فهرست مطالب

Caspian Journal of Internal Medicine
Volume:13 Issue: 1, Winter 2022

  • تاریخ انتشار: 1400/10/12
  • تعداد عناوین: 20
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  • Nasim Hafezi, Reza Alizadeh Navaei, Monireh Golpour, Parisa Zafari, Abolghasem Ajami* Pages 1-9
    Background

    Frizzled receptors (FZD) play a pivotal role in the initiation and progression of a wide array of cancers. Dysregulated expression of FZD receptors is correlated with higher metastasis and invasive potential, as well as short survival in many malignancies. In this meta-analysis, we aimed to verify the prognostic value of FZD receptor expression on patients’ survival with different types of gastrointestinal (GI) cancers, including gastric, colorectal, and esophageal cancers.

    Methods

    A systematic search was performed using PubMed, Scopus, and Web of Science from 2000 to November 2020. Fourteen studies, including 2997 patients met our inclusion criteria, in which nine articles were considered FZD7 while the rest were about other FZD members. The fixed-effect model was used to estimate the pooled hazard ratio (HR) and the 5-year overall survival (OS) rate. We used the Newcastle-Ottawa scale of cohort articles to determine the quality of included studies.

    Results

    The results showed that high expression of FZD receptors is associated with the poor survival in patients with GI cancers (HR= 1.83, 95% CI: 1.5–2.17). Moreover, multivariate analysis indicated that FZD receptors could be considered as an independent prognostic factor (HR = 1.76, 95% CI: 1.37–2.16).

    Conclusion

    According to our results, overexpression of FZD receptors predicts a poor prognosis in patients with GI cancers and could be used as a useful therapeutic target.

    Keywords: Frizzled receptor, expression gastrointestinal cancer, survival
  • Afsaneh Mohammadi, Zinatossadat Bouzari, Karimollah Hajian Tilaki, Mehrdad Nabahati, Raheleh Mehraeen* Pages 10-15
    Background

    Placenta accreta is one of the known causes of maternal mortality and morbidity. If diagnosed before delivery, appropriate actions can be taken. The aim of this study was to investigate the role of scaling combination of risk factors in predicting placenta accreta spectrum (PAS).

    Methods

    In this cross-sectional study, 120 pregnant women with two criteria and more of placenta previa in their ultrasound, underwent MRI. Clinical scores (history of surgery, cesarean section, previa, etc.) and paraclinical scores (ultrasound and MRI) were recorded and combined. In cases of hysterectomy, pathological examination was performed. The results were compared and analyzed using SPSS Version 22. The significance level was less than 0.05.

    Results

    Of the120 studied patients, 90 (75%) women were diagnosed with placenta previa in which, 32(36%) patients had placenta accreta and 12 patients had placenta accreta without placenta previa. The mean ultrasound score in women without and with placenta accreta were 0.05±0.32 and 2.43±1.83 (p<0.001). The mean MRI score in women without and with placenta accreta were 0.05±0.27 and 2.07±2.02, respectively. The cut-off point, sensitivity and specificity were 0.50, 100% and 93.4%, respectively. The mean clinical score without and with placenta accreta were 1.97±1.32 and 4.89±3.21, respectively. The cut-off point, sensitivity and specificity were 2.50, 70% and 80%, respectively. The cut-off point of combination score, sensitivity and specificity were 3.50, 89%, 83%.

    Conclusion

    The results of the present study showed that the most specific test to confirm the definitive diagnosis of placenta accreta is paraclinical score, alone.

    Keywords: Placenta accreta, clinical findings, imaging findings, ultrasound, magnetic resonance imaging, pregnant women, prediction, combination
  • Guzin Cakmak*, Davut Sinan Kaplan, Caner Yildirim, Hasan Ulusal, Mehmet Tarakcioglu, Zeynel Abidin Öztürk Pages 16-22
    Background

    It has been suggested that curcumin may be useful in diseases with cognitive dysfunction because it slows the progression and leads to the improvement of cognitive functions. In this study, the protective effects of curcumin on scopolamine-induced rat models of cognitive impairment were evaluated.

    Methods

    21 male Wistar Albino rats, 1 year old, 200±25 grams, were included in the study. They were divided into three groups (n: 7 in each group); the untreated control group, scopolamine group, and the group treated with curcumin and then exposed to scopolamine. Animals were evaluated for behavioral tasks with the Morris Water Maze test. Interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), total oxidative status (TOS), and total antioxidative status (TAS) were measured in hippocampal tissues. CRP levels were measured in serum specimens.

    Results

    We found that the length to reach the platform was the highest in the scopolamine group, and the lowest in the curcumin group (p<0.001). Time to reach the platform was the longest in the scopolamine group, and the shortest in the curcumin group (P=0.002). The length to reach the platform was the highest in the scopolamine group, and the lowest in the control group in the probe test (p<0.001). IL-6 levels were higher in the scopolamine group than the curcumin group (P=0.017) and the control group (P=0.005).

    Conclusion

    We revealed that curcumin provides a protective effect on scopolamine-induced cognitive impairment mimicking Alzheimer's disease.  The use of curcumin for the protection of cognition in individuals at risk of developing AD may be considered.

    Keywords: curcumin, scopolamine, Alzheimer’s disease, dementia, Morris Water Maze, inflammation
  • Arezou Hamzehzadeh Alamdari*, Samira Ahrabi, Manouchehr Khoshbaten, Shahram Roustaei, Sara Araqchin Ahrabi, Mohammad Asghari Jafarabadi Pages 23-28
    Background

    Due to the interruption of the EHC pathway in NAFLD patients, we hypothesized that parenteral vitamin D supplementation is superior to oral in vitamin D insufficient patients with NAFLD. Therefore, this study aimed to compare the efficacy of oral and parenteral routes of vitamin D supplementation on serum 25(OH) vitamin D levels in patients with NAFLD.

    Methods

    In this prospective randomized trial, 66 NAFLD cases with vitamin D deficiency were studied. For 33 cases, oral vitamin D was supplemented, whereas the other 33 patients were given an intramuscular injection of vitamin D. Laboratory tests and liver ultrasound were performed at the beginning and the end of the trial for each subject.

    Results

    Regardless of the drug administration route, at the end of this trial the mean of serum 25-hydroxy vitamin D level increased from 8.74±2.47 to 33.16±17.61 (P=0.00), and the mean±SD for serum triglyceride decreased from 191.46±92.79 to 166.00±68.30 (P=0.02), both were statistically significant. Liver ultrasound reported statistically significant changes in the grade of fatty liver disease (P=0.003). In the comparison between the two groups, serum 25-hydroxy vitamin D level changes were not statistically significant (P=0.788).

    Conclusion

    The intramuscular method of supplementation was not better than the oral route in improving serum 25(OH) vitamin D levels in NAFLD patients. In this study, the impaired EHC and vitamin D absorption inhibitor factors in NAFLD patients did not affect the final result of serum vitamin D levels significantly.

    Keywords: Nonalcoholic fatty liver disease, Vitamin D, Routes of administration
  • Ravi Kant, Poonam Yadav*, Madhuri Pratti, Shruti Barnwal Pages 29-37
    Background

    Hypoglycemia is frequently associated with insulin therapy in diabetic patients; it leads to many short and long-term complications and even death if not addressed in time. This study was undertaken to observe the circadian propensity of hypoglycemia and its recovery time based on type 2 diabetes mellitus patients’ clinical parameters.

    Methods

    We included type 2 diabetes mellitus (DM) hospitalized patients with the exclusion of patients suffering from critical illness. Data were collected for a period of three months (September to November 2019).

    Results

    A total of 120 patients were included, comprising 60% males and 40% females. Approximately 55% of patients had hypoglycemic episodes at around 12 am– 6 am. The most common comorbidity present in these patients was hypertension (43.3%, P=0.931). Anemia (OR-3.765, CI-1.350-5.500, P=0.011), retinopathy (OR 6.066, CI-2.031-8.113, P=0.001), and duration of DM (OR-6.266, CI-2.209-7.774, P=0.001) were significantly associated with the recovery time of hypoglycemia, around 50±14.14min in the elderly population of age 60-70. People with BMI 22.5- 27.5 Kg/m2 took around 45.66 ± 19.37 min to recover after treatment.

    Conclusion

    Time taken to recover from hypoglycemic episodes vary with age and BMI. Associated comorbidities such as anemia, retinopathy, and DM duration had a significant bearing on the time taken to recover from hypoglycemia. Recovery time was directly proportional to BMI, a new finding that needs further molecular level evaluation. Circadian propensity of hypoglycemia in these patients have been identified in the early morning hours of the day.

    Keywords: Anemia, Body mass index, Comorbidity, Diabetes Mellitus, Hypoglycemia, hypoglycemic episode, Insulin, Retinopathy
  • Yousef Moghaddasi Kouchaksaraei, Farshad Ghazalian, Saeid Abediankenari*, Khosro Ebrahim, Hossein Abednatanzi Pages 38-43
    Background

    Increasing prevalence of diabetes and its complications, including cardiovascular problems, increase the cost of health care. With proper planning to change lifestyle, like costs and complications of type 1 diabetes could be diminished. The present study investigated the effect of aerobic and resistance training on blood CRP level of type 1 diabetic patients as a protective marker on cardiovascular cells.

    Methods

    In this descriptive cross-sectional study, 32 patients with type 1 diabetes were divided into two groups of aerobic and resistance exercise training. Serum CRP levels were measured in all patients before and after exercise. Data were analyzed using Mann-Whitney, Bootstrap and SPSS tests.

    Results

    In this study, for abnormal data, Bootstrap method was used, which created an acceptable confidence interval. And using analysis of variance to control the effect of CRP (interfering) level before and after exercise was not significant (P=0.37).

    Conclusion

    Considering the relationship between exercise training with CRP level in type 1 diabetic patients specially in aerobic training group as well as CRP level according to the training program condition, it can be concluded that there is not effective relationship between this biomarker and exercise training in type 1 diabetic patients.

    Keywords: Type 1 diabetes, CRP protein, aerobic, resistance training
  • Kambiz Sheikhy, Ramin Rouhani*, Saviz Pejhan, Alireza Sanei Motlagh, Ali Sheikhy Pages 44-50
    Background

    Hydatidosis is one of the most critical worldwide parasitic zoonotic diseases. The lung is the second most common site of hydatidosis. This study aimed to evaluate the clinical status, diagnosis, treatment, and radiological findings of pulmonary hydatid cyst in patients referred to tertiary lung center.

    Methods

    From April 2014 to July 2019, patients referred to Masih Daneshvari University Medical Center with the impression of alveolar hydatidosis included. Demographic data of 304 patients were collected including clinical symptoms, laboratory studies, radiological findings, location of the lung involvement, and cyst characteristics. Also, surgical procedures, medical treatments, and post-operative complications were recorded.

    Results

    Pulmonary hydatidosis was confirmed for 234 patients. 55% of patients were males with the mean age of 45.1±16.6 years. The most common symptoms were cough (59.8%), dyspnea (31.1%), and hemoptysis (26%). Left lung, right lung, and bilateral involvement were reported in 40.1%, 55.1%, and 4.8% of cases, respectively. Cyst perforation (39.8%) was the most common intra-operative finding. Surgical interventions included thoracotomy, rigid bronchoscopy, cyst aspiration, and enucleation. The liver was the most concomitant organ involved due to pulmonary hydatidosis (16.6%). The most common postoperative complication was atelectasis, with the rate of 35.7%. 52.2% of patients were discharged within 10 days after surgery. No mortality was reported.

    Conclusion

    Sometimes atypical findings in different imaging modalities make the hydatid cyst diagnosis challenging. Although lobe involvement more than 50% has the indication for lobectomy, we conserved lobes with about 70% involvement in our institution, and patients had no postoperative complications.

    Keywords: Pulmonary hydatid cyst, Radiological findings, Treatment, Thoracic surgery
  • Fahimeh Naderi Behdani, Fatemeh Heydari, Shahram Ala*, Siavash Moradi, Saeid Abediankenari, Hosein Asgarirad, Elmira Khodabakhsh Pages 51-60
    Background

    Hyperglycemia is a common finding which is associated with increased mortality and morbidity among critically ill patients. There is currently no evidence that melatonin could improve stress induced hyperglycemia (SIH). In this study, we evaluated the effect of melatonin on blood sugar and insulin resistance (IR) in critically-ill patients.

    Methods

    104 critically-ill patients with SIH divided into two groups, receiving melatonin (6 mg BD for 3 days) or placebo. Changes of blood sugar, IR indices including homeostasis model assessment for insulin resistance and homeostasis model assessment adiponectin (HOMA-AD) ratios, Glasgow coma scale (GCS) were evaluated on the 4th day of melatonin prescription. On the 7Th day of study, changes of ventilator dependency and delirium were considered. Mortality and intensive care unit (ICU) stay were also compared between groups.

    Results

    On day 4, patients in the melatonin group had significantly lower blood glucose and HMOA-IR level compared with the placebo group (P=0.04 and P=0.03, respectively) whereas HOMA-AD level did not differ significantly from placebo group (p>0.2). Also, we did not observe any significant difference in GCS level at this time between groups (p>0.2). On day 7, melatonin could not improve ventilator dependency and delirium significantly (p>0.2) and also could not reduce mortality and ICU stay in comparison with placebo (p>0.2, P=0.2, respectively).

    Conclusion

    Melatonin supplementation showed positive effect on blood sugar and somehow insulin resistance whereas it could not improve ICU complications.

    Keywords: stress induced hyperglycemia, insulin resistance, Melatonin, APACHE II, ICU
  • Mohammadreza Rafati, Hossein Karami, Bita Lashtoo Aghaee, Bahareh Lashtoo Aghaee, Mojdeh Dabirian, Razieh Avan* Pages 61-69
    Background

    Beta-thalassemia major patients typically require chronic transfusion and iron-chelating agents to reduce serum iron overload. Osveral® is an available Iranian brand name of deferasirox used by majority of thalassemic patients. The aim of this study was to compare the efficacy of Osveral® vs. Exjade® in major beta- thalassemia patients.

    Methods

    In this randomized clinical trial, all patients received a single daily dose of 30 mg/kg either of Osveral® or Exjade® for 6 months. Primary outcome was the mean of bimonthly changes in serum ferritin concentration and secondary outcomes included mean changes of heart and liver MRI T2* after a year.

    Results

    Finally, 80 patients completed the study. The mean serum ferritin level at the end of sixth month significantly decreased in Osveral® and Exjade® groups (p<0.01). After a year, means cardiac MRI T2* in Osveral® group were changed from 25.9±9.6 ms to 25.4±9.7 ms and in Exjade® group from 24.8±9.2 ms to 26.9±5.9 ms, with no significant difference (P=0.43). Mean liver MRI T2* for Osveral® and Exjade® groups were 8.6±6.4 ms (baseline 6.3±4.7) and 6.3±4 ms (baseline 4.9±3.5), respectively and there was no significant difference between two study arms (P=0.1).

    Conclusion

    Osveral® decreased significantly the serum ferritin level and improved heart and liver iron overload as efficient as Exjade®. It can be a suitable cost-effective alternative agent in beta-thalassemia major patients.

    Keywords: Deferasirox, Osveral, Exjade, Ferritin, MRI T2*
  • Maryam Abolghasemi, Soleiman Mahjoub*, Sedighe Esmaeilzadeh Pages 70-75
    Background

    Evidence showed that abnormal alteration of adipokines level may perform a key role in polycystic ovary syndrome (PCOS) pathogenesis. Dipeptidyl peptidase-4 (DPP4) and progranulin (PGRN) are two novel adipokines related to insulin resistance (IR). Thus, we aimed to determine the serum DPP4 activity and PGRN level in PCOS patients with and without IR, and non-PCOS women.

    Methods

    Ninety women were recruited in the present study including 60 PCOS patients (divided into two groups of 30 IR and 30 non-IR) and 30 non-PCOS women. Serum levels of insulin, fasting blood glucose, PGRN, and DPP4 activity were measured, and IR indices were calculated.

    Results

    DPP4 activity was significantly higher in PCOS-IR and PCOS-NIR patients than non-PCOS women (p<0.001, P=0.011, respectively), whereas no significant variation was detected between two groups of PCOS subjects. There was no significant difference in the level of PGRN in the three groups of the present study.

    Conclusion

    The present study suggests that increasing DPP4 activity may be associated with PCOS.

    Keywords: Polycystic ovary syndrome, Dipeptidyl peptidase-4, Progranulin, Adipokine, Insulin resistance
  • Leili Sadeghi Amiri, Novin Nikbakhsh, Mostafa Javanian, Simin Mouodi*, Tahere Mousavi, Sedighe Alijanpour, Fattaneh Vala, Mostafa Mirzad, Javad Shokri Shirvani, Hoda Shirafkan Pages 78-83
    Background

    Unlike some regions of the world where digestive system cancers are not considered as important health problems, these neoplasms are among the most common malignancies in the northern region of Iran.

    Methods

    This observational analytical study was carried out based on data collected by the Cancer Registration Center affiliated to the Vice Chancellery for Health of Babol University of Medical Sciences, North of Iran, during 2008-2017. Crude incidence rate (CR), and age-standardized incidence rate (ASR) have been calculated for different GI cancers, based on the primary involved site; and have been compared in different years, patients' age, gender and place of residence.

    Results

    Totally, 4332 records were related to digestive system cancers. Mean age of patients was 63.48±14.73 years; men (2743; 63.3%) were more affected than women (1589; 36.7%) (p<0.001). The most incident malignancies of digestive system were from stomach, colorectal and esophagus in men; and colorectal, stomach and esophagus in women, respectively. These three cancers accounted for 3725 (85.98%) of total GI malignancies. The mean age of patients in various types of GI cancers was statistically different (p<0.001). Age- standardized incidence rate showed different values in different years; from 521.40 (95% CI: 462.79-580.00) in year 2016 to 1834.33 (95% CI: 1637.36-2031.29) in year 2008.

    Conclusion

    Gastric, esophageal and colorectal cancers were the most prevalent digestive system malignancies in Babol, North of Iran, and accounted for about 86% of all GI tract cancers. A considerable variation has been found in incident gastrointestinal cancers in different years.

    Keywords: Digestive System, Gastrointestinal Neoplasms, Incidence, Registries
  • Fatemeh Zahra Bagheri, Mahboobeh Azadehrah, Bizhan Shabankhani, Hooshang Akbari*, Ebrahim Nasiri Ferami Pages 84-89
    Background

    Misoprostol is a myometrial stimulant with uterotonic properties and can be administered rectally, vaginally, or sublingually. Numerous studies have investigated the effect of misoprostol on the prevention and treatment of PPH (postpartum hemorrhage) after vaginal delivery, but its use to control PPH during cesarean section has not been widely studied.

    Methods

    In this clinical trial study, 180 pregnant women who were candidates for cesarean section were included in the study. They were divided into 3 groups of 60 people (sublingual misoprostol group, rectal misoprostol group, control group). In all three groups, the volume of blood lost was recorded in the checklist at the end of surgery. Data were entered into SPSS software and analyzed.

    Results

    The mean bleeding in the control group was 225.4±63.9, while it was 137.9±33.8   and 118.9±28.5 in the sublingual misoprostol group and rectal misoprostol group, respectively. We had significantly more bleeding in the control group (p<0.001) compared to the other two groups.

    Conclusion

    These results confirm the positive effect of misoprostol in reducing bleeding and show the superiority of using rectal misoprostol compared to other methods of reducing bleeding during cesarean section.

    Keywords: misoprostol, rectal administration, sublingual administration, cesarean section, bleeding
  • Sara Assadpour, Javad Akhtari, MohammadReza Shiran* Pages 90-99
    Background

    Sumatriptan is a routine medication in the treatment of migraine and cluster headache that is generally given by oral or parental routes. However, a substantial proportion of patients suffer severe side effects. The aim of this study was to investigate the physicochemical characterization and pharmacokinetic parameters of a novel delivery system for sumatriptan succinate (SS) using nanoliposomes (NLs) coated by chitosan (CCLs) to optimize the formulations to enhance its bioavailability.

    Methods

    The new formulation was used to minimize drug particle size and extend its release and bioavailability. The mean particle size and entrapment efficiency for NLs and CCls were optimized and the formulations with better characteristics were chosen for in vivo studies. The concentration-time profile of intravenous SS, intranasal SS, SS-NLs, and CCLs were examined in a rabbit model.

    Results

    The results demonstrated that CCLs were absorbed more rapidly from nasal drops containing chitosan compared to those of SS and SS-NLs as indicated by a shorter tmax, and a higher Cmax in both states. A comparison of the AUC (0-240 min) values revealed that chitosan improved the extent of SS absorption for CCLs formulation. The results of the present study indicated that loading SS into the liposome and coating with chitosan improves drug absorption and a large amount of the drug can be efficiently delivered into the systemic circulation.

    Conclusion

    The liposomal and chitosan formulations of SS had better kinetic behavior than the soluble form in the animal model.

    Keywords: Chitosan, Nanoliposome, Sumatriptan succinate, Migraine, Bioavailability
  • Saba Alvand, Behnaz Aghaee, Zahra Momayez Sanat* Pages 100-106
    Background

    With the appearance of enhancing high-resolution manometry (HRM), realizing the difference of achalasia symptoms between classified groups by HRM is an outcome of interest in areas with remote access to this device.

    Methods

    All patients newly diagnosed with achalasia from January 2019 to March 2020 were enrolled in the study. All the patients were diagnosed via HRM after undergoing endoscopy to rule out pseudo-achalasia, and grouped based on the Chicago classification criteria and answered a questionnaire assessing relevant symptoms.

    Results

    We included 62 patients recently diagnosed with achalasia with a mean age of 53.66 in males (n=30), and 45.4 in females (n=32). Mean time of diagnosis was 24 months. Thirty-seven percent were in type I, 50% in type II, and 13% in type III. Dysphagia and weight loss were higher in type III, while all other relevant symptoms were higher in type II, none of which, however, was statistically significant. Weight loss was reversely associated with duration of symptoms (Spearman correlation= -0.3, P=0.01), and this reverse association was more prominent in females (Spearman correlation= -0.47, P=0.009), type III (Spearman correlation= -0.74, P=0.03), and in the first clinical stages (Spearman correlation= -0.55, P=0.04) in sub analysis.

    Conclusion

    Type II is the most common type of achalasia in this study. Unlike HRM classification, clinical manifestations alone cannot be used to group patients into different types. However, significant weight loss of the newly diagnosed subjects can become an indicator of on-time diagnosis of the patients.

    Keywords: Achalasia, Clinical characteristics, weight loss, Iran
  • Abbas Arj, Zeinab Ghaletakizadeh, Hamidreza Gilassi, Mohsen Razavizadeh* Pages 107-112
    Background

    The aim of this study was to evaluate the relationship between the long-term use of PPI and hypomagnesemia in patients with gastroesophageal reflux disease.

    Methods

    This case control study was conducted on GERD patients with long-term use of proton pump inhibitor and patients with no history of gastroesophageal reflux and proton pump inhibitor referring to gastrointestinal clinic in 2019. Then concentration of serum magnesium (Mg) and potassium (K) were measured using atomic absorption spectrophotometer according to protocol. Other data were extracted from medical records. Statistical tests such as t-test, chi-square test and ONE WAY ANOVA were used for analysis of data.

    Results

    In the current study, 263 patients were classified into two groups (case: 132, control: 131). The mean level of potassium in case and control groups was 3.92±0.64 and 4.20±0.43, respectively (P=0.001). Moreover, the mean level of Mg in two groups was 2.03±0.36 and 2.09±0.52, respectively (P=0.24). In addition, significant difference was seen between serum level of K, regarding the type of proton pump inhibitor and duration of medication use (p<0.01). However, no significant difference was seen between serum levels of Mg, regarding the type of proton pump inhibitor such as omeprazole, pantoprazole and other drugs (p>0.05).

    Conclusion

    Based on these results, long-term use of proton pump inhibitors is not associated with hypomagnesemia in GERD patients. However, long-term use of PPIs may reduce serum potassium levels in these patients. Therefore, periodic evaluation of serum Mg level in PPI-treated patients seems to be unnecessary.

    Keywords: Gastroesophageal reflux disease, Hypomagnesemia, Proton pump inhibitor
  • Sajad Shafiee, Saeed Ehteshami, Mahmoodd Moosazadeh, Saeed Aghapour, Kaveh Haddadi* Pages 113-121
    Background

    A constituent of diffuse axonal injury (DAI) is supposed to be present in about 1/3 of all severe traumatic brain injury (TBI) as specified by pathologic documents. Diffuse axonal injury is categorized by extensive injury to axons in the brain. A rise in the incidences of TBI, and the limited study to verified effect of drugs like amantadine and zolpidem in improving the consciousness levels of patients with acute traumatic brain injury with axonal injury enthused us to initiate this study in the acute TBI patients.

    Methods

    In our randomized, controlled trial involving patients with acute severe TBI, we studied 66 patients in 3 groups. Group 1 (n=22) received oral amantadine, Group 2 (n=22) received oral zolpidem, whereas group 3 (n=22) received placebo, the first 8 days after injury respectively. The primary outcome measures included GCS (Glashow coma scale) through the initial admission, a complete medical history was recorded, and each patient had a meticulous physical and neurological investigation.

    Results

    We found that the administration of amantadine in an acute phase after injury improved the rate of patients GCS and GOS (Glasgow Outcome Scale) compared with zolpidem and placebo groups, but without any significant statistical difference.

    Conclusion

    Our results has emphasized that because amantadine has intense biochemical effects on several ways, it appears to be beneficial in acute period after DAI-associated TBI.

    Keywords: Amantadine, Zolpidem, Traumatic Brain Injury, Diffuse axonal injury
  • Seyed Ali Dehghan Manshadi, Mojtaba Sedaghat, Fatemeh Mohammadhashem, Mohammadreza Salehi, Esmaeil Mohammadnejad, Arash Seifi*, Arezoo Salami Khaneshan Pages 122-126
    Background

    Proper hand hygiene is the most important action in preventing healthcare-associated infections (HCAIs). In this study, the knowledge and perception of hand hygiene assessed among nurses as the most exposed personnel to patients.

    Methods

    In this analytical cross-sectional study, the nurses working in different wards of a collegiate tertiary hospital in Tehran were investigated by standardized WHO questionnaires.

    Results

    Of the 101 participating nurses 89 (88.1%) were females. 81 (80.2%) had received formal related training. The 69 respondents estimated the mean prevalence of HCAI to be 38.91% and 98 (97.1%) considered hand hygiene an effective prevention in this regard. 78 (77.3%) perceived hand hygiene as the center priority; 82, 83 and 79 of participants would think that good hand hygiene matters for their superiors, colleagues and patients, respectively. The practice of hand hygiene was stated to be difficult by 48 (47.5%) respondents. There was no significant difference in self-reporting of hand hygiene practice among nurses in age (P=0.68), the degree of education (P=0.574), work experience (P=0.64), nor their wards (P=0.131). There was a significant reverse relationship with the supposed difficulty level of doing hand hygiene (P=0.049). The mean score of the nurses' knowledge was 66.53 (±9.41) based on the answers to the questions of the knowledge questionnaire.

    Conclusion

    Knowledge and perception of hand hygiene, as this study showed, might not to be satisfactory; therefore, planning to improve these indicators and regular monitoring using standard tools is necessary for all healthcare centers.

    Keywords: Hand hygiene, Knowledge, Perception, Cross infection
  • Samaneh Azizianesh, Fatema Rizvi, Hamed Zainaldain, Samira Alesaeidi* Pages 127-131
    Background

    IgG4-related disease is a newly recognized fibroinflammatory disease presenting with multiple features including mass forming lesion; a dense lymphoplasmacytic infiltrate; a characteristic histopathological appearance and often elevated serum of IgG4. This disease can potentially affect any organ and interestingly, the affected organs share common histopathological features including a dense lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells, storiform fibrosis, and mild to moderate eosinophilia

    Case Presentation

    A 45-year-old man presented complaining of proptosis and gradual decrease in visual acuity of right eye. He had undergone many work-ups but without any definitive diagnosis. Through a combination of clinical and para-clinical investigations, the diagnosis of IgG4-RD was established. 693 mg/dL). Aggressive treatment (pulse of cyclophosphamide and pulse of corticosteroid) was started hoping to save the patient’s vision. Two weeks following the treatment, there was improvement with his visual acuity and proptosis.

    Conclusion

    In any patient with chronic tumor like lesions and pseudotumors without the evidence of malignancy, we should think of IgG4-related disease. In this circumstance, biopsy may lead us to the definitive diagnosis. Early diagnosis and treatment of IgG4-RD may inhibit further irreversible organ damages.

    Keywords: IgG4-related disease, IgG4-related orbitopathy, visual acuity, Proptosis
  • Leila Kiani Markani, Fatemeh Kiani Markani, Maryam Kadivar, Elahe Safari*, Negar Hosseinaei Pages 132-135
    Background

    There are rare cases of breast metastasis from gastric carcinoma origin. In this regard, we presented a case of signet ring cell stomach cancer with metastasis to the breast.

    Case Presentation

    The case was a 44-year-old female with a history of gastric cancer and chief complaint of progressive bilateral and gradual breast enlargement and mass palpation 6 years after stomach surgery. An excisional biopsy of the right breast was performed at the early phase of her clinical symptoms with the pathology at the early phase of fibroadenoma and sclerosing adenosis. Given the persistent right breast thickening and enlargement, the ultrasonography and MRI together showed right breast large masses, ductal enhancement in left retro areolar space beside the bilaterally enlarged axillary lymph nodes after 6 months. In this phase, the core needle biopsy showed right breast mass adenocarcinoma consistently with metastatic gastric carcinoma and also core needle biopsy of both axillary lymph nodes indicating the involvement by tumor consistently with metastatic gastric carcinoma. In the IHC, breast tumor cells were negative for ER, PR, HER2/ neu, GATA3, GCDFP15 and CK20, but positive for CK7, CK19, and CDx2.

    Conclusion

    The diagnosis of breast metastasis of gastric carcinoma was confirmed according to the past history of patient, histological finding, and immune-histological markers.

    Keywords: Breast, gastric carcinoma, metastasis
  • Pezhman Hadinezhad, Hamzeh Hosseini* Pages 136-138
    Background

    Selective serotonin reuptake inhibitors (SSRIs) have proven more problematic in terms of some side effects than the original clinical trials suggested. Sertraline may displace warfarin from plasma proteins and may increase the prothrombin time. The aim of this study was to report a rare case of the sertraline- induced severe anal pain and rectal bleeding without concurrent of taking any other drugs including non-steroidal anti-inflammatory drugs (NSAIDs).

    Case Presentation

    Here we report a case of a 31-year old married man who referred to a psychiatrist with depressive disorder and started to take sertraline up to 400 mg daily, thereafter the patient reported severe anal pain and bleeding. Other etiologies of this side effect were evaluated with Naranjo evaluation scale and rolled out. The patient did not report any anal pain or bleeding after eight months of stopping sertraline.

    Conclusion

    Reported from sertraline, the psychiatrists must be more cautious when prescribing sertraline and monitor the patient properly for a long time to ensure these rare adverse effects and complic ations do not happen.

    Keywords: sertraline, bleeding, case reports