Reviews in Clinical Medicine
Volume:1 Issue: 4, Autumn 2014

Vascular access failure is known as a principal cause of morbidity of end stage renal disease (ESRD) patients. The major reason for vascular access failure is the neointimal hyperplasia which leads to venous thrombosis and stenosis. The efficacy of different pharmacological therapies has been studied in increasing the vascular access patency duration or decreasing the thrombosis of arteriovenous grafts or fistulas. In the current review, we reviewed the results obtained in different randomized control trials considering the efficacy of pharmacotherapy on the thrombosis rate and duration of vascular access grafts patency in HD patients.

Vascular access failure is known as a principal cause of morbidity of end stage renal disease (ESRD) patients. The major reason for vascular access failure is the neointimal hyperplasia which leads to venous thrombosis and stenosis. The efficacy of different pharmacological therapies has been studied in increasing the vascular access patency duration or decreasing the thrombosis of arteriovenous grafts or fistulas. In the current review, we reviewed the results obtained in different randomized control trials considering the efficacy of pharmacotherapy on the thrombosis rate and duration of vascular access grafts patency in HD patients.

Drug delivery to the inner part of the eye is still a problem in treatment of ocular disease. Iontophoresis has been used in the field of medicine for many years. This technique consists of applying a weak electrical current to drive charged drug molecules across tissue barriers. Transcorneal iontophoresis delivers a high concentration of drug to the anterior segment of the eye (cornea, aqueous humor, ciliary body, iris, and lens), for the treatment of anterior segment diseases. There are different types of iontophoresis such as ophthalmic, transdermal, transungual, oral, buccal, and transnasal. The benefit of iontophoretic drug delivery in ophthalmology lays in its capacity to provide high drug tissue concentration safely, while minimizing the systemic drug exposure. This review summarizes basics of ocular iontophoresis and iontophoretic device, trans corneal and transscleral iontophoresis, and the applications of iontophoresis in ophthalmology.

Currently, a large burden of hospital admissions is related to minor head trauma and its related imaging studies. One of the challenging issues for emergency physicians is brain computed tomography scan. Sensible use of computed tomography studies could minimize unnecessary radiation exposure and resource use. On the other hand, it can result in delayed or missed early treatment of intracranial injury. The aim of this review is to evaluate and summarize the costs and benefits of using diagnostic measurements in minor head trauma with particular focus on computed tomography scan and the advances and limitations of available guidelines. We studied different issues related to the current approach to minor head trauma in emergency departments. Altogether, it seems using brain computed tomography scan in the setting of emergency is a cost-effective method for the selected patients with minor head injury. However, concerning considerable costs of caring for patients with head injury and high sensitivity of brain computed tomography in terms of minor head injury, it seems reasonable to use brain computed tomography scan for a wider range of patients with minor head injury.

Heart failure (HF) is a serious and growing public health concern, which has many causes. Pregnancy is a critical condition with significant hemodynamic and immunologic changes. Peripartum cardiomyopathy (PPCM) is a disease of unknown cause in which left ventricular (LV) dysfunction occurs during the last trimester of pregnancy or the early puerperium. PPCM is known to be the most common cardiovascular cause of severe complications in pregnancy. Risk factors for peripartum cardiomyopathy include advanced maternal age, twin pregnancy, smoking, pregnancy-related hypertension and preeclampsia, multiparity, African descent, and long-term tocolysis. Oxidative stress and some inflammatory markers have been diagnosed in PPCM pathophysiology. Recent observations have suggested that bromocriptine might favor recovery of LV systolic function in patients with PPCM. Patients developed peripartum cardiomiopathy treated with bromocriptine showed significantly improved LV ejection fraction and heart failure symptoms. This article tries to have a short review on this clinical scenario.

Hepatitis C virus (HCV) causes 308000 deaths due to liver cancer and 758000 deaths due to cirrhosis every year. Almost 170 million people have HCV infection around the world. Information regarding this virus helps us to determine the prevalence of other hepatitis C genotypes in population, especially in intravenous drug users. It is assumed that some genotypes are more common in certain areas or groups of people. A recent study strongly confirms the central role of injecting network traits, not only as a transmission factor but also as a predictor of HCV genotype and phylogenetic determination in different communities. Hepatitis C genotypes and subtypes have different prevalence considering the country. Risk factors such as transfusion, hemodialysis, root of acquisition and etc, are detected in intravenous drug users. Several conducted studies have investigated the prevalence, risk factors, and predominance of HCV genotypes infection in different parts of Iran.

Central serous chorioretinopathy is a common cause of visual morbidity. It is characterized by idiopathic serous retinal detachment in macular or paramacular regions. The symptoms of the CSC include decreased vision, micropsia and metamorphopsia. The prognosis of the disease is good and almost 90% of patients obtain visual recovery in a few months. However, in less than 5% of patients the chronic disease with poor prognosis is developed. The acceptable approach is to observe patients with acute central serous chorioretinopathy, because central serous chorioretinopathy is self-limited. The pathophysiology of central serous chorioretinopathy is not clear and not well understood. Therefore, various medical treatments have been suggested such as propranolol, indomethacin, bevacizumab, acetazolamide, mifepristone, labetalol, etc. However, wait and watch would be the most recommended management of the central serous chorioretinopathy.

Amblyopia is one of the most important reversible eye disorders in children and different treatments are suggested. Early diagnosis and effective treatment in amblyogenic age are important criteria. These critical periods correspond to the period when the child’s developing visual system is sensitive to abnormal input caused by stimulus deprivation, strabismus or significant refractive errors. Traditional treatments such as glass wearing, contact lens used with patch therapy have limitations. Laser corneal refractive surgeries introduce an alternative for the treatment of anisometropic amblyopia. Current indications for refractive surgery include anisometropia, bilateral high myopia and accommodative esotropia. Several reports confirmed that with recent development in keratorefractive surgery, it could be a safe method to be used in children. The goal of the permanent surgical treatment is to reduce refractive errors, treat amblyopia and make better the binocular function. Corneal haze is certainly a major concern in children receiving surface ablation, especially in high myopic treatments. However, controversies still exist on whether it could be done in this population or not. This article reviews the available data about refractive surgery for treating anisometropic amblyopia.

Thioredoxin system comprised of thiorexin and NADPH dependent thiorexin reductase, is responsible for redox regulation of cells by controlling the apoptosis, proliferation and other vital processes of cells. The efficacy of thioredoxin system has been represented in a wide range of physiological and biological reactions in bacteria, yeast, plants, mammals and etc. including DNA synthesis, regulation of transcription factors, protein repairing, regulating the photosynthesis and controlling the apoptosis and preventing oxidative stresses, filamentous phage assembly, immune-modulating, neuronal survival, pregnancy and birth and many other physiological and biological functions. The up-regulation of thioredoxin has been observed in various malignancies, which was associated with tumor angiogenesis and development. In this regard, the thiordoxin system has become a putative target in new chemotherapeutic methods. In this study, we mentioned various features of thioredoxin system in malignant cells and reviewed the articles which have evaluated the expression rate of thioredoxin system in malignancies.

Vitamin D receptors are located in body tissues and cells. In various physiological processes of the body the primary circulating form of vitamin D, 25-hydroxyvitamin D, will become the active form, 1,25-dihydroxyvitamin D, through many enzymatic. Although different functions of vitamin D has been identified, reducing the possibility of several chronic diseases, including common cancers, autoimmune, infectious, and cardiovascular diseases is proposed as the major role of this component. According to various experimental and clinical studies, vitamin D affects the immune system activity. In this review we study the possible effects of vitamin D on sepsis. The purpose of this review is to evaluate and summarize the role of vitamin D in the immune system, with particular focus on infections and sepsis. We studied different areas related to vitamin D in the literature review including its roles sepsis and infection incidence, as well as seasonal and racial variation in sepsis. Based on evidence, vitamin D positively affects the immune system, so it might act as a therapeutic strategy. Despite several experimental studies which demonstrated the beneficial effects of vitamin D on improved functioning of the immune system, its association with prevention or management of infections and sepsis is not revealed through clinical investigations.

Hyperbilirubinemia is a common disease and unconjugated hyperbilirubinemia has been seen mainly in neonates. Severe form of unconjugated hyperbilirubinemia may cause kernicterus and even death. Conventional treatment for severe unconjugated hyperbilirubinemia consists of phototherapy and exchange transfusion that have several known disadvantages; specially exchange transfusion is associated with a significant morbidity and even mortality. These harmful effects indicate the need to develop alternative pharmacological treatment strategies for unconjugated hyperbilirubinemia. One of these pharmacological agents is zinc salts. Zinc has been shown to lower the bilirubin levels by inhibition of the enterohepatic cycling of unconjugated bilirubin. Oral zinc has been shown to reduce serum unconjugated bilirubin in animals, adolescents and low birth weight neonates. However, studies in healthy term neonates given oral zinc showed no reduction in hyperbilirubinemia based on daily measurement. In order to improve the accuracy, hyperbilirubinemia may be determined based on measurements every hour. More studies are needed to know the effect of zinc in neonatal jaundice.

Attention deficit hyperactivity disorder is one of the most common psychiatric disorders in childhood. Around 25-50% of these children suffered from some kind of sleep disorder especially with chronic form of insomnia. The physicians usually have a plan for improving hyperactivity and attention deficit of this disease but unfortunately, they forget to manage the sleep disorders, which are a major part of patients’ problems.Nowadays, we know that there is a noticeable relationship between attention deficit hyperactivity disorder and sleep disorders and by improving these children''s sleep, not only the daily functions improve, but also the symptoms of attention deficit hyperactivity disorder maybe become better. Thus, it is needed to avoid the administration of psychostimulants, which have recognized side effects. Moreover, having better sleep, we will see a better relationship between children and their parents and finally a rise in the standard of life of family members, which is a very important goal in our treatment. This review article evaluates available evidence on sleep medication in children with attention deficit hyperactivity disorder to present an appropriate guidance for this high prevalence problem.