Caspian Journal of Internal Medicine
Volume:4 Issue: 1, Winter 2013

Erythrocyte sedimentation rate (ESR) is one of the predictors of improvement in handling rheumatoid arthritis. This study was designed to define and compare the time of achieving normal ESR and also the percentage for the normalization of this marker at several points of time in two different combination therapies. Fifty-two rheumatoid arthritis patients randomly received methotrexate, chloroquine, prednisolone (MCP) or azathioprine, chloroquine, prednisolone (ACP) and all were followed up for 34 weeks. Chloroquine and azathioprine were given, 150 mg/d and 2 mg/kg/d, respectively. Methotrexate was given, 0.2 mg/kg/week and simultaneously increased 2.5 mg monthly if no clinical response was seen. Prednisolone was started, 0.3 mg/kg/d and tapered after one week. ESR at baseline and during follow-up were checked. The data were collected and analyzed. This clinical trial was registered in the Iranian Registry of Clinical Trials (www.irct.ir) with registration number ID: 2012110611383N1. The percentages of obtaining normal ESR after 2nd, 4th, 6th, 8th, 18th, 34th weeks of follow up were 42.4%, 53.9%, 57.7%, 65.4%, 88.5%, 96.2% in the MCP group and 47.9%, 65.3%, 74%, 78.3%, 82.7%, 87% in the ACP group. The mean time of obtaining normal ESR was 9.15 (95%CI, 5.58 to 12.73) weeks in MCP group and 9.04 (4.04 to 14.05) weeks in the ACP group (p>0.05). The results show that the time to achieve normal ESR and percentage of its normalization were almost the same in both treated groups.

Pregnant women take iron supplements in order to prevent iron deficiency anemia which may have undesirable effects for both the mother and fetus. This study aimed to compare the daily and intermittent dose of iron supplementation in blood and iron indices in healthy pregnant women. In this clinical trial study, 145 healthy pregnant women were selected with Hb≥11g%. The participants were randomly divided into two groups. Group 1 received daily iron supplement at 50 mg/day and group 2 received an intermittent dose of 3 times per week. Blood samples were assessed for complete blood count (Hb, Hct, RBC), iron, ferritin and zinc at baseline in the first trimester in all participants and the two groups were compared in regard to mean changes from baseline to the end of the study period in the third trimester. This clinical trial was registered in the Iranian Registry of Clinical Trials (www.irct.ir) with registration number ID: 2012082810682N1. The incidence of iron deficiency anemia was 2.7% in both groups. The mean levels of Hb, Hct and RBC in the first trimester were 13.3 g/dl, 39.4% and 4.5 mil/ml3, respectively. At the end of the study, Hb, Hct, and RBC reduced significantly in both groups compared with baseline values (p<0.05). The difference from baseline in Hb and other blood indices did not differ significantly across the two groups. These findings indicate that daily or intermittent administration of iron supplement to pregnant women has the same outcome. Regarding the side effects of iron in pregnancy, intermittent method seems preferable to daily intake.

Full blood count has been shown to predict disease severity and mortality risk in cancer patients. This study aimed to highlight the degree of derangements of full blood count parameters and provide mean values in pre-chemotherapy breast cancer patients compared with apparently normal control subjects. This was an unmatched case-control study among breast cancer patients attending Oncology clinic of Lagos State University Teaching Hospital, Ikeja and the nurses of the institution as control. A total of 4.5 mls of blood was collected from each participant into EDTA bottle for full blood count analysis, done on the same day of collection. A total of 100 histologically diagnosed, consenting, pre-chemotherapy patients of the clinic (cases) and 50 nurses of the institution as controls were studied. Anemia was found in 58%, 43% and 20% of cases compared with 38%, 36% and 2% of controls using PCV< 36%, 30-36% and 30%, respectively. The mean MCV, MCH, MCHC (82.62±7.48 fl, 26.01±2.78 pg, 30.73±4.06 g/l respectively) of cases were lower than the controls (85.36±5.74 fl, 27.24±1.90 pg, 31.81±0.8 g/l, respectively and RDW of cases (15.61±3.53) was higher than the control (14.24±0.75). The mean WBC counts, neutrophil and lymphocyte percentages of cases (6.96±7.22, 54.75±13.1% and 38.19±12.70%, respectively) were higher than the controls (5.47±1.57, 44.39±8.78% and 8.82±15.97%, respectively). The mean platelet count of cases 291.51±103.38 was also higher than the controls (222.82±57.62). Breast cancer patients presented with deranged full blood count pattern, consequent to the disease compared with the controls.

Hypertension is considered as a major health problem in our society. The association between educational level with hypertension and its control in the Golestan Province (northern Iran) were the main objectives of this study. This was a population-based cross-sectional study that enrolled 3497 subjects aged 15-65 years using stratified and cluster sampling. The interviewers recorded the data using a multidimensional questionnaire, including blood pressure level. Blood pressure was measured three times with 5 minutes interval and defined based on Join National Committee (JNC-7). Totally, 741 (21.2 %) cases suffered from hypertension and illiterate people were significantly more aware of their disease (p=0.011). In the aware group, 435 (89.6%) cases used one method to control their disease and it was not statistically significant as far as educational levels was concerned. The control of hypertension was significantly greater in college educated group than the illiterate one (32.4% vs 68.8%) (p=0.001). Logistic regression analysis revealed that illiteracy is a risk factor for hypertension (p<0.001). In spite of awareness in the illiterate people was high, the rate of hypertension control was low in this group. Prevention, detection, treatment, and control of hypertension especially the illiterate people should be given high priority.

More than half of myocardial infracted (MI) patients have no conventional risk factors. Regarding the belief that opium addiction has a protective effect on heart diseases, addiction prevalence has unfortunately increased in recent years. This study was conducted to investigate the effect of opium addiction on patients with acute myocardial infarction. This case-control study was performed on 118 patients with acute myocardial infarction admitted to CCU ward (case group), and 118 patients with no history of MI to other wards (control group) of Shahid Beheshti Hospital in Babol, Iran. Opium addiction conventional risk factors were evaluated for both groups, and the data were analyzed using chi-square test and logistic regression model was used to adjust the conventional risk factor effects. Moreover, demographic variables as well as the extent of MI (extensive or non-extensive), and infarction type (ST-elevated or non-ST elevated) also were evaluated. Sixty-seven patients in MI and 6 subjects in control group had a history of opium consumption (p<0.0001, OR=24.5). Blood pressure, hyperlipidemia, and smoking showed a significant difference between the two groups (p<0.05), whereas, no significant difference was observed for diabetes and family history. The results of adjusted model report a significant effect of opium consumption with the development of MI (OR=26.3). No significant difference was found in terms of infarction type and the extent between the addicts and non addicts in MI group. The results show that opium addiction is a strong risk factor for myocardial infarction.

Cardiovascular mortality and morbidity are high in chronic renal failure (CRF) patients. Increased dispersion of QT intervals is known to predispose to ventricular arrhythmias and sudden cardiac death. This study was conducted to assess the effect of hemodialysis (HD) on corrected QT (QTc) intervals and their dispersions (QTd) in chronic hemodialyzed patients. Fifty-eight patients (mean age 54.2±15.8 years) with chronic renal disease on chronic hemodialysis (HD) were assessed by standard examination including blood pressure, body weight, heart rate, 12–lead electrocardiography and laboratory tests like electrolytes (Na +, K +, Ca ++, phosphate), urea, and creatinine 30 minutes before and after HD. The QT intervals and QTc QTc= QT R-R/ (in milli seconds [ms]) for each lead were measured manually by one observer using calipers. The difference between the maximum and the minimum of QT interval was noted as QT dispersion (QT d). The mean of pre and post dialysis R-R intervals was 859.22±96.85 ms and 870.43±91.45 ms, respectively (p>0.05). The mean of corrected QT cmax intervals increased significantly from 423.45±24.10 to 454.41±30.25 ms (p<0.05). The mean of QT dispersions and the corrected QT interval dispersions changed from 51.56±12.45 to 63.21±14.43 ms (p<0.05) from 59.40±13.58 to 68.33±14.55 ms (p<0.05), respectively. The changes in serum potassium and calcium levels were related with QT interval prolongation. QT and QTc interval and dispersion increase in HD patients. Prolonged QT interval indices had relation with K+ and Ca++ ions before but not after HD.

Post spinal puncture headache (PSPH) is a well known complication of spinal anesthesia. It occurs after spinal anesthesia induction due to dural and arachnoid puncture and has a significant effect on the patient’s postoperative well being. This manuscript is based on an observational study that runs on Babol University of Medical Sciences and review of literatures about current concepts about the incidence, risk factors and predisposing factors of post spinal puncture headache.The overall incidence of post-dural puncture headache after intentional dural puncture varies form 0.1-36%, while it is about 3.1% by atraumatic spinal needle 25G Whitacre. 25G Quincke needle with a medium bevel cutting is popular with widespread use and the incidence of PSPH is about 25%, but its incidence obtained 17.3% by spinal needle 25G Quincke in our observation. The association of predisposing factors like female, young age, pregnancy, low body mass index, multiple dural puncture, inexpert operators and past medical history of chronic headache, expose the patient to PSPH. The identification of factors that predict the likelihood of PSPH is important so that measures can be taken to minimize this painful complication resulting from spinal anesthesia.

Poor response to various vaccines especially hepatitis B is common. The purpose of this study was to evaluate the effect of selenium on immune response against hepatitis B vaccine with accelerated method in insulin-dependent diabetes mellitus patients. In this randomized clinical trial study, 62 insulin dependent diabetic patients were divided into case and control groups (each of 31 cases). In the control group, hepatitis B vaccine 20 µg was done by intra-deltoid injection on a 0, 10, 21 day schedule with placebo, and in case group, 200 µg of selenium as a supplement was added once daily to same vaccine schedule from the first day to the 30th day of the month. After one month, serum sample was obtained and evaluated for anti-HBs using ELISA method. Data were collected and analyzed. In the case group, 23 cases (74.2%) and in control group, 15 cases (48.4%) achieved protective level of anti-HBs irrespective to sex and age (p=0.037). The mean antibody levels were 233.75±163.45U/L and 144±69.29U/L in selenium and control groups, respectively. Our study showed that selenium could help to increase protective rate and level of anti-HBs by accelerated vaccination method. Adding selenium by routine HBV vaccination in diabetic patients is recommended for increasing the rate and level of anti-HBs in such group.

Pediculosis capitis is a common parasitic infection of children. In this study we assessed the prevalence of head pediculosis among the middle schoolchildren in the urban and rural areas of Fars province, southern Iran. All middle schoolchildren ages 11-14, in all the urban and rural areas of the province were screened for head lice infestation by examining their hair and scalp. The parents of the infested children were also examined. The study was repeated in the different seasons in the same areas. Moreover, the infested children were treated with permethrin shampoo and re-examined one week later for any relapse. The general prevalence of head lice infestation in middle school students was 0.23% in autumn, 0.27% in winter and 0.11% in spring. In all three seasons, pediculosis capitis prevalence was higher among females and in the rural areas. Treatment with permethrin shampoo was markedly more successful in males from both regions in all months except the urban areas in spring. The results show that pediculus capitis is generally uncommon among Fars Province middle schoolchildren. It is needed that health providers promote heath education programs especially in the rural areas.

Hemodialysis patients are at greater risk of cardiovascular disease. Higher than expected cardiovascular morbidity and mortality in this population has been attributed to dislipidemia as well as inflammation. The causes of inflammation in hemodialysis patients are multifactorial. Several markers were used for the detection of inflammatory reaction in patients with chronic renal disease. These markers can be used for the prediction of future cardiovascular events. Among the several parameters of inflammatory markers, serum, CRP is well known and its advantages for the detection of inflammation and its predictor ability has been evaluated in several studies. This review addressed the associated factors and markers of inflammation in hemodialysis patients. In addition, their ability in predicting future atherosclerosis and effect of treatment has been reviewed. However, this context particularly in using CRP as a prediction marker of inflammation and morbidity requires further studies.

Crimean-congo hemorrhagic fever (CCHF) is an acute tick-borne viral, zoonotic disease with hemorrhagic manifestations and considerable mortality in humans. The purpose of this study was to introduce CCHF as a case report from Babol, north of Iran. It is known as an endemic pathogen in some regions of Iran. We present a case of CCHF suffering from sudden onset of fever, headache, nausea, vomiting, melena and hemorrhagic manifestations like petechiae and epistaxis accompanied with evidence of ticks bite in a non-endemic area in the north of Iran. The laboratory dignosis was CCHF. He was treated with ribavirin and recovered completely. CCHF may be seen in non- endemic regions and clinicians must be awarded about its diagnosis and treatment.

Rhabdomyosarcoma (RMS) is one of the common malignant tumors in infants and children, but it is extremely rare in the kidney. In this paper, we present a case of RMS the kidney of a child. A 6-month old girl presented with agitation, low fever and abdominal distention which started 5 days ago. On physical examination, the infant had a large and firm soft tissue mass in the palpation of her abdomen.Plain abdominal x-ray, sonography and CT scan showed soft tissue mass and Doppler ultrasound demonstrated regions of vascular flow in mass. The abdominal mass was replaced and on pathological examination and immunohistochemistry the diagnosis was embryonal RMS. Rhabdomyosarcoma of the kidney should be considered in the differential diagnosis of children with huge abdominal mass.