Caspian Journal of Internal Medicine最新文献

Background: Brucellosis is a common disease between humans and animals that still exists in most parts of Iran. This study investigated the epidemiology of brucellosis in Mazandaran province, Iran, during a nine-year period from the beginning of 2009 until the end of 2017.

Methods: This descriptive-analytical study was conducted based on the guidelines of Iran's Ministry of Health and Medical Education on the data of 3732 brucellosis patients. The data were retrieved from the private and public laboratories gathered in a Ministry's database. We used the generalized estimating equation (GEE) for the Poisson regression model (Poisson GEE) to examine the disease incidence based on the studied variables.

Results: The age-standardized incidence rate has been 13.2 per 100,000 people (15.6 in men and 21.3 in rural areas). The highest rate (17.2) was in 2012 and the lowest (10.6) was in 2014. The cities of Galugah (35.0) and Qaemshahr and Fereydunkenar (3.0) had the highest and lowest incidence rates. The patients' professions had been 30% housewives, 14.9% ranchers, and 14.4% livestock-related professions. The highest standard incidence was in people older than 55 years old. The results of the Poisson GEE regression model showed that the disease incidence has been higher in men compared to women and in rural compared to urban areas (risk ratio = 1.5, 3.4, P = 0.001).

Conclusion: Mazandaran faces the risk of increased brucellosis incidence rate. Taking preventive measures, including educating people, are recommended for the near future.

Background: Ifosfamide-induced Fanconi syndrome is a relatively infrequent complication that generally occurs in young patients with a high cumulative dose of ifosfamide; and is commonly characterized by glycosuria, proteinuria, electrolyte abnormalities, and a normal anion gap metabolic acidosis.

Case presentation: In this study, we present the case of a 16-year-old male patient with of osteosarcoma of the right femur with pulmonary metastasis, who received ifosfamide as part of chemotherapy 1 year and 2 months ago and required hospitalization for cellulitis. During inpatient management, he presented with hypokalemia, hypophosphatemia, polyuria, glycosuria, and proteinuria, by which he was diagnosed with Fanconi syndrome and nephrogenic diabetes insipidus, induced by ifosfamide. Management was focused on the control of the internal environment and use of potassium supplements and potassium-sparing diuretics.

Conclusion: Patients receiving ifosfamide should be periodically monitored for kidney function and internal environment to detect any potential complications. It is thus important to carefully observe the cumulative dose of ifosfamide to prevent its associated nephrotoxicity, since its appearance can impoverish the prognosis in patients with neoplasms. Therefore, physicians should always be aware about the possibility of nephrotoxicity development.

Background: This study evaluated the correlation between corrected Thrombolysis in Myocardial Infarction (TIMI) frame count (CTFC) and major adverse cardiovascular events (MACE) within the first month following primary percutaneous coronary intervention (PPCI).

Methods: Eighty patients who underwent PPCI at Ayatollah Rouhani teaching Hospital in Babol Eighty patients who underwent PPCI at Ayatollah Rouhani teaching Hospital in Babol were included. CTFC, a measure of coronary blood flow, was assessed. Demographic and clinical data, were collected. ST segment resolution, a criterion for successful PPCI, was evaluated. MACE, including cardiac deaths, need for repeat revascularization of culprit vessels, and recurrent non-fatal myocardial infarction, and CVA (cerebrovascular accident) were recorded. Statistical analyses were performed to assess the association between CTFC and demographic/clinical variables, as well as ST resolution and MACE.

Results: The majority of patients were (78.8%) men and (81.2%) nonsmokers. No significant association was found between CTFC and demographic/clinical variables. The left anterior descending (LAD) artery was the most commonly involved vessel (48.8%). ST segment resolution of more than 50% was observed in 51.2% of patients. During the one-month follow-up, 13.7% of patients experienced MACE, including 7 cardiac deaths. However, there was no significant association between CTFC and MACE. (P=0.30).

Conclusion: This study concludes that CTFC is not a reliable predictor of MACE within the first month after PPCI. Furthermore, ST segment resolution of more than 50% was associated with a lower prevalence of cardiovascular events.

Background: Although vaccination is the most effective and specific approach for prevention of infectious diseases, but in a small percentage of vaccinated person's breakthrough infections can occur. This study aimed to determine the effectiveness of different common coronavirus vaccines in this area.

Methods: 109 COVID-19 vaccinated patients were enrolled, with different types of vaccines (Sinopharm, AstraZeneca, Sputnic, Bharath, CovIran Barkat and Pasto-CoV) and time of administration in 2021 in Babol, Iran. Patients after 14 days of administration of the final dose of corona vaccines with positive COVID-19 RT-PCR test entered to study. Patients' data such as RT-PCR, type of vaccine, age, sex and outcome were collected using electronic medical records.

Results: 47 patients were not fully vaccinated, 62 had two vaccine doses and 51 were fully vaccinated and considered to a breakthrough infection. Although, most of the patients with SARS-CoV-2 infection were either mild (n=18 [16.56%]), or moderate (n=86 [78.9%]), 5 (4.6%) patients had severe or critical illness, of whom 3 admitted in intensive care unit, 3 intubated, and 4 died. The average age of the participants with COVID-19 infections was 61.23 ± 19.91 years.

Conclusion: Based on our results, the COVID-19 breakthrough occurring with two doses of current vaccines were mild and moderate.

Background: Hepatocellular carcinoma (HCC) posed significant health problems and deaths. There are various challenges in the management of HCC, including the late detection or diagnosis. The ongoing diagnostic method in HCC also hinders the detection on the early stages of the disease, thus biomarkers need to be explored further for HCC detection. Serum alpha fetoprotein (AFP) and Midkine (MDK) are two proteins which might be the biomarker of choice in the detection of HCC. This meta-analysis aims to analyze the accuracy of Midkine and AFP in the detection of HCC.

Methods: The systematic review and meta-analysis was conducted by adhering to the Preferred Reporting System for Systematic Review and Meta-Analysis (PRISMA) guidelines. We conduct literature screening and selection followed by quality assessment from various databases such as PubMed, MEDLINE, SpringerLink, ProQuest, EBSCOhost, Cochrane, and EMBASE. The included studies were then extracted and analyzed cumulatively using MedCalc and MetaDTA with forest plot and ROC curve as outcome.

Results: 12 studies were included in this study. The AFP biomarker yields sensitivity value of 62.5% (97.5% CI 0.442 - 0.778) and specificity value of 95% (97.5% CI 0.842 - 0.986), while the Midkine biomarker denotes sensitivity value of 91.6% (97.5% CI 0.83 - 0.961) and specificity value of 82.2% (97.5% CI 0.83 - 0.96).

Conclusions: Both AFP and MDK are proven to be a good diagnostic tool or biomarker in the detection of HCC. The use of both in combination should provide high quality diagnostic marker for HCC suspected patients. Further studies on this should be conducted.

Background: Rehabilitation plays an important role in improving symptoms in patients with multiple sclerosis (MS). There are studies evaluating the effects of robotic rehabilitation in patients with MS, but the results varied between the studies. So, we designed this systematic review and meta-analysis to estimate pooled effects of robotic rehabilitation on fatigue, disability, and quality of life in subjects with MS.

Methods: We systematically searched PubMed, Scopus, EMBASE, Web of Science, Google Scholar, and also gray literature including references of the included studies, and also conference abstracts on October 1^th 2022. Data regarding the total number of participants, first author, publication year, country of origin, mean age, EDSS, and results of fatigue and quality of life were recorded.

Results: The first literature search revealed 6878 results, after deleting duplicates, 5019 studies remained. Two researchers, evaluated the titles and abstracts, and finally 77 full texts were assessed. For meta-analysis, we included 11 studies. The pooled Standardized Mean Difference (SMD) of Kurtzke Expanded Disability Status Scale (EDSS) (after-before) estimated as -0.56 (95%CI: -0.89,-0.23). The pooled SMD of Fatigue Severity Scale (FSS) estimated as -0.54(95%CI: -1.06, -0.01) (I²=66.7%, P=0.01). The pooled SMD of physical health subscale of multiple sclerosis quality of life (MSQOL-54) estimated as 0.36(95%CI:-0.23, 0.96) (I²=51.4%, P=0.1). The pooled SMD of mental health subscale of MSQOL54 estimated as 0.48 (95%CI: 0.07, 0.88) (I²=0%, P=0.6).

Conclusions: The results of this systematic review and meta-analysis show that robotic rehabilitation has positive effects on fatigue, and disability in patients with MS.

Background: Diabetes, a currently threatening disease, has severe consequences for individuals' health conditions. The present study aimed to investigate the factors affecting the changes in the longitudinal outcome of blood sugar using a three-level analysis with the presence of missing data in diabetic patients.

Methods: A total of 526 diabetic patients were followed longitudinally selected from the annual data collected from the rural population monitored by Tonekabon health centers in the North of Iran during 2018-2019 from the Iranian Integrated Health System (SIB) database. In analyzing this longitudinal data, the three-level model (level 1: observation (time), level 2: subject, level 3: health center) was carried out with multiple imputations of possible missing values in longitudinal data.

Results: Results of fitting the three-level model indicated that every unit of change in the body mass index (BMI) significantly increased the fasting blood sugar by an average of 0.5 mg/dl (p=0.024). The impact of level 1 (observations) was insignificant in the three-level model. Still, the random effect of level 3 (healthcare centers) showed a highly significant measure for health centers (14.62, p<0.001).

Conclusion: The BMI reduction, the healthcare centers' socioeconomic status, and the health services provided have potential effects in controlling diabetes.

Background: Osteoporosis is the most common metabolic bone disease that begins with a decrease in bone mass and deterioration in the micro-architecture of the bone tissue, making the bones thinner and susceptible to fragility. A comprehensive estimation of the prevalence of osteoporosis in provinces of Iran seems to be necessary.

Methods: This study was a descriptive-analytical study. The study population included 518 people aged 30-65 years including 297 males and 221 females to measure their bone density. The data collection method was through BMD measurement using Dual-Energy X-ray Absorptiometry (DXA) method. All obtained data stored in the SPSS-16 database and statistically analyzed. The data analyzed using analytical, statistical methods. The significance level of the test was considered to be P≤0.05.

Results: In the present study, according to BMI status, 45.2% of the patients were obese, 38.2% were overweight. Despite the general belief that increasing in weight can be associated with an increase in bone mass, the present research revealed that nearly 35.9% of the research population, suffered obesity and osteoporosis at the same time. Metargression analysis of data from different studies have illustrated that changing in frequency of osteoporosis as an oriented change in prevalence of osteoporosis from west to east and south to north (P≤0.05).

Conclusion: Iran society is under concern to more osteoporosis in the coming years at young and old ages which doubled with severe decline in growth rate of population from 3.7% to 0.63% in 2022. This can increase older people ratio over 30% in 2050.

Background: Bladder cancer is one of the most common cancers in the world and is associated with high treatment costs and mortality. The role of different enzymes and molecules in this cancer has been the subject of extensive research in recent years. Among these, the role of metabolic enzymes such as FASN and LDH has been studied less than others. Therefore, the present study was designed to investigate the role of FASN and LDH in bladder cancer patients.

Methods: One hundred cases diagnosed with bladder cancer and 50 sex-age- matched healthy individuals as control were examined. FASN and LDH serum levels in both patients and controls were determined by human-specific sandwich ELISA kits.

Results: Serum levels of FASN and LDH elevated in bladder cancer patients in comparison to healthy individuals (P= 0.03, P= 0.01, respectively). We also found that than higher stages of bladder cancer (III-IV) had higher serum levels of LDH and FASN compared to early stages (I-II) (P= 0.007 and P= 0.006, respectively). Moreover, there was a statistically significant association between smoking history and serum FASN levels in bladder cancer patients (P=0.015). However, there were no remarkable associations between the serum levels of LDH and FASN with other clinicopathological features including sex, age, tumor grade, and tumor size.

Conclusion: The data indicate that LDH and FASN may be good and useful biomarkers in the diagnosis and clinical management of bladder cancer. However, further studies are needed.

Background: In Permanent congenital hypothyroidism (PCH) is a lifelong condition characterized by a deficiency in thyroid hormone, leading to various neurodevelopmental complications. Early clinical signs are often nonspecific and easily overlooked, but newborn screening programs have improved early detection.

Methods: This narrative review aims to provide insights comparatively transient and permanent PCH and also the diagnosis, risk factors, underlying pathophysiology, and genetic causes associated with PCH. Relevant studies were identified through a comprehensive search using the term 'Permanent congenital hypothyroidism' (Mesh) across scientific databases of electronic databases such as PubMed, Scopus, and Web of Science.

Results: Prompt initiation of thyroid hormone replacement therapy, particularly within the initial two weeks postpartum, crucially enhances neurocognitive development outcomes. Multiple predictive approaches, encompassing screening TSH levels, maternal thyroid history, and levothyroxine dosage per kilogram assessment, aid in identifying PCH. Recent studies have demonstrated a mounting prevalence of PCH, contributing significantly to the overall rise in CH incidence. Genetic factors, primarily DUOX2 and DUOXA2 mutations, alongside environmental influences such as post-term birth, low birth weight, and macrosomia, may induce PCH. Nonetheless, reliable markers for early PCH prediction upon diagnosis remain elusive, leading to delayed recognition post-ceasing levothyroxine treatment around age 3.

Conclusions: Recent studies have observed an increased incidence of PCH, contributing substantially to the overall rise in cases of congenital hypothyroidism. Understanding the diagnostic options and genetic etiologies associated with PCH is crucial for the early identification and appropriate management.