فهرست مطالب

Caspian Journal of Internal Medicine
Volume:13 Issue: 3, Summer 2022

  • تاریخ انتشار: 1401/05/01
  • تعداد عناوین: 25
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  • Maryam Masoumi, Alireza Sharifi, Sepideh Rezaei, Sima Rafiei, Hossein Hosseinifard, Saghar Khani, Maryam Doustmehraban, Mona Rajabi, Zahra Beiramy Chomalou, Parisa Soori, Akbar Javan Biparva, Afsaneh Dehnad, Fatemeh Pashazadeh Kan, Ahmad Ghashghaee* Pages 447-457
    Background

    Behcet’s disease is a chronic fatal illness with a relapsing remitting nature and significant organ-threatening morbidity and mortality. The aim of this research was to examine studies which were conducted on investigation of prevalence of quality of life among patients with Behcet’s disease.

    Methods

    A total of 13 articles were extracted from four main databases including PubMed, EMBASE, Scopus, and Web of Science from the onset of 2000 to January 2021. All studies published in English with the purpose of examining quality of life (QOL) among patients with BD or investigating its main determinants were included.

    Results

    Totally, 1137 BD patients participated in 13 studies. Based on random effect analysis, the total score of physical health-related QOL was 46.7 (95% CI=41.26 to 52.13) and the total score of mental health-related QOL was 49.01 (95% CI=43.83 to 54.18) representing a moderate level of QOL among BD patients. Furthermore, weighted effect size analyses showed a significant correlation between QOL and variables such as patients’ age, gender, disease duration and depression (pvalue: 0.00).

    Conclusion

    As the symptoms of BD worsen over time, patients confront with more severe body pain, mobility restrictions, and difficulties in chewing, eating, speaking and swallowing which negatively affect social interactions of patients and reduce their QOL. Furthermore, depression was proved to act as a deteriorating factor for HRQOL among BD patients. Thus, patients need to be psychologically supported by a specialized team and be informed during the course of treatment to gain useful information about the disease, treatment approaches and coping strategies.

    Keywords: Global, health-related quality of life, Behcet’s disease, systematic review
  • Mehrdad Rafati-Rahimzadeh, Mehravar Rafati-Rahimzadeh, Sohrab Kazemi, Seyedeh Roghieh Jafarian Amiri, Abbas Soleymani, AliAkbar Moghadamnia* Pages 458-468
    Background

    Amongst the chemical warfare agents, blistering (vesicant) agents can be significant materials. The most important agent in this group is sulfur mustard (mustard gas) which is known as “King of chemical warfare (CW) agents “. Exposure to this agent, seriously causes damages in several organs, such as the eyes. This article reviews the ophthalmological aspects of sulfur mustard with reference of its management.

    Methods

    A wide-ranging search in PubMed databases, Thomson Reuters and Scopus was done and different aspects of chemical properties of sulfur mustard, its mechanism of action and effects on eyes, clinical finding, diagnostic evaluation, initiate actions, pharmaceutical and surgical interventions was reported.

    Results

    Sulfur mustard can alkylate DNA and RNA strands and break down structures of protein and lipid of cell membrane. This may impair cell energy production, and leads to cell death. Exposure to sulfur mustard, therefore, causes such problems for organs, including irreversible damage to the eyes.

    Conclusion

    Understanding the mechanism of the sulfur mustard effect and the early training in prevention injuries will cause fewer complications and damage to organs, including the eyes. Washing the eyes with tap water or eyewash solutions, using mydriatic drops, anti- inflammatory drugs, matrix metalloproteinase inhibitors and antibiotics may help to the management of poisoning. Surgical interventions including tarsorrhaphy, amniotic membrane transplantation, stem cell transplantation and corneal transplantation could reduce the harm to the victims.

    Keywords: Sulfur Mustard, Mustard Gas, Blistering Agents, Alkylating, Keratoplasty, Tarsorrhaphy, Corneal Transplantation
  • Mehdi Zeinalizadeh, Roya Yazdani, MohammadMehdi Feizabadi, Maryam Shadkam, Arash Seifi, Seyed Ali Dehghan Manshadi, Alireza Abdollahi, Mohammadreza Salehi* Pages 469-474
    Background

    Post-neurosurgical meningitis is a significant cause of mortality and morbidity. In this study we aimed to compare the differences of clinical, laboratory features and outcomes between the post-neurosurgical meningitis caused by gram-negative bacilli (GNB) and gram-positive cocci (GPC).

    Methods

    Cases of post-neurosurgical meningitis (with positive CSF culture) were included. After classifying patients as GNB and GPC groups, clinical and paraclinical data were compared.

    Results

    Out of 2667 neurosurgical patients, CSF culture was positive in 45 patients. 25 (54.3%) were GNB, 19 (41.3%) GPC. The most common microorganisms were Klebsiella pneumoniae (n=14, 31.1%), Coagulase negative staphylococcus (n=8, 17.8%), Staphylococcus aureus (n=6, 13.3%), Acinetobacter baumannii (n=4, 8.9%), Pseudomonas aeruginosa (n=2, 4.4%), and Escherichia coli (n=2, 4.4%). There were no correlation between CSF Leakage, Surgical site appearance, presence of drain, Age and GCS between two groups (P=0.11, P=0.28, P=0.06, P=0.86, P=0.11 respectively). The only different laboratory indexes were ESR (86.8 mm/h vs. 59.5 mm/h, P=0.01) and PCT (13.1 ng/ml vs. 0.8 ng/ml, P=0.02) which were higher in GNB cases. 20% (n=5) of patients with GNB meningitis received preoperative corticosteroid, while none of GPC cases received (P=0.03). The median length of hospitalization for GNB and GPC cases was 56 and 44.4 days respectively (P=0.3).

    Conclusion

    The GNB antibiotic coverage should be designed more carefully in post-neurosurgical meningitis especially in patients with recent corticosteroid therapy and elevated ESR and procalcitonin.

    Keywords: Nosocomial Infections, Neurosurgery, Meningitis, Gram negative bacilli
  • Saeed Hakiminia, Zahra Esmaeeli, AliAkbar Moghadamnia, Seyyed GholamAli Jorsaraei, Farideh Feizi, Sorayya Khafri, Zahra Memariani, Hoda Shirafkan, Seyyed Ali Mozaffarpur* Pages 475-483
    Background

    Cassia fistula was used traditionally as laxative in pregnant women. Nevertheless, its fetal and maternal effects in pregnancy have not been studied yet.

    Methods

    Oral (Lethal Dose, 50%) LD50 was determined in mice. In addition, a control group, pregnant rats in other 5 experimental groups (n=12) received orally C. fistula aqueous extract (500, 1000 and 2000 mg/kg), tween80 (10%) and distilled water during pregnancy up to the delivery (21-23 days). Some serum indices were evaluated in maternal blood samples after delivery. Histopathologic and histomorphometric evaluations were performed on the selected slices of newborn rats.

    Results

    Anthraquinone‎ content of the aqueous extract was 0.34% w/w. Oral LD50 was obtained more than 5000mg/kg. No abortions and newborn anomalies were observed in groups. The height and weight of the offspring were significantly reduced by the administration of 500, and 2000 mg/kg of extract compared to control. There was no significant change in maternal blood urea and creatinine. Higher concentration (2000mg/kg) led to ALT elevation. ALS levels decreased dose-dependency in treatment groups comparing to control. Histopathological findings showed significant lung vascular congestion, and hypertrophy of heart in group tween80, and significant hepatic parenchymal inflammation in tween80 and 2000mg/kg and 1000mg/kg groups. In all tissues of all groups, malpighian body area and bowman’s capsule space significantly increased compared to the control group.

    Conclusion

    It seems C. fistula extract is safe in pregnancy. Because of confounding role of tween80 in histopathological finding, more research is necessary.

    Keywords: Laxatives, Pregnancy, Cassia, Herbal medicine, Teratogenesis, Persian Medicine
  • Saeideh Salehizadeh, Roghayeh Saeidi, MohammadAli Sahraian, Hossein Rezaei Aliabadi, Seyedeh Nafiseh Hashemi, Sharareh Sharareh, MohammadReza Gheini, Shaghayegh Shahmirzaei, Mahsa Owji, Abdorreza Naser Moghadasi* Pages 484-489
    Background

    The present study aimed to address the effect of Rituximab on the cognitive impairment in patients with secondary progressive MS (SPMS).

    Methods

    The present interventional study used a convenience sampling method to select the study participants from SPMS patients. All these patients had progressive disability over the last two years before being admitted in the study. Prior to the administration of Rituximab, the minimal assessment of cognitive function in the multiple sclerosis (MACFIMS) test was performed for each patient who was a candidate to be included in this study. This test was repeated by passing 6 and 12 months from the initial treatment with Rituximab. Since the data needed for this study were obtained at different time intervals, so a linear mixed model was used for their analysis. Analysis of variance (ANOVA) was also used to investigate whether time and sex generally affect the cognitive impairments in SPMS patients. A p-value <0.05 was considered as statistically significant in this study.

    Results

    Of the total 35 patients, 34% and 66% were men and women with a mean age of 41.33 and 41.39 years old, respectively. Rituximab showed a significant positive effect on a number of subgroups of MACFIMS test, including Controlled Oral Word Association Test (COWAT) (P-value: 0.038) and Brief Visuospatial Memory Test (BVMT-total) (P- value: 0.019).

    Conclusion

    The present study revealed that Rituximab has a positive effect on the cognitive impairment resulted from MS in secondary progressive patients.

    Keywords: Secondary Progressive Multiple Sclerosis (SPMS), Rituximab, MACFIMS, Cognitive impairment
  • Ali Shabestani Monfared, Ali Bijani, Khadijeh Tahmasebi, Mousa Yaminfirooz* Pages 490-497
    Background

    Considering the importance of internal medicine and the lack of sufficient scientometric data on the research status of the field in Iran, the study aimed at investigating the state of scientific output in the country compared to the countries in the world.

    Methods

    This applied research used a scientometric approach. The related MeSH-driven terms in "internal medicine" were selected as search phrases and searched in the SCImago database. SPSS and Excel software packages were used for statistical analysis. Geographical mapping was done with Google Maps for depicting country geographical distribution.

    Results

    Out of all 4,972,258 papers published by 230 countries worldwide in the field, about 60% belonged to the USA and Western European countries. These countries were at top of citation and self-citation counts as well as the h-index indicator. The citations per paper indicator were 27.1 and about 25.1% of total citations were self-citations. A significant positive correlation was found between the number of papers, citation count, and self-citation rate, and h-index in the field (p<0.001).

    Conclusion

    The research status of internal medicine in developed regions and countries was quantitatively and qualitatively better than that of developing countries, including Iran.

    Keywords: Internal medicine, Bibliometrics, Citation Analysis, Iran
  • Fatemeh Khansari*, Fariba Asghari, Sara Mortaz Hejri, Fatane Bathaie, Bagher Larijani Pages 498-510
    Background

    Bioethics is the foundation of medical practices, and can be applied in the different levels of medicine. In Iran, Medical Ethics started to be taught in the form of PhD course in Tehran University of Medical Sciences (TUMS) in 2007. Although many aspects of this plan are successfully implemented, some deficits also are frequently pointed out by many professors and students. The purpose of this study was to recognize the deficits and weaknesses of the current curriculum.

    Methods

    This study was a qualitative descriptive type which was conducted based on semi-structured deep interview with open questions. The sample population of this research was composed of faculty members in Medical Ethics department of TUMS, students and graduates of PhD in Medical Ethics and also, the experts who worked on codification of the initial curriculum.

    Results

    Overall, eleven individuals were interviewed. In general, “Practical application”, “Feeling the Need”, “Professional Doctorate”, “Human Sciences”, “Paramedical”, “Possible”, “Impossible”, “Defining the Discipline Nature”, “Student Attraction”, “Professor”, “Training”, “Evaluation Procedure”, “Student Admission”, “Educational Content”, “Teaching Method”, :Student Evaluation”, and “Course Management” were the main themes.

    Conclusion

    With regard to the deficiencies in Medical Ethics training and also, the problems identified through interviews, it seems that a great deal of problems are possible to solve if Medical Ethics is considered an interdisciplinary field instead a monodisciplinary one. One of the main purposes in interdisciplinary fields is investigating, analyzing and introducing measures for issues and problems that cannot be known and solved by a single discipline.

    Keywords: Ethics, Medical, Education, Curriculum
  • Maryam Nabati*, Ghasem Janbabai, Mohammadreza Najjarpor, Jamshid Yazdani Pages 511-518
    Background

    Cardiovascular disease is the main cause of death among breast cancer survivors. Several chemotherapy drugs may cause cardiovascular toxicity. Our study aimed to assess the late effects of chemotherapy on left ventricular (LV) systolic and diastolic function in a group of female breast cancer survivors.

    Methods

    Our study was a case-control study consisted of 60 breast cancer survivors who had undergone chemotherapy for more than 5 years and a control group of 49 women without breast cancer. All patients underwent echocardiography and left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), pulse-Doppler early transmitral peak flow velocity (E wave), early diastolic (e'), and left atrial (LA) diameter were calculated.

    Results

    The mean LVEF and GLS were reduced in chemotherapy group (51.63±7.93% vs. 55.37±3.50%, P=0.002 and -17.99±3.27% vs. -19.25±2.27%, P=0.025). Also, the chemotherapy group had a larger left ventricular end-systolic internal diameter than the control group (1.74±0.44cm/m2 vs. 1.58±0.22cm/m2, P= 0.011). Logistic regression analysis showed among the different cardiovascular risk factors, chemotherapy had an association with decreasing LVEF.

    Conclusion

    Breast cancer survivors might have an excess risk of having subclinical LV dysfunction over time. These findings present the potential benefits of echocardiographic assessment in breast cancer survivors.

    Keywords: cancer, cardiotoxicity, chemotherapy, left ventricular dysfunction, strain
  • Behrang Motamed, Mahsa Kohansal Vajargah, Saeed Kalantari, Afshin Shafaghi* Pages 519-526
    Background

    NAFLD is one of the most common liver diseases in the world. HOMA-IR as an indicator of insulin resistance is commonly used in clinical trials in NAFLD patients. The aim of this study was to evaluate the application of HOMA-IR index in the diagnosis of NAFLD.

    Methods

    This study was performed on 54 patients with NAFLD and 54 non-NAFLD patients that referred to Razi Hospital in Rasht during 2019-2020. FibroScan was used to diagnose NAFLD in the patient group and ultrasound was used to rule it out in the control group. Metabolic and hepatic parameters were measured for each patient. Data were entered into SPSS 22 software and the necessary analyses were performed.

    Results

    The mean age of the subjects in the study was 44.01±13.12 years and ranged from 18 to 75 years. 72.2% of people affected by NAFLD were men (p <0.001) .The optimal cut-off point for HOMA-IR in NAFLD was 1.65 with a sensitivity of 89.7% and a specificity of 76.9% in men and 1.90 with a sensitivity of 86.7% and a specificity of 82.9% in women. Overall, the optimal cut-off point for HOMA-IR in NAFLD was 1.75 with a sensitivity of 87.0% and a specificity of 81.5%. In addition, the results showed that there was no significant relationship between steatosis and hepatic fibrosis with HOMA-IR index.

    Conclusion

    The results showed that HOMA-IR can be used as a reliable criterion for early detection of NAFLD.

    Keywords: NAFLD, HOMA-IR, insulin resistance, FibroScan, BMI
  • Mohammadreza Ardalan, Ali Safaei, Audrey Tolouian, Ramin Tolouian, Vahideh Ebrahimzadeh-Attari*, Mahsa Jalili Pages 527-532
    Background

    Beyond the adverse effects of hyperphosphatemia in patients with chronic kidney disease (CKD(, hypophosphatemia has also been proposed as a common challenge after dialysis. Therefore, the present study aimed to evaluate the serum phosphate level immediately after hemodialysis (HD) and its association with some clinical complications in CKD patients.

    Methods

    The present cross-sectional study was conducted on 54 eligible CKD patients undergoing regular hemodialysis. Blood samples were taken, prior to the start and immediately after the end of hemodialysis to determine the serum levels of urea, creatinine, sodium, potassium, phosphorus, PTH, blood sugar and albumin. Moreover, the clinical complications of patients including muscle cramps, nausea, vomiting, headache, confusion, weakness and inability to speak are assessed by a questionnaire, before and after HD.

    Results

    As we expected, the mean of serum creatinine, urea and phosphate levels significantly decreased after dialysis. Post-dialysis hypophosphatemia was graded as mild (3.5 > P ≥ 2.5 mg/dl), moderate (2.5 > P ≥ 1 mg/dl), and severe (<1 mg/dl) based on serum phosphate levels. The frequency of mild and moderate hypophosphatemia was 39.2% and 45.1 %, respectively. None of the participants had severe hypophosphatemia and 13.7% had normal phosphate levels. There was a significant correlation between post-dialysis hypophosphatemia and incidence of nausea and confusion after adjusting for confounding factors.

    Conclusion

    To our knowledge, this is the first time that the possible association of some of the post-dialysis clinical complications with hypophosphatemia was investigated. Future large-scale studies are required to confirm the association of post-dialysis hypophosphatemia with clinical complications.

    Keywords: Dialysis, Hypophosphatemia, Nausea, Chronic kidney disease
  • MohammadReza Hatamnejad, Hamed Bazrafshan*, Morteza Hosseinpour, Peyman Izad Panah, MohammadReza Kasravi, Mehdi Bazrafshan Pages 533-545
    Background

    Ventricular repolarization measurement by QTc interval and QT dispersion can recognize high-risk patients. Previous research tended to evaluate the act of repolarization indicators alone but this study aimed to elucidate their prognostic utility before and after modifying confounding parameters in risk stratification of different aspects of prognosis in decompensated heart failure patients with systolic dysfunction.

    Methods

    Data of 98 variables were evaluated to determine their predictive value concerning arrhythmic events, in-hospital, and long-term mortality.

    Results

    From 858 cases that presented with acute heart failure, 19.2% (n=165) were enrolled in the study. During hospitalization, arrhythmic events and cardiac-related mortality occurred in 56(33.9%) and 11(7%) patients, respectively. QTc and QT dispersion were independent predictors of arrhythmia and in-hospital mortality after adjustment of the variables (arrhythmic events: QTc interval OR 1.085, P=0.007, QT dispersion OR 1.077, P=0.007, in-hospital mortality: QTc interval OR 1.116, P=0.009, QT dispersion OR 1.067, P=0.011). After being discharged, they were tracked for 181 ± 56 days. Within the 16 deaths in follow-up time, 6 sudden cardiac deaths were documented. Cox regression, defined QTc as the predictor of all-cause and sudden death mortality (all-cause: HR 1.041, 95% CI 1.015-1.067, P=0.002; sudden death: HR 1.063, 95% CI 1.023-1.105, P=0.002); nevertheless, efforts to demonstrate QT dispersion as the predictor failed.

    Conclusion

    The predictive nature of QT parameters was significant after modification of the variables; therefore, they should be measured for risk stratification of ventricular repolarization arrhythmia and death in decompensated heart failure patients.

    Keywords: Prognostic value, QT parameters, Decompensated heart failure, ventricular systolic dysfunction
  • Mina Alvandipour, MohammadYasin Karami*, Mahmood Azadfar, Jamshid Yazdanicharati Pages 546-554
    Background

    Fecal incontinence is the main morbidity of inter-sphincteric resection (ISR) in ultra-low rectal cancer. Malone Ante grade Continence Enema (MACE) has been proposed for these patients. We aimed to compare the quality of life outcomes in cases with ultra-low rectal cancer who had undergone ISR±MACE.

    Methods

    The current randomized clinical study was accomplished for two years from December 2016 to February 2018 in Imam Khomeini Hospital (Sari City, I.R.Iran) on 30 patients (15 in each group) with rectal cancer. The inclusion criteria of the study were stage 1 and 2a of low rectal cancer with type 2 and 3 of Rullier's classification, those who received neoadjuvant chemo radiotherapy. The exclusion criteria were comorbidity diseases, immune deficiency, poor follow-up. The follow-up period was one year. The Quality of Life (Qol) was reported as primary endpoint. The EORTC QLQ-C30 score and Wexner questionnaires were used. SPSS Version 22 was used. A p-value less than 0.05 was considered statistically significant.

    Results

    The mean age of patients was 56.23±8.72 years. The overall Qol score was better in the ISR-MACE (P=0.023). The overall Qol was lower in women than in men in both groups. Low anterior resection syndrome score was lower in the ISR plus MACE group than the ISR group (P=0.030). The Wexner score revealed better scores in the ISR with MACE group than the ISR without MACE group (p<0.0001).

    Conclusion

    Patients who underwent ISR plus MACE surgery had better defecation control and better quality of life than patients without MACE.

    Keywords: Inter-sphincteric Resection, Rectal Cancer, Quality of Life
  • Bita Rabbani, Hossein Chiti*, Faranak Sharifi, Saeedeh Mazloomzadeh Pages 555-566
    Background

    Lifestyle modifications, especially improving nutritional patterns and increasing physical activity are the most important factors in preventing obesity and metabolic syndrome in children and adolescents. For this purpose, the following interventional study was designed to investigate the effects of educational programs for students, as well as the changes in diet and physical activity on obesity and components of the metabolic syndrome.

    Methods

    This study is part of an interventional research project (elementary school) conducted on all students of Sama schools in Zanjan and Abhar in three levels;elementary, middle and high school, including 1000 individuals in Zanjan (intervention group) and 1000 individuals (control group) in Abhar in 2011. Interventions were based on educating students, teachers and parents, changes in food services and physical activity. We primarily measured anthropometric indices, fasting blood sugar, lipid profiles and blood pressure and completed standard nutrition and physical activity questionnaires. Also, blood insulin levels were randomly measured in a number of students. Data analysis was done by SPSS software Version 16.0.

    Results

    Overall, 589 individuals (252 males, 337 females) entered the case group and 803 individuals (344 males, 459 females) entered the control group. After two years of intervention, the mean waist circumference (63.8±10.9) and diastolic BP (63.8±10.4) were significantly lower, however, the mean systolic BP (10.1.0±12.5), food score (25.0±5.0) and drinking score (12.1±2.3) were higher in the intervention group (p<0.001). Comparing the components of metabolic syndrome between the second year and at the time of recruitment within the intervention group, showed that although the number of overweight/obese individuals, individuals with hypertriglyceridemia and high LDL increased, while those with abdominal obesity, high BP, hyperglycemia, and insulin resistance decreased (p<0.001). On the other hand, in the control group, the number of individuals with high BP increased significantly.

    Conclusion

    The prevalence of abdominal obesity and hypertension, which are the two major components of metabolic syndrome, are much higher in our study than the other regions of the country. However, interventions for modification of diet and increasing physical activity, are effective in lowering of their prevalence.

    Keywords: Metabolic syndrome, Physical activity, Attitude, Life style, Nutrition, Elementary school
  • Shahriar Nikpour, Mohammad Salehi, Sina Homaee*, Farnaz Saberian, Saeid Kalbasi Pages 567-574
    Background

    Various ways of treating H.pylori infection are reported, such as triple-therapy and quadruple therapy for two weeks. Some side effects have been seen during these treatments, besides Helicobacter pylori becoming resistant to these antibiotics easily. According to some studies, there is a relationship between metformin and reduction in Helicobacter pylori infection. Thus, in this study, we determine the effects of metformin on Helicobacter pylori infection.

    Methods

    We performed this assessment in a randomized, case-controlled way in the diagnosis of Helicobacter pylori infected outpatients and inpatients. In both groups (case group and control group), patients took two tablets for a two-week period. In the case group, the patients were given two metformin tablets (each containing 500mg of metformin (extended release) and in the control group, they were given two placebo tablets (each containing 500mg of white flour). We took h.pylori Ag stool test and rapid urease test to confirm the presence of Helicobacter pylori infection.

    Results

    In this study, at first all the patients had positive h.pylori Ag stool test or positive rapid urease test. At the end of this study, the results of h.pylori Ag stool*- test presented that Helicobacter pylori infection was negative in 82.7% of the case group patients and 76% of control group patients which illustrates suppression of Helicobacter pylori infection. However, comparing to the control group (P=0.36), this difference was not statistically remarkable.

    Conclusion

    According to these findings, it is stated that having metformin along with prescribed antibiotics can help decrease Helicobacter pylori infection.

    Keywords: Helicobacter Pylori eradication, metformin, Helicobacter Pylori infection
  • Samad Ghodrati, Mohammad Memarian, Shohreh Alian Samakkhah, Masoud Asadi Khiavi, Aiyoub Pezeshgi* Pages 575-581
    Background

    Mustard is one of the most destructive chemical gases used in chemical warfare. Several studies showed effectiveness of inhaled morphine as a secondary treatment for the improvement of dyspnea. Therefore, this study aimed at determining the efficacy of low dose inhaled morphine for respiratory function improvement in patients who were exposed to the mustard gas.

    Methods

    This study was designed as a cross-over double-blinded clinical trial. Patients exposed to mustard gas were randomly assigned into two groups: 1) received 0.4 mg of morphine by inhalation and 2) received 5 ml of normal saline serum as a placebo in the same manner. After a washout period of one week, the first group received the placebo and the second group received morphine for 5 days. Spirometric indices, expiratory flow peak, exercise test, severity of dyspnea, and quality of life were evaluated as respiratory function parameters. Data analysis was done using SPSS software Version 16.

    Results

    The mean maximum expiratory flow was significantly higher among cases who used morphine in comparison with the placebo group (p<0.05). Moreover, the severity of dyspnea, quality of life, and the frequency of coughing during the day were significantly improved among the recipients of morphine (p<0.05) while the spirometric indices and exercise tolerance tests were similar between the two groups (p>0.05), but the mean peak expiratory flow (PEFR) was significantly higher among the patients receiving morphine than the placebo patients (p<0.001).

    Conclusion

    The use of inhaled morphine had a significant positive effect on the respiratory system of people exposed to mustard gas. We can use low doses of inhaled morphine to improve the respiratory function of these patients as a secondary therapy.

    Keywords: Dyspnea, Mustard gas, Morphine, Quality of life
  • Seyyedeh Fatemeh Langari, Seyed Reza Hosseini, Ali Bijani, Niloofar Jenabian, Mina Motalebnejad, Elham Mahmoodi, Zahra Sadat Madani, Fatemeh Sayadi, Mohammadmehdi Naghibi Sistani, Reza Ghadimi, Fateme Baladi, Mohammad Hajimirzamohammad, Mahsa Mehryari, Atena Shirzad* Pages 582-588
    Background

    Hypertension is one of the most common chronic diseases in the world. The prevalence of hypertension in the elderly is increasing. Patients with high blood pressure have to take medication throughout their lives. In this study, the relationship between antihypertensive drugs and oral health-related quality of life in the elderly was evaluated.

    Methods

    This modified cross-sectional study, which is the part of the second phase of the Amirkola Health and Ageing Project (AHAP), was performed on 900 elderly people. Participants included 300 people with hypertension under medical treatment, 300 people with hypertension without medication and 300 people with normal blood pressure. All patients’ blood pressure was recorded, and the standard xerostomia questionnaire and GOHAI questionnaire (Geriatric Oral Health Assessment Index) was completed for all participants. Then, the obtained data were analyzed by SPSS 17, whereby student’s t-test, ANOVA and chi square, Pearson correlation coefficient and logistic regression model were used. A p<0.05 was considered statistically significant.

    Results

    The mean GOHAI score in the three studied groups: hypertensive under medication treatment, hypertensive without medication treatment and normal blood pressure (51.1±7.4, 51.7±7.3, 51.1±7.5, respectively) did not differ significantly (P=0.533).The frequency of xerostomia was significantly different in the three groups (P=0.008). Among the antihypertensive drugs, the highest rate of xerostomia was due to the use of calcium channel blockers (31.1%) and diuretics (26.8%).

    Conclusion

    In our study, although antihypertensive medications were associated with xerostomia, they did not decrease the oral health-related quality of life.

    Keywords: quality of life, xerostomia, elderly, anti hypertensive drugs
  • Raziehsadat Mousavi, Ghahraman Mahmoudi, MohammadAli Jahani*, Hossein Ali Nikbakht Pages 589-598
    Background

    Prerequisite for achieving the goals of the registration program is the existence of valid and accurate data, and the usability of this data is possible if they are coded correctly. This study assets the quality of pathological data of the population-based cancer registration centers based on ICD-O-3.

    Methods

    This applied study was performed descriptively and retrospectively. The study population included 20129 pathology reports sent to the population-based cancer registration center of Mazandaran Province during 2018-2020. A total of 2015 out of, 2050 samples of the received reports were examined according to stratified random sampling method. A researcher checklist was made to collect the data, and STATA 13 and Cohen's Kappa agreement coefficient were used to analyze the data.

    Results

    Among the 2015 reports of pathology, 1114 (55.3%) pathology reports were related to government centers, (42.9%) 865 cases were registered with their topographic code, morphology and behavior. Based on the registration of the exact topographic code, the kappa coefficient and the total agreement were 0.266 and 27.70%, respectively. Kappa coefficient in all received reports and reports with topographic code was 0.346 and 0.906, respectively. In the reports with topographic code, the most reports of cancers were related to cancers of the gastrointestinal organs (97.6%) 246.

    Conclusion

    The accuracy of the codes given in the pathology centers in terms of topographic, morphological, behavioral and grade codes based on the percentage of agreement with the coding was above average, which were higher in governmental centers and also in some cancers.

    Keywords: Neoplasms, Grade, Assessment, Accuracy, Reliability
  • Moge Hajiesmaeil, Samaneh Mirzaei Dahka, Ruin Khorami, Samira Rastgoo, Fatemeh Bourbour, Sayed Hossein Davoodi, Fatemeh Shafiee, Maryam Gholamalizade, Saheb Abbas Torki, Mohammadesmail Akbari, Saeid Doaei* Pages 599-606
    Background

    The risk of cervical cancer was reported to be influenced by dietary components. This study aimed to illustrate the association between cervical cancer with the intake of food groups in women with a history of cervical neoplasia.

    Methods

    This nested case-control study was conducted in 558 people with a history of cervical intraepithelial neoplasia (CIN), including 279 women with cervical cancers and 279 controls with low-grade squamous intraepithelial lesions (LSIL). A validated food frequency questionnaire (FFQ) was used to assess the intake of food groups.

    Results

    The intake of fruits and vegetables in the case group was significantly lower than the control group (P=0.001). Low intake of dairy products, vegetables, and fruits was associated with cervical cancer risk (OR=4.67; 95% CI 1.2-9.49, P=0.001; OR=9.75, 95% CI 1.36-19. 51, P=0.001; and OR=4.82, 95% CI 1.09-7.25, P=0.001, respectively). After adjusting for age, family history, age at first menstruation, number of children, history of vaginal infection, and age at first sexual intercourse, the results were still significant. Additional adjustments to BMI did not change the results.

    Conclusion

    The results indicate that the risk of cervical cancer can be affected by the intake of certain food groups. Further longitudinal studies are needed to confirm these findings and determine the underlying mechanism of the influence of dietary components on cervical cancer risk.

    Keywords: cervical cancer, cervical intraepithelial neoplasia, dietary intake, food groups
  • Majid Eydi-Baygi, Abdolaziz Aflakseir*, Mehdi Imani, MohammadAli Goodarzi, MohammadHossein Harirchian Pages 607-616
    Background

    MS is a demyelinating disease that can result in significant disability. Along with physical complications, this disease is associated with significant psychological complications, including cognitive decline. Therefore, this study aimed to determine the efficacy of mindfulness-based cognitive therapy in combination with rTMS on information processing and working memory in patients with MS.

    Methods

    The current study used a single-case experimental design and included a follow-up (A-B-A). The statistical population of the present study was all MS patients in Tehran who referred to Imam Khomeini Hospital in Tehran in 2020. The present study sample consisted of 5 MS patients selected by the sampling methods available. Subjects were assessed three times before, during, and after the intervention using the Zahlen-Verbindongs and n-back tests in the two-back position. Subjects received cognitive therapy based on mindfulness and rTMS at a frequency of 10 Hz. Visual and graphical recovery percentage and effect size methods were used to analyze the data.

    Results

    The current study's findings indicate that combining mindfulness with rTMS has a beneficial effect on the information processing and working memory of MS patients. Overall, 67.24% recovered following the intervention stage, 53.64% recovered following the follow-up for information processing, 104.04% recovered following the intervention stage, and 76.98% recovered following the follow-up for working memory.

    Conclusion

    The study shows the effect of mindfulness combined with rTMS on cognitive problems in MS patients. Significant improvements in MS patients' information processing, working memory, and therapeutic outcomes were observed throughout the follow-up period

    Keywords: Mindfulness-Based Cognitive Therapy, Repetitive Transracial Magnetic Stimulation, Information Processing, Working Memory, MS Patients
  • Sajjad Daneshyar, Masoud Ghiasian*, Sahar Moradi, Elham Khanlarzadeh Pages 617-622
    Background

    Juvenile myoclonic epilepsy (JME) is one of the most important types of generalized idiopathic epilepsy. Patients generally respond quickly and perfectly to standard antiepileptic drugs but lifelong medication is necessary. Sodium valproate is the drug of choice in most references but it has some adverse reactions and some patients cannot tolerate the complications. Because of the need for life long treatment in this young aged group particularly child bearing women, we aimed to analyze the efficacy of these drugs to determine which has better efficacy with lower adverse effects.

    Methods

    In this double-blind clinical trial 102 patients suffering from juvenile myoclonic epilepsy were randomly divided to three groups and treated with valproate, levetiracetam or lamotrigine and followed for 12 months at specified intervals.

    Results

    Patients' mean age was 22.8 years and 28.4% of them were males and 71.6% were females. Effective terminal dose of sodium valproate, levetiracetam and lamotrigine were 1000, 1000 and 250mg, respectively. The rate of failure in controlling seizures and myoclonic jerks in lamotrigine group was meaningfully more than levetiracetam and sodium valproate (P=0.037).The general side effects of sodium valproate were much more; but there was not any significant difference between their effects on electroencephalogram (EEG) findings (P=0.81).

    Conclusion

    Levetiracetam and sodium valproate have similar efficacy. But in the group of lamotrigine, rate of failure, myoclonus and drug adverse reactions were meaningfully more than sodium valproate and levetiracetam. According to our study, lamotrigine could not be a suitable treatment option for JME patients as a mono therapy. Levetiracetam can be a good alternative to sodium valproate, especially in women of childbearing age

    Keywords: Sodium valproate, levetiracetam, lamotrigine, juvenile myoclonicepilepsy
  • Masoud Pezeshki Rad, Bita Abbasi, Niloufar Valizadeh, Farbod Hatami, Fariba Tohidinezhad, Zahra Gharehbaghi* Pages 623-633
    Background

    The normal range of kidney size is a controversial issue among different populations given to its impressibility by multiple factors, therefore, this study aimed to provide valid reference ranges for kidney dimensions in the adult population of Mashhad. Also, we assessed the association of kidney size characteristics with some personal predisposing factors.

    Methods

    This cross-sectional study was conducted on 938 healthy individuals. Ultrasound measurement, physical examination, and laboratory analysis were performed. Demographic, dietary, and anthropometric data were obtained. The variables were categorized into 5 groups each, and data analysis were performed using the following statistical tests: Pearson correlation test, variance analysis, t-test, and chi-square test. A value of p<0.05 was considered statistically significant.

    Results

    Weight had the most association with kidney size followed to a lesser extent by height and age. Even after adjustment for other confounding variables, weight remained as an independent factor, while this effect was resolved for height and age. Also, all values for renal function, body bio-impedance, blood pressure components, and water intake were notably correlated with kidney size.

    Conclusion

    This study determined the normal kidney size in healthy adults. We also declared the normal range of kidney size is a dynamic concept and should be assessed for each individual separately according to their personal determinative factors.

    Keywords: kidney Size, Ultrasound, Anthropometric characteristics, renal function
  • Sahar Montazeri, Asghar Aghaei*, Mohsen Golparvar Pages 634-638
    Background

    Patients with chronic diseases such as multiple sclerosis (MS) suffer more from psychiatric consequences than others, and their quality of life may be drastically affected, causing syndromes like depression and anxiety. Mindfulness-integrated cognitive behavioral therapy (Mi-CBT) seems to improve stress coping strategies in chronically ill patients, but its effectiveness has been little studied in MS. So, in this study, we aimed to assess its effectiveness on stress coping strategies in women suffering from MS in Mazandaran province, Iran.

    Methods

    In this semi-experimental study, we selected 40 women with MS who had been referred to a neurologist in Mazandaran province, Iran during the year 2016 by convenient sampling and randomly assigned to the Mi-CBT and control group with a one-to-one ratio. Patients in the intervention group were under treatment for eight 120-minutes session, while the control group only stayed on the waiting list. After obtaining the ethics committee’s approval (IR.IAU.CHALUS.REC.1397.018) and patient’s informed consent, both groups underwent a pre-test assessment with a stress status questionnaire developed by Endler and Parker in 1988. The same assessment was done for both groups two times more, one after compilation of all sessions, and one 45 days later. Repeated measures analysis of variance was done using SPSS Version 24 software.

    Results

    There was a difference between intervention and the control group for avoidance-oriented, and problem-oriented stress coping strategies (p<0.01), but there was not a significant difference for emotion-oriented strategy between groups (P=0.22).

    Conclusion

    MiCBT is effective in improving stress coping strategies in women with MS, and overall mental health.

    Keywords: Multiple sclerosis, mindfulness, women, cognitive-behavior therapy, stress coping strategies
  • Abhishek Singhai*, Rishabh Bose, Piyush Manoria Pages 639-641
    Background

    Iron deficiency is the most common cause of anemia in many developing countries including India. Inadequate iron in diet, poor iron absorption, excessive bleeding, or chronic blood loss in the stool/ urine may be the cause. Cameron lesions are mucosa injuries of gastric body or fundus in the background of hiatal hernia.

    Case Presentation

    Here we describe a case report of a 50-year-old female who presented to hospital with pain in abdomen. During laboratory workup she had severe anemia due to iron deficiency. Esophagogastroduodenoscopy revealed a large hiatal hernia with a superficial ulcer present in the hiatal pouch, the GE junction being 35 cm from the incisors. So, a hiatus hernia with a Cameron ulcer was identified as the culprit of iron deficiency anemia.

    Conclusion

    The diagnosis of a Cameron lesion is difficult and sometimes ignored. In patients with anemia/bleeding, thorough surveillance of all stomach folds is essential, especially if a significant hiatal hernia is present.

    Keywords: Hiatal hernia, endoscopy, bleeding, anemia
  • Abrar-Ahmad Zulfiqar* Pages 642-645
    Background

    Giant cell arteritis (GCA) is a vasculitis of the large and medium-sized arteries in the elderly whose ischemic complications adversely affect the eye. The irreversible loss of visual acuity is most often related to acute anterior ischemic optic neuropathy. Very few cases of scleritis have been described in the literature.

    Case Presentation

    The patient presented an obvious case of giant cell arteritis, initially revealed by an ophthalmologic involvement in the form of posterior scleritis, an ear, nose, and throat (ENT) involvement with vestibular and neurological involvement with a type of peripheral neuropathy, all evolving in the context of a weight loss of 8 kg and a marked biological inflammatory syndrome. The patient presented several relapses of giant cell arteritis in the form of several episodes of anterior and posterior, right and left, and even bilateral, isolated scleritis without any other clinical or biological abnormalities, always in conjunction with a decrease in corticosteroid therapy. In the presence of corticosteroid dependence and resistance to methotrexate, tocilizumab was initiated.

    Conclusion

    The therapeutic management of scleritis associated with giant cell arteritis is difficult. In the absence of a codified scheme, the treatment remains empirical, based on the experience of the various teams. In this context, biotherapies (anti-IL6 type, such as tocilizumab) are increasingly used.

    Keywords: Giant Cell Arteritis, scleritis, association
  • Ghassen Gader*, Chaden Fakhfakh, Alia Zehani, Sabeur Thamlaoui, Ihsèn Zammel, Mouna Rkhami, Mohamed Badri Pages 646-649
    Background

    Intracranial inflammatory pseudotumors (IIPT) are one of the differential diagnosis for the central nervous system (CNS) tumors. They represent a rare condition that may mimic clinically and radiologically intracranial tumors and induce their complications. Among their etiologies, neurosarcoidosis is one of the less known and less frequent. To the best of our knowledge, only two cases of posterior fossa IIPT have been reported in the literature. We present here the 3rd case related to a neurosarcoidosis.

    Case presentation

    We report the case of a 55-year-old female patient who presented with an altered state of consciousness associated to severe intracranial hypertension syndrome for four months. Glasgow coma scale on admission was 14/15. Brain imaging revealed bilateral cerebellar micronodular meningeal enhancement regarding the mesencephalon and the pons, as well as a nodular lesion of the 4th ventricle causing a triventricular acute hydrocephalus. The patient had a ventriculo-peritoneal shunt with a favorable outcome. Afterwards, she underwent a salivary gland biopsy which confirmed the diagnosis of neurosarcoidosis.

    Conclusion

    Posterior fossa IIPT are very rare, mainly when located in the posterior fossa, leading to confusion with other pathologies. MRI has an important role in the diagnosis of these lesions, and the determination of their etiology. It shows other than the IIPT itself, many other signs such as leptomeningeal enhancement, nodular lesions or pituitary stalk thickening. These signs can orientate towards the diagnosis. Treatment may associate to symptomatic approach, corticosteroids. Surgical resection may be proposed when the diagnosis remains doubtful.

    Keywords: Posterior Fossa, Sarcoidosis, Hydrocephalus