Caspian Journal of Internal Medicine
Volume:5 Issue: 2, Spring 2014

Ankylosing spondylitis (AS) may manifest with heterogeneous patterns according to ethnic origins. The objectives of this study were to describe the influence of various Iranian ethnic origins on clinical measures in patients with AS. 0ne hundred sixty-three AS patients diagnosed by modified New York 1984 criteria were enrolled consecutively in a cross-sectional study. The patients were classified into Fars, Turk, Kord, Lor and other ethnic origins. Several clinical measures were described and compared between the ethnic origins. The highest and the lowest finger to floor distance was observed for Fars ethnicity (20.4±14.8) and other ethnicities (5.9±8.1), respectively (p=0.04). The frequency of severe decrease in cervical slope was significantly different between various ethnicities (P=0.025). The most and the least frequency of severe decrease in cervical slope was observed in Fars patients (61.3%) and other ethnicities (20%), respectively. The frequency of severe thoracic kyphosis was significantly dissimilar between various ethnicities (P=0.006). The most and the least frequency of severe increase in thoracic kyphosis was observed in Fars (68.8%) and Lor patients (25%), respectively. A significant relationship was seen only between other ethnicities and finger to floor distance, lateral lumbar flexion, chest expansion and BASDAI (P<0.05). Clinical expression variations in AS disease might be influenced by various Iranian ethnic origins. A survey with larger sample size and inclusion of other Iranian ethnicities (Baluch, Arab, etc) to study population is required to clear the definite relationship between Iranian ethnicities and clinical expression.

Many studies have been carried out on the relationship between testosterone levels and depression in the elderly. Due to the different results of these studies and the importance of depression in old age, this study seems to be necessary. This cross- sectional study is a part of the Amirkola Health and Aging Project (AHAP) that involves people aged 60 and above living in Amirkola, a small town in northern Iran. The testosterone levels were measured using ELISA on morning blood samples (ngr / ml) and depressive symptoms were identified using Geriatric Depression Scale (GDS). The data were collected and analyzed. In this study, 830 elderly men with a mean age of 70.02±7.7 years were included. On the basis of GDS criteria, 593 individuals had no depressive symptoms and 237 had at least one of these symptoms. The mean serum testosterone level in men without symptoms of depression (4.94±4.22) was significantly higher than in men with such symptoms (4.19±3.65) (P=0.011). Also, there was a significant inverse correlation between the testosterone levels and number of depressive symptoms (P= 0.015, r= - 0.084). The results of this study showed a significant inverse relationship between serum testosterone levels and depressive symptoms in elderly men

The role of psychological factors in peptic ulcer disease (PUD) and functional dyspepsia (FD) has not been clearly determined. In this study the role of conflict management styles, psychiatric symptoms, and alexithymia were assessed in patients with PUD and FD and in the healthy individuals. Ninety subjects [30PUD (15 women, 15 men), 30 FD (15 women, 15 men), and 30 healthy individuals (15 women, 15 men) in two endoscopy wards of Babol University of Medical Sciences were evaluated. Three groups were matched with regard to demographic variables. Conflict management styles, psychiatric symptoms, and alexithymia were evaluated by appropriate questionnaires. The patients with PUD reported less mean scores on psychiatric symptoms than the FD patients (depression 12.6±7.5 vs 28±9.5, anxiety 8.2±5.9 vs 18.7±6. obsessive-compulsive disorder 15.7±7.5 vs 21.8±8.4, interpersonal sensitivity 9.5±7.4 vs 16±7, psychoticism 8.03±4.5 vs 14.3±6.3, somatization 12.5±10.8 vs 20.7±8.1, and the total score of psychiatric symptoms 94.4±49.9 vs 160.1±46.6). The mean scores use of unconstructive conflict management styles in PUD patients were lower than FD (dominating 17.7±3.5 vs 20.2±2.7, avoiding 17.5±3 vs 23.8±4.4). Alexithymia symptoms were higher in FD patients than PUD individuals (difficulty in identifying feelings 23.5±6.3 vs 27.8±3.9, difficulty in describing feeling 16.5±4.4 vs 17.3±3.6). The PUD and FD patients had higher scores regarding these variables than the healthy subjects. The results show that both PUD and FD patients experienced more psychiatric symptoms, unconstructive conflict management styles, and alexithymia than the healthy subjects. FD patients had worse psychiatric problems than PUD.

The health of elderly population in the world has been an important issue in recent century and the use of appropriate or inappropriate medications is challenging among them. The purpose of this study was to assess the pattern of medication in elderly population in Amirkola, northern of Iran. This study was conducted on 1534 elderly subjects who participated in Amirkola Health and Ageing Project (AHAP) in 2013. The number of drugs that was used regardless of their indication in terms of age, level of education, disease, cognitive or depression and social support were recorded and compared in both sexes. The mean number of drugs used in men and women was 2.1±2.45 and 3.59±2.75, respectively (P=0.000). Concurrent use of > 4 drugs was seen in 16.5% of men and in 35.12% of women (P=0.000). The difference for using the number of drugs was significant between sexes with low educational level, but was similar in educated individuals. The use of polypharmacy was associated with the number of concurrent diseases (r=0.58, P=000), cognitive status (r=0.065, P=0.012), social support (r=-0.1, P=0.008), and depression (r=0.273, P=0.000). The results show that the use of polypharmacy in the elderly population in Amirkola is relatively high and they need to be educated. Considering the other indices, this problem highly manifested more in the elderly women.

Dysmenorrhea is one of the most common medical problems in gynecology causing several problems in the personal and social life of women. This study was conducted to compare the effect of thymus vulgaris and ibuprofen on the treatment of primary dysmenorrhea This clinical study was conducted on 84 students of Babol University of Medical Sciences with primary dysmenorrhea. The students were randomly assigned to three groups receiving thymus vulgaris, ibuprofen and placebo. In all three groups, with the beginning of pain, 200 mg capsules and 25 drops of essential oil were given every 6 hours for two consecutive cycles. Pain intensity used the visual scale before and one h after each dose for 48 h after starting medication. The data were collected and analyzed. This study was registered in the Iranian Registry of Clinical Trial (www.irct.ir) with registration number ID: IRCT201101245683N1 The mean age of participants was 20.5±1.8 years. Both thymus vulgaris and ibuprofen were effective to reduce the pain severity of dysmenorrhea. Before treatment, using a linearly-visual pain scale, the mean pain intensity in thymus vulgaris, ibuprofen and placebo groups were 6.57±2.02, 5.30±2.23 and 6.18±1.78, respectively and after treatment decreased to 1.21±1.06, 1.48±1.62 and 3.54±2.26, respectively. Reduction of pain severity was not statistically significant between the two medications; however, it was significant for each drug compared with placebo (p<0.001). The results suggest that thymus vulgaris as well as ibuprofen can be effective in reducing the severity of pain and spasm in primary dysmenorrhea

Total colectomy is used in children with total colonic aganglionosis, Ulcerative colitis (UC) and familial adenomatous polyposis (FAP). The purpose of this study was to maintain ileocecal valve and rectal-sparing surgery for the prevention of fecal incontinence in these children. From1990 to 2011, 14 children with diagnosis of UC, FAP and Hirschsprung’s disease were operated. Total colectomy was done with the preservation of patch of cecum with ileocecal valve and half of the rectum with ileocecorectal anastomosis. Distal ileum designed as S shape pouch and ileocecal valve were preserved. In Hirschsprung’s disease, posterior rectal myotomy was established. The data were collected and analyzed. The mean age of the patients was 54 months (ranged from 2 months to 18 years). Ten patients were male. Among 14 patients, Hirschsprung’s disease, ulcerative colitis and FAP were seen in 10, 3, and one case, respectively. They were followed up annually. Clinical and endoscopic examinations were performed to evaluate the function of ileocecorectal anastomosis. They followed from 2 to 24 years. At first year, the patients experienced four to six bowel movements during the day and one at night. This frequency decreased over time. The main postoperative complications included recurrent enterocolitis (n=2), perianal fistula (n=2). Only 2 patients were suffering from some degree of fecal soiling. The results show that the Ileocecal patch- low rectal anastomosis in total colectomy leads to low complications and prevent fecal frequency and incontinence. It also increases absorptive function of ileum in children.

A nurse’s commitment is the most important factor that influences her performance and depends on other variables. The purpose of this research was to study the relationship between length of service of the nurses with the amount of occupational commitment and organizational commitment. From Winter 2012 to Spring 2013, 266 nurses were chosen in selected hospitals of Social Security Organization (SSO). These nurses were randomly categorized into six different classes of service records including < 5, 5-9, 10-14, 15-19, 20-24, and 25-29 years. The length of service is related to the organizational, occupational, affective, continuance, and normative commitment. The data were collected and analyzed. Generally 84% of the responders were women and the rest were men of which 95% had a bachelor’s degree and the rest had higher academic degrees. The length of service in 81% of nurses was <15 years and 19% were higher than 15 years. Significant correlation were seen between continuance and occupational commitments and length of service (r=0.23, P=0.04 and r=-0.26, P=0.02, respectively). There were not any significant differences regarding organizational, affective and normative commitments (P=0.12, P=0.33, P=0.47, respectively). The results show that the length of service was related to continuance and occupational commitment. So pre-retirement of the nurses after 20 years of work can result in an increase in average commitment of employees.

Hearing loss is one of the common complaints of diabetics. The aim of this study was to evaluate the hearing status of diabetic patients in Babol, North of Iran. The hearing status of 50 type 2 diabetic patients (case group) and 50 healthy individuals (control group) were evaluated from October 2011 to September 2012. Audiometry was done with the frequencies of 250, 500, 1000, 2000, 4000, 6000, 8000 HZ and speech tests like SRT (speech reception threshold), SDS (speech discrimination score) were performed. The data were collected and analyzed. The mean age of case group was 50.1±3 and in control group was 49.9±3.2. Hearing thresholds were 10.55.6, 10.76.1, 15.27.1, 169.6, 21.213.5, 26.416.5, 28.32 db in the right ear of the case group and 11.25.3, 9.74.9, 127.1, 14.29.4, 20.913.3, 25.115.6, 27.620.2 db in control group with different frequencies (p<0.05). Similar results were obtained in the left ear of both groups. The mean SRT in the right ear of the case group was 15.77.7 and control group was 9.24.8 and 13.56.9 in case and 9.14 in the left ear of case group (P=0.0001). SDS was 94.33.7 and in 96.23.3 in the right ear for the case and control group, respectively (P=0.0001). For the left ear, these values were 94.44.4 and 95.93.2, respectively (P=0.023). The results show that hearing loss in different frequencies and speech reception threshold were higher in diabetic group but speech discrimination score was higher in normal individuals. Audiological monitoring is recommended in diabetic patients during therapy.

Vaspin is associated with decreased blood glucose concentration. In this study, we aimed to investigate the effects of resistance exercise training on plasma vaspin and lipid profile levels in patients with type 2 diabetes. Thirty men were divided into 2 groups: control (n=15), and resistance exercise (n=15). The resistance group performed a resistance exercise consisting of 3 circuits of 8-15 repetitions of the 8 exercises. Lipid profiles and vaspin levels were measured at baseline and at the end of study. This study was registered in the Iranian Registry of Clinical Trial (www.irct.ir) with registration number ID: IRCT2013060911772N1 Intergroup study showed that after an 8-week of resistance training, resistance group had reductions in vaspin (330.50±82.51 ng/ml vs 251.62±107.28 ng/ml, p=0.03), and TC levels (185.21±47.51 mg/dL vs 171.10±37.91 mg/dL p= 0.02); but, had increase in HDL-C levels (38.20±20.65 mg/dL vs 43.80±7.87 mg/dL p=0.01), whereas, vaspin levels significantly increased in control groups (344±78.64 ng/ml vs 436 ± 70.47 ng/ml, p= 0.03). On the other hand, significant difference was seen in plasma vaspin levels between two groups. Our findings suggest that resistance training significantly decreased the level of vaspin without affecting the lipid profile level.

Identifying regional types and evaluating the frequency of pneumococcal strains has become increasingly important especially in vaccination. The purpose of this study was the identification and frequency determination of our regional serotype and evaluation of the performance of recent type specific multiplex PCR for the diagnosis of streptococcus pneumonia serotypes. All isolated S. pneumonia from suspected patients in Tehran and Isfahan Hospitals from June to December of 2012 were evaluated. All specimens and their serotypes were identified through a conventional method and specific antisera. Serotype specific multiplex PCR was applied and ran in seven reactions consisting of 34 S. pneumonia primer pairs plus a primer pair as an internal control for this purpose. Overall, 14 genotype specific serotypes (including two subtypes for 19 and 23) were detected and had identical results with stereotyping method except for serotype 28 and one of the identified serotype 23. The serotypes 19, 6 and 23 were dominant with the frequency of 51.8%. A cross reactivity was also observed between genotypes 1 and 9A/9V. Applied multiplex PCR format can be suitable and cost effective tool for identification of S. pneumonia serotypes.

Bilateral salpingo-oophorectomy in women may lead to metabolic consequences in patients. This study was performed to determine the glucose tolerance and lipid profile after menopause resulting from bilateral salpingo-oophorectomy. From September 2011 to March 2013, 31 women participants aged 46-52 years who underwent hysterectomy and bilateral salpingo-oophorectomy for benign reasons were recruited. An oral glucose tolerance test (OGTT), triglyceride (TG), total cholesterol, low density lipoproteis (LDL), high density lipoprotein (HDL) was performed before and 6 months after surgery. Fasting insulin and 2-hour insulin levels, fasting insulin / glucose indexes and homeostasis model assessment HOMA indexes were also measured. The mean age of the patients was 48.6±2.9 years.The mean 2-h glucose level in OGTT changed from 26.7 before surgery to 111.1 (P=0.030). The mean level of lipid profile before and after surgery for TG was 132.3 versus 181.2 (P=0.005), total cholesterol 177.4 versus 206.7 (P=0.0001) and LDL 98.4 versus 115.3 (P=0.003). The other variables showed no significant difference. The results indicate that lipid profile changes like increase of TG, total cholesterol and LDL should be considered before removing the ovary during hysterectomy in premenopausal women.

In many cases of ILD (interstitial lung disease), overlap diagnosis is considered. Here, a few cases with diagnosis of a variety of ILDs, where eventual open lung biopsy has been performed are selected. Reference will be made to reliable sources to show that NSIP can still be a variant of UIP (Usual interstitial pneumonia) with better treatment response and prognosis. In case 1, there is a difference between the HRCT(High Resolution Computed Tomography) result (NSIP pattern without fibrosis) and pathologic result (which includes fibrosing NSIP more closely related to UIP).Case 2 shows obvious discord between HRCT result (UIP pattern) and pathologic result (NSIP pattern). In case 3, there is again a discrepancy between HRCT report (very mild architectural distortion suggestive for ILD like NSIP) and pathology report (destructed lung tissue with interstitial fibrosis suggestive of HP (Hypersesitivity Pneumonitis) and not NSIP. In this paper, we demonstrate that although NSIP can be a distinct diagnosis in most cases, but in rare cases the distinction between the other kinds of ILD especially UIP and NSIP in spite of full workup including tissue assessment can be very difficult.

Primary intra cardiac tumors are rare. In this article, we present papillary fibroelastoma of mitral valve chordae. A 35-year old man presented with atypical chest pain and palpitation. Physical examination and electrocardiogram were normal. Transesophageal echocardiography (TEE) revealed a mass of 1015 mm attached to chordae of anteromedial papillary muscle of mitral valve. The tumor was completely resected and the mitral valve chordae tendineae was preserved successfully. The pathological diagnosis was papillary fibroelastoma. In any patient with atypical chest pain and palpitation, valvular tumor should be considered in differential diagnosis.

Brucellosis can involve almost any organ system and may present with a broad spectrum of clinical presentations. In this study we present a case of deep vein thrombosis due to human brucellosis. A 15 year old boy presented acute pain and swelling in his left thigh. When admitted to the hospital in june 2011, he complained of fever, chills and lowers extremity pain in which he could barely walk. In family history his older brother had brucellosis 3 weeks ago and appropriate medication was given. The tubal standard agglutination test (wright test) and 2ME test were positive (in a titer of 1/1280 and 1/640, respectively). Peripheral venous doppler ultrasound of left lower extremity showed that common iliac, femoral, external iliac, superficial and deep femoral vein and popliteal vein were enlarged and contained with echogenous clot. He was treated with rifampicin 600mg once a day, doxycycline 100mg twice a day (both for three months) and amikacin 500 mg twice a day (for 2 weeks) accompanied with anti-coagulant. By 10 days after the onset of this treatment, thrombophlebitis was cured. Follow up of the patient showed no abnormality after approximately one year later. In brucellosis endemic areas, the clinicians who encounter patients with deep vein thrombosis with a current history of a febrile illness, should consider the likelihood of brucellosis.