Caspian Journal of Internal Medicine
Volume:12 Issue: 2, Spring 2021

Almost half of cancer patients experience cachexia syndrome. Cachexic patients are at risk of increased side effects of chemotherapy, reduced tolerance to chemotherapy drugs, longer duration of treatment period, and decreased quality of life. Cancer cachexia is a multifactorial syndrome. Micro ribonucleic acid (miRNA), a “non-coding RNA”, is considered to be a risk factor of cachexia and muscle wasting in cancer patients. miRNA has a role in affecting protein regulation, associated with different inflammatory and disease pathways. miRNA can also affect cytokines or directly change the regulation of metabolism that lead to cachexia. In this review, we want to focus on the pathophysiology to give a better understanding about the role of miRNA in the development of cancer cachexia. Based on various pathways of miRNA in cancer cachexia, it can be a potential target for therapeutic strategies. Improved knowledge about miRNA can give the opportunity to develop new treatment in the management of cancer cachexia.

To the aim of this study was to evaluate the association between mean platelet volume (MPV) and diabetic retinopathy (DR).

Patients with diabetes mellitus (DM) referred to Ophthalmology Clinic of Rohani Teaching Hospital in Babol, Northern Iran were entered into this case-control study. Healthy subjects in control group included individuals without history of DM. The patients were classified into four groups including I. Control (n=79), II. Diabetic patients without DR (n=68), III. Non-proliferative DR (n=61), and IV. Proliferative DR (n=64). Blood samples were collected, and necessary laboratory tests were performed.

The MPV value was significantly higher in each group of II, III and IV compared to group I (p<0.001). This value was also significantly higher in each group of III and IV compared to group II. On the other hand, there was no significant difference between III and IV groups in MPV. A significant correlation was found between MPV and fasting blood sugar in groups II (r=0.349, p=0.004), III (r=0.269, p=0.036) and IV (r=0.258, p=0.040). Moreover, there was a significant correlation between MPV and hemoglobin A1c in groups II (r=0.366, p=0.002), III (r=0.312, p=0.015) and IV (r=0.278, p=0.026).

The results of this study showed that the increased MPV value was directly associated with DR and its severity. A positive association was also found between MPV and indicators of glycemic status. Considering that measurement of MPV as a suitable parameter reflecting platelet function can be easily conducted, it can be clinically used to monitor status of DR.

Aging in men causes a gradual decline in endogenous testosterone levels, which may have detrimental effects on their health status. Testosterone deficiency is thought to promote atherosclerosis by modulating lipid metabolism. Therefore, this study was conducted to evaluate the serum testosterone level and its correlation with lipid profile in men aged ≥60 years old.

All elderly men aged ≥60, residing in Amirkola and participating in a phase of the comprehensive project on "investigating the health status of the elderly in Amirkola" were entered into this descriptive cross-sectional study. After fasting over 12 hours, the venous blood samples were taken. Serum concentration of testosterone was determined using ELISA method. Moreover, HDL-LDL, total cholesterol, triglyceride and fasting blood glucose were measured.

The prevalence of hypogonadism was 91.28% among the 792 participants of this study with a cut-off point of 9.72 nmol/L (95% confidence interval, 93.25-89.31) and the prevalence of severe hypogonadism with a cut-off point of 5.2 nmol/L was reported 71.59% (95% confidence interval, 74.73-68.44%). Based on the results, there was no significant statistical correlation between the serum level of testosterone and triglyceride (r=0.03, P=0.34). Furthermore, there was a negative correlation between testosterone and HDL, which was not statistically significant(r=-0.05, P=0.13). No significant statistical correlation was found between testosterone and LDL (P=0.98). There was a negative correlation between testosterone and cholesterol, which was not statistically significant (r=-0.02, P=0.49).

According to the study results, 91% of men aged ≥60 years old had hypogonadism, no correlation was found between testosterone and lipid indices.

The interaction between nervous and immune systems has been under investigation. Transient receptor potential vanilloid type 1(TRPV1) is a ligand gated calcium channel expressed by sensory neurons which mediates neurogenic inflammatory response. Substance p which can be released following exposure to capsaicin is a TRPV1 inducer, shown to have altered concentration and function in mice with systemic lupus erythematosus (SLE). We evaluated skin reaction to capsaicin in newly diagnosed and established SLE patients compared to healthy controls.

Twenty-nine SLE patients (12 newly diagnosed cases under treatment, and 17 established ones, not receiving medications) who referred to rheumatologic disease research center, and 33 healthy subjects of the control group were recruited in this study. A topical solution of capsaicin (0.075%) was applied on the volar forearm during skin test, and time to the tingling sensation, area of induration and area of redness (centimeters2) were recorded after 5, 10, and 20 minutes.

The area of redness and area of induration within 15 minutes, time to the tingling sensation (P=0.02), and the overall frequency of tingling sensation (P=0.01) after capsaicin skin test was considerably higher in SLE patients than the healthy controls. Redness, induration and tingling sensation were more frequent but not statistically significant among the established SLE group compared to the newly diagnosed patients.

Since skin reaction to capsaicin is more prominent in SLE patients than the healthy individuals, neurogenic inflammation and the role of P substance should be investigated more in ongoing lupus. Capsaicin test can not predict lupus activity.

Chest pain indicating acute coronary syndrome (ACS) accounts for approximately 5-10% of presents in the emergency departments (EDs). Rapid decision making is very important because longer hospital stay is associated with higher financial burden. The aim of this study was to compare current practice with a 2-hour accelerated diagnostic protocol (ADP) to manage chest pain in patients suspected to have ACS.

This is a longitudinal follow-up study on 900 patients with negative troponin measured on entrance to the ED and initially low-risk for myocardial infarction according to the emergency department of chest pain assessment score (EDACS) at the Loghman Hakim Hospital, Tehran, Iran in 2018. Patients were divided in two groups (based on odd or even days at admission time) at a ratio of 2:1 (i) current protocol with a second troponin measuring after 6 hours and (ii) ADP with a second troponin measured after 2 hours. Major adverse cardiac events (MACE) associated factors assessed in two groups over 30-days.

Totally, the rate of return to EDs with the major adverse cardiac events was 4% (n=24) in the current protocol group and 1% (n=1) in the ADP group within 30 days. The odds ratio for MACE in 30 days in the current protocol was 4.3 times more than ADP group (95% CI: 1.28-14.56, OR: 4.33, p:0.02). In multivariable logistic regression analysis, this estimation for the current protocol was 4.10 times more than comparison group (95% CI: 1.23-13.81, OR: 4.10, p:0.01).

A 2-hour ADP in patients at low-risk for myocardial infarction by EDACS had fewer adverse follow-up events than the current protocol.

Parkinsonchr('39')s disease (PD) is defined as a long-lasting, neurological illness. Low levels of serum lipid fractions are related with a high risk of PD. Current investigation was designed to evaluate the concentration blood lipid fractions in patients suffering from PD and compared with healthy subjects.

This case-control study was conducted from February 2016 to September 2018 in Tabriz University of Medical Sciences, Tabriz, Iran. The present investigation consisted of 75 persons who had PD and 75 normal people. The blood levels of lipid fractions were measured by concentrations of total cholesterol (TC), serum triglycerides (TG), low-density lipoprotein (LDL-C), high-density lipoprotein (HDL-C), and total cholesterol. The results were analyzed with SPSS software using Kolmogorov-Smirnov, chi-square, and studentchr('39')s t-test.

Serum level of TG was remarkably lower in patients with PD (111.92±8.75 mg/dL) compared with healthy subjects (123.64±9.97 mg/dL, P=0.008).  Furthermore, we saw an important difference in the level of LDL-C (P=0.001) and TC (P=0.004) between the two groups. However, there was not any observed meaningful difference in the serum concentrations of HDL-C between the studied groups (P=0.135).

Our results showed that the serum concentration of TG, LDL-C, and TC are noticeably lower in the PD suffering patients. Further investigations are needed to provide comprehensive information on the participantschr('39') cognitive layout and subsequent actions.

Psoriasis is a chronic inflammatory disease affecting many organs. Recent studies have demonstrated that psoriasis is associated with cardiovascular disorders. We investigated the echocardiographic and conduction system changes in psoriasis patients.

In this case-control study, 36 psoriatic patients and 36 healthy controls were enrolled. Demographic and clinical data, echocardiographic and P wave dispersion (PWD) in 12-lead electrocardiogram were evaluated in both groups. We recruited patients with confirmed diagnosis via biopsy and have not been under recent systemic treatment. Patients with underlying cardiovascular disease were excluded from the study.

Mean age was 41.56±16.20 and 39.67±13.85 year in case and control groups, respectively. There was no significant difference in the baseline characteristics of the two groups. PWD was significantly higher in the case group (p<0.05). High pulmonary artery pressure was observed in 14 psoriatic patients and 1 individual in the control group (p<0.001). Left ventricular diastolic dysfunction was significantly higher among individuals who were above 60 years of age (p<0.01) but not significantly different between the two groups.

Psoriatic patients are more susceptible to future development of atrial fibrillation because of higher PWD. There is no significant difference between the diastolic function in these patients.

Heart diseases are the main reasons of death in the developed countries. This study was conducted with the aim of investigating the patterns of pain intensity and psychosomatic symptoms among cardiac patients.

This is a descriptive study and the statistical population included all the cardiac patients who were admitted to an Iranian Hospital (Kermanshah-Imam Ali Hospital) during 2018 (From July to November) 250 people were selected out of the population using convenience sampling and 180 patients answered pain intensity assessment tools, the patient health questionnaire (PHQ-15) and the patient demographic information form.

The results of this study indicated moderate (52.2%), low (36.1%) and high  (11.7%) levels of pain intensity plus mild (4.4%), moderate (28.3%) and severe (67.2%) psychosomatic symptoms with the most common psychosomatic symptoms being chest pain (52.8%), fatigue (52.8%), shortness of breath (49.4%), heart palpitation (47.8%).The results of chi-square test showed a no significant relationship between psychosomatic symptoms and variables of age, marital status, drug abuse and pain intensity (p> 0.05), however, significant relationship was found between psychosomatic symptoms and gender (p< 0.001). Moreover, there was no significant relationship between pain intensity and age, gender, marital status and drug abuse at the level of (p>0.05).

Psychosomatic symptoms and pain intensity are associated with certain functional disorders and health care, therefore, identifying psychosomatic symptoms and pain intensity is very useful in assessing the effectiveness of clinical approaches on cardiac patients.

Due to persistent infections of human central nervous system (CNS), polyomaviruses have been identified as one of the risk factors for brain tumor development. Human BK virus is of significant interest due to its experimental neuro-oncogenic potential and the possible association with CNS neoplasms. However, the results of different studies are discrepant. In the present study, we aimed to investigate the prevalence of BK virus genome and quantify BK viral load in Iranian patients with primary and metastatic brain malignancies.

To assess the prevalence of BK virus sequences, a total of 58 fresh brain tumors were examined by quantitative real-time PCR. The BK viral load was determined as viral copy number per cell.

Of the 58 brain tumor samples BK tumor antigen (TAg) sequences were detected in 26 (44.8%) of cases. In primary brain tumors, BK virus sequences were recognized more frequently in schwannomas (15.5%) and meningiomas (12.1%). The mean BK virus TAg copy number in positive cases was 0.20×10-3±0.27×10-3 (range 0.01×10-3- 0.8×10-3) copies per cell.

Taken together, in the present study low copy numbers of BK virus TAg gene was detected in brain tumor cells, which can indicate that BK virus may contribute to tumor induction by indirect mechanisms or neuro-persistence of this virus without any pathological consequences.

Narrowband ultraviolet B (NB-UVB) phototherapy has been used as a common treatment for dermatologic diseases such as psoriasis and vitiligo and generally considered a safe form of therapy during pregnancy. Invitro photodegradation of folate after exposure to UVB radiation has been documented but studies on UVB-induced alternation of serum folate level have reported inconsistent results. The aim of this study was to investigate the effect of NB-UVB radiation on serum folate level.

In this study, serum folate levels were evaluated in patients at baseline and after 30 sessions of NB-UVB irradiation.

Twenty patients completed the study: 10 psoriasis, 7 vitiligo and 3 mycosis fungoides (patch stage). Mean serum folate level had significantly decreased from 2.76±0.59 ng/ml at baseline to 1.34±0.15 ng/ml after 30 sessions. (Mean NB-UVB cumulative dose 40.35±16.80 j/cm2, P=0.001).

Serum folate levels may decrease after long-term NB-UVB phototherapy in patients with skin disorders.

The physician-patient relationship is important because the patientchr('39')s satisfaction affects trust in physician and accepting physicianchr('39')s recommendations in medical treatment decisions. Understanding a patient’s opinion about a trustworthy and friendly physician as well as ethical issues regarding family medicine, therefore, gains double importance. This paper attempts to provide a comprehensive evaluation of the subject.

In summer 2018, a conventional qualitative content analysis was done on 21 participants who were referred to family physicians in the North of Iran. Data were collected by means of purposive sampling and semi-structured face to face individual interviews. Participants shared their experiences about ethical considerations in family medicine. All interviews were recorded and transcribed word for word, data were analyzed using qualitative content analysis.

Data analysis resulted in the extraction of 7 categories and 21 sub-categories from the 71 initial codes. The categories include "responsibility", "patientchr('39')s privacy", "informed consent", "respect and dignity of patient", "effective physician-patient communication", "trust in physician" and "conflict of interests".

There are some differences between the participantschr('39') perceptions of ethical considerations in family medicine and opinions of medical ethics curriculum designers in Iran and particularly in the world. Some shared elements including "resource allocation", "the beginning and end of life", "research ethics", "substitute decision-making", etc. – all of them are main titles of ethics curriculum – could not be weighed as major ethical issues from the patientschr('39') perspectives. The patientchr('39')s satisfaction and, therefore, the enhancement of mutual trust is essential. Patients’ comments should be considered when providing ethical guidelines.

One of the common functional gastrointestinal disorders in children is functional abdominal pain (FAP). The aim of the present study was to determine whether the administration of a synbiotic composed of fructo-oligosaccharides (FOS) and the seven types of beneficial bacteria is useful in FAP of childhood.

In this placebo-controlled, double-blind trial, 4-15-year-old children who met the Rome III criteria for FAP were randomly divided to receive either synbiotic or placebo twice daily for 4 weeks. Primary outcome was at least 50% reduction in the number of pain episodes, and secondary outcomes were a decline of at least two scales in the pain duration and intensity based on Wong-Baker scale. Response to therapy was decrease of pain frequency/intensity.

A total of 67 children completed the trial (35 with synbiotic). Response rate was higher with synbiotic than placebo after four weeks (53.1 vs 11.4%; p<0.001), and synbiotic had significant superiority to placebo to relieve the duration (4.56±9.12 vs12±18.59, min/day, P=0.04), frequency (0.31±0.53vs 1.17±0.7, episode/Wk., P<.001) and intensity (2.38±2.29 vs 5.49±1.83, p<0.001) of abdominal pain.

Synbiotic compared to placebo significantly decreased the intensity, frequency and duration of FAP in children.

Loss of bone mineral density is one of the most important complications of menopause. The results of studies about the relation between body fat and bone mineral density are controversial. The aim of this study is to determine the association between fat mass and bone mineral density on non-obese post-menopausal elderly women.

This cross-sectional study is a part of the second phase of the AmirKola Health and Ageing Project (AHAP) that has been done on 356 elderly women with BMI of 18.5-30. Bone mineral density (BMD) and total body fat were measured using the Hologic Horizon-WI densitometer. Statistical tests were ANOVA and Pearson’s correlation coefficient and P value less than 0.05 was considered significant.

The mean age of participants was 70.22±7.34 and the mean age of menopause was 47.68±5.05. Women with highest fat mass, had a greater spine, femur and whole body BMD (p<0.0001). In this study we observed a direct and positive significant correlation between body fat mass and BMD at spine (r=0.308), femur (r=0.420) and whole body (r=0.312) (p<0.0001).

This study showed a positive correlation between fat mass and bone mineral density in all three anatomical sites in post-menopausal women although lean mass had a greater effect on bone mineral density than fat mass. To prevent osteoporosis in post-menopausal women, it is important to target the lean mass more than fat mass.

Fever is the most common complaint among the children admitted to health care centers. The aim of this study was to compare the anti-pyretic effect of diclofenac and high dose acetaminophen suppository in 1 to 6 years old children.

This double-blind clinical trial study was performed on 1-6-year-old children hospitalized in 17th Shahrivar Teaching Hospital, Rasht, Iran. Children were divided into two groups of 45 using a block randomization design. The first group received a high dose of acetaminophen suppository at a dose of 30 mg/kg and the second group received a diclofenac suppository at a dose of 1 mg/kg. The rectal temperature of the patients was measured using a digital thermometer at the time of drug administration, and one and three hours after that.

90 children were studied in two groups of 45 each. Temperature changes in the diclofenac group were significantly greater than the acetaminophen group, so from zero to 3 hours after administering diclofenac, the temperature decreased to 1.76±0.95°C. This reduction was lower in acetaminophen group (1.26±0.49°C, P=0.019).

Both acetaminophen and diclofenac suppositories significantly reduced the rectal temperature. However, the effect of rectal diclofenac on reducing temperature is more than rectal acetaminophen.

The aim of this study was to compare the analgesic effects of pregabalin and ketamine on reducing pain after abdominal hysterectomy.

In this double-blind clinical trial, one hundred forty ASA I and II patients of age range 30-60 years scheduled for abdominal hysterectomy undergoing general anesthesia in 2018, were randomly divided into 4 equal groups. Pregabalin group received 300 mg oral pregabalin, ketamine group received 0.3 mg/kg of intravenous ketamine, and pregabalin- ketamine group received the combination of the two-above medication, and placebo group received the placebo and saline. Patients were evaluated for pain intensity according to the visual analogue scale (VAS) at 2, 4, 6, 12, 18, and 24 hours after surgery. Also, the need for analgesic drugs and the frequency of repetitions were also recorded. Statistical analysis was performed using STATA, Version 14. A p- value less than 0.05 was considered statistically significant.

In the pregabalin and pregabalin-ketamine groups, pain in the first 6 hours after the end of operation was significantly less than the other two groups (p<0.05), but there was no significant difference between the 4 groups at 18 and 24 hours after surgery. The need for analgesic medications in the pregabalin group was lower than in other groups (p<0.05).

The results of this study show that the administration of oral pregabalin with and without intravenous ketamine before abdominal hysterectomy can decrease postoperative pain and reduce the need for analgesia.

Determination of modifiable risk factors for treatment and prevention of acute chronic obstructive pulmonary disease (COPD) exacerbation is very crucial. Therefore, the present study determined the role of serum magnesium level in acute COPD exacerbation.

This prospective study involved 100 patients with an exacerbation of COPD. Demographic data were collected for all the patients, and serum magnesium (Mg2+) levels were determined at two different time intervals. These patients were given standard treatment for COPD. All the patients were followed up after one month and later at three-month intervals for one year.

Majority (72%) of the patients had serum Mg2+<1.7 mg/dL and the odds of hypomagnesemia was 6.54 times more during exacerbations than when they had stable COPD during follow-up. Patients with serum Mg2+<1.7 mg/dL had 9.34 times higher risk of an increased number of acute exacerbations. A significant difference (p<0.05) was observed in the mean serum Mg2+ levels and number of COPD exacerbations among patients with hypomagnesemia at different stages of COPD.

Low serum magnesium level during acute exacerbation is correlated with the increased frequency of acute exacerbation in COPD.

It is a rare cardiac malignant primary tumor that seems to derive from the same cellular line as myxomas, but the prognosis is very different. It is a rare cardiac malignant primary tumor that seems to derive from the same cellular line as myxomas, but the prognosis is very different. It is a rare cardiac malignant primary tumor that seems to derive from the same cellular line as myxomas, but the prognosis is very different. Cardiac myxosarcoma is a rare neoplasm that appears to rise from the same cellular source like myxoma. It is difficult to differentiate a myxoma tumor from a myxosarcoma tumor because of its appearance and pathology examination. Myxosercoma tumor requires surgery and chemoradiotherapy, but myxoma is treated only by surgery.

We describe a case of a 58-year-old patient with a left atrium myxosarcoma, presenting with congestive heart failure. Transthoracic echocardiogram (TTE) showed a large polypoid and mobile mass in the left atrium, the patient underwent cardiac surgery and the tumor was successfully extracted, and histopathological result revealed typical features of myxoma. 15 days after surgery, he underwent explorative laparatomy because of progressive GI bleeding. Laparatomy revealed extensive metastatic masses in abdomen and the pathology diagnoses was myxosaroma. Unfortunately, in spite of supportive care, the patient expired on postoperative day one.

It is difficult to differentiate a myxoma tumor from a myxosarcoma tumor because of its appearance and pathology examination. Maybe magnetic resonance imaging can help us to achieve more data suggesting malignancy.

Peritoneal infection following pleural empyema is not a common occurrence. Concomitant pleural empyema and peritonitis have been described in the literature mostly in immunocompromised patients with different pathogenic mechanisms and a wide array of microorganisms. Here we report a case of concomitant pleural empyema and peritonitis with an unusual microorganism in an immunocompetent host.

The patient is a 42-year-old man with a history of 2 weeks epigastric pain who had been referred for surgical consult after failure of outpatient medical therapy. Physical examination at emergency ward revealed generalized abdominal guarding, tenderness and rebound tenderness. On emergent laparotomy, the peritoneal cavity was full of malodor pus. All abdominal viscera were intact but there was a 2x2 centimeter defect in the top of left hemi-diaphragm. Pus originated from the left thoracic cavity and then drained to the peritoneal cavity. Morganella morganii grew in the culture of aspirated pleural fluid. After abdominal lavage and chest tube drainage and receiving 14 days course of parenteral antibiotics, the patient experienced marked clinical improvement. Punctual history taking revealed a history of pneumonia before the beginning of abdominal symptoms.

In concomitant empyema and peritonitis in an immunocompetent patient, one should keep in mind the possibility of diaphragmatic defect and infection by unusual organisms like M. morganii.