Reviews in Clinical Medicine
Volume:1 Issue: 3, Summer 2014

Intravitreal injections of anti-vascular endothelial growth factors (anti-VEGFs) have become more popular quickly in recent years. Bevacizumab is an anti- vascular endothelial growth factor agent (anti-VEGF) used to treat choroidal neovascularization and retinal vascular disorders. Rare long lasting ocular adverse events are reported in the intravitreal injection of this drug that include intraocular inflammation, retinal tears, vitreous hemorrhage, endophtalmitis, and lens changes. One important concern about intravitreal injection of anti-VEGF drug is intraocular pressure (IOP) elevation. There are two kinds of IOP elevation. First one is an acute elevation of IOP (after few minutes) and the second is delayed IOP elevation (after few months). The prevalence of IOP elevation immediately after injection is significantly high and seems to have the potential risk for optic nerve fiber loss results in decreased vision but fortunately this IOP elevation seems to be transient in most of studies.

The severe sepsis and septic shock are as common and lethal that emergency physicians routinely confront. Actually, more than two thirds of sepsis patients present initially to the ED. Only a few laboratory tests for markers of sepsis are currently available. The serum lactate level can help in determining prognosis and to risk-stratify patients with severe sepsis. This independent review of the literature includes 83 studies published in all electronic-based database such as Elsevier, PubMed, and SID during the last 18 years (40–320 patients in each). Data gathered from English language articles and books published between 1995 and 2013. The serum lactate concentrations measured in almost all patients with severe sepsis raised at admission and were higher in patients who had the worst outcomes such as higher Apache-II and SOFA score. Serum lactate was associated with mortality independent of clinically apparent organ dysfunction and shock in patients with severe sepsis admitted to the emergency department and intensive care unit. This review focuses on the association between initial and serial serum lactate level and mortality in patients presenting to the emergency department with severe sepsis.

Liver metastatic disorders usually occur in patients with stomach, pancreas, breast, colon, and lung and etc tumor. About 30 percent of patients die because of malignancies, have liver metastases. Liver imaging examination is a fundamental preclinical test to predict patient’s prognosis and is required to monitor treatment. Despite recent advances in radiologic examination, liver metastases are still remaining as a challenge in human oncology. It seems that US is a reliable alternate for CT scan in metastases detection. CT scan should be considered in patients are highly suspension for liver metastases, who have normal or undetermined US findings. The aim of this study was a brief review of radiologic assessment in liver metastases.

Leishmaniasis including Cutaneous, mocucutaneous and Visceral forms of clinical syndromes is one of the important health care problem in the world specially in developing countries. Because of long time duration of treatment, being expensive, many associated side effects and eventually resisted cases to conventional therapy, enormous efforts have been performed to replace herbal and new therapeutic strategies as alternative choices. This review argue about reported studies have conducted by many researchers around the world since 1990 that the subject of all of them were about herbal medicine in treatment of leishmaniasis with emphasis on cutaneous leishmaniasis.

Chronic obstructive pulmonary disease (COPD), characterised by partially reversible contracture of small respiratory airways seems to be among leading causes of death in the world. COPD is characterized by inflammation, protease/antiprotease imbalance, genetic variability and oxidative stress. The latter refers to a condition in which oxidative agents overcome against antioxidants. In this review literature, the consequences of oxidative stress in COPD, such as systemic and pulmonary neutrophil influx, hypersecretion, dual and reciprocal effects with inflammatory contributors and systemic manifestations are discussed. In addition, a review of oxidative stress biomarkers as well as therapeutic strategies based on recent researches for antioxidant supplementation therapy is provided.

Coronary artery diseases affect both systolic and diastolic functions and can be assessed both globally and regionally. Tissue doppler imaging is a novel technique with additional advantages to the currently used two-dimensional echocardiography. This paper is a review of the published articles on documented Coronary artery diseases patients confirmed by angiography, without any previous myocardial infarction and with normal left ventricular ejection fraction. Accordingly, a significant relationship was achieved between systolic rather than diastolic parameters with Coronary artery diseases. Furthermore, major heterogeneity was noticed among the available studies in this respect. The incremental values of tissue doppler imaging in patients with stable angina in addition to other non invasive tests has led to its recommendation by ACC/AHA.

Psoriasis is an inflammatory and proliferative disease. Psoriasis clinical features vary from plaque-type psoriasis to pustular form. Psoriasis is an immune-mediated disease, which affects epidermal keratinocytes. Regard to serious side effects of chemical therapy in psoriasis patients, various projects were performed all around the world to find new therapeutic approaches for psoriasis. Various studies confirmed that Indigo naturalis treatment induced long-term remission in patients with psoriasis in all ages.

In this research Glioblastoma has been studied as one of the most common brain tumors and a short review of the available therapeutic methods have presented including surgery, radiotherapy, chemotherapy and particularly adjuvant chemotherapy with temozolomide, as the most effective developed treatment. Moreover, MGMT gene promoter methylation has been introduced as an important predictive factor of treatment response to temozolamide. The different mechanisms of methylation and the available literature on its association with patient survival and disease recurrence have been summarized. Taken together, Glioblastoma is a tumor in which the MGMT gene expression can potentially deliver the highest amount of data in comparison to other tumors; as almost every related study has emphasized on the direct association between MGMT methylation and patient survival. Regarding this debate, the pseudoprogression pattern in Glioblastoma patients and the laboratory methods studying MGMT gene methylation have been examined. At the end of this review, the obstacles to its development have been briefly mentioned.

Human T-lymphotropic virus (HTLV-1) is an ancient pathogen for human being but arising and recognized recently. The routes of transmission are vertical (mainly by breastfeeding), unsafe sexual contacts and through contaminated blood components specially in whom need frequent and repeated blood transfusions such as permanent anemia due to blood loss in hemophilia and major thalassemia. Patients who should undergo hemodialysis in their lifelong are another instance for increased risk of HTLV-1 exposure. The main HTLV-1-associated diseases are tropical spastic tetraparesis (HAM/TSP), an inflammatory myelopathy and adult T-cell leukemia (ATL). Although HTLV-1 is scattered around the world, only in endemic areas where prevalence rate is more than 1%, viral burden of infection have accumulated. Japan, Southern and Central parts of Africa, Caribbean basin and Iran are examples of endemic areas of HTLV-1. In this article, a rapid and brief review of HTLV-1 virology, immunology and pathogenesis have emerged. In addition, a short debate has driven about current statues of HTLV-1 in Iran.

Pancreatitis is the most common and important complication of endoscopic retrograde cholangiopancreatography (ERCP). Several risk factors play a role in the formation and progression of pancreatitis. These risk factors may be related to the patient, procedure or operator. All of these risk factors should be considered and should be lowered as far as possible with attention to pathogenesis of the development of post-ERCP pancreatitis. The pathogenesis include sphincter spasm, infection, contrast toxicity and pancreatic secretion that induce the activation of proteolytic enzymes and inflammatory processes. Some methods and pharmacologic agents assessed for the prevention of pathway in the pathogenesis to decrease post-ERCP pancreatitis.

Blunt chest trauma accounts for the majority of mortalities and morbidities in traumatized patients. Rib fractures are one of the most common chest wall injuries due to blunt chest trauma, which is estimated to occur in 10% of all traumatic injuries. Conventional radiography and ultra-sonography are two commonly methods used for rib fracture diagnosis with different accuracy. In this study, we described different methods used in diagnosis of injuries related to blunt chest trauma and we aimed to review several studies compared the diagnostic value of these methods.

Ischemic nephropathy is defined as a clinically significant progressive reduction in glomerular filtration rate that is usually associated with significant renal artery stenosis (unilateral or bilateral involvement). Atherosclerotic renal artery disease is known as the most common cause of the ischemic nephropathy. These patients may develop secondary hypertension. In addition, epidemiologic data has showed a clear association between atherosclerotic renal artery stenosis and coronary artery disease and other cardiovascular disease. Despite the preserving function of kidney on various autoregulation processes, unusual microvascular function will be resulted due to sustained decline in renal perfusion. The ischemic nephropathy of asymptomatic cases may result in renovascular hypertension and renal failure. The reduction of renal function in these patients might be decreased or stopped by early appropriate diagnosis and also might be treated with renal artery angioplasty or surgery, after medical management. There is a debate about the occurrence of ischemic nephropathy as a result of atherosclerotic renal artery stenosis. In this study we aimed to review the prevalence of ischemic nephropathy due to atherosclerotic renal artery stenosis.