Caspian Journal of Internal Medicine
Year:2013 | Volume:4 | Issue:4|Papers Count:12

Helicobacter pylori (H.pylori) infection is probably the most important factor that has been associated with the development of gastric cancers in human populations. However, there are no reliable data on the prevalence of this infection in the Middle East. In this article, based on a comprehensive literature review, we aimed to evaluate the situation in this region. The literature has been searched for the incidence and prevalence of H.pylori infection by Pubmed and Google Scholar. Search was repeated for each of the Middle Eastern countries, and to empower the method, citations of each found article were searched for the related studies. Seventy seven reports from the countries of the Middle East region had been reviewed and they all indicated a high rate of infection either in the general population or in the dyspeptic patients, the rate seemed to be higher in patients with dyspepsia, in patients with histologically confirmed gastritis and in patients of older age groups.

Background: The vascular response to recurrent tissue hypoxia and reperfusion following red blood cell sickling causes acute chest syndrome and chronic lung disease. The purpose of this study was to determine the pattern of chronic lung lesions and possible risk factors in sickle cell patients in lagos, Nigeria.Methods: From July 2012 to April 2013, Pulmonary function test (PFT) and chest-x-ray were determined in 56 eligible patients with sickle cell disease. Full blood count, red cell indices, hemoglobin F level, oxygen saturation, liver function tests, lactate dehydrogenase and tricuspid regurgitant jet velocity were measured.Results: The mean age of the patients was 22±6 years. The mean forced vital capacity was low (76.49%±16). Abnormal PFTs were restrictive lung lesion (53%), obstructive lesions (3.7%) and mixed lesions (11%). The vital capacity had negative correlation with the white cell count and platelet count while it had positive correlation with age. There were no significant differences when normal and abnormal PFTs were compared based on the following laboratory data: lactate dehydrogenase (244 vs. 301), hematocrit (22.7 vs. 23.6), fetal hemoglobin (6.2% vs. 4.2%), mean corpuscular hemoglobin concentration (33.7 vs 33.3), aspartate transferase (34.2 vs. 35.1), tricuspid regurgitant jet velocity (1.3 vs. 0.92) and oxygen saturation (95.8 vs. 95.5). Abnormal x-ray findings were present in 84% of participants. Chest x ray showed ischemic (17%), congestive (69%), fibrotic and inflammatory (14%) changes.Conclusion: Chronic lung lesion is common in sickle cell disease associated with rising white cell count, platelet count. All adult patients should have regular spirometry done to ensure early detection.

Background: Anemia may be considered to be an independent risk factor for the development of diabetic retinopathy (DR) in patients with renal failure. The purpose of this study was to investigate the association between blood hemoglobin level and retinopathy in diabetic patients with normal renal function tests.Methods: From 2009 to 2011, 1100 diabetic patients underwent retinal examination. Among them, 159 subjects were diagnosed to have DR and were compared with 318 diabetic subjects with normal retinal examination as the control group. The level of hemoglobin (Hb), Hb A1C, serum iron, ferritin, and total iron binding capacity were compared between these two groups.Results: Among the 159 patients with DR, 112 (70.4%) had mild to moderate no proliferative retinopathy (NPDR) and 47 (29.6%) had advanced retinopathy (severe NPDR or proliferative). The mean hemoglobin level in case and control group was 12.15±1.50 and 12.73±1.38 g/dl, respectively (p<0.001). Anemia was seen in 45.9% and 26.1% in the case and the control groups, respectively (p<0.001). Ferritin <15ng/ml was seen in 7.4% and 6.1% of patients with and without DR, respectively (p=0.8).Conclusion: The results show that diabetic patients with retinopathy have lower level of hemoglobin and higher frequency of anemia. It is suggested that the level of hemoglobin should be evaluated periodically in diabetic patients.

Background: The mechanism of hypoglycemic and hypolipidemic activities of Pyrus biossieriana Buhse leaf extract (PbBLE) and its phytochemical component arbutin, have not been well determined. The present study was performed to understand the hypoglycemic activity mechanisms of pbBLE and arbutin more clearly.Methods: In vitro enzymatic carbohydrate digestion with PbBLE and arbutin was assessed using a-amylase and a-glucosidase powders. The enzyme solutions were premixed with PbBLE and arbutin at different concentrations (0.1, 1, 10 and 100 mg/ml). Substrate solutions and colorimetric reagents were added to the reaction. The release of glucose was determined by spectrophotometric method. Acarbose was used as the positive control.Results: The extract (10, 100 mg/ ml) completely inhibit a- amylase and a- glucosidase activities. The extract produced higher reduction of a-amylase and a-glucosidase activity than arbutin. Inhibition at various concentrations (0.1, 1, 10, 100 mg/ml) were significantly different (p<0.05).Conclusion: Our results exhibited that both the extract and arbutin were able to suppress the enzymes strongly.

Background: Metastasis and recurrence of colorectal cancer after treatment is attributed to stem cells. The aim of this study was to determine the relationship between the expression of stem cell marker CD166 in colorectal cancer by immunohistochemistry and clinicopathologic parameters.Methods: From 2006 to 2012, 121 colectomy specimens of patients with colon cancer that were operated in Babol Medical University in Iran were evaluated. The paraffin blocks were extracted from the archive and the slides were prepared and stained for H&E and Immunohistochemical (IHC) methods. The samples with cytoplasmic and/or membranous staining more than 50% of tumor cells were considered as positive. Pathological parameter including type of tumor, stage and grade, vascular invasion and location of the tumors were recoerded.Results: The mean age of the patients was 58.7±15.1 years. Sixty-four (54.9%) patients were males. Eighty-six (71.1%) subjects were positive for cytoplasmic and 42 (34.7%) for membranous and 42 (34.7%) for both cytoplasmic and membranous staining. The cytoplasmic expression of marker CD166 marker in mucinous type was 10 (50%) and was lower than non-mucinous type 76 (75.2%) (p=0.031). There was significant relationship between membranous expression of CD166 marker and tumor location (right colon in 23(54.8%), left colon in 18 (24.3%)] (p=0.001). There was no significant difference in the expression of marker with other demographic and clinicopathologic variables.Conclusion: The results show that CD166 expression was seen in more than two-thirds of the patients. The cytoplasmic expression of CD166 marker was higher in non-mucinous type. The distributions of membranous expression of marker CD166 was related more in right colon with colorectal cancer.

Background: Few studies regarding oral lesions of children and adolescents were reported in the medical literature. The aim of this study was to determine the frequency of these lesions in patients from birth to 20 years old in Babol, Northern Iran.Methods: The slides of all cases of oral lesions in children and adolescents, between 1990 and 2012 were obtained from the pathology archives of Shahid Beheshti Hospital and School of Dentistry, Babol University of Medical Sciences in Iran. The lesions were categorized as follows: cystic lesions, tumor/tumor-like lesions and inflammatory/reactive lesions. The data were collected and analyzed.Results: The 244 retrieved cases accounted for 27% of total oral biopsies (8956) were performed during this period. Male to female ratio was 0.8. Inflammatory / reactive category (61.9%), tumor/ tumor-like category (23%) and cystic category (15.2%) were in order of frequency. Mucocele was seen in 55 (35.8%) of 151 cases of inflammatory/ reactive, centeral giant cell granoloma (CGCG) in 15 (26.8%) of 56 tumor/ tumor like and radicular cyst in 14 (37.9%) of 37 cystic lesions.Conclusion: Our findings indicate that mucocele, CGCG and radicular cyst were frequent lesions in inflammatory / reactive, tumor / tumor like and cystic categories, respectively in our region.

Background: Chest x-ray has an important role in the diagnosis of tuberculosis (TB). The aim of this study was to determine the radiological changes in patients with smear positive pulmonary tuberculosis.Methods: In this study, 325 patients with smear positive pulmonary TB was enrolled. The affected lobe or lobes of the left or right lung were recorded. The types of involvement were categorized based on patchy consolidation, cavitation, collapse consolidation and bronchopneumonia. The data were collected and analyzed.Results: From the 325 patients, 116 (35.7%) were males and 209 (64.3%) were females. The most frequent involved site was the left upper lobe in 175 (53.8%) followed by the right upper lobe in 134 (41.2%) cases. The most frequent radiographic finding was bronchopneumonia in 242 (74.4%) cases. Patchy consolidation was detected in 99 (30.4%) patients. Cavitary lesion and pleural effusion were observed in 68 (20.9%) and 35 (10.7%) patients, respectively.Conclusion: The results show that pulmonary upper lobes were the most frequent involved sites.

Background: Toxoplasmosis is a common parasitic infection in human around the world and can cause life-threatening encephalitis in human immunodeficiency virus (HIV) infected host. The aim of this study was to assess the frequency of toxoplasma infection in illicit drug users (IDUs) with and without HIV infection in Iran.Methods: This study was carried out on 84 IDUs (42 HIV positive as case group and 42 HIV negative subjects as control group) from 2008 to 2009. Serum samples were tested for T. gondii IgG antibodies by Enzym linked immunosorbant assay (ELISA). Based on the company brochure kit, the test was defined positive if the antibody titer was 3 IU/ml or more. The data from these two groups were collected and analyzed.Results: The mean age of HIV positive cases was 34.4±8.6 and for HIV negative cases was 35.9±9.3 year. The mean age and distribution of sex in both groups were equal. The frequency of toxoplasma-IgG in HIV positive and HIV negative was 73.8% and 81%, respectively (p=0.19).Conclusion: The results show that prevalence of toxoplasmosis infection in the illicit drug users with HIV positive or negative is equal.

Background: One of the fundamental issues of infectious disease treatment is drug resistance. The aim of the present study was to investigate the first-line anti-tuberculosis drug resistance rates and determine the risk factors related to multidrug resistant mycobacterium tuberculosis.Methods: From March 2011 to September 2012, mycobacterial strains were collected from one hundred fifteen diagnosed smear positive patients in the central province of Iran and tested for drug susceptible against ethambutol, rifampicin, isoniazid and streptomycin and the risk factors influencing the development of drug resistance were determined.Results: The mean age of patients was 52.23±19.75 years. The rate of multi-drug resistant tuberculosis (MDR-TB) was 7.8%. Our study revealed that there were significant associations between prior treatment, age<45 years, positive smear result at the end of the second month and positive smear result at the end of the third month. However, there was no association found between gender, inhabitant, nationality, close contact with TB patient, HIV infection and size of mantoux test.Conclusion: The results show that about 8% of TB cases in Arak are MDR TB. The age under 45 years, previous TB treatment and positive smear at the end of the second and third months of treatment were the main factors in the development of MDR-TB.

Background: Breast cancer is the most common type of malignancy in the female population, rarely is reported by thromboembolic events during the course of the disease. In this case, we present a rare case of breast cancer presenting as deep vein thrombosis of the axillary vein.Case Presentation: A 40-year- old female was admitted due to pain and swelling of her right arm and forearm of two months’ duration. The right arm was grossly edematous with pitting edema. Breast examination showed non-tender fixed nodules in the right outer quadrant of the right breast. Doppler ultrasonography showed right axillary vein thrombosis. The pathologic examination of the nodules confirmed infiltrating ductal adenocarcinoma.Conclusion: This case highlights the procoagulant state of malignancies and it is important to remember that though rare, breast malignancies can present as deep venous thrombosis. This case also highlights the early and aggressive evaluation of any breast discharge to rule out carcinoma of the breast.

Background: Superficial mucocele presents as small, clear vesicle on noninflamed mucosa. In this study, we report several vesicles on the bucal mucosa of a woman diagnosed as superficial mucocele.Case Presentation: A 48-year old woman presented with multiple vesicles on her labial mucosa, ventral surface of the tongue, floor of the mouth and palate. A mucosal biopsy was taken from the vesicle. Histopathologically, intraepithelial mucocele was diagnosed. The lesion was successfully treated with mouthwash betamethasone. There has been no recurrence for 18 months.Conclusion: In the present study, several mucoceles were seen in the oral mucosa. No similar case was reported previously.

Sir: Non-alcoholic fatty liver disease (NAFLD) encompasses a wide spectrum of conditions, ranging from a simple fatty liver to non-alcoholic steatohepatitis (NASH) with or without fibrosis, to cirrhosis and its complications (1). It is important to distinguish NASH from simple fatty liver because NASH patients are in greater risk of developing cirrhosis, liver failure and hepatocellular carcinoma (2). At the present time, the gold standard for determining severity and morphology of fatty liver is liver biopsy (3). Although liver biopsy determines liver damage, liver structure and inflammation process, this technique is invasive and to somehow life threatening, so it cannot be applied for screening or the early detection of NASH or follow up of the cases.