Caspian Journal of Internal Medicine
Volume:5 Issue: 3, Summer 2014

Chronic obstructive pulmonary disease (COPD) is a major health dilemma and cause of morbidity and mortality in either industrialized or developing countries and inhaled corticosteroids are widely used worldwide in these patients. In this systematic review, we aimed to analyze the effectiveness of these gents compared to placebo. Pubmed and Google Scholar literature search has been done to find randomized placebo-controlled trials investigating effectiveness of inhaled steroids in COPD patients. Finally, the data from 18 trials had been retrieved and included into a database, and analyzed using Stata ® v.9.0. Data of 12, 297 COPD subjects were analyzed. Analysis of survival of patients in the two groups showed no significant difference between those taking inhaled corticosteroids or placebo (relative risk (RR): 1.071, 95% confidence interval (CI): 0.938-1.224, P=0.309). Patients taking inhaled steroids were significantly less likely to develop an exacerbation episode (RR: 0.697, 95%CI: 0.596-0.816, p<0.001) or to have less withdrawal rate than placebo (RR: 0.882, 95%CI: 0.811-0.960; P=0.004). Because steroid inhalers represent no survival effects in COPD patients, and due to their life threatening side effects (pneumonia, candidemia, etc.), we propose to replace steroid inhalers to cheaper agents which provide patients with comparable advantages (e.g. few exacerbations) and fewer side effects. Pulmonary rehabilitations as well as anti-inflammatory drugs are recommended to be more attended in COPD patients.

The association of HP and insulin resistance degree (IR) has not been evaluated in the diabetic patients so far. In this study, we evaluated the association between HP seropositivity and the homeostatic model assessment for insulin resistance (HOMA-IR) in diabetic patients. In this study, 211 diabetic patients admitted to the endocrinology clinic of Shahid Beheshti Hospital of Qom for routine diabetic check-ups were evaluated. The patients were divided into HP+ and HP- groups based on the seropositivity of helicobacter pylori IgG antibody. The serum H. pylori IgG antibody, blood sugar, serum insulin, HbA1c, LDL, HDL, cholesterol, triglyceride, HOMA-IR and BMI were measured. Seropositivity for H. pylori was detected based on the serum titers of >30 AU/mL. We found that serum insulin (HP-=6.97±5.64 vs. HP+=10.12±7.72, P=0.002) and insulin resistance degree (HP-=3.160±3.327 vs. HP+=4.484±3.781, P=0.013) is significantly higher in HP+ group. We also found that there is no significant difference between these groups according to the short-term or the long-term indices of glycemic control as well as most of the diabetic risk factors or complications. The treatment type was also not significantly different between these groups. It seems that the HP+ diabetic patients require higher levels of serum insulin to reach the same degree of glycemic control compared to the HP- ones.

General anesthesia draw the most commonly used modalities for post cesarean delivery pain relief is systemic administration of opioids, while the administration of small dose of intrathecal opioid during spinal anesthesia can be a possible alternative. The aim of this study was to evaluate the effects of buprenorphine on cesarean section prescribed intrathecally. In this double blind randomized clinical trial, all scheduled patients for cesarean section under spinal anesthesia were enrolled. The patients were randomly divided into 2 groups. Case group received 65-70mg of 5% lidocaine plus 0.2 ml of buprenorphine while the same amount of 5% lidocaine diluted with 0.2 ml of normal saline was given to the control group. Hemodynamic changes and neonatal APGAR scores (Appearance, Pulse, Grimace, Activity, Respiration) were recorded. Pain score was recorded according to the Visual Analogue Scale. Systolic blood pressure was not significantly different until 45th minutes but diastolic blood pressure showed a significant difference at the 15th and 60th minutes (P-value<0.001). Heart rate changes were significantly different between cases and controls at the initial 5th, 15th and after 60th minutes (P<0.001). Pain-free period was significantly different between the two groups (1.25 h versus 18.73 h) (P<0.001). The results show that prescription of intratechal bupernorphine prolong the duration of analgesia without any significant considerable side effects.

The role of vitamin D in the pathogenesis of rheumatoid arthritis is under investigation. This study was designed to evaluate the correlation between serum values of 25(OH) vitamin D [25(OH)D] and disease activity in rheumatoid arthritis (RA) patients according to Disease Activity Score 28 joints and ESR (DAS28ESR). Ninety-nine patients according to ACR classification criteria for RA and 68 healthy controls were included in this study. The participants with known confounding risk factors affecting serum values of 25(OH)D were excluded. All patients were under treatment with supplementary calcium carbonate (1500 mg), 25(OH)D (800U), and Hydroxychloroquine (6mg/kg). The control group was mostly recruited from patients’ relatives who lived with them to minimize the impact of diverse lifestyles on 25(OH)D status. Disease activity was assessed by DAS28ESR. Serum concentrations of 25(OH)D were measured. Serum values of 25(OH)D less than 50 nmol/L were considered 25(OH)D deficiency. The mean 25(OH)D serum values were 83.74±46.45 nmol/L in patients and 46.53±34.07 nmol/L in controls. After adjustment for age, sex and BMI, multivariate analysis showed no correlation between 25(OH)D serum levels and DAS in RA (P=0.29, rp=0.11). However, 25(OH)D serum values were significantly lower in patients with early diagnosed RA (p=0.012) compared with the other patients. In the early diagnosed patients, 25(OH)D and anti-CCP serum values negatively correlated (p=0.04,rs=-0.5). This study showed that there was no correlation between 25(OH)D serum values and DAS over a short duration of disease course. However, in early RA, 25(OH) D serum values were lower than the established RA. Treatment with physiological doses of 25(OH) D kept the mean serum values of 25(OH)D sufficient in RA patients.

Chitosan nanoparticles have become of great interest for nanomedicine, biomedical engineering and development of new therapeutic drug release systems with improved bioavailability, increased specificity and sensitivity, and reduced pharmacological toxicity. The aim of the present study is to synthesis and optimization of chitosan nanoparticles for industrial and biomedical applications. Fe3O4 was synthesized and optimized as magnetic core nanoparticles and then chitosan covered this magnetic core. The size and morphology of the nano-magnetic chitosan was analyzed by scanning electron microscopy (SEM). Topography and size distribution of the nanoparticles were shown with two-dimensional and three-dimensional images of Atomic Force Microscopy (AFM). The nanoparticles were analyzed using Transmission Electron Microscopy (TEM). The chitosan nanoparticles prepared in the experiment exhibited white powder shape. The SEM micrographs of the nano-magnetic chitosan showed that they were approximately uniform spheres. The unmodified chitosan nanoparticles composed of clusters of nanoparticles with sizes ranging from 10 nm to 80 nm. AFM provides a three-dimensional surface profile. The TEM image showed physical aggregation of the chitosan nanoparticles. The results show that a novel chitosan nanoparticle was successfully synthesized and characterized. It seems that this nanoparticle like the other chitosan nano particles has potential applications for nanomedicine, biomedical engineering, industrial and pharmaceutical fields.

The appropriate colon cleansing is a major determinant of quality of colonoscopy. The aim of this study was to compare the efficacy and tolerability of the morning (AM) PEG (polyethylene glycol) solution to previous-evening (PM) PEG solution for the afternoon colonoscopy. This comparative study compared the AM to PM prep for afternoon outpatient colonoscopy. The subjects randomly received PEG PM dose; 4 liters of water plus 4 pack PEG powder at 6 pm before colonoscopy (250 ml every 15 min) or AM (the same dose solution at 6 am on the day of colonoscopy). The preparation and colonoscopy quality, PEG side effects, sleep quality, lesion detection, flush need and suction fluid were compared in these two groups. One hundred seven cases received AM prep and 102 received PM prep. The colon prep was adequate in 94.4% in AM group and in 90.2% cases in PM group (P=0.2). The incidence of adverse events in these two groups was similar. Sleep quality and the need for flush was lower in the AM group (P=0.004 and P=0.03). The mean volume of suction fluid was higher in the AM group (P=0.01). The detected lesions were similar between the two groups. Adequate prep was associated with lower flush need in AM group (P=0.001). AM and PM PEG solutions were clinically equivalent with cleansing efficacy and side effect and lesion detection. AM group was associated with a better sleep quality and less flush need, but more suction fluid.

Depression and anxiety had negative effects on the quality of life of cancer patients, thus hospital anxiety and depression scale (HADS) is a useful instrument for screening these problems. This research was performed to assess the prevalence of their anxiety and depression. From 2012-2013, one hundred fifty patients with recent diagnosis of different cancers in Babol, Iran were assessed. A presumptive diagnosis of anxiety and depression was based on a four point 14-item HADS. The score of 0-7 means without clinical symptoms of anxiety or depression, 8-10 mild and 11-21 symptomatic anxiety or depression. The data were collected and analyzed. Forty-four (29.3%) patients had mild anxiety, 25 (16.7%) symptomatic anxiety but mild and symptomatic depression were seen in 40 (26.7%) and 32 (21.3%) patients, respectively. There were significant relationships between anxiety, depression and the age group of the patients with higher frequency in older ages. There were significant relationships between anxiety and depression with the type of cancer and type of treatment. Breast and stomach cancer patients had the highest prevalence of anxiety and depression and the higher prevalence was observed in the patients who received chemotherapy as the single treatment. The results show that patients with breast and stomach cancer had the highest prevalence of anxiety and depression among all others cancer patients.

The rates of postneurosurgical infections, particularly meningitis and the most common pathogens have been reported variable during the recent years. The aim of this research was to determine the prevalence of postneurosurgical meningitis and its current spectrum of infectious agent. In a descriptive study, the postneurosurgical patients’ cerebrospinal fluid was cultured on blood and MacConkey agar plates and evaluated at Microbiology Laboratory. 55 significant isolates as species level were recognized by bacteriological techniques. Acinetobacter baumannii (A. baumannii) was the most common organism [29(52.7%)], followed by Klebsiella pneumoniae [8(14.5%)], Methicillin-resistant Staphylococcus aureus [6(10.9%)], Staphylococcus saprophyticus [5(9.1%)], Pseudomonas aeruginosa [3(5.5%)], Methicillin-sensitive Staphylococcus aureus [3(5.5%)], and Enterococcus faecalis [1(1.8%)]. The majority of carbapenem-resistant isolates were A. baumannii isolates. Our research revealed that the rate of postneurosurgical meningitis due to carbapenem-resistant A. baumannii had increased. This finding emphasized the importance of preventive strategies against A. baumannii. The changing pattern of infectious agents in postneurosurgical meningitis over time suggests the necessity of other studies.

One of uncommon complications in patients with peritoneal catheter is colon rupture which usually occurs during catheter insertion. In this paper, we present a case of delayed perforated colon following insertion of peritoneal catheter. A 37-year-old man was suffering from chronic renal failure (CRF). Nine months after peritoneal catheterization, peritoneal dialysis was initiated for him. Dialysis fluid was introduced in the abdomen and severe watery diarrhea appeared. Due to intolerable symptoms (pain and severe watery diarrhea) he was referred to our hospital. By obtaining clinical history and physical examination, with suspicion to probable perforated colon, abdominal radiography with contrast through peritoneal catheter was performed. In his radiography, the catheter was detected in cecum. The patient underwent supportive treatment and the catheter was removed without laparotomy. The symptoms improved with antibiotic therapy, intravenous feeding and initiated bowel rest via NPO (nothing per oral) and he was discharged after 10 days with good general condition. According to our presentation, it seems that in patients with catheter dysfunction, peritoneal catheter should be immediately removed to prevent colonic perforation.

Human hydatid disease is caused by echinococcus granulosus and has a global distribution. It mainly affects the liver, but can involve other organs. In this paper, we present a case of a primary hydatid cyst of the fallopian tube. A 69-year-old (gravida 16, para 16 woman) with abdominal pain and urinary frequency was presented to the Gynecology Clinic of Imam Khomeini Hospital Sari, Iran, in September 2011. On physical examination, there was a nontender abdominal mass under umbilicus. The sonography of abdomen and pelvic showed a multiloculated mass with thick septation in right adnexa suggesting mucinous ovarian tumor, while the uterus, left adnex, liver, spleen and kidneys were all normal. The patient’s chest x-ray was normal. Serum tumor markers including CEA, CA125, αFP and βHCG were negative. An exploratory laparotomy was performed. There was a 20 cm firm elastic mass in the anterior surface of uterus originated from the right fallopian tube and was removed. Hydatid cyst was confirmed by pathological examination. Although primary hydatid cyst of genital tract is rare, in high prevalence countries it should be considered

Eosinophilic gastroenteritis (EG) is rare and is characterized by recurrent eosinophilic infiltration of the gastrointestinal tract and chronic diarrhea. In this report we present a case of EG with acute pancreatitis and deep vein thrombosis (DVT). A 30 years old male was admitted to our hospital with the complaints of epigastric pain, vomitting and swelling of his left limb for the past six days. He was also having diarrhea for the last several months. He had been evaluated for chronic diarrhea and ascites before he sought the current consultation. Duplex color doppler of left limb showed DVT of distal calf vein. Contrast enhanced CT imaging of abdomen revealed thickening of duodenum, proximal jejunal wall and presence of ascites. Duodenal biopsy showed normal villous pattern with mild inflammation and eosinophilic infiltration. The constellation of clinical presentation, hypereosinophilia, CT and biopsy findings all is in consistence to EG. The patient was treated with prednisolone 20 mg/day for four weeks and tapered slowly. Acute pancreatitis was managed conservatively while DVT was treated with heparin and oral anticoagulants. The patient’s diarrhea settled and ascites resolved completely. At follow up, the absolute eosinophil count was 300/μl and the patient was doing well. This case report emphasizes that one should consider these rare disorders during the differential diagnosis of unexplained gastrointestinal symptoms in the presence of hypereosinophilia