Caspian Journal of Internal Medicine
Year:2015 | Volume:6 | Issue:2|Papers Count:14

Osteoporosis is one major cause of bone fracture and subsequent morbidity and mortality in the elderly population (1). Several clinical and demographic parameters including aging, menopause, parity, inflammatory disease, hormonal, gastrointestinal, renal and metabolic disorders like vitamin D deficiency, obesity, weight loss may affect bone mass and result in bone mineral density changes (BMD) and osteoporosis (2-6).Helicobacter pylori (H. pylori) which is a known cause of gastritis and peptic ulcer disease is associated with systemic inflammation. In addition, H. pylori infection has been linked to many other disorders like autoimmune thyroid diseases, diabetes mellitus, dyslipidemia, obesity, osteoporosis and primary hyperparathyroidism (7).

Background: Metabolic syndrome (MetS) is a complex clustering cardiovascular risk factors such as abdominal obesity, hypertension, diabetes and dyslipidemia. It has been a growing health problem in Iranian adults in recent decade. The objective of this article was to review the prevalence of MetS and the corresponding risk factors among Iranian adults.Methods: We conducted a systematic review to extract the published articles regarding metabolic syndrome and its risk factors among Iranian adults aged>19 years by searching in PubMed, Google Scholar, SID, Magiran and Iranmedex databases. The forty-three published articles were selected regarding MetS among Iranian adults in this review during 2005-2014.Results: From the 43 studies, the rate of MetS varied from 10% to 60% depending on sex, age and region. The highest rate reported among postmenopausal women in Shiraz was over 60%. There was almost a consistent finding that the rate of MetS was higher among women compared with men across national level except in one study. A very sharp difference (43.3% vs. 17.1%) was observed in western Iran (Kordestan province) between sexes. MetS was significantly more prevalent among older adults, postmenopausal women, less-educated people, those living in urban areas and those with low physical activity and unhealthy eating habits across national level consistently.Conclusion: An emerging high rate of MetS across national level highlights the lifestyle modification as preventive measures in Iranian population by focusing primarily on high risk profiles such as low socioeconomic background, low level of education, older age and postmenopausal women.

Background: Low bone mass is a frequent complication of chronic inflammatory disease. The pathogenesis of osteoporosis in chronic inflammatory disease may be secondary to releases of cytokines such as TNF-a and IL6. Chronic gastritis due to helicobacter pylori (HP) infection may lead to decreased bone mineral density (BMD) and predispose patients to osteoporosis. The objective of this study was to determine the BMD status in HP positive patients with gastritis versus HP negative cases.Methods: In this cross-sectional study, we enrolled 967 participants aged 60 years old and more from Amirkola Health Study Ageing Project. Seven-hundred and fifty eight HP positive and 209 HP negative patients were analyzed. BMD was measured by dual-energy x-ray absorptiometry (DXA) method in the spine and femoral neck in all participants.Results: The mean age in HP+ and HP- negative patients was 68.3±6.8 and 69.3±7.4 years, respectively. BMD g/cm2 in the spine and femoral neck did not differ between the two groups (P=0.19 and 0.22 respectively). The prevalence of osteoporosis did not also differ across the two groups as well. There was no relationship between the level of antibodies against HP and BMD.Conclusion: According to the findings of this study, H. pylori infection is not associated with BMD changes in the elderly population.

Background: The early postoperative feeding after caesarean section (C- section) has remained controversial. This study was designed to evaluate the safety and efficacy of early versus delayed postcaesarean section oral feeding regarding gastrointestinal complications and patients postoperative satisfaction after C- section.Methods: This clinical trial study was conducted on 200 pregnant women undergoing planned C-section under spinal anesthesia (Registration Number: IRCT: 138712211760N1). Women were randomly divided in two groups; group A (early feeding group) comprised of 101 patients who were encouraged to take oral fluid. If they tolerated, they continue semi-solid and solid foods starting 2 h after caesarean section. Group B (delayed feeding group) comprised of 99 patients who were given oral fluid 8 h after surgery. After beginning of feeding the patients’ tolerance, first flatus, first defecation, beginning of regular diet, the length of hospital stay and also patient satisfaction level were evaluated in each group by visual scale analog (VAS).Results: The mean time of the first passage of flatus was 10.2±1.7 hours for the early oral feeding group versus 10.7±1.6 hours for the delayed feeding group and the difference was significant (P=0.03). Duration to first defecation and length of hospital stay as well as patient satisfaction level did not differ significantly between the two groups.Conclusion: The results of this study suggest early postcaesarean feeding. It is well tolerated and helps return normal feeding habits.

Background: Hypocalcemia is a well-recognized complication after total thyroidectomy. Hypovitaminosis D may have additional effect in the development of hypocalcemia. This study aimed to determine the effect of total thyroidectomy on postoperative serum calcium in patients with and without hypovitaminosis D.Methods: This prospective study was performed on patients who underwent total thyroidectomy from 2011 to 2014 in Imam Khomeini General Hospital of Mazandaran University of Medical Sciences. Serum calcium and vitamin D values were recorded before and after surgery. The patients were classified according to serum vitamin D concentrations as less 10 ng/ml (vitamin D deficiency) or higher (control group). The mean values of postoperative calcium level for each class of serum vitamin D were determined and compared. Hypocalcemia was defined as a postoperative calcium level<8 mg/dl.Results: 125 patients due to thyroid disease underwent total thyroidectomy. The incidence of symptomatic and asymptomatic hypocalcemia after surgery was 12% (n=15) and 3.2% (n=4) respectively. 82 (65.6%) patients had vitamin D deficiency and 43 (34.4%) patients had sufficient vitamin D level. There was not any significant difference in calcium level (8.67±0.58 mg/dl vs. 8.70±0.59 mg/dl) between two vitamin D studied groups after thyroid surgery (p>0.05).Conclusion: The findings of this study indicated that vitamin D deficiency had no significant effect on post-thyroidectomy serum calcium level.

Background: Diabetes is a common metabolic disorder leading to the development of many complications, among which diabetic retinopathy and macular edema are the most significant. These complications can contribute to blindness if not diagnosed or treated properly, and several studies have been conducted to evaluate the methods for the prevention or slowing down their progression. Therefore, serum lipids, apparently play an effective role in the creation and acceleration of macular edema, we therefore determined the relationship of serum lipid level in patients with diabetic macular edema in the present study.Methods: 180 participants were selected from patients with the definite diagnosis of diabetes referred to the eye clinic of Shahid Beheshti and Ayatollah Rouhani Hospitals of Babol during 2011-2012, the patients with a history of taking lipid –lowering drugs and hypertension were excluded from the study. The study data were provided from the medical records of each patients. SPSS Version 18 was used for analyses.Results: In the present investigation, the mean age of participants was 53.22±with the age range of 18-77 years. Ninety patients with diabetic retinopathy and macular edema were compared with ninety patients with diabetic retinopathy without macular edema (control group) were compared. There was a significant difference in serum cholesterol and LDL-cholesterol between patients and groups (p<0.000).Conclusion: The results of this study indicate that high serum cholesterol and LDL-cholesterol is associated with severity of diabetic retinopathy particularly with macular edema.

Background: Recognition of the predisposing factors of bladder cancer is very important and provides possible prevention measures. The aim of this study was to investigate the types, distribution of bladder tumors and their relationship with opium consumption and smoking in patients who referred to Shahid Beheshti Hospital, Babol, Iran.Methods: In this case-control study, all patients diagnosed with bladder cancer who underwent surgery during 2001-2012 were enrolled. The subjects of the control group were selected among the patients who underwent ERCP (endoscopic retrograde cholangiopancreatography) for gallstone and had no tumors and genitourinary problems. Data regarding demographic, pathology reports and tumor type, smoking status, history of opium consumption and its duration were collected. Patients and controls were compared using t-test and chi-square test. SPSS software Version 20 was used for analysis.Results: In this study, 175 patients with an average age of 63.30±15.29 years and 175 age matched controls were studied. A significant association was observed between smoking and opium consumption with bladder cancer (P=0.001 for both).Conclusion: The results of this study showed that opium consumption and smoking are associated with bladder cancer

Background: Although some patients can tolerate colonoscopy procedure using fentanyl/ midazolam without any sedation and analgesic requirements but some patients may require additional sedation with benzodiazepines. We performed the present study to compare the effect of paracetamol/midazolam with fentanyl/ midazolam.Methods: In a clinical trial, 96 patients aged 18 to 75 years old, who were candidate for elective colonoscopy assigned consecutively into two groups as paracetamol/midazolam and fentanyl/midazolam. The first group received 1 gr paracetamol 45 minutes before colonoscopy and 0.5 mg/kg midazolam 5 minutes before colonoscopy whereas the second group received 04- 0.5-1 mcg/kg fentanyl 3 minutes before colonoscopy and similar dose of midazolam. The two groups were compared in regard to patient intensity, discomfort, acolonoscopist and, patient satisfaction and rescue dose of propofol during colonoscopy and vital signs.Results: There was no significant difference between the two groups for patient pain score, colonoscopist satisfaction, patient satisfaction and rescue dose of propofol (P=0.817, 0.978, 0.460, and 0.104, respectively). The incidence of apnea was greater in fentanyl group (P=0.045). After adjusting for age and education, there was also no significant difference between the two groups.Conclusion: This study indicates that paracetamol can be considered as an alternative drug regimen in preparation of colonoscopy.

Background: Vitamin D has a potential to modulate inflammatory response against noxious particles in patients with chronic obstructive pulmonary disease (COPD). The present study was conducted to determine the status of serum vitamin D in COPD versus healthy group.Methods: The patients presented to the outpatient pulmonary clinic of Ayatollah Rouhani Hospital, Babol Iran. Diagnosis of COPD was confirmed based on airflow limitation defined as FEV1/FVC ratio<70% and FEV1<80% of predicted. All eligible patients aged³40 years old entered the study. Pulmonary infection, tuberculosis, pleural effusion, congestive heart failure, pulmonary hypertension and embolism, restrictive airway disease, conditions leading changes in vitamin D metabolism and absorption were excluded. Serum 25-hydroxyvitamin D (25-OHD) was determined by electrocheminluminescence method and levels<20, 20-29, and³30ng/ml were considered as deficiency, insufficiency, and sufficiency. In statistical analysis, the frequency of serum 25-OHD deficiency and insufficiency in patients were compared regarding age of£50 or>50 years old. All patients were males and age and sex-matched controls were selected among healthy subjects accompanied COPD patients.Results: Ninety patients and 100 controls with respective mean (±SD) age of 64.8±11.7 and 62.6±11.7 years old (P=0.19) were studied. Compared with control, proportions of serum 25-OHD deficiency and insufficiency in patients>50 years were higher and deficiency was lower (61.5% vs 87.5%, P=0.11).Conclusion: These findings indicate that a significant proportion of young COPD patients have insufficient serum 25-OHD. Regarding a positive relationship between 25-OHD and FEV1 in COPD, these findings highlight serum 25-OHD assessment in COPD for recognizing high risk patients.

Background: Excessive lumbar vertebrae translation and rotation in sagittal plane has been attributed as an associated factor of lumbar segmental instability (LSI) and low back pain (LBP). Reduction of these abnormalities improves back pain. The aim of this study was to investigate the effect of core stability exercise on the translation and rotation of lumbar vertebrae in sagittal plane in patients with nonspecific chronic LBP (NSCLBP).Methods: In this randomized clinical trial, 30 patients with NSCLBP due to LSI were included. The participants were randomly divided into two groups of treatment and control. The treatment group received general exercises plus core stability exercise for 8 weeks whereas; the control group received only general exercises. The magnitude of translation (mm) and rotation (deg) of lumbar vertebrae in the sagittal plane was determined by radiography in flexion and extension at baseline and after intervention. The primary outcome measures were to determine the mean changes from baseline in translation and rotation of the lumbar vertebrae in the sagittal plane after 8 weeks of intervention in each group. The secondary outcome was to compare the two groups in regard to translation and rotation of the lumbar vertebrae at the end of the study period. Data were analyzed using paired t-test and independent t-test.Results: Thirty patients aged 18-40 years old with clinical diagnosis of NSCLBP entered the study. Compared with baseline values, mean value of translation and rotation of the lumbar vertebra reduced significantly in both groups (P<0.05), except L3 translation in the control group. At the endpoint, mean translation value of L4 (P=0.04) and L5 (P=0.001) and rotation of the L5 (P=0.01) in the treatment group was significantly lower than the control group.Conclusion: These findings indicate that in patients presented with NSCLBP due to lumbar segmental instability, core stability exercises plus general exercises are more efficient than general exercises alone in the improvement of excessive lumbar vertebrae translation and rotation.

Background: Non-melanoma skin cancer is the most common malignant tumor in humans. The role of ultraviolet radiation is well-known in the pathogenesis of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). CD10 is a zinc-dependent metallopeptidase known as common acute lymphoblastic leukemia antigen (CALLA). Although CD10 expression has been investigated in some cutaneous tumors, to our knowledge, data regarding its expression in cutaneous epithelial neoplasms are very limited. In this study, we aimed to determine the immunohistochemical expression of CD10 in BCC and SCC and to find whether it could distinguish between these two skin malignancies.Methods: Twenty SCC and 42 BCC cases were retrieved randomly from Ayatollah Rouhani Hospital pathology archive and CD10 expression was determined in tumoral and stromal cells of each case based on immunohistochemical method. Positive CD10 staining was identified as brown cytoplasmic, with or without cell membrane staining.Results: In all the 20 SCC cases, tumor cells failed to stain with CD10 in contrast to the stromal cells that showed CD10 expression in 18 cases (90%). In BCC cases, the expression of CD10 was noted in tumor cells in 25 cases (59.5%) and in stromal cells of 32 cases (76.2%). There was no relation between CD10 expression in aggressive and non- aggressive BCC.Conclusion: Our findings suggest that CD10 is a useful immunohistochemical marker to differentiate between BCC and SCC. At least, if tumor cells were CD10 positive, this would favor BCC over SCC. Due to small number of aggressive BCC in contrast to non- aggressive types, more studies need to be done to prove or rule out this finding.

Background: Coronary arteriovenous fistulas (CAVFs) are direct connections from one or more coronary arteries to cardiac chambers or a large vessel. They are mostly of congenital origin. The aim of this study was to describe clinical presentation and also delineate the course and management of CAVF.Methods: Clinical data, chest x-rays, echocardiographic and angiographic evaluation of 40 patients with congenital CAVF during 1990 to 2008 were reviewed retrospectively.Results: Seventeen patients were£20 years old (42.5%) were mostly asymptomatic, and twenty tree cases were older than 20 years old (57.5%), mostly symptomatic (P<0.05). Twenty one (52.5%) patients had pure CAVF and nineteen (47.5%) patients with associated intarcardiac congenital heart disease (15%) or acquired valvular and coronary arteries diseases (32.5%). CAVFs mostly originated from left anterior descending artery (LAD) (42.5%) and mostly drained into the main pulmonary artery (MPA) (35%). Twenty-four patients underwent CAVF surgical ligation. From twenty-one patients with pure CAVF, eight (38%) patients were complicated by congestive heart failure and aneurism formation of fistula.Conclusion: Unlike some previous reports, in our study, the most prevalent origin site for CAVFs was the left anterior descending (LAD). Most patients with CAVFs especially those who went first diagnosed before 20 years old were asymptomatic. On the other hand, as the continuous murmur is not always detected in children or infants, consequently, cases of spontaneous closure may remain undetected. All symptomatic and asymptomatic patients with moderate to severe shunting should be operated on and minimal morbidity and good surgical results could be expected.

Background: Chemotherapy plays a very important role in the treatment of leukemia but the resistance properties of the lymphoblasts limit the effect of chemotherapy. One of the main mechanisms of resistance to chemotherapy is the increased expression of MDR1 gene. The aim of this study was to explore the effect of resveratrol on the expression of MDR1 gene in leukemic lymphoblast of new cases of acute lymphoblastic leukemia (ALL) patients in vitro.Methods: Separation of lymphoblasts of 5 new case ALL patients from peripheral blood was performed by ficoll density gradient centrifugation. Lymphoblasts were cultured in RPMI 1640 medium. Lymphoblasts were treated with 50mmol/L resveratrol for 48h. Total RNA was extracted with guanidine isothiocyanate. RNA was converted to cDNA. Real time PCR was used to detect mRNA expression of MDR1.Results: The results of gene detection showed that the expression of MDR1 did not change significantly in the patients however, in one patient expression of MDR1 increased upon treatment with resveratrol.Conclusion: The results of this study did not support resveratrol as a compound to reverse multidrug resistance in leukemic lymphoblasts.

Background: Influenza A virus is the most virulent human pathogen and causes the most serious problem. Having epidemiological knowledge about this disease is important. The aim of this study was to determine the prevalence of influenza A/H3N2 virus infection in northern Iran from 2011 to 2013 using the real-time polymerase chain reaction (RT-PCR).Methods: In this cross-sectional study 57 samples were collected from patients with influenza-like illness (T³38oC and cough or sore throat. Influenza-RNA was extracted from the samples using PureLinkTM Viral RNA/DNA Kit. RT-PCR was one using SuperScript III Platinum, Quantitive Real Time PCR system from invitrogen with a specific type of primers and probs. All samples were examined in the Influenza laboratory of Mazandaran University of Medical Sciences.Results: The mean age of patients was 38.2±14.5 year, 278 (48.69%) were males and 293 (51.31%) females. A total number of 201 patients (35.2%) were diagnosed as influenza A1 H3 N2 infection.Conclusion: The results show that the prevalence of A/H3N2 in the North of Iran is considerable and needs more attention for preventive measures.