فهرست مطالب

Caspian Journal of Internal Medicine - Volume:3 Issue:4, 2012
  • Volume:3 Issue:4, 2012
  • تاریخ انتشار: 1391/07/01
  • تعداد عناوین: 12
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  • Sasan Fallahi, Ahmad Reza Jamshidi, Farhad Gharibdoost, Mahdi Mahmoudi, Pedram Paragomi, Mohammad Hossein Nicknam, Elham Farhadi, Mostafa Qorbani Page 508
    Background
    Increased incidence of renal stone has been reported in ankylosing spondylitis (AS), but unlike some well-known renal involvements, they have not been fully studied. The aim of this study was to investigate the association of AS with urolithiasis and also the relation between urinary stone and severity markers.
    Methods
    One hundred-sixty three AS patients were included in a cross-sectional study from Iranian AS association, Iran Rheumatology Center and Rheumatology Clinic of Shariati Hospital in Tehran. Prevalence of urolithiasis in AS patients was compared with results of a nationwide survey in Iran. Bath ankylosing spondylitis disease activity index (BASDAI), bath ankylosing spondylitis functional index (BASFI) and bath ankylosing spondylitis metrology index (BASMI) were determined for assessment of disease severity.
    Results
    Urolithiasis was observed in 11.7% of AS patients versus 5.7% of normal population (p=0.001). After the elimination of corticosteroid effect, the prevalence of urolithiasis was still higher in AS patients than normal population but without maintaining significant difference. Significant higher values of BASFI, BASMI, BASDAI scores were observed in AS with urolithiasis than AS without urolithiasis.
    Conclusion
    The results confirmed the association of AS with urolithiasis. However, this may be partly due to the effect of other factors such as corticosteroid. Moreover, urolithiais is accompanied with more severe diseases.
    Keywords: Ankylosing spondylitis, Urolithiasis, BASDAI, BASFI
  • Farshid Oliaei, Roghayeh Akbari, Ali Mohammad Ghazi Mirsaeid Page 514
    Background
    Thymoglobuline (TG)، is used for both induction and rejection therapy in kidney transplantation (TX). This study was conducted to compare between adding TG or not to the conventional drugs to evaluate the rate of rejections، infections and costs.
    Methods
    In two groups of patients، each of 45 cases; group A received conventional drugs (cyclosporine، mycophenolate and prednisolone) and in group B، TG was added; both groups were then compared. TG was administered for 5 doses (1. 5 mg/kg/d for the first 3 days and 1 mg/kg/d for the last 2 days. Suspicious signs of rejection (fever، graft tenderness، graft enlargement and increase in length and depth)، creatinine rise، diethylene triamine penta-acetic acid scan (DTPA) results and urinary tract infections (UTI) with counts > 105 CFU/ml were recorded. The duration of the first hospitalization، the CMV incidence of infection in the first 6 months and their costs were finally compared.
    Results
    There was no difference for age، duration of hospitalization and CMV infection between the two groups. UTI occurred more frequently in TG group (p=0. 049). Creatinine rise، suspicious signs of rejection occurred more frequently in TG group (p<0. 05). Creatinine rise and suspicious signs of rejection occurred more frequently in conventional group (p=0. 020، p<0. 000، respectively). The need for additional steroid pulses was more frequent in conventional group (p<0. 000). The total costs of TG، ganciclovir، antibiotics and steroid pulses in both groups were similar.
    Conclusion
    The results show that the posttransplantation problems (signs of rejection، rise of creatinine، graft losses and delayed graft function) occurred rarely in TG group. The incidence of infection and the cost of both regimens were similar. We strongly recommend this protocol as induction therapy.
    Keywords: Kidney transplantation, Anti rejection therapy, Immunosuppression, Cost, cost analysis
  • Shima Soleimani Amiri, Shariar Shafaee, Mohammad Reza Hasanjani Roushan, Masomeh Baiani, Mahmoud Hajiahmadi Page 519
    Background
    Viral load and alanine aminotransferase (ALT) levels may not be the key points for making a decision in the treatment of anti-HBe positive chronic hepatitis B. The purpose of this study was to assess the histological evaluation of liver to find the need for treatment on 72 patients with anti-HBe positive chronic hepatitis B.
    Methods
    The liver biopsy slides of the 72 patients (56 subjects with viral load >105 with any ALT levels, 16 cases with viral load <105 copies/ml with abnormal ALT levels) were evaluated at the Department of Pathology, Babol University of Medical Sciences, Iran from April 2006 to August 2011. Ishak Scoring system was used to determine the hepatitis activity index (HAI) and fibrosis score. Those with total score >3 were considered for treatment. Data were collected and analyzed.
    Results
    The mean age of the patients was 34.4±12 years. The mean ALT level was 105±10.5 IU/L. The mean HAI with viral loads more or less than >105 was 5.9±2.6 and 4±1.9, respectively (p=0.04). HAI >3 was seen in 9 (56.3%) and in 43 (76.8%) subjects with viral loads <105 and > 105 copies/ml (p<0.05). No fibrosis was seen in 25 (34.7%) of these cases. Fibrosis stage regarding viral loads more or less than105 copies/ml was equal (p=0.12). The need for treatment was seen in 62 (86%) patients.
    Conclusion
    The results show that any viral load values may cause significant injuries that need to treatment. Liver biopsy is indicated in any case of anti-HBe with any viral loads with increased ALT levels.
    Keywords: Hepatitis activity index, Fibrosis, Treatment, Viral load
  • Keykhosro Mardanpour, Mahtab Rahbar Page 523
    Background
    Fine-needle aspiration of breast cancer often provides moderate cellular material that is representative of the tumors. These samples can be used not only for cytological diagnosis but also to obtain information on the prognosis and likely response to therapy by using immunohistochemical staining studies.
    Methods
    We assessed the degree of correlation between prognostic biologic markers by means immunohistochemistry (IHC) on cytoblock obtained from fine-needle aspiration (FNA) and immunohistochemical determination on their corresponding tissue sample of five markers; steroid hormone receptors, MIB-1 (Ki-67), p53, and c-erb-B-2 (Her2/neu) in 45 mastectomy of breast cancer.
    Results
    Interobserver reproducibility ranged from 93 to 100%, depending on the marker. A good correlation was observed between immunostaining assessment on cytoblock and on their corresponding tumor tissues as follows: Ki-67 (87%), ER (80%), PR (93%), p53 (96%), and c-erb-B-2 (76%).
    Conclusion
    We conclude that cytoblock prepared from fine-needle aspiration specimens of breast cancer is a useful and noninvasive procedure when planning neoadjuvant treatment.
    Keywords: Breast cancer, Fine, needle aspiration, Immunohistochemistry, cell block, Esteroid receptors, P53, Ki67, C, erb, B2
  • Seyed Mohammad Alavi, Manoochehr Makvandi, Saied Najafi, Fard, Leila Alavi Page 530
    Background
    Both influenza A virus (IAV) and respiratory syncytial virus (RSV) cause acute respiratory infection (ARI) in infants and young children. This study was conducted to determine Influenza A virus and its co infection with RSV among the hospitalized children with ARI.
    Methods
    A total of 153 throat samples of the hospitalized young children aged between below one year and 5 years with the clinical signs of ARI were collected from the different hospitals in Khuzestan from June 2009 to April 2010. The samples were tested for Influenza A viruses by real time PCR. Positive IAV samples were tested for influenza A sub type H1N1 and for RSV by the nested PCR.
    Results
    In this study, from the total 153 samples, 35 samples (22.9%) including 15 (42.8%) females and 20 (57.2%) males were positive for influenza A viruses. From the 35 positive samples for IAV, 14 were positive for swine H1N1 subtype. All the positive samples for influenza showed negative for RSV infection which revealed no coinfection with RSV. The prevalence of influenza A among age/sex groups was not significant.
    Conclusion
    Influenza A is a prevalent viral agent isolated from young children with ARI. Influenza A subtype H1N1 was accounted for the 40 percent all laboratory-proven diagnoses of influenza in 2009. No evidence of coinfection of influenza A and RSV has been observed in the present study.
    Keywords: Respiratory syncytial virus, Influenza A virus, swine H1N1, Acute respiratory infection, Co, infection
  • Behzad Heidari, Maryam Beygom Haji Mirghassemi Page 535
    Background
    Exposure to sunlight is the main source of vitamin D production. This study was performed to assess the status of serum vitamin D across the different seasons in geographic region of Babol, with latitude of 36 in northern Iran.
    Methods
    The study – female participants were 15 years old and above selected prospectively according to the inclusion criteria who attended an Outpatient clinic. The serum 25-hydroxyvitamin D 25-OHD was measured with enzyme-linked immunosorbent assay (ELISA). Serum OHD <20 ng/ml was considered as vitamin D deficiency. Serum 25-OHD levels were compared across various seasons according to sex and age. Proportions of serum 25-OHD deficiency were also compared between the various seasons according to sex and age.
    Results
    A total of 576 females and 120 males with respective mean age of 44.8±14.1 and 47.8±29 years entered into the study. The mean serum 25-OHD was 20.8±27 ng/ ml, the prevalence of serum 25-OHD deficiency was 70.1%. In women compared with men, the mean serum 25-OHD was significantly lower but the proportion of deficiency was not significant (20.6±24.9 ng/ml vs 23.2±31.4 ng/ l. p=0.021 and 70.8% vs 67.5% p=0.60 respectively). The mean 25-OHD nd proportion of deficiency did not vary across the different seasons with regard to age. However, in the summer and in the autumn, the women had significantly lower serum 25-OHD concentrations than the men (p= 0.021and 0.016 respectively).
    Conclusion
    The findings of this study indicated no significant seasonal variations of vitamin D in geographic regions of Babol. However, during the autumn and the winter months, the women are at high risk of vitamin D deficiency which corresponds to nadir of serum 25-OHD levels.
    Keywords: Vitamin D, Seasonal change, Sex, Age, Deficiency
  • Novin Nikbakhsh, Parviz Amri, Asdollah Shakeri, Aydin Shakeri Page 541
    Background
    Esophagectomy is considered to be the main treatment for esophageal malignancies. Among the different methods, transhiatal approach can cause less damage to patients and is widely used; however, manipulation of esophagus result in heart rate and blood pressure variations. The aim of this study was to investigate changes in blood pressure and heart rhythm during transhiatal esophagectomy.
    Methods
    This prospective study was performed on 51 patients with esophageal cancer admitted for transhiatal esophagectomy. Anesthesia method was similar for all the patients. Blood pressure and heart rhythm were monitored in three stages; 30 min before, during, and up to 24 hours after mediastinal manipulation (blood pressure, every minute, and heart rhythm, continuously, were controlled during manipulation). Collected data were analyzed. Using SPSS statistical software
    Results
    Over the first 5 minutes, systolic blood pressure declined significantly compared with preoperation time (p=0.001). Diastolic pressure declared from to 2 to 5 minutes postoperatively (p=0.001). Before mediastinal manipulation, AF was observed in 3 and PVC in 5 patients; whereas, arrhythmia was not found in other 43 patients. During mediastinal manipulation, 1, 25 and 10 patients developed AF, bradycardia and PVC respectively, and 4 patients had bradycardia and PVC, simultaneously. Arrhythmia was not detected in 11 patients. Before manipulation, arrhythmia was seen in 15.7% of patients which increased to 78.4% during operation time (p=0.0001).
    Conclusion
    According to the findings of this study the development of hypotension and arrhytmia are common during mediastinal manipulation. These changes recover after surgical procedure without treatment. If the alterations remain after surgery, remedial actions will be required.
    Keywords: Esophageal neoplasm, Transhiatal Esophagectomy, Blood pressure, Heart rate
  • Alireza Janbakhash, Feizollah Mansouri, Siavash Vaziri, Babak Sayad, Mandana Afsharian, Ahmadreza Abedanpor Page 546
    Background
    HSV2 has an important role in acquiring and transmitting HIV through genital ulcers. This study was conducted to determine the prevalence of this virus in HIV infected subject in Kermanshah, Iran.
    Methods
    This descriptive study was performed among 170 HIV positive patients (case group) and 165 non-HIV cases (control group)) referred to Behavioral Counseling Center of Kermanshah, western of Iran. For the evaluation of HSV2 infection, blood sample was obtained and assessed for IgG antibody of HSV2 using ELISA method. The data were collected and analyzed.
    Results
    Out of 170 cases, 11 were seropositive for HSV2 (6.5%) in case group and 2 of 165 (1.21%) in control group (p=0.015). Seropositivity was 17.6% in female and 5.2% in male, 59% under and 8% age over 40. In HIV infected subjects, seroprevalence in female was 17.6% and in male was 5.2% (p=0.083).
    Conclusion
    It can be derived that the seroprevalence of HSV2 in HIV positive patients in our region is relatively low. Hence, we do not recommend that HSV2 needs to be considered in HIV pretreatment evaluation program.
    Keywords: HIV, HSV2, seroepidemiology
  • Hassan Zamani, Kazem Babazadeh, Rahman Ghaffari, Hossein Karami, Saeid Fattahi, Farzad Mokhtari Esbuie Page 550
    Background
    Central venous catheters (CVCs) have been used widely in clinics. These catheters are also recommended for children and infants receiving chemotherapy and total parenteral nutrition (TPN) and etc. In this paper, we present migrated fractured control line of the heart of a girl.
    Case Presentation
    A 2.5 year old girl with migrated of the fractured central line into the heart. In the catheterization laboratory, first we placed a long sheath (8 F) into the inferior vena cava via femoral vein and then trapped the foreign body by pigtail catheter and wire 0.035 inch and pulled it down to make its proximal free. After that, we snared the catheter by snare-catheter and pulled it into the femoral vein, and then the cardiac surgeon bridged it out by cut-down successfully.
    Conclusion
    A rare complication in the use of central catheters is fraction and cardiac embolization. We offer gentle bringing out of the catheter lines under fluoroscopy guide in all of the cases, if this is technically possible and safe.
    Keywords: Central Venous Catheter, Foreign body, Cardiac embolization, Snare
  • Aref Hosseinian Amiri, Alireza Rafiei Page 554
    Background
    Alkaptonuria (AKU) or ochronosis is a rare progressive degenerative arthropathy that results from deficiency of enzyme homogentisate 1,2 dioxygenase (HGD). The features include arthritis of the spine and in larger peripheral joints, with chondrocalcinosis. In this paper, we present a case of alkaptonuria in a 54 year old woman in Tehran, Iran.
    Case Presentation
    A 54 year old woman with pain and limitation of motion in hip and lumbar spine was admitted in Firoozgar Hospital, Tehran. The problem began about 12 years ago with a history of darkening of urine and discoloration of sclera and ears. In imaging studies, there were degenerative changes in spine. In urine examination, the darkening of urine after exposure to air or bicarbonate found. Alkaptouria was confirmed by demonstrating an increased homogentisic acid (HGA) in urine. Her sister had back pain for a long period of time without response to therapy. She was subsequently diagnosed with alkaptonuria.
    Conclusion
    Alkaptonuria must be considered in the evaluation of low back pain of patients especially with having a positive family history and bluish discoloration of cartilage tissues.
    Keywords: Alkaptonuria, Ochronosis, Degenerative arthropathy
  • Soleiman Mahjoub Page 559
    Thank you very much for publishing our manuscript entitled: «Quantification and comparison of bone-specific alkaline phosphatase with two methods in normal and paget''s specimens» in the latest issue of the journal (Caspian Journal of Internal Medicine, Summer 2012; 3(3): 478-483). Unfortunately, we noticed the mistake in the date of our study after its publication in your latest revised manuscript. In the Method section (page 479), where the first sentence appeared «from July 2010 to April 2011 venous blood sample was taken from 50 normal adults in the fasting state». Please be informed that the mistaken date supposedly should be written «July 2001 to April 2002 instead of July 2010 to April 2011». I would appreciate it so much if you could rectify this problem in the next issue of the Caspian Journal of Internal Medicine.