Caspian Journal of Internal Medicine
Volume:11 Issue: 4, Autumn 2020

Non-alcoholic fatty liver disease (NAFLD) is emerging as a major health problem worldwide. NAFLD is a continuum of disease ranging from mild liver steatosis to severe steatohepatitis, which will ultimately lead to end-stage liver disease with high morbidity and mortality rates. This disorder is considered as a silent liver disease. The metabolic syndrome and its components are accounted as the major risk factors for the progression of NAFLD to NASH and cirrhosis. Liver transplantation is considered as an appropriate treatment for the end-stage disease. For the last two decades, NASH has been the most common reason for liver transplantation, especially in the developed countries; however, the outcome of post-transplantation in these patients is of a great concern. The recurrent NASH and NAFLD seem to be the usual issues in LT. Steatosis appears in more than 80% of LTs; however, re-transplantation caused by steatohepatitis is rare. Recently, several risk factors of the recurrent NAFLD, including age, donor steatosis, metabolic syndrome, and immunosuppressant agents, have been introduced. Among the metabolic syndrome components, obesity seriously has negative effects on the outcomes of post-liver transplantation in patients. Unfortunately, there is no standard medicine to prevent or treat the recurrent NAFLD; however, it seems that weight loss and lifestyle modification play critical roles in controlling or inhibiting the recurrent NAFLD or NASH.

Mutations in the EGFR signaling pathway play an important role in the development of colorectal cancer (CRC). Mutations in these genes, like KRAS and BRAF, affect the treatment strategies and associated with poor prognosis and relative resistance to anti-EGFR therapies. Our aim was to conduct a systematic and meta-analysis on all studies that have been conducted on the prevalence of these gene mutations in Iranian CRC patients.

Four science citation index databases (MEDLINE, EMBASE, Web of Science and Cochrane library) and local databases were searched up to March 2018 with related keywords. Two reviewers independently screened and extracted the data. Quality of all included studies was assessed using an adapted checklist from STROBE. A random-effect model was used to calculate the total prevalence of KRAS and BRAF mutations in CRC subjects by the event rate (ER). Meta-regression was utilized to explore heterogeneity causes.

In total, from 573 records, 23 eligible studies (2662 patients) were included for data extraction and analysis. In 18 of 23 included studies, the prevalence of KRAS mutations was 33.9% (95% CI=30.1-37.9) with I2=65.17 (p<0.001). The occurrence of KRAS mutations in codon 12 and 13 was 76.9% (95% CI = 70.4-82.3%) with I2=84.88 (p<0.001) and 23.5% (95% CI=17.9-30.3) with I2=85.85 (p<0.001), respectively. In 9 of 23 studies, the BRAF mutation rate was 3.2% (95% CI=0.003-13.6) with I2=88.61 (p<0.001).

The prevalence of these mutations in CRC patients shows a significant difference in the different regions of Iran, which is probably due to environmental and racial factors.

 Cardio-metabolic syndrome indicates the clustering of several risk factors. The aims of this study were to identify the subgroups of the Iranian children and adolescents on the basis of the components of the cardio-metabolic syndrome and assess the role of demographic characteristics, socioeconomic status and life style related behaviors on the membership of participants in each latent class. 

 This cross sectional study was performed on 3730 Iranian students in 2015 using stratified cluster. All students in each class completed anonymous and structured questionnaires. Abdominal obesity, high triglyceride (TG), low high-density lipoprotein (HDL), high blood pressure (BP), high fasting blood sugar (FBS), high low-density lipoprotein (LDL), high cholesterol and obesity were used for assessing pattern of cardio metabolic risk as a latent variable. Data analysis was performed using PROC LCA in SAS software.

Four latent classes were identified in this study; namely 1) healthy (59.6%), 2) low risk (20.4%), 3) moderate risk (13.7%) and 4) high risk (6.4%). Being girl (OR=0.59, 95% CI: 0.46-0.74), living in rural area (OR=0.45, 95% CI;0.33-0.60), high screen time (OR=1.56, 95% CI:1.09-2.24), and parental obesity (OR=1.52, 95% CI: 1.18-1.95) were associated with moderate risk class. Only living in rural area (OR=0.71, 95% CI; 0.51-0.99) was associated with high risk class.

About 20% of the students are in the moderate risk and high risk classes.  Design and implementation of interventions according to risk-based class seems necessary with considering probably risk and protective factors for prevention of complications of cardiometabolic syndrome.

Asphyxia is one of the main causes of infant mortality and long-term neurologic complications. This cohort study was aimed to compare the diagnostic value of the hematologic and biochemical factors in prediction of prognosis of asphyxia according to the high prevalence of asphyxia and its complications.

In this cohort with two-year follow up study with availability sampling 196 term asphyxic infants were involved during 2009 to 2018. A researcher designed questionnaire was used as the data collection tool containing infantile and maternal particulars as well as the clinical and laboratory assessments. Serum levels of interleukin-1β(IL-1β), IL-6, pro-oxidant/antioxidant balance (PAB), heat shock protein (HSP) and nucleated red blood cells (NRBC) were checked in infants with perinatal asphyxia. Denver II developmental screening test (DDST-II) was performed at 6, 12, 18, and 24 month post-discharge follow-up visits. Data analysis for comparison of infants with normal and abnormal outcomes was performed using student T test, Chi-square, ROC curve, and regression models.

IL-6, IL-1β, PAB, and NRBC count are among the most important predictors of abnormal complications in asphyxic newborns. PAB>22 (HK) showed sensitivity and specificity of 88.6% and 71.6%, respectively in prediction of complications of asphyxia. The sensitivity and specificity of an IL-6 higher than 28 (pg/mL) in prediction of complications of asphyxia was found to be 96.1% and 78.6%, respectively. Elevated levels of IL-6 and IL-1β were associated with increased unfavorable outcomes.

Combinations of: IL-1β + IL-6 + NRBC; IL-6 + HIE grade + PAB; and IL-6 + HIE grade + NRBC had the highest predictive value (100%) for prognosis of asphyxic infants.

Colorectal cancer (CRC) is considered the fourth type of cancer that causes death in the world. Changes in levels of Zinc (Zn), Copper (Cu), and Selenium (Se) as well as low glutathione peroxidase (GPx) activity can lead to CRC and this study was aimed to evaluate their possible use as diagnostic markers.

CRC patients (n=90) were divided into three groups; newly diagnosed, before surgery, and after surgery. These groups were compared to healthy subjects (n=30); the mean age ±SD was 50.63±9.26 and 49.97 ±10.85 for CRC patients and healthy subjects, respectively. Biochemical study for serum levels of Zn and Cu were measured by FAAS, Se was measured by HGAAS, and ELISA for GPx.

Zn, Cu, Se and GPx were significantly lower in all CRC patient groups, except for the after surgery group which showed no differences for Zn and GPx as compared to the healthy subjects. Positive correlations were found between Se and Zn and between Se and GPx (r = 0.71, r = 0.42; P < 0.01, respectively) in all CRC patient groups. A receiver operating characteristic (ROC) curve analysis applied for the newly diagnostic group showed that all parameters can be used as diagnostic markers for CRC.

The present results conclude that Zn, Cu Se, and GPx can be used as diagnostic markers for CRC, where the decrease of these parameters may be associated with an increased risk of CRC and as indicators of the response to therapy.

The decisive etiology of Oral squamous cell carcinoma (OSCC)  is still ambiguous, but we recognize the contribution of genetic aberration and environmental agent due to OSCC initiation. In the current study, we elucidate the potential impact of EGFR gene polymorphisms in the risk of OSCC in the southeast of Iran.

Forty-eight OSCC patients along with 100 normal volunteers were included. Three polymorphisms of EGFR gene (rs2227983, rs2293347 and rs2227984) were genotype by Tetra-ARMS PCR. Data analyzed with chi-square test and P-value < 0.05 was considered significant.

In rs2227983, the frequency of AG and GG genotypes were 62.5%, 37.5% in cases and 42%, 57% in the control group (P = 0.02, OR = 2.3) and also A allele frequency was 31.3% in case and 22% in the control (P= 0.08, OR= 0.62). AG + AA genotype frequency was 62.5% and 43% in case and control, respectively (P = 0.03, OR = 2.2). In rs2227984 and rs2293347 no statistical differences showed in the distribution of genotypes between the case and control group, also the majority of the OSCC has belonged to the grade I (43.8%).

The present investigation indicated that rs2227983 polymorphism may contribute to OSCC susceptibility in the southeast population of Iran. Although with the inconsistent interpretation mentioned due to the various geographical residency and different populations, more study of major population suggested being performed our finding validation.

Stroke is known to be the third most prominent cause of death in the developing countries and the most common debilitating neurologic disease. This study aimed to investigate the association of platelet count (PC) and mean platelet volume (MPV) index with various stroke types.

This cross-sectional study was carried out on patients over the age of 18 years who presented with signs and symptoms of the first acute stroke. Exclusion criteria were underlying chronic liver or renal disease and the time more than 6 hours from symptom initiation, hematological and infectious disorders in patients. After recording of demographic data, a complete blood cell count (CBC) test was performed.

From 150 patients, who enrolled in the study, 54.7% of patients were males. The initial brain CT scan was normal in 13 (8.7%) patients and showed evidence of brain infarction and intracranial hemorrhage in 84 (56%) and 53 (35.3%) patients respectively. Patients with intracranial hemorrhage had significantly higher mean of MPV index than the patients with normal brain-CT scan and patients with evidence of brain infarction (p<0.001).

The MVP index can be a predictor of the type of hemorrhagic or ischemic finding in emergency CT scan in stroke patients. This relationship may help to better understand the physiopathologic role of platelets in the development of stroke (hemorrhagic or ischemic), but will not replace cerebral computed tomography to diagnose the type of stroke, or it may not initiate treatment for hemorrhagic stroke.

Chemotherapy for treatment of breast cancer uses some drugs to target and destroy the cancer cells. However, most of antineoplastic treatments are non-specific and the innate cells will be damaged. In this study, the effect of Adriamycin/Cytoxan (AC) chemotherapy on status of antioxidant enzymes and Se levels in breast cancer patients was evaluated.

A prospective study, includes 50 breast cancer patients treated with AC chemotherapy (Adriamycin 60 mg/m2, Cytoxan 600 mg/m2) from July 2016 until March 2017. First sampling was obtained before chemotherapy and the second, after 3 cycles of the intervention. Antioxidant enzyme activities (Catalase, Glutathione Peroxidase, Glutathione Reductase and Superoxide Dismutase) and Selenium (Se) levels in serum were measured by spectrophotometry and atomic absorption methods, respectively. Age, BMI, familial history, stage and grade of cancer, tumor site, type of surgery, Estrogen, Progesterone and HER2 receptors, were recorded from each patient. Paired-t test was employed for comparing the data before and after chemotherapy. Age and disease stages were compared by independent t-test.

After 3 courses of chemotherapy, a significant decrease was observed in antioxidant enzymes and also Se (P<0.001). These studied indices were not significant in different age groups (≤48, >48) and stages of disease (early, advanced).

Our findings show that the AC chemotherapy in the breast cancer patients result in drastic changes in oxidant/antioxidant system of the body, specially reduction of Se levels and antioxidant enzymes activities. However, it seems that these changes are not necessarily dependent on the age and disease stage.

Acute radiation proctitis (ARP) is a usual adverse effect in patients undergoing pelvic radiotherapy. The symptoms include diarrhea, rectal blood or mucus discharge, fecal urgency and tenesmus with pain. Sucralfate, an aluminum-based salt of sucrose octasulfate, is a cytoprotective agent that forms a coating barrier at injured sites by adhering to mucoproteins. It has been used in topical management of a wide variety of local lesion. This study was designed to evaluate the preventive effect of rectal sucralfate on acute radiotherapy induced proctitis.

Seven percent sucralfate ointment was prepared for topical use. Drug quantification, chemical stability and microbial limit tests were performed carefully. In this randomized double blind placebo controlled trial, fifty-seven patients with pelvic malignancies undergoing radiotherapy were allocated to receive either 1 g of sucralfate or 1 g of placebo, given as a twice daily ointment, one day before and during radiotherapy for six weeks. The eligible patients were evaluated based on RTOG acute toxicity criteria and the following ARP symptoms weekly: rectal hemorrhage, diarrhea, rectal pain, and fecal urgency.  The influence of symptoms on lifestyle were also recorded weekly.

Acute proctitis was significantly less prevalent in patients in the sucralfate group. The incidence of rectal bleeding (P=0.003), diarrhea (P= 0.002), rectal pain (P=<0.001) and fecal urgency (P=0.002) were significantly less common in the sucralfate group. No statistically significant difference was observed for radiotherapy induced cystitis in the placebo and sucralfate groups (P=0.27).

This study suggests that sucralfate7% ointment reduces the incidence of symptoms associated with acute radiation proctitis.

Nowadays, radiotherapy is used effectively for treatment of head and neck cancers. Mucositis is one of the most important side effects of radiotherapy. Radio-protective agents protect tissues and cells against the adverse effects due to ionizing radiation and cleave radiation-induced free radicals. Lycopene as a potent antioxidant protects cells against oxidative damage by free radical–scavenging.  The present study investigated the antioxidant effect of lycopene on oral mucosa of irradiated rats.

In this experimental animal study, 28 rats were placed in four groups as follows: treated with 50 mg /kg of lycopene (L50), solvent+irradiation (SR), 25 mg / kg of lycopene+irradiation (LR25), and 50 mg / kg of lycopene+irradiation (LR50). The rats received lycopene intraperitoneally. On the irradiation day (day 0) and tenth day of radiation, blood samples were taken from the animals for FRAP and TBARS tests.

The results showed that the LR50 group didn’t show mucositis higher than Grade 2. There was a significant difference (p <0.05) between SR and the L50 regarding the severity of mucositis. In addition, L50 showed higher antioxidant activity and lower peroxidation than SR.

The lycopene reduced the severity of mucositis. Therefore, it can be used as a potential and promising nutritional substance to prevent radiotherapy complications, especially in the treatment of head and neck cancers. However, further research is necessary to confirm these results.

A routine phenotypic test has not been recommended for detection of metallo-β-lactamases (MBLs) producing Enterobacteriaceae species such as Escherichia coli. The current study was conducted to compare the 2-Mercaptopropionic acid (2-MPA) phenotypic method and ertapenem non-susceptibility test with polymerase chain reaction in predicting the production of MBLs in clinical isolates of E. coli.

Antimicrobial susceptibility test for beta-lactam antibiotics were performed by disk diffusion method. All isolates which showed inhibition zones of ≤ 22 mm for CAZ and ≤ 27 mm for CTX were considered potential MBLs producing isolates. The production of MBLs was confirmed using 2-MPA compound. Also, susceptibility to ertapenem was evaluated in all isolates. Conventional PCR was performed to detect blaIMP-1 and/or blaNDM-1 genes in all potential MBLs producing E. coli isolates.

Of 259, 138 (53.3%) isolates were potential MBLs producing bacteria. One hundred and fifteen out of 138 (83.3%) isolates were susceptible to ertapenem. MBLs production was confirmed in 75/138 (54.4%) isolates by 2-MPA phenotypic method.  The blaNDM-1 or/and blaIMP-1 genes were found in 30/75(40%) and 39/115(33.9%) isolates which were confirmed by 2-MPA and were susceptible to ertapenem, respectively. The Sensitivity of 2-MPA method and ertapenem non-susceptibility test compared with PCR were 65.2% and 15.2%, and the specificity was 52.1% versus 82.6%, respectively.

This study demonstrated that the 2-MPA phenotypic method does not have acceptable sensitivity and specificity in comparison with PCR, but its results are more reliable for the detection of MBL producing E. coli isolates compared with non-susceptibility to ertapenem.

Observing the enhancing plaques in magnetic resonance imaging (MRI) is one of the most valuable diagnostic modalities in confirming the diagnosis of multiple sclerosis (MS), its recurrence and for better detection of active disease. Since active lesions discovery can improve designating diffusion in time diagnosis of MS and controlling disease activity, and there is not any definite time for delay image acquisition, therefore, the aim of the current study was to evaluate the enhancement of MS plaques in different delayed phases.

In this interventional study, after receiving written consent, 40 MS patients with at least one enhancing plaque in a previous MRI were evaluated in Babol Ayatollah Rouhani Hospital. Gadolinium was injected to all patients at the dose of 0.1 mg/kg, and MRI was taken at 5 and 15 minutes. The results were analyzed using SPSS 23. A p<0.05 was considered as significant level.

The mean of plaque signal intensity was 1190.20 and 1349.60 at 5 and 15 min, respectively, and this difference was significant (p<0.001). Moreover, the mean of plaque total size was 5.16 cm and 7.04 cm at 5 and 15 min with significant difference, respectively (p<0.001). The mean of plaque number was 1.92 and 2.58 at 5 and 15 min, respectively, which was significantly different (P<0.001).

The results indicated improvement in detection of MS plaques in images taken in the delayed phase compared to those in the early phase. The plaque intensity, size and number were significantly higher in the delayed phase (15 min), than early phase (5 min).

The aim of this study was to investigate the effects of Melissa officinalis tea on the total antioxidant capacity of saliva among smokers.

24 smokers were selected by convenience sampling. Demographic information and duration of smoking were recorded at the beginning of study. Two cups of Melissa officinalis tea were given to the participants with specific instruction for 30 days. The unstimulated saliva was collected on first day, 15th and 30th days. Then, total antioxidant capacity was measured by a special kit. Statistical analysis was conducted by repeated measure ANOVA test.

The mean values of total antioxidant capacity of saliva was significantly higher in days 15 and 30 from the baseline. (p<0.0001, p=0.006). In day 30, the mean value of antioxidant was not significantly different from day 15. (p=0.271).

Melissa officinalis tea consumption increase salivary antioxidants level in smokers.

Leptospirosis is characterized by very diverse clinical manifestations, which may range from flu-like subclinical forms to very severe presentations characterized by multi-organ failure, or to atypical presentations. One of its most aggressive presentations is Weil’s disease, characterized by jaundice, hemorrhagic phenomena and renal failure. Cases with high bilirubinemia over 30mg/dL aren’t communes in human leptospirosis.
Our aims are to present an atypical case presentation of human leptospirosis, characterized by jaundice and hemolytic anemia, and to make a short review in PubMed for similar cases. At the same time we want to emphasize the diversity of the clinical presentation of human leptospirosis

A 54-year-old man presents at the emergency department of the infectious medicine with severe fatigue, nausea, vomiting, and generalized weakness. On exam, he was alert and well oriented, blood pressure was 80/50 mmHg and icteric. First blood examinations confirmed high bilirubinemia, thrombocytopenia and acute renal failure.

Based on anamnestic and clinical evaluations, blood and serology examinations, the patients resulted with leptospirosis. The bilirubin reached 73.4mg/dL. At the same time on PubMed research we found only limited cases with leptospirosis associated with bilirubinemia over 30mg/dL and over less with hemolytic anemia.  

Based on our clinical experience, as well as literature data, we suggest that clinicians should have a high index of suspicion in cases of jaundice with exposure possibilities for infectious diseases. Connection of high bilirubinemi over then 30mg/dL and hemolytic anemia in human leptospirosis is an uncial case report.

Bilateral synchronous testis germ cell tumors with different histopathology are not common.

Here, a case of 27-year-old male who is reported presented with bilateral testicular swellings. There was a high α-fetoprotein level with bilateral lesions on scrotal USG. Bilateral orchiectomy was performed. According to pathology report, there was a right testicular seminoma and left testicular mixed germ cell tumor composed of seminoma, yolk sac tumor and embryonal carcinoma.

He received one cycle of chemotherapy with BEP regimens

 Hashimotochr('39')s thyroiditis can be present with a localized palpable nodule though presentation as a hyperfunction "nodule" is extremely rare.  The first case of Hashimotochr('39')s thyroiditis and hot nodule was reported in 1971 by warner.

We reported a 26-year-old hypothyroid woman in Hashimotochr('39')s thyroiditis background with a hyperactive thyroid nodule in both 99mTc and I131scintigraphy. The nodule disappeared after eight months sufficient thyroid hormone replacement therapy.

Toxic adenoma in hypothyroid patients can be resolved after the thyroxin replacement therapy.

Common arterial trunk (CAT) is a rare congenital heart disease, and often leads to the early development of pulmonary hypertension and disability. Among the critical structural heart defects, the frequency of CAT is 3%, which reflects the severe hemodynamic disturbances. The natural course of the disease is characterized by a high mortality rate up to 88% during the first year of life. We introduce a patient with common arterial trunk disease.

The article describes a case of a 9-year old boy with a diagnosis of type I common arterial trunk (CAT) that rejected recommendations of many physicians for many years. At 7 months, the baby was diagnosed as CHD and at 3 years, a cardiac catheterization was performed and the final diagnosis was common arterial trunk, type I with defect of interventricular septum and pulmonary hypertension. During, parents refused the operation. The health status of the last examination was bad due to high pulmonary hypertension and chronic arterial hypoxemia. Drug therapy continued with bosentan, sildenafil, captopril, kudesang, spironolactone and aspirin

The late detection of children with CAT or late surgery leads to the rapid progression of pulmonary hypertension and significantly reduces the patientchr('39')s chances for performing surgical correction of the defect.