Caspian Journal of Internal Medicine
Volume:2 Issue: 3, Summer 2011

Diagnosis of knee osteoarthritis can be confirmed based on clinical and/or radiological features. The potential of progressive disease can be prevented or decreased by earlier recognition and correction of associated factors. Obesity and alignment especially varus malalignment are recognized factors of progressive disease. Both nonpharmalogical as well as pharmacological modalities of treatment are useful in managing the symptoms of knee osteoarthritis. Surgery should be considered only in patients who do not respond to medical therapy. Prevalence and risk factors of knee osteoarthritis have been described in the first part of this review. In this issue, the diagnosis progressive factors and management of knee osteoarthritis are discussed.

The major cause of peptic ulcer disease is Helicobacter pylori (Hp), and it is also implicated in the pathogenesis of adenocarcinoma of the distal stomach and gastric lymphoma. Incidence of peptic ulcer disease, atrophic gastritis, and gastric adenocarcinoma are more common in people infected of cagA positive strains of Hp. The aim of this study was to determine the prevalence of the anti-Hp and anti-cagA antibodies among healthy persons in Golestan province-North of Iran. Blood samples of 1028 healthy people were collected all over Golestan province by cluster sampling. A demographic questionnaire was completed and body mass index (BMI) was calculated for each case. Hp-IgG (Pishtaz teb Co, Iran) and anti- CagA (DIA.PRO Italy) titer were evaluated by ELISA method. Data were collected and analyzed. Six hundred-eighty three individuals (66.4%) were positive for Hp and 395 (57.8%) of them were CagA positive. Hp positive cases were (66.3%) and (66.6%) in male and female, respectively. Prevalence of CagA was 56.3% and 58.9%, respectively. The most seropositivity of Helicobacter Pylori (75.4%) was in 55-64 years old (P<0.001). Prevalence of Cag A (63.4%) was more in age between 15-24 years. Prevalence of anti-Hp antibody and strains of cagA seropositive in healthy persons of this province of Iran were relatively high. Preventive protocol for reducing of the infection is recommended.

Basic fibroblast growth factor (bFGF) is a glycoprotein with stimulating ability of angiogenesis. In addition, bFGF plays an important role in wound healing process in some tissues for example gastrointestinal tract, but its ability for discrimination of various stages of wound severity in these diseases was not reported. Therefore, we aimed to determine the bFGF levels in gastric ulcer patients compared with healthy control as a biomarker for staging the severity of wound The study group consisted of 33 patients with gastric ulcer and 27 healthy controls. The diagnosis of patients was based on standard clinical, endoscopic, and histological criteria. Serum levels of bFGF were analyzed by an ELISA kit. According to the histological findings, 19 (57.6%) patients were in moderate stage of ulcer and 14 (42.4%) patients were in the severe stage of gastric ulcer. The mean bFGF serum levels in patients group (7.8±1.3pg/ml) were lower than the healthy group (8.2±1.4pg/ml) in crude data, but in statistical analysis the differences were not significant (p=0.082). The mean bFGF serum levels in patients with severe stage of gastric ulcer were greater than patients in moderate gastric ulcer (8.4±1.3 vs. 7.4±1.2 pg) and the differences were statistically significant (p<0.05). Differences in serum bFGF levels in patients with severe stage of gastric ulcer vs. moderate gastric ulcer was significant. Therefore, serum bFGF level measurements can be used as a useful clinical tool for discrimination of patients with severe stage of gastric ulcer vs. moderate gastric ulcer, when endoscopic and histological examination are not possible to perform.

It is clear that Helicobacter pylori (H. pylori) is a spiral bacterium that infects the human and causes gastritis and peptic ulcer. The aim of this study was to determine the relationship between H. pylori infection and the iron status of the body. Case: From August 2007 to July 2008, this study was conducted in Shahid Beheshti Hospital of Babol University of Medical Sciences, Babol, Iran. The study group consisted of 35 patients with H. pylori and 35 matched healthy subjects as the control group. The members of both groups were enrolled in the study voluntarily. Serum iron and total iron- binding capacity were measured by Darman-kav Standard kit. Ferritin was measured by Padtan-e-Elm Standard kit. Collected data were analyzed by SPSS version 16. p-value of <0.05 was considered significant. Serum iron and total iron-binding capacity in H. pylori positive group were lower than in the control group (108.67±31.26 vs. 110.92±28.45 µg/dL, p=0.578) and (327.88±81.39 vs. 342.51±79.45 µg/dL, p=0.153) respectively. The mean of ferritin was significantly lower in H.pylori positive group (210.51±132.01 ng/ml, p=0.047) than H.pylori negative group (265.03±170.79 ng/mL, p=0.047). The results of the present study show that serum iron and total iron binding capacity in H.pylori infected group was lower than the control group. H.pylori may impair iron metabolism. It is possible that H.pylori may both directly compete with the host for available iron by impairing its uptake.

Postoperative nausea and vomiting is a high unpleasant symptom in surgical procedures. This study compares the effectiveness of midazolam with promethazine as multipurpose drug in postoperative nausea and vomiting as a preoperative and anesthetic medication after appendectomy. This randomized, double – blind clinical trial study was performed in patients who underwent appendectomy. These patients randomly received either placebo or midazolam or promethazine 5 minutes before appendectomy. All episodes of vomiting and nausea within 24 hours after surgery were recorded. The study population (N=75) comprised 3 comparable subgroups (N=25 in each group). A standard general anesthetic technique and postoperative analgesia were used. Data were collected and analyzed. Vomiting and nausea occurred in 19.20%, 0% and 81.80% of the patients in the midazolam, promethazine and placebo groups, respectively. The frequency of postoperative nausea and vomiting was as follows: the first 6 hours after surgery 0%, 0% and 50%, during the second 6 hours after surgery 19%, 0% and 19%, during the third 6 hours after surgery 0%, 0% and 7%, during the forth 6 hours after surgery 0%, 0% and 4% in the midazolam, promethazine and placebo groups, respectively. There were no significant differences between promethazine with midazolam in reduction of postoperative nausea and vomiting. Our study suggest that midazolam can be used as multipurpose drugs in postoperative nausea and vomiting as a preoperative medication after appendectomy and treatment using midazolam for anti-emetic prophylaxis provide a similar effect compared to promethazine in the present study.

Patients with symptomatic malignant pleural effusion (MPE) may gain profit from pleurodesis for relief of dyspnea and in to preventing the accumulation of fluid or air in the pleural space. Pleurodesis methods are palliative and regard the patient''s symptoms and underlying disease condition that are different. The purpose of this study was to assess the efficacy of bleomycin in the treatment of malignant pleural effusion. From March 2003 to August 2009, 50 cases of malignant pleural effusion referred for chemical pleurodesis. Malignant pleural effusion was diagnosed by cytotogical examination of pleural fluid after thoracosynthesis. Pleurodesis was done by pleural fluid instillation of bleomycin. The severity of effusion with response to treatment was compared. Nineteen (38%) cases were males and 31 (62%) were females. The mean age of these patients was 60.3±15.8 years (ranged 31 to 85 years). The majority of patients had breast cancer and lung adenocarcinoma. The mean volume of pleural fluid drained was 2282±848.69cc (range 800-4500 cc). Pleural effusion was mild in 2 (4%) patients, moderate in 25 (50%) and severe in 23 (46%). There was no statistically significant difference between the response to treatment and the amount of effusion (p=.087). Complete response was seen in 33 (66%) patients, partial response in 11 (22%) and failure to treatment in 6 (12%). There was no relationship between the response to treatment and tumor type. There was not any complication in 33 (66%) patients, but fever was seen in 2 (4%) and chest pain in 7 (14%) and both of them in 8 (16%). The results show that pleurodesis with bleomycin has improved the symptoms of 88 percent of patients without causing any significant complications. Although pleurodesis does not have any effect on patients'' survival, it has positive impact on their lives continuously by enhancing the quality of life.

Primary dysmenorhea is common among the young girls and child-bearing women. The purpose of this study was to compare the efficacy of fish oil and Ibuprofen on the treatment of primary dysmenorhea. This clinical trial study was done on students of Babol University of medical Sciences in 2010. One hundred- twenty students who had moderate and severe dysmenorrhea were randomly divided in two groups. The first group (0 girls) received 1000 mg/day fish oil capsule in all her cycle days and the second group received  mg ibuprofen when their pain started (duration of this study was  months). Student t-test, Mann Whitney and Freidman tests were used when appropriate. This clinical trial was registered in the Iranian Registry of clinical Trials (www.IRCT.Ir) (IR21101133004N4). There was a significant difference between the intensity of pain before and after treatment by ibuprofen (p=1) and fish oil (p=1). Furthermore, reduction of pain in fish oil recipient was higher than the IBV prefer group (p=0001). The results show that the efficacy of fish oil is better than ibuprofen on treatment of severe pain in primary dysmenorrhea.

Takayasu arteritis is a granulomatous vasculitis mainly involves large arterial vessels. The disease is rare and it is more common in females aged between 15-30 years old. In this paper, we report a case of takayasu arteritis in Babol, north of Iran. Case: A 22 - year old female was admitted to the department of infectious diseases of Rohani Teaching Hospital due to anemia, high erythrocyte sedimentation rate (ESR), and low grade fever and weight loss in early summer of 2011. Her problems started four years ago and was hospitalized in another hospital and after full investigation, there was no diagnosis. Physical exam showed vascular problem, then MRI angiography was done and showed involvement of right carotid, abdominal aorta and right iliac arteries and the diagnosis of Takayasu Arteritis was confirmed. Prednisolone was administered and fever subsided and ESR and CRP and hemoglobin were normalized. Takayasu a. should be considered in the differential diagnosis of patient with protracted low grade fever, anemia and dramatically elevated ESR in young female in order to prevent late complications of the disease.

Aluminum Phosphide or rice tablet is one of the most common pesticides which lead to accidental or intentional acute intoxication and finally death. In this paper, we describe a successful management of intoxication with rice tablet in a young girl. Case: A 14-year-old girl was admitted due to consumption of rice tablet. Gastric washing with two vials of sodium bicarbonate and discharge suction was done. In the first 24 hours, the patient underwent recurrent hydration, dopamine infusion with sodium bicarbonate, calcium, magnesium and amiodarone. In the second day of admission, the patient was transferred to intensive care unit (ICU) and five days later, she was discharged without liver or renal complications. Short interval between consumption of this tablet and start of the treatment and on time rescue to the patient can be some of the important factors to prevent early death in intoxication with this tablet.