Caspian Journal of Internal Medicine最新文献

Background: Late in pregnancy or soon after delivery, peripartum cardiomyopathy (PPCM) which is an uncommon type of cardiomyopathy, can develop. To assess the association between the level of irisin expression and (FNDC5) (rs3480) gene polymorphism with peripartum cardiomyopathy.

Methods: This is a case control study included a thirty female patients with new-onset PPCM and sixty healthy females at the at the peripartum period in same time window for PPCM as a control. For each patient, comprehensive medical history was taken, full clinical assessment was done, ECHO., FNDC5 (rs3480) & Irisin assay.

Results: The left ventricle end diastolic dimensions &left atrium diameters were statistically significant higher in patients' group than controls' group (P=0.000 for all), Also left ventricular ejection fraction (%) was statistically significant lower in patients than controls and as regards irisin, its Mean ±SD was lower in patient group than control group (8.44±1.1 vs 10.65±2.31) with (p <0.001) which is considered a significant difference statistically.

Conclusion: Irisin level was lower in peripartum cardiomyopathic patients when compared with normal individuals and regarding its genotype, the homotype A/A was higher than homotype G/G.

Multiple Sclerosis (MS) pathophysiologically is a dynamic and progressive disease that involves all parts of central nervous system. This widespread involvement of the CNS has paved the way for proposing a new theory in MS in which MS is considered as a connectomopathy. Connectomopathy is a new concept describing the diseases in which not only the brain connectome is completely and extensively damaged, but the defective connectome itself can also become a breeding ground for the disease's progression. Connectomopathy provides a dynamic picture of MS. Since each person's connectome is unique to him/herself, so MS patients' connectomopathy varies from one to another. This variety not only challenges the classification of MS into different phenotypes, but also emphasizes the need for providing a personalized approach for the treatment of these patients.

Background: In this study, we aimed to identify the predicting pathological factors affecting sentinel lymph node biopsy (SLNB) in patients with clinically node-negative breast cancer.

Methods: Our single institution retrospective study was conducted at the Cancer Research Center of Shahid Beheshti University of Medical Sciences from 2018 to 2021. Data were imported into and analyzed using SPSS Version 28 for Windows (IBM Corp., Armonk, NY, USA).

Results: Of the 76 patients who underwent SLNB, 43 (56.6%) had negative SLNB and 33 (43.4%) had positive SLNB which led to axillary lymph node dissection (ALND). The relationship between hormone receptor status (ER/PR/Her2), pathology type (IDC, ILC, DCIS, LCIS), tumor size, and Ki67 expression was assessed. According to the results, axillary lymph node involvement can be predicted based on the scores and results of the three variables: IDC tumor type, lympho vascular invasion (LVI), and Ki67 expression. The positive relationship between IDC tumor type and LVI with SLNB indicates that with positive IDC tumor type and LVI, there is a higher probability of positive axillary lymph nodes (3.88 times higher probability for IDC tumor type and 6.75 times higher probability for the LVI factor). However, when the Ki67 expression is lower, the probability of positive axillary lymph nodes is higher (3.58 times higher probability).

Conclusion: IDC tumor type, LVI, and lower Ki67 expression are independent predictive factors of positive SLNB.

Background: One of the complications of multiple sclerosis (MS) is cognitive impairment (CI). The prevalence of CI is reported variously in previous studies. The goal of this systematic review and meta-analysis to estimate pooled prevalence of CI in patients with MS and also the prevalence of CI based on the type of applied test.

Methods: Two independent researchers systematically searched PubMed, Scopus, EMBASE, Web of Science, and google scholar as well as gray literature (conference abstracts, references of the references) which were published before up January 2022.

Results: We found 4089 articles by literature search, after deleting duplicates 3174 remained. Ninety articles remained for meta-analysis. The pooled prevalence of CI using all types of tests was 41% (95% CI: 38-44%) (I2=91.7%, p<0.001). The pooled prevalence of CI using BRB test was 39% (95%CI: 36-42%) (I2=89%, p<0.001). The pooled prevalence of CI using BICAMS was 44% (95%CI: 37-51%, I2=95.4%, p<0.001). The pooled prevalence of CI using MACFIMS was 44% (95% CI: 36-53%) (I2=89.3%, p<0.001).

Conclusions: The pooled prevalence of cognitive impairment in patients with MS is estimated as 41%, so CI it should be considered by clinicians.

Background: Salmonella osteoarticular involvement is a rare complication, occurring in about 2% of the cases. Septic arthritis is exceedingly rare, involving only 0.2 % of all salmonellosis patients. Endocarditis is another complication that occurs in less than 0.8 % of cases. These complications are more likely to happen among immunocompromised patients.

Case presentation: We report a previously healthy 25-year-old man who presented with left limb pain. He had been treated for brucellosis ten days earlier by his primary care physician. Arthrocentesis and subsequent hip-joint biopsy confirmed septic arthritis due to Salmonella. However, he was unresponsive to the treatment. We found no underlying immunosuppression. A trans-esophageal echo was performed due to the continued fever and positive blood cultures. It revealed Salmonella endocarditis of the naïve tricuspid valve. He was treated via arthrotomy and antimicrobials for four weeks. Follow-up after 20 months showed no underlying immunosuppression.

Conclusion: This case highlights that in patients with positive Salmonella blood cultures and a focus of infection compatible with Salmonellosis but unresponsive to treatment, searching for other foci of infection is necessary. Furthermore, physicians in endemic areas of brucellosis should consider other differential diagnoses in patients with fever and limping because any delay in diagnosing Salmonella septic arthritis can destroy the joint space with lifelong discomfort.

Background: Having a weakened immune system can make patients easily get nosocomial infection (NI) with multi-drug resistant (MDR) bacteria and put them in a dangerous situation. It causes long hospital stays, disability, economic burden, and even death. The present study aimed to determine the prevalence of NI in patients suffering from COVID-19.

Methods: In this retrospective study, the information on 250 patients suffering from COVID-19 in the intensive care unit (ICU) (2020 to 2021) was considered. For statistical analysis, analysis of variance (ANOVA), paired samples t-test, and chi-square using SPSS-23 software were used (p<0.05).

Results: Two hundred and fifty hospitalized (107 females and 143 males, mean ± standard deviation (SD) of age; 56.50 ± 17.20) patients were considered. The most (97.60%) medicine prescribed was remdesivir. Candida spp. (two females), Escherichia coli (two females), Acinetobacter spp. (one female), Citrobacter spp. (one female), Pseudomonas spp. (one male), Sphingomonas spp. (one male), Stenotrophomonas spp. (one male) and Enterobacter spp. (one male) were isolated from the patient's specimens. Four of seven bacterial isolates were positive for MDR. NI was diagnosed in six patients. There was no significant relationship between the age with the isolated microbes (P=0.154) and MDR (P=0.987) and also between gender with common microbes (P=0.576) and MDR (P=0.143).

Conclusion: The coexistence of bacteria and NI was observed in patients. Remdesivir was prescribed for most patients. Most bacteria were resistant to antibiotics, especially, β-lactams.

Background: According to the significance of extraintestinal symptoms in inflammatory bowel disease (IBD) patients and their connection with obesity, we aimed to investigate the prevalence of fatty liver in IBD patients of Sayyad Shirazi Hospital in Gorgan, Iran, in relation to obesity, anthropometric indicators and body image in these patients.

Methods: Forty patients with IBD were recruited from all registered patients at the Golestan Research Center of Gastroenterology and Hepatology, following the specified inclusion and exclusion criteria. After obtaining written informed consent and filling in the questionnaire, the demographic and anthropometric indicators, and variables related to the disease were measured. The liver sonography was performed on all patients and graded by an expert radiologist. Data were analyzed using SPSS Version 16.0 statistical software at the significance level of 0.05.

Results: We showed no significant difference between the distribution of demographic and anthropometric indicators in different groups of IBD patients. However, we demonstrated that the inappropriate values of HDL (0.004) and high values of LDL (0.015) were associated with fatty liver in IBD patients. Our findings also showed that NAFLD was significantly associated with overweight and obesity among IBD patients (P = 0.003).

Conclusion: Our findings showed the epidemiological burden of NAFLD in IBD patients. Since fatty liver was associated with obesity, it is recommended that IBD patients be screened for risk factors associated with NAFLD to prevent liver disease.

Background: Every year, drug poisoning is the most prevalent reason for referring patients to medical centers. This study aimed to evaluation of morphine, methadone, digoxin, and dronabinol poisoning in Shahid Mostafa Khomeini Hospital in Ilam.

Methods: In this In this Cross-sectional study, patient samples suspected of morphine, methadone, digoxin, and dronabinol poisoning referred to the toxicology laboratory of Ilam University of Medical Sciences were analyzed using the HPLC method, and the results were analysed using SPSS software.

Results: Results showed that the percentage of drug use is greater in men than in women. The highest percentage of morphine and methadone poisonings were detected in those under the age of 40, whereas the highest percentage of digoxin poisonings were recorded in those over the age of 80. As a result, the average age of digoxin users was substantially greater in men than in women. Methadone consumers showed significantly greater blood levels than others. In addition, there was a significant difference (P<0.01) in blood levels between men and women who used morphine.

Conclusion: In general, it is important to understand the status of drug poisoning with drugs such as morphine, methadone, digoxin, and dronabinol, as well as the prognosis associated with the treatment process of such poisoning.

Background: Endometriosis is one of the common gynecological problems during the reproductive years, affecting the quality of life, fertility, and sexual function of women. It is known that sexual dysfunction and quality of life are interrelated. Therefore, this study aimed to evaluate the effect of resection of endometriosis lesions via laparoscopic surgery on the improvement of sexual dysfunction in women with endometriosis.

Methods: This clinical trial was performed on 30 patients with endometriosis. The Female Sexual Function Index, Endometriosis Health Profile-30, and Visual Analog Scale were completed for the patients before laparoscopic surgery and three, six, and 12 months after surgery. The results were examined and compared before and after the intervention using the ANOVA test.

Results: The present results showed that the mean pain score of the patients (dysmenorrhea, dyspareunia, and pelvic pain) was significant after laparoscopic surgery (P<0.005). The female sexual function improved after laparoscopic surgery compared to the preoperative phase, and changes in the domains of psychological stimulation, humidity, and sexual orgasm were significant (P<0.005). Moreover, the female quality of life scores increased in all dimensions compared to the preoperative phase, although these improvements were not statistically significant.

Conclusion: The present results revealed that laparoscopic surgery is an effective treatment, leading to a considerable improvement in female sexual function.