Archives of Iranian Medicine
Volume:24 Issue: 9, Sep 2021

Polypharmacy can negatively affect the life of type 2 diabetes (T2DM) patients. There is little evidence on the associated factors of, and patterns of polypharmacy among T2DM patients in developing regions. The aim of this study is to determine the population-based prevalence of polypharmacy, its associated factors, and pattern in southern Iran.

We used baseline data from the Pars Cohort Study (PCS). Age-standardized prevalence of polypharmacy and its 95% confidence interval (CI) were estimated. Association of polypharmacy with demographic and socio-economic factors, anthropometric measures, serum biomarkers, physical activity, cigarette and tobacco smoking, and multimorbidity was assessed by applying multivariable Poisson modeling. Prevalence ratio (PR) and its CI were estimated. The Anatomical Therapeutic Chemical (ATC) classification system was used for drug classification.

Totally, 874 previously diagnosed T2DM patients with a mean age of 56.3±9.2 participated in the study. The estimated agestandardized prevalence for men and women was 17.2% (CI: 12.0–22.0) and 34.1% (CI: 33.2–39.4), respectively. The prevalence of hypertension, hyperlipidemia and cardiovascular disorders among the study population was 39%, 58% and 20%, respectively. Having more than four comorbidities (PR, 3.90; CI, 2.39–6.34), central obesity (PR, 2.66; CI, 1.03–6.84), and female gender (PR, 1.49; CI, 1.14–1.97) were associated with polypharmacy. Also, 56.0% of patients and 23.0% of elder patients (>59 years old) reported using anti-diabetic agents.

Polypharmacy was low among T2DM patients. More than 75% of the elder population were not on anti-diabetic medications. Polypharmacy was higher among patients with multiple comorbidities, central obesity, lower physical activity, lower socio-economic status, younger age at diagnosis, and longer duration of T2DM.

Colectomy is considered as a part of therapeutic armamentarium in ulcerative colitis. The availability of new biologic treatments might have affected the trend of using this modality.

The hospital records of all tertiary centers in Shiraz, which are the main centers for the treatment of ulcerative colitis (UC) in southern Iran, were reviewed to estimate the total number of admissions for the treatment of severe UC and colectomy among patients from 2009 to 2019. In this historical cohort study, information about the current status of the patients was collected by phone calls during December 2019.

Totally, 111 (4%) UC patients, out of 2933 admissions, underwent colectomy. Sixty-five (54.6%) UC colectomy patients were female. The results revealed an upward trend for the ratio of the frequency of colectomies to total UC admissions (Z = 3.39, P < 0.001). Colectomy complications occurred in 44 patients (40%), and most of the patients 38 (34%) had late complications, leading to readmission. Seven patients (6.3%) had died from colectomy during the follow-up calls. Most of the dead patients underwent urgent surgery and were young.

Despite the use of biologics during the past decade in southern Iran, there was a rising trend among the UC patients’ colectomies. The frequencies of post-operative complications and mortality was considerable, highlighting the need for refinement of UC care in this region.

Endometriosis is an estrogen-dependent disease that adversely affects women’s quality of life (QOL). We aimed to compare the effect of dienogest and oral contraceptive pills (OCPs) on pain and QOL in women with endometriosis.

This randomized double-blind trial was conducted at Rasoul-e-Akram hospital, affiliated to Iran University of Medical Sciences, Tehran, Iran, from March 2018 to March 2020, on women with severe endometriosis confirmed by laparoscopic surgery. Ninety patients were randomly given either dienogest (Vissane 2 mg tablet; n = 30), or OCPs (LD; n = 30), or placebo (n = 30) daily for 12 weeks. The primary objective of this study was to evaluate the patient’s pain including dyspareunia, dysuria, dyschezia, and pelvic pain. The secondary outcome was considered as a change in patients’ QOL score.

The mean age of population was 32.99 ± 7.1 years. There was no significant difference in the three groups regarding baseline characteristics. Pelvic pain was significantly reduced, while the effect of medication on dysuria and dyschezia was not significant. The overall QOL score between the control and dienogest (P = 0.02) and OCPs groups (P = 0.001) was significantly different; however, the difference was not significant between the two intervention groups

The finding of the present study revealed that there is no difference in the efficacy of dienogest and OCPs in management of pain and the QOL. But there was a significant difference between the placebo and intervention groups.

Reza Bahramabadi  , Zahra Honarvar, Maryam Iranpour, Mohammad Kazemi Arababadi, Tania Dehesh, Bahram Dabiri, Abbas Mortezaeizadeh Anari, Sahar Amirpour Rostami, Mohammad Salajegheh, Shahriar Dabiri*

Multidrug resistance pathogens are important heath challenges. In this study, the antibacterial activity of 20 plant extracts was tested against standard as well as 20 multidrug-resistant (MDR) strains of Pseudomonas aeruginosa and Escherichia coli. The most active plant extract (Quercus infectoria) was selected for the synergistic activity assay.

Plant extracts were prepared by maceration using water, methanol and ethanol. The antibacterial activity of extracts was determined by both broth and agar dilution methods. The synergistic activity of QIG with ceftazidime (CAZ) was evaluated by checker board assay. Antioxidant activity was determined by colorimetric Ferric reducing antioxidant power (FRAP) assay.

Only the methanol extract of QIG inhibited the growth of all the bacterial strains at a concentration of 1000 µg/mL. Other active extracts were Myrtus communis and Eucalyptus globulus inhibiting the growth of most bacterial strains tested at 2000 µg/ mL. In checker board assay, the minimum inhibitory concentration (MIC) to both QIG extract and CAZ was reduced. The MIC of CAZ was reduced from 64-4096 µg/mL to 4 µg/mL for P. aeruginosa and to 16 µg/mL for E. coli isolates.

The QIG extract exhibited potent antioxidant activity determined by FRAP assay. The result of this study showed a strong synergistic activity between QIC and CAZ on P. aeruginosa and E. coli. The activity within ethyl acetate-methanol (7:3) fraction indicates that the active components of the plant have a semi-polar nature and further work with this fraction may lead to understanding the mechanism of this synergistic activity

Psoriasis vulgaris (PsV) is an immune-mediated skin disease of unknown mechanism. Interleukin 33 (IL-33) is a member of IL-1 cytokine family and suppression of tumorigenicity 2 (ST2) is the specific ligand of IL-33. It has been found that IL33 and ST2 are increased in psoriatic lesions, but the expression levels in serum and their relationship to clinical features are still unclear. The aim of this study is to assess IL-33, ST2, IL-17 and IL-5 serum levels as well as serum concentration of blood glucose and blood lipids in PsV patients and their relationship with clinical characteristics.

Sixty-eight PsV samples and 60 healthy individuals were recruited. Serum levels of IL-33, ST2, IL-17 and IL-5 were measured by enzyme-linked immunosorbent assay and blood glucose and blood lipid were assayed by automatic biochemical analyzer.

Serum levels of IL-33, ST2, IL-17 and IL-5 were increased significantly in PsV patients compared with controls (P<0.01). Cytokines were overexpressed in PsV patients during active stages compared with controls (P<0.05). Expression levels of IL-33, ST2 and IL-17 confirmed a significance in different severity groups of PsV patients (P<0.05). Serum concentration of triglyceride (TG) was also increased compared with controls (P=0.024). IL-33 levels were positively correlated with total cholesterol (TC) levels (r=0.319, P=0.008).

IL-33/ST2 could generally reflect the activity and disease severity in PsV patients, which indicates that the IL-33/ST2 signaling pathway plays an important role in the pathogenesis of PsV.

Despite the high prevalence of occupational airway disorders, they are usually underestimated by physicians. This study designed to study the prevalence of work-related symptoms (WRS) and their association with occupational exposure in outpatient pulmonary clinics.

Adults with more than one year of lower respiratory symptoms were included. Retired patients, housewives and those unable to perform spirometry were excluded. Demographic, anthropometric and medical data were documented. The Persian version of National institute for health and safety respiratory questionnaire was used to classify job titles. WRS were defined as 2 (or more) positive questions with improvement of symptoms on days off work. Job exposure matrix (JEM) was used for classifying the type of occupational exposure into one of three categories: high molecular weight (HKW), low molecular weight (LMW) and mixed.

A total of 250 patients (69% male) with mean (±SD) age of 40 (±11.6) years, 178 cases of asthma and 59 chronic obstructive pulmonary disease (COPD) cases entered. Occupational exposure was seen in 51.2% of patients (26, 51 and 51 cases with HMW, LMW and mixed, respectively). WRS were lower in those who exercised regularly (24.6% vs. 39.4%) and higher in those with eczema (62.5% vs. 33.6%). Eczema had an odds ratio (OR) of 4.13 (95% CI 1.3 to 12.9, P = 0.01). Exposure to LMW almost tripled the risk of WRS (OR: 2.9, 95% CI: 1.4 to 5.9, P = 0.003) in our patients.

Pulmonologists are firmly advised to take their patients’ occupational and vocational exposures into consideration for treatment plans, especially in those with positive history of eczema and exposure to LMW.

Pulmonary lymphangioleiomyomatosis (LAM) is an uncommon disease principally affecting women during childbearing years and eventually leading to progressive respiratory failure. Lung transplantation is a viable option for patients with end-stage disease. LAM-related complications remain common, but recurrence of LAM following allograft transplantation is rare. We present a 25-year-old woman who presented with progressive dyspnea five years after bilateral lung transplantation for end-stage LAM. Histological examination of transbronchial lung biopsy sample confirmed recurrent LAM. We changed cyclosporine to sirolimus and she is currently being considered for re-transplantation.

Determining a relationship between coronavirus disease 2019 (COVID-19) and the ECG findings of the patients with this disease can assist in early diagnosis and patient management based on these findings. This study aimed to investigate whether COVID-19 patients had characteristic ECG findings in the acute period.

A total of 124 patients were divided into two groups as those diagnosed with COVID-19 and controls. The ECGs of these patients were evaluated in terms of rate, rhythm, presence of ST changes, PR interval, QRS width, QTc and QT interval, and presence of right and left bundle branch blocks.

On the ECG, the median heart rate of the COVID-19 patients was 104/min (IQR: 99–114), and there was a significant difference compared to the control group (P<0.001). The median PR interval was 157/ms, the QRS width was 86 ± 9/ms in the COVID-19 patients, with no significant difference compared to the controls (P = 0.161 and P = 0.631, respectively). The median QT interval of the COVID-19 patients was normal (400/ms), but a significant difference was detected compared to the controls (P = 0.005). The QTc, ST change, AF, and presence of right and left bundle branch blocks were not significantly different between the two groups.

Considering the importance of ECG findings in order to diagnose COVID-19 disease early, we can state that sinus tachycardia is very common in COVID-19 patients, but there is no characteristic ECG finding for COVID-19, including tachycardia.

The emergence and fast spread of coronavirus disease 2019 (COVID-19) threatens the world as a new public health crisis. Little is known about its effects during pregnancy. This study aimed to investigate the clinical manifestations of COVID-19 on maternal and neonatal outcomes.

In this systematic review, PubMed, Scopus, Web of Science, and Google Scholar databases were searched focusing on pregnancy and perinatal outcomes of COVID-19.

The initial search yielded 1236 articles, from which finally 21 unique studies, involving 151 pregnant women and 17 neonates, met the criteria. Mean ± SD age of included mothers and mean ± SD gestational age at admission were 30.6 ± 6.2 years and 30.8 ± 8.9 weeks, respectively. The common symptoms were fever, cough, fatigue, dyspnea and myalgia. The mortality rates of pregnant women and neonates were 28 out of 151 (18.5%) and 4 out of 17 (23.5%), respectively. Most of the neonates were preterm at the time of delivery. Three neonates had positive RT-PCR test on the first day after birth and three others on day two. On the average, neonate’s PCR became positive on day 4 for the first time.

Early diagnosis of COVID-19 is crucial due to the possibility of the prenatal complications. Strict prevention strategies may reduce the risk of mother to infant transmission.