeks and another group received clotrimazole within this period of time. After two weeks, the patients were examined in terms of clinical symptoms and side effects of medications. Moreover, they were reexamined for recurrence of disease after the completion of treatment and four weeks later. Furthermore, the level of patients' satisfaction was evaluated four weeks after treatment.

Mean and standard deviation of Scoring Index 7.16±2.20 and 6.45±2.10 before treatment (P=0.184), 4.08 ± 1.82 and 2.78 ± 2.14 two weeks after treatment (P<0.001), and 2.62 ± 2.13 and 0.89 ± 1.09 four weeks after the end of treatment (P<0.001). Additionally, the relapse rate in clotrimazole and sertaconazole groups was found to be 32% and 21.7%, respectively. Furthermore, the complication rate was reported as 8% and 8.5% in clotrimazole group and sertaconazole group, respectively (P=0.220). Moreover, the rate of good satisfaction in clotrimazole and sertaconazole groups was reported as 38% and 71.1% (P<0.001), respectively.

Based on the results of the study, the frequency of complications and recurrence of disease in patients treated with sertaconazole was comparable to treatment with clotrimazole. However, sertoconazole was found to be more effective and bring more satisfaction to patients.

Diabetes type 2 has been estimated as the seventh leading cause of death worldwide. Diabetic patients are 2-3 times more likely to be at the risk of atherosclerosis, compared to normal people. It has been reported that exercise prevents atherosclerosis in diabetic patients. Therefore, the aim of this study was to investigate the effect of exercise on vascular variables of patients with type 2 diabetes. 

This clinical trial was conducted on 40 patients out of 702 volunteers with diabetes who were randomly assigned into two groups of combined (aerobic and resistance) and control. The intervention protocol included 24 30-min sessions of aerobic exercise on the treadmill without any slope during 8 weeks (three sessions per week). The protocol intensity was set at 50-70% maximum heart rate and volunteers wore a weighted vest during exercise. On the other hand, the control group had no exercise for two months. All variables were measured before the intervention and after 24 sessions of the intervention protocol.

According to the results, there were no differences between the groups regarding demographic characteristics and a history of type 2 diabetes before the intervention. After 24 sessions, there was a significant decrease in the intima-media thickness. Moreover, the ratio of the intima-media thickness to the lumen in three sections of Carotid Bulb, Internal Carotid, and Common Carotid was significantly reduced in the combined exercise group, compared to the control group (P<0.05); however, no significant difference was observed in the lumen diameter (P>0.05). All vascular parameters remained unchanged in the control group (P>0.05).

In total, 24 sessions of aerobic and resistance exercise had a positive effect on vascular parameters. According to the simulation of a backpack by a weighted vest, the method used in this study was considered as a cheap and useful technique for patients with type 2 diabetes.

Adherence to antihypertension medications is an important factor in the control of hypertension. In this regard, the present study aimed to estimate the extent of medication adherence in hypertensive patients and its determinants in the special clinic of Seyed-al Shohada Cardiovascular Tertiary Hospital in Urmia, Iran.

In this cross-sectional study, a total of 650 hypertensive patients were investigated during October to December 2016. In this study, two questionnaires were used to collect the data. The first questionnaire included the demographic and clinical characteristics, smoking status, family history of hypertension, and blood pressure measurements. The eight-item Morisky medication adherence scale was used to measure the extent of medication adherence of the participants. Moreover, the Chi-square test and logistic regression model were employed to identify the determinants of medication adherence.

Mean value of the participant age was reported as 59.5±10.4 years, and 63.5% of the subjects were female. Overall, 48%, 30.8%, and 21.2% of the subjects were reported with complete, moderate, and poor adherence, respectively. Among the investigated determinants, age (OR=1.02, 95% CI: 1.01-1.05), occupational status (OR=1.83, 95% CI: 1.19-2.83), absence of adverse effects of the drugs (OR=1.83, 95% CI: 1.02-2.71), use of two drugs (OR=1.75, 95% CI: 1.12-2.74), use of three drugs and more (OR=2.25, 95% CI: 1.30-3.88), and history of angioplasty (OR=1.80, 95% CI: 1.19-2.71) were associated with good adherence (i.e., complete and moderate) in this study. Only 39.4% of all participants had controlled level of hypertension.

According to the obtained results, the patients with hypertension had good medication adherence. The determinants effective in medication adherence outlined in this study can help identify patients with low extent of adherence.

Splenectomy is one of the most common abdominal surgeries following internal and hematologic diseases, as well as trauma which is along with some complications. This study aimed to investigate the effects and outcomes of drain placement after splenectomy, open splenorrhaphy, or laparoscopy.

This descriptive cross-sectional study included patients with various indications who underwent splenectomy with midline or left subcostal incisions in Besat Hospital, Hamadan, Iran, during 2017-2018. It should be noted that the patients underwent drain insertion, and the final outcomes were evaluated after surgery. Regarding the aim of the study, variables, such as hospital stay duration, postoperative infection, the incidence of collection and dehiscence, the duplication of surgical procedures, and secretion levels on days 1 to 5 post-operation were assessed using checklists and clinical examinations. All data were analyzed using SPSS software (version 21.0). A P-value less than 0.05 was considered statistically significant.

According to the results, the mean age of the patients was 42.12±20.26 years. Moreover, out of 31 patients under study, 21 cases were male. In total, 16 (51.6%) and 15 (48.4%) patients underwent splenectomy using subcostal and midline incisions, respectively. The indications for surgery in patients included idiopathic thrombocytopenic purpura (n=10, 32.3%), hemolytic anemia (n=2, 6.45%), trauma (n=7, 22.6%), spleen mass (n=2, 6.5%), diagnostic procedure (n=3, 9.7%), splenomegaly (n=5, 16.1%), and hematological problems along with biliary stone disease (n=2, 6.45%). Regarding the surgical complications, the wound site collection (n=6, 6.45%) and left sub-diaphragmatic and Morison's pouch collection (n=6, 19.35%) were reported in this study. It should be noted that the duplication of the surgery was performed only in one patient, and all the cases had drainage secretions until the third day.

The insertion of the drain after splenectomy not only prevents complications, such as hematoma, seroma, or pancreatic secretion collection below the left diaphragm but also informs the surgeon, in some cases, about bleeding after surgery. Therefore, it seems that the benefits of drain placement may outweigh the risks of not using it.

Toxocariasis is a common infection between humans and animals, which can be considered as a health issue in vulnerable populations due to its indigenous nature to the country and the region.  Therefore, the purpose of this study was to estimate the risk of contamination with Toxocara canis infection and exposure to its parasite in children.

This descriptive cross-sectional study was performed on 621 children aged 2 to12 years referred to health centers
in Kermanshah, Iran. After sampling and recording the demographic characteristics, the samples were tested for anti-T. canis antibody (IgG) by enzyme-linked immunosorbent assay method. Data analysis was done using SPSS software and Fisher's exact test.

Out of 621 tested serum samples, 8 samples (1.3%) were positive for anti-Toxocara IgG antibodies. Of these, 5 and 3 samples were from male and female patients all living in urban areas. It is noteworthy that none of these individuals had a history of earth-eating, as well as touching or playing with the dog. However, a dog was kept at one of the child's home.

The results of the study showed a relatively low prevalence of toxocariasis infection in children, although the findings confirmed the establishment of the parasite transmission cycle in the region. Therefore, considering the importance of hygiene issues, it is necessary to develop and implement strategies for controlling and preventing the infection in the definitive hosts of the parasite in order to reduce the incidence of human infections.

Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo with peripheral origin, and its psychologic consequences frequently ignored by clinicians. In this regard, the present study aimed to investigate the effects of BPPV on patient auditory-verbal memory.

In this cross-sectional study, a total of 40 volunteer patients with acute vertigo underwent auditory and vestibular function tests. In addition, after the confirmation of BPPV, the Persian version of Dizziness Handicap Inventory was completed by all the subjects. Then, the Persian version of the Rey Auditory-Verbal Learning Test was conducted on the participants.

The obtained results showed that the level of disability caused by BPPV could lead to a decrease in the capacity of auditory-verbal memory in comparison to that in normal individuals.

Patients with BPPV who suffer from severe rotator vertigo have higher number of problems in learning through auditory-verbal memory in comparison to normal individuals. Moreover, suffering from acute vertigo as an unpleasant physical condition can lead to considerable cognitive consequences in these patients.

Human immunodeficiency virus (HIV)-infected people are at higher risk of opportunistic infections due to immunodeficiency. The current study aimed to evaluate the different levels of CD4 in HIV-infected patients and its relationship with clinical and paraclinical manifestations of the patients.

This cross-sectional study was conducted on 94 HIV-infected patients referred to the Counseling Centers for Behavioral Diseases and Sina Hospital in Hamadan, from 2014 to 2015. At the commencement of the study, written consent was obtained from the participants. Thereafter, demographic data, history of underlying diseases, symptoms and clinical syndromes, medical history, and serum CD4 levels were evaluated by flow cytometric recorded in the questionnaire and data were analyzed in SPSS software(version 16).

Out of 66 HIV-positive patients, 70.2% (n=38) were male and the mean age of the patients was 40.06±10. 04 years. In terms of classification of the clinical stage of the disease, the patinets in the first, second, and third stages were reported as 11 (11.7%), 36 (38.3%) and 34 (36.2%), respectively. The mean serum CD4 count of the patients at the beginning of antiretroviral therapy was measured at 284.241±284 and 377.19±271.41 cells /μl, respectively. The difference in the mean of serum CD4 count before and after antiretroviral therapy was revealed to be statistically significant (P=0.001). The most common clinical symptoms observed included cough and sputum (29.9%), oral aphthous ulcer (12.7%), weight loss (11.7%), and fever (7.4%). Based on the results of the study, there was a significant difference between the mean of platelet count, hemoglobin and alkaline phosphatase at different levels of CD4 (P<0.05).

According to the results of the present study, serum CD4 levels rise with the initiation of antiretroviral therapy in HIV infected patients; therefore, early antiretroviral therapy in HIV-infected patients with any serum CD4 level is of paramount importance.

Neonatal neurological diseases are characterized by a range of clinical symptoms and signs that can be confirmed by Magnetic Resonance Imaging (MRI) in some cases. This study aimed to examine the neonatal cerebral MRI descriptively.

In this comparative cross-sectional study, 69 MRI neonatal images were analyzed from January to April 2019. These images were extracted from the archives of the MRI Center affiliated to Besat Hospital, Hamadan, Iran. Moreover, demographic characteristics of the infants, including age, gender, birth rank, consanguineous marriage among their parents, as well as initial and final diagnosis were extracted and analyzed in this study.

According to the results, 65.4% of the infants were male, and the mean age of the neonates was obtained at 13±9.9 days. The initial and final diagnoses confirmed the seizure in most cases. In general, the MRI results were completely normal in 60.9% of the neonates. There was no significant relationship between the variables studied and abnormal MRI results in the cases.

In total, 39.1% of the MRI cases were abnormal. According to the results, the most common reason for MRI was a seizure. Moreover, the rate of abnormal MRI findings in seizures was found to be 16.7 %. This finding is different from the results of other studies, which may be due to differences in the pattern of the initial diagnosis

Temporomandibular joint (TMJ) dysfunction following Mandibular fractures can lead to limitation of jaw movement especially month opening, pain, and muscular atrophy. In this regard, the current study aimed to determine the effect of manual mobilization along with other physiotherapy modalities on the improved function of TMJ in a patient with Mandibular symphyseal fracture.

A 16-year-old girl with a complaint of  severe jaw pain and disability of mouth opening was referred to physical therapy clinic of Besat Hospital affiliated to Hamadan University of Medical Sciences. The patient underwent an open surgical treatment due to mandibular symphyseal fracture. A visual analog scale was used for the measurement of pain intensity and the maximal mouth opening was obtained by measuring the distance of the maxillary and mandibular central incisal edges using a dental ruler scaled in millimeters. Thereafter, physical therapy treatment was administered to both TM joints for five sessions every other day. The physiotherapy sessions included Transcutaneous Electrical Nerve Stimulation (TENS), ultrasound, hot pack, and Maitland manual mobilization techniques. The patient demonstrated significant reduction in pain and improved maximal mouth opening upon the completion of 5-session physical therapy treatment.

Physical therapy treatment which includes physical modalities along with manual mobilization techniques may be an effective method in the management of TMJ dysfunctions following mandibular symphyseal fracture leading to faster improvement in the function of this joint.