مجله پزشکی بالینی ابن سینا
سال سی‌ام شماره 4 (پیاپی 110، زمستان 1402)

Extracorporeal shockwave lithotripsy (ESWL) is mong the the low-risk treatment methods of treating kidney stones. Specialists are looking for ways to remove small stones caused by ESWL in patients as soon as possible. The present study aimed to determine the effect of isosorbide on the duration of renal pelvis excretion after ESWL.

In this clinical trial, 176 patients with renal pelvis < 20 mm, who were referred to the ESWL Department of Moradi Hospital, Rafsanjan, Iran, in 2019, were examined. After lithotripsy, the patients were randomly assigned into two intervention groups of receivers of isosorbide 20 mg tablets every 12 hours for two weeks and placebo control for two weeks. The collected data was analyzed using Mann-Whitney and Kruskal-Wallis statistical tests.

The success of ESWL was 78.2% in the isosorbide group and 77.5% in the placebo group (P=0.919). The average duration of stone excretion in the isosorbide group was 4.21 ± 1.05 days, and the placebo group was 4.79 ± 1.16 (P=0.001). In the isosorbide group, the duration of stone excretion in patients with stone size 16-20 mm was less than 16 mm (P=0.011). The average duration of stone excretion in patients 36-55 years old (P=0.021) and patients with right-sided stones (P=0.008) in the isosorbide group was less than the placebo group.

Isosorbide, accompanied by other treatments, reduced the duration of stone excretion after ESWL. Moreover, although Isosorbide can be used to improve the management of patients with kidney stones, more studies are needed to confirm this finding.

Considering the role of oxidative stress in the pathogenesis of ischemic stroke, antioxidant and anti-inflammatory drugs can be a potential treatment in these patients. This study aimed to investigate the effectiveness of doxycycline on the improvement of oxidative stress biomarkers in patients with ischemic stroke.

This clinical trial study was performed on 48 patients with ischemic stroke who had referred to Besat Hospital in Hamadan, Iran, in 2023. They were randomly and equally assigned to the intervention (doxycycline at the rate of 100 mg every 12 hours) and placebo groups for one week. Before and after the intervention, serum levels of malondialdehyde (MDA), glutathione (GSH), total oxidant status, total antioxidant capacity, c-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were measured.

The study groups had no statistically significant difference in all measured biomarkers in the first 24 h after the stroke (P>0.05). In both study groups, the biomarkers of MDA and total oxidant status decreased after treatment. This decrease was greater in the intervention group, compared to the placebo group with a statistically significant difference. The total antioxidant capacity and GSH increased in both groups, and this increase was more significant in the intervention group, compared to the placebo group. In both groups, serum levels of CRP and ESR decreased, but no statistically significant difference was observed between the two groups.

Addition of doxycycline to the standard treatment of ischemic stroke patients may reduce oxidative stress biomarkers; however, to confirm the results of this study, studies with a larger sample size are needed.

Vitamins play a crucial role in cellular growth, function, and evolution. Additionally, they contribute significantly to pathogen defense through cellular responses and immune enhancement. Cobalamin has been identified to play a role in suppressing virus replication, generating anti-inflammatory responses, and boosting immunity in infected patients with COVID-19. Therefore, we hypothesized that the low cobalamin levels are associated with a predisposition to severe COVID-19 infection. The present study aimed to investigate the relationship between cobalamin levels and disease severity and prognosis in COVID-19 patients.

This cross-sectional study included 117 COVID-19 patients hospitalized at Sina Hospital and categorized them into three groups based on their disease severity: mild to moderate, severe, and critical. Demographic information and clinical findings of the patients were recorded. Serum cobalamin levels were assessed using biochemical methods. Logistic regression and Receiver Operating Characteristic (ROC) analyses were employed for mortality prediction based on serum cobalamin levels.

The results revealed that patients with low cobalamin levels are more susceptible to severe COVID-19 infections. Furthermore, with each additional day of hospitalization, the mortality rate due to COVID-19 increased by 24%. The high area under the ROC curve (0.837) indicated that mortality in COVID-19 patients can be effectively predicted based on cobalamin levels.

It appears that cobalamin supplementation may have positive effects on COVID-19 patients’ outcomes. Additionally, serum cobalamin levels serve as a valuable indicator for predicting the mortality rate in COVID-19 patients. However, comprehensive, longer-term studies with a larger number of patients are required.

One of the most important steps in the treatment of patients with mediastinal lymphadenopathy is the definitive diagnosis using tissue sampling of the intra-mediastinal lesion. Mediastinoscopy is one of the methods used for this purpose. In this regard, this study aims to investigate the role of mediastinoscopy in determining the cause of mediastinal lymphadenopathy in patients referred to Shahid Beheshti Hospital in Babol, Iran.

This cross-sectional study was conducted on 36 patients with mediastinal lymphadenopathy who were admitted to Shahid Beheshti Hospital in Babol (April 2009-March 2020) and underwent mediastinoscopy. Recorded medical information of all patients without known lung cancer under mediastinoscopy was reviewed. Mediastinoscopy was performed by a specialist doctor for all patients and the biopsy sample was sent to Shahid Beheshti Hospital Pathology for final diagnosis. Descriptive data were analyzed using SPSS25 software at a significance level of 0.05.

The mean age of the patients was 47.97±11.04 years (range: 28-76 years). The majority of patients were women (n=27; 75.00%). According to the pathology results, the final diagnosis for 33 people (91.67%) was benign, and 3 people (8.33%) were diagnosed with malignant. The most common pathology result was sarcoidosis with 23 cases (63.90%), active infection in 4 cases (11.11%), and squamous cell carcinoma in 3 cases (8.33%). Other benign results were reported with the frequency of one case (78.2%). Pathology findings had no significant relationship with the age and gender of patients (P<0.05).

Based on the findings of the study, it can be concluded that mediastinoscopy can help determine the causes of mediastinal lymphadenopathy and it is still a reliable method for examining mediastinal lesions.

The measurement of renal size is of utmost importance in patients with renal failure, especially azotemia. The present study aimed to assess and compare kidney size using ultrasonography and computed tomography (CT) scans.

This cross-sectional study was conducted on subjects over 18 years of age who were referred to Hajar Hospital of Shahrekord for an ultrasound and CT scan of the kidney or abdomen with a time interval of less than one week. Kidney dimensions were measured by transabdominal ultrasound model Mindray DC-60Exp with 2-5 MHz probe in supine position and oblique if needed. After less than a week, the dimensions of the kidneys were determined by a Siemens 16-slice CT scan machine (with reconstruction at different stages). Data were analyzed in SPSS software using statistical tests.

Right and left kidney dimensions using ultrasonography were obtained at 103.46±13.53 and 107.44±12.15 mm, respectively. These dimensions were 103.10±15.76 and 108.81±14.77 mm, respectively, using a CT scan. The agreement between the ultrasonography and CT scan in determining right and left kidney dimensions was higher than 95% in 96.7% and 95% of all cases, respectively. Sensitivity, specificity, false positive value, negative-positive value, positive predictive value, and negative predictive value for right kidneys were reported as 82.4%, 92.6%, 7.4%, 17.6%, 73.7%, and 95.4% using ultrasonography. These values for the left kidney were 88, 88.6, 11.4, 11, 45.8, and 98.5%, respectively.

Regarding the importance of kidney size in determining renal failure, it seems that in some cases, reliance on ultrasonography is unclear, and it is recommended that kidney size be determined using a CT scan in patients with suspected kidney failure

Self-immolation is a terrible method of suicide. Coping skills are important protective measures against suicide. In this regard, the present study aimed to investigate the coping styles of people committing self-immolation and their relationship with demographic characteristics and burn indices.

This cross-sectional study was performed on people who attempted self-immolation and were admitted to the burn center of Imam Reza Hospital in Mashhad, Iran between 20 February 2018 and 20 February 2020. They filled Jalowiec coping styles questionnaire after their informed consent was obtained. The styles that received the highest score were considered their dominant coping styles. Moreover, the relationships of dominant styles with other variables were investigated.

In total, 44 samples were collected, 32 of which were females (72.7%). The mean age of participants in this study was 30.2 ± 13.1 years. Furthermore, the dominant coping style of most of the participants (47.7%) was emotive. Besides, males used emotive coping style more significantly than females (P=0.05). In addition, a negative significant correlation was found between age and emotive coping style (P=0.02, r= -0.35).

According to the results, young males who engaged in self-immolation used emotive coping style more significantly, compared to others. It seems that by teaching healthy coping skills to people at risk, the occurrence

Cardiovascular diseases and nonalcoholic fatty liver disease are the most common non-communicable diseases in most developed countries, and due to lifestyle changes, their incidence is increasing day by day. The present study aimed to assess the correlation of fatty liver with epicardial fat volume and coronary artery calcium score.

This cross-sectional study was conducted on 136 patients referred to Hamadan Farshchian Cardiovascular Hospital for computed tomography (CT) angiography. They were selected using a consecutive sampling method. Using a 128-slice multidetector CT scanner, the coronary artery calcium score based on the Agatston criteria and epicardial fat volume were measured. A liver ultrasound was performed using a GE voluson E6 and a 3-5 MHz depth probe, and the severity of the fatty liver was determined based on the echogenicity of the liver on the ultrasound. Data analysis was conducted using the SPSS software (version 26).

The mean age scores of patients were 52.90±12.10 years. Regarding gender, 50.5% and 49.5% of cases were male and female, respectively. In terms of fatty liver grade, 64 (47.1%), 48 (35.3%), 21 (15.4%), and 3 (2.2%) cases had grades zero, I, II, and III, respectively. The mean calcium score was 30.76±35.40, and epicardial fat volume was 86.84±36.56. The severity of fatty liver demonstrated no significant relationship with calcium score and epicardial fat (P>0.05).

As evidenced by the obtained results, the severity of fatty liver had no relationship with the amount of coronary epicardial fat and coronary artery calcium.

Diadochokinesis tasks, as a traditional component of speech-motor assessment, are an indicator of the evaluation of oral motor skills. This study aimed to help determine a criterion for the evaluation of the speed of consecutive movements by determination of diadochokinesis in normal children aged 7 to 9 years. Moreover, by creating syllabic assignments, consisting of closed and open vowels, it was possible to compare the speed of production in reciprocal movement conditions.

The current descriptive-analytical study used a cross-sectional design. It was conducted on 210 primary school students in three age groups of 7, 8, and 9 years old in Kermanshah City, Iran, who were randomly selected. Students had to repeat two-syllable structures 15 times and three-syllable structures 10 times. The structures consisted of consonants and vowels/a/ and /u/ to determine their durations.

The production speed of the two-syllable structures /pata/ and /paka/ was significantly higher, compared to that of /putu/ and /puku/, respectively (P=0.002). However, in the two-syllable structures /taka/ and /tuku/ (P=0.09) and trisyllable structures /pataka/ and /putuku/ (P=0.11), the difference of the mean diadocokinesis was not significant. Therefore, the vowel /a/ increased the ability of diadochokinesis in some syllabic combinations but had no effect on some other combinations.

With the increase of age, the ability to produce two- and three-syllable structures quickly and accurately increases. Usage of the vowel /a/, compared to the vowel /u/ in some syllabic combinations increased the speed of diadochokinesis but had no effect in some syllabic combinations