Caspian Journal of Internal Medicine
Volume:13 Issue: 2, Spring 2022

We aimed to compare the efficacy of local injection therapies for lateral epicondylitis in a Bayesian framework.

We searched the Embase, PubMed, Cochrane Central Register of Controlled Trials, Web of Science, Scopus, and ProQuest, for randomized controlled trials published from inception to February 2021 in any languages. The injection therapies included corticosteroids (CSs), autologous blood (AB), botulinum toxin (BT), and platelet-rich plasma (PRP). Placebo was the reference group for comparison. The study outcomes were pain, function, and strength, at 1, 3 and 6 months after injection.

Thirty-one trials were finally included in this network meta-analysis, comprising 1,948 patients. In the first month of treatment, CS and BT were more efficacious than placebo in terms of pain reduction, and CS was superior to BT. In the same follow-up time, CS was also superior to placebo in terms of functional improvement. In the third month of treatment, BT was the only intervention that was more efficient than placebo in pain relief. With regard to functional improvement, none of the treatments significantly had a higher effectiveness than placebo in the same period. Moreover, no therapies were found to be more efficient than placebo in the sixth month of treatment in terms of any study outcomes. In addition, we did not identify an intervention superior to placebo regarding strength improvement outcome in any times of follow-up.

CSs and BT are efficient in improving clinical outcomes of lateral epicondylitis in the short term. Also, the efficacy of CSs seems to be greater than BT. On the other hand, AB and PRP were not significantly more efficient than placebo in any times of follow-up.

 The predictive power of obesity measures varies according to the presence of coexistent measures. The present study aimed to determine the predictive power of combinations of obesity measures for diabetes by calculation of a linear risk score.

 Data from a population-based cross-sectional study of 994 representative samples of Iranian adults in Babol, Iran were analyzed. Measures of obesity including waist circumference (WC), body mass index (BMI), waist–to–height ratio (WHtR), and waist to hip ratio (WHR) were calculated, and diabetes was diagnosed by fasting blood sugar >126 mg/dl or taking antidiabetic medication. Multiple logistic regression model was used to develop a logit risk score based on BMI, WC, WHtR, and WHR. The ROC analysis was applied to determine the priority of every single index and combined logit score for the prediction of diabetes.

 All four measures of general and abdominal obesity were predictors of diabetes individually in both sexes (P=0.0001). Calculation of risk score for a combination of all measures use full model improved predictive power. Adjustment for age resulted in further improvement in diagnostic power and combined novel risk score differentiated individuals with and without diabetes with an accuracy of 0.747 (95%CI: 0.690-0.808) in men and 0.789 (95%CI: 0.740, 0.837) in women.

These findings indicate that the simultaneous calculation of age-adjusted risk score for all measures provides stronger diagnostic accuracy in both sexes. This issue suggests the calculation of combined risk scores for all obesity indices especially in a population at borderline risk.

Depression as a frequent comorbidity in patients with diabetes requires serious attention, as failure to early detect and treat it can adversely affect the patients' complications. This study was performed to assess the prevalence of depression and quality of life in these patients.

This cross-sectional study was carried-out on adult patients with type 2 diabetes mellitus referred to the endocrinology hospital clinics affiliated to Babol University of Medical Sciences, Babol, Iran, during 2018-2019. The presence and severity of depressive symptoms in patients have been assessed by Beck Depression Inventory-II; and the quality of life was measured by SF-36 questionnaire.

Totally, 400 patients with type 2 diabetes mellitus (300 females and 100 males) with mean age of 55.36±11.56 years were recruited. One hundred and thirty (32.5%) had depressive symptoms. Of the patients with depression, 115 (28.8%) had mild and 15 (3.8%) had moderate depression. After entering different variables in logistic regression analysis, gender (P=0.036) and ophthalmic complications (P=0.011) showed a significant association with depressive symptoms. The patients with depression had a worse quality of life compared to those who had not depressive symptoms. Quality of life score in patients with depression was significantly lower than patients without depression (p<0.0001).

Nearly one third of the patients with type II diabetes mellitus might have depression. Diabetic patients with depression have a worse quality of life compared to those who have not depression symptoms.

The northern coastal regions of Iran are endemic for leptospirosis which may range from a subclinical illness to a progressively fatal disease. There has been growing evidence that inflammatory markers play a significant role in the severity and prognosis of leptospirosis. This study aimed to investigate inflammatory cytokines in patients with leptospirosis.

This descriptive-analytical prospective study was performed in 75 patients over 18 years old who had a positive microscopic agglutination test (MAT) titer from January to June 2019. SPSS software Version 20 was used for statistical analysis and the significance level was considered as p<0.05.

The patients’ age enrolled in this study are from 21 to 75 years with a mean and standard deviation of 48.6 ± 14.0. The male to female ratio in our participants was 54/21. Fever was the most common symptoms in 66 (88.0%) patients, followed by myalgia in 62 (82.7%) cases. The level of interleukin 10 was significantly higher in severe illness (P=0.003) and fatal cases (p<0.028) compared with recovered patients. The level of TNF-α level was also higher in the severe illness and Weil's syndrome compared with the mild kind (P=0.022).

Our results showed that the levels of TNF-α and IL-10 significantly increased in severe leptospirosis. Also, IL-10 was significantly higher in fatal cases. The inhibition of IL-10 production might play an important role in decreasing the risk of fatal outcomes in leptospirosis.

Radiodermatitis is the most common complication of radiotherapy. There is no gold standard for managing the radiodermatitis. This study aimed to evaluate the effect of topical Recove® burn ointment; basically compounded of sesame oil, camphor, and zinc oxide; in preventing acute radiodermatitis.

This double blind RCT (IRCT No.: 201204047136N2) was performed on 71 patients that referred for radiotherapy after mastectomy to Shahid Rajaee Hospital (Babolsar-Iran) during 2013-2017. Patients were allocated into 2 groups; 34 in control group and 37 in Recove® group. Patients applied the ointment 2 times a day, before every radiation therapy session for 5 weeks. The radiation oncologist assessed the severity of dermatitis weekly for 5 weeks and graded it from 0 to 4 according to the RTOG criteria.

Baseline characteristics including age, and BMI had no significant difference between groups. The Recover group patients experienced significantly less severe dermatitis compared to the controls (p<0.001). None of the patients in Recove® group encountered more than grade 2 of RTOG criteria, however, in the control group, 4 (12.9%)patients experienced grade 3 of RTOG and 3 (9.7%)patients developed grade 4 of RTOG at the end of the 5th week.

Our results indicate that Recove® ointment significantly reduces the severity of acute radiodermatitis.

Chemotherapy inducing nausea and vomiting (CINV) is one of the significant   side  effects of anti-cancer treatment, and its full prevention is a potential challenge. This study was done to specify the effect of olanzapine in this setting.

In this randomized, double-blind, clinical trial study, olanzapine was compared with a placebo in combination with dexamethasone and granisetrone in patients with cancer. Patients in the intervention group received dexamethasone , granisetron and olanzapine. Patients in the control group received a placebo instead of olanzapine. Overall, acute nausea and vomiting prevention were the primary and secondary end points; complete response (no nausea,no vomiting) in the delayed period of chemotherapy was the third end point. Response to treatment was evaluated by the Functional Living Index Emesis (FLIE) questionnaire completion in the first, the third and the fifth of chemotherapy.

  Percentage reduction in mean±SD nausea and vomiting in the overall phase (0-120 hours) of intervention group compared to the control group respectively were 29.94±2.06, 69.75±2.32 [(57.93% reduction (p<0.001)]. For the acute phase (0-24 hours) were 26.08±2.36, 51.85±2.24 [(47.21% reduction  (p<0.001)], for the delayed phase (24-120 hours), were 31.26±2.57, 67.91±2.12 ,[(55.11% reduction;(p<0.001)] respectively.

Olanzapine, along with dexamethasone and granisetron, significantly reduced vomiting and nausea in patients undergoing chemotherapy. No adverse event of olanzapine was observed in the patients.

Inflammatory bowel disease (IBD) is a broad term that refers to a group of chronic inflammatory disorders that have an unknown origin and might be associated with other diseases. The aim of this study was to determine the frequency of chronic diseases in patients with IBD.

In this case-control study, 280 patients with IBD were compared with 280 healthy individuals, frequency-matched by age, sex, place of residence and marital status. Random sampling was performed in patients that referred to the internal medicine and gastroenterology wards of hospitals affiliated to Babol University of Medical Sciences. Data collection tools included a demographic questionnaire and a checklist for chronic diseases, which were completed through interviews with the case and control groups.

Two hundred and twenty-nine (81.78%) patients with IBD had at least one chronic disease. Patients with IBD were at increased risks of rheumatoid arthritis (OR= 4.48, 95%CI: 1.48, 13.54, P= 0.008), eye diseases (OR= 3.49, 95%CI: 1.68, 7.28, P= 0.001), liver diseases (OR= 2.74, 95%CI: 1.40, 5.34, P= 0.003 ), anemia (OR = 2.53, 95%CI: 1.56, 4.13, P= 0.000), depression (OR= 2.43, 95%CI: 1.58, 3.74, P= 0.000), skin diseases (OR= 2.36, 95%CI: 1.18, 4.74, P= 0.015) and hypertension (OR= 1.77, 95%CI: 1.06, 2.95, P= 0.028).

  The frequency of chronic diseases associated with IBD has been high, therefore, physicians and health care professionals should consider the possibility of other chronic diseases when dealing with IBD patients.

Chronic idiopathic thrombocytopenic purpura (ITP), is an autoimmune disease associated with a reduction in circulating blood platelets under 150x109/L which persists longer than 6 months without any specific cause. With the current study, we aimed to evaluate the efficacy and safety of laparoscopic splenectomy in ITP patients with a very low platelet count and normal coagulation status.

From April 2007 to January 2012, laparoscopic splenectomy was performed on 60 patients with chronic ITP who could not achieve a sustained recovery after steroid therapy.

Patients consisted of male/female ratio of 24 (40%):36 (60%) with the mean age of 53±15.1 years. All patients had normal coagulation state even with very low platelet count (below 5×103) before laparoscopic splenectomy. The mean operative time was 140.00±15.00 minutes. Blood transfusion was required in 10 (16.7%) and 8 (13.3%) patients before and after the operation, respectively. Preoperative transfusion of PRBC was not statistically significant between groups (P=0.265). Bleeding complications during within or after surgery was rare (5.0%). Convalescence was rapid and the mean hospital stay was 3.58±0.68 days (1-14 days) which shows that there was no significant difference in operative time and after operative hospitalization time among the three groups (P=0.070). The patients made a good uneventful recovery and were followed for at least one week who exhibited no postoperative problems.

Laparoscopic splenectomy should be considered initially in the management of ITP. Also, very low platelet count should not be contraindicated for laparoscopic splenectomy in ITP patients and sometimes perioperative platelet transfusion may be unnecessary.

The treatment for ineligible transplant multiple myeloma is melphalan prednisone. Curcumin has an anti-inflammatory and antiangiogenesis in cancer-directed to nuclear factor-kappa B (NF-kB) pathway. Interleukin 6 (IL-6), vascular endothelial growth factor  (VEGF), tumor necrosis factor-alpha (TNF-α), C-reactive protein (CRP), and lactate dehydrogenase (LDH) were also involved in the pathogenesis of myeloma. No clinical study has evaluated the efficacy of curcumin in myeloma patients.To evaluate the efficacy of curcumin as adjuvant into melphalan prednisone in myeloma patients

33 myeloma patients at Dr. Kariadi General Hospital, Semarang, Indonesia during 2016-2017 were randomly assigned single-blindedly into MPC (n=17) and control group (n=16). The MPC group was treated with melphalan 4 mg/m2, prednisone 40 mg/m2 for 7 days, and curcumin 8 gram daily for 28 days. The MP control group was treated with melphalan, prednisone, and placebo. The primary endpoint was the overall remission.  Pre- and post-treatment was examined for NF-κB, VEGF, TNF-α, IL-6, LDH, and  CRP levels All data analyses were per protocol.

There was a significant difference in overall remission between the MPC and MP control groups [75%vs 33.3%, x2=6.89, P=0.009]. A significant decrease of NF-κB, VEGF, TNF-α levels were shown in the MPC group compared with the MP control group. There was a significant decrease in IL-6 levels in a subgroup analysis of the MPC group. TNF-α levels had a significant correlation with remission [OR=1.35; (95%CI=1.03-1.76); P=0.03]. 

Curcumin has an efficacy in improving overall remission and decreasing NF-κB, VEGF, TNF-α, and IL-6 levels in myeloma patients.

Retinopathy of prematurity (ROP) is a vasoproliferative retinal disease in premature infants that causes lifetime visual impairment and blindness in the early ages. In this study, we investigated the differences in the values of clinical laboratory parameters between different ROP and its remission/progression statuses regarding stages and zones.

This historical cohort study includes 828 infants divided into two groups after the first examination containing ROP infants and controls. The biochemical and hematological parameters of the two groups have been collected from the patient’s history.

In infants with ROP, the hematopoiesis-related parameters, including the mean level of hemoglobin, total bilirubin, potassium, calcium were significantly less than controls (P =0.039, P =0.001, P =0.001, and P=0.046, respectively). The percentages of reticulocyte and the levels of BUN in ROP patients were significantly higher than in normal infants (P=0.015 and p <0.001, respectively). Moreover, the levels of hemoglobin and BUN were significantly different in the different zones of ROP (P=0.017 and P=0.001, respectively). Also, higher hemoglobin levels, total bilirubin, and CRP were observed in the reduced stages of ROP (P=0.041, P=0.045, and P=0.039, respectively).

Laboratory parameters are different in different stages, zones and remission/progression ROP infants.

Recurrence of endometrial polyp following the hysteroscopic polypectomy is a significant concern for both the patients and physicians. This study aimed to evaluate the efficacy of combining hysteroscopic polypectomy with endometrial resection in reducing the rate of recurrence in women over 40 years old.

In a single-blinded clinical trial, 94 women with endometrial polyps who were unwilling to future pregnancy were identified and randomly allocated to the intervention (hysteroscopic‎ polypectomy + endometrial resection) ‎and control group (hysteroscopic‎ polypectomy alone) group (n=47/each). Randomization was done using a simple randomization technique‎. The primary outcome measure was the polyp recurrence. The secondary outcome measure was the number of adverse events.

In total, polyp recurrence occurred in two (4.3%) patients of the intervention group and nine patients (19.1%) of the control group (P=0.019). All the recurrences occurred in the premenopausal patients (P=0.012). No adverse event was observed in any patients of both groups.

Adding endometrial resection to hysteroscopic polypectomy, especially in postmenopausal women, is a safe method that significantly reduces the risk of recurrence of the endometrial polyp.

Helicobacter pylori infection can be a risk factor for non-cardia gastric cancer. In the present study, we aimed to assess the rate of Helicobacter pylori infection, its virulence factor and precancerous lesion among over 50 years old, dyspeptic patients with normal endoscopy.

A total of 620 patients over 50 years of age with dyspepsia that referred to Shahid Sadoughi Hospital, Yazd, Iran from December 2018 to January 2019 were evaluated. One hundred fifty patients with normal appearance endoscopy were selected, and six gastric biopsy specimens were taken from each subject. Data were analyzed using chi-square and logistic regression tests.

A total of 150 patients with mean age of 65.8±11.9 years old participated in this study. Sixty-three (42%) patients were males. Thirty-four (22.6%) patients had precancerous lesions. Ninety (60%) patients had positive PCR results for H. pylori. H. pylori infection test was positive in 24 (70.6%) patients with precancerous lesion. Sixty-six (57%) patients without the precancerous lesions (116 cases) were positive for H. pylori.

There was no a significant difference in the rate of H. pylori infection and its genotype distribution was between patients with and without the precancerous lesions.

The aim of the present study was to compare the six-month results in terms of prolapse symptoms in postmenopausal patients with advanced pelvic prolapse (POP) who underwent LeFort colpocleisis surgery or with pessary placement.

In this prospective cohort study, 110 older women were enrolled from April 2016 to January 2018. The women were diagnosed with stage III or higher genital prolapse according to the POP quantification (POP-Q) system. The patients were divided into two groups: surgical (LeFort colpocleisis surgery; n=55) and non-surgical (pessary placement, n=55). The study population underwent LeFort colpocleisis surgery or pessary placement in two university clinics (Beheshti or Alzahra Hospitals). All patients completed the Pelvic Floor Distress Inventory Questionnaire-20 (PFDI-20). The main short-term outcome measurement (six months) was the manifestation of a pelvic prolapse in the groups.

The patients had a mean age of 68.98±8.79 years in the non-surgical group and 64.76±7.04 years in the surgical group. The analytic results showed a significant difference between the two groups (P=0.006). After treatment, the prolapse symptoms improved in both groups (p<0.001). However, the total PFDI-20 score did not show any significant differences at the end of the six-month follow- up (P=0.19).

Both strategies (pessary placement or LeFort colpocleisis surgery) provide a short-term option for the treatment of older women with stage III or higher POP. The findings of this study could assist with treatment options and allow better guidance for older patients with symptomatic POP in the treatment decision process.

Brain injury is one of the complications of open heart surgery. Glutamate plays a key role in this process. In this study, we evaluated the neuroprotective effect of memantine as NMDAR inhibitor in patients undergoing on-pump coronary artery bypass graft surgery (CABG).

From July 2019 to May 2020, thirty-four consecutive patients selected for elective isolated on-pump coronary artery bypass graft surgery (CABG) enrolled in the trial. Patients were randomly assigned into two groups; memantine and the control group. For the memantine group, 10 mg of memantine twice daily was administered at least 72 h before surgery. Venous blood samples were collected before surgery (T1), at the end of cardiopulmonary bypass (CPB) (T2), 6h and 24h after CPB (T3 and T4). Serum concentration of S100-B was measured by enzyme-linked immunosorbent assay (ELISA) technique.

Serum S100-B increased during CPB with a peak plasma concentration at the termination of CPB. Then it gradually decreased during the first 24 hours in both groups (P=0.001). The mean S100-B levels were significantly lower in the memantine group compared to the control group at the termination of CPB (0.863±0.203 μg/l vs 1.117±0.304 μg/l), at 6 hours post-CPB (0.731±0.168 μg/l vs 0.938±0.206 μg/l), and 24 hours post-CPB (0.595±0.189 μg/l vs 0.852±0.227 μg/l), respectively (P=0.023). The mean level of serum S100-B in memantine group was about 0.19 μg/l less than the control group during the study (CI, 0.07 to 0.30; P=0.001). One (6.2%) patient in the control group had post-operative left arm paresthesia

Administration of memantine before on-pump CABG can attenuate the post-operative concentrations of serum S100-B, which may reduce cerebral damage during surgery.

Low back pain is one of the most common causes of referral to physicians. Lumbar disc degeneration (LDD) is the main cause of back pain in different countries. It seems that genetic factors are more effective than environmental factors in the developing of degenerative phenomena. The aim of this investigation, therefore, was to study the association of the aggrecan gene (ACAN) variable number tandem repeat (VNTR) and the vitamin D receptor (VDR) rs731236 (TaqI) polymorphisms, with lumbar intervertebral disc degeneration in a population in the North of Iran.

In this study, 55 patients with symptomatic intervertebral disk degeneration and 55 control subjects were included. VDR gene polymorphism was genotyped by PCR-based RFLP. The isolated DNA was used to genotype the VNTR of ACAN gene via conventional PCR.

For VDR gene polymorphism, the CC genotype (OR=5.337, P=0.019) was significantly higher among the patients compared with the controls, revealing a higher frequency of the C allele in patients compared with controls (OR=2.707, P=0.005). The lower number of frequent repetitions in the VNTR aggrecan gene was associated with a six-time increase of lumbar disc degeneration. Also, high BMI can be considered as an independent factor in the incidence of this disease.

Aggrecan gene VNTR polymorphism had an association with degeneration of lumbar intervertebral discs that the shorter VNTR repeats increasing the chance of the disc degeneration in this population in the North of Iran. Moreover, an association between the mutant allele (C) of VDR gene TaqI polymorphism and disc degeneration is found.

Preventing dependency is a public health objective. We want to evaluate the ability of the “Zulfiqar Frailty Scale” (ZFS) tool to detect frailty as defined by Fried's criteria among a group of patients aged 75 and older.

Prospective study conducted in Poitou-Charentes (France) for 12 months on patients aged 75 and over and considered autonomous in terms of the ADL scale. To be eligible, the patients could not reside in a nursing home and needed an ADL score of 4 or higher.

Among the group of 200 patients (with a mean age of 81.4 years, +/- 4.82), the prevalence of frailty according to Fried's criteria was 32.5%. The prevalence of frailty according to the “Zulfiqar Frailty Scale” tool was 35.0% and all items except home confinement were significantly associated with frailty. With this tool, the threshold for identifying frailty was 3 out of 6 criteria. It was quick (average completion time of 2 minutes and 2 seconds) with a sensitivity score of 88.0% and a negative predictive value of 91.0%.

The “Zulfiqar Frailty Scale” tool measures frailty just as effectively as Fried’s criteria, with sensitivity and negative predictive values no lower than the latter.

Historical evidence revealed that alcoholic beverages have been produced, used and abused thousands of years before the discovery of alcohol by Rhazes for medical purposes. Alcohol-induced liver disease (e.g., steatosis, steatohepatitis, fibrosis and cirrhosis) is one of the most prevalent causes of chronic liver disease all over the world. This study aims to find the early report of this complication in an ancient Persian historical text.

In this study, the book of Minooye Kherad, a Zoroastrian manuscript on wisdom which was written in the late Sassanid Empire (224–637 CE) is reviewed.

However, the concept of alcohol hepatotoxicity as one of the most important complications of alcoholism is a new terminology, by researching historical documents it can be found that one of the oldest reports of benefits and disadvantages of drinking wine focusing on liver complications is mentioned in the book of Minooye.

Description of the liver disease and damage caused by excessive alcohol consumption in this valuable book can be considered as the early report of hepatotoxicity of alcoholic beverages in the medical history.

Respiratory failure secondary to bilateral diabetic phrenic neuropathy is an uncommon clinical scenario. It is challenging to treat and often results in the need for long-term respiratory support.

We report a patient with long standing diabetes mellitus (DM) who presented with respiratory failure requiring mechanical ventilation. He was subsequently found to have reduced phrenic nerve and diaphragm compound action potential amplitude bilaterally on nerve conduction studies.

Diabetic patients with unexplained shortness of breath should raise suspicion for diaphragmatic paresis from phrenic neuropathy.

Bone scintigraphy with 99mTc labeled radiopharmaceuticals is a valuable method in nuclear medicine for assessing the bony structure. In clinical setting, bone scintigraphy is accomplished after the injection of 99mTc labeled diphosphonate complexes into a peripheral vein. Inadvertent intra-arterial injection on the antecubital region may cause a special form of artifacts leading to problems inaccurately interpreting these studies as functional images.

We present a 44-year-old man with history of chest wall pain for bone scintigraphy as part of a work-up for determining the pain source. The patient received an injection of 740MBq 99mTc-methylene diphosphonate (MDP) into a blood vessel at the right forearm. Two hours later, an increased uptake of activity was observed on the right forearm and ulnar half of the wrist-hand in the whole body and spot images. The scan findings were consistent with the anatomical and physiological expectations of the ulnar arterial perfusion range. This case displays that an incidental injection with a 99mTc labeled diphosphonate into the ulnar artery results in a hot ulnar half of the palm and ulnar-sided three digits, because these areas are directly exposed to radiopharmaceutical, therefore more radiopharmaceutical is deposited.

It is important for the physician, and especially for the nuclear medicine technician, to know the specific appearance created in the bone scan due to such an event so that they do not make a diagnostic mistake.

Goodpasture syndrome (GPS) rarely affects parturients which may quickly result in severe pulmonary and renal damage with significant fetomaternal morbidity.

A 35-year-old white multiparous lady, presented with acute progressive respiratory failure at 32th gestational age. She had fever, cough, severe dyspnea and lately hemoptysis and severe hypoxia with bilateral alveolar opacity in chest imaging, with no response to broad spectrum antibiotic. GPS diagnosis was confirmed by high anti- glomerular basement membrane (anti GBM) titer, without the similar history in the past parities. High dose intravenous methylprednisolone ended to dramatic clinical response. She was maintained on glucocorticoids for five weeks before the successful delivery of a live healthy fetus at 39 Weeks.

This study demonstrated a successful pregnancy outcome which was achieved in the present GPS parturient with a careful antepartum care involving maternal-fetal status by serial pulmonary, renal monitoring and special treatment of disease.