Caspian Journal of Internal Medicine最新文献

Background: Irritable bowel syndrome (IBS) is the most common disorder of the gastrointestinal system. The study aimed to determine the effect of Mesalazine prescription on patients' symptoms and level of fecal calprotectin in patients with IBS with predominant diarrhea and high fecal calprotectin.

Methods: We conducted a double-blinded randomized clinical trial with 90 patients aged 18 to 45. These patients were selected from referrals to the gastroenterology clinic. They were evenly divided into two groups: the Mesalazine group, with an average age of 35.4, and the placebo group, with an average age of 36. The patients in both groups were then monitored for 8 weeks. There were no differences in the distribution of sexes between the two groups.

Results: In comparison between before and after Mesalazine therapy in our patients marked a statistically significant effect on the quality of life variables (p<0.05), patient's level of pain (p<0.05), abdominal distension (p<0.05), and calprotectin level (p<0.05) compared to before Mesalazine in patients studied, which showed the effectiveness of this treatment. However its effect on stool form was not significant (P=0.11).

Conclusion: Comparing the two groups after the intervention, the quality of life in patients treated with Mesalazine was significantly higher than in patients of the placebo group. The number of defecations in patients treated with Mesalazine was significantly lower than in patients of placebo groups. Abdominal distention and calprotectin levels were significantly lower in these patients than in patients of the placebo group.

Background: Carotid endarterectomy (CE) is currently the main surgical treatment and preventative measure for ischemic stroke (IS) in patients with atherosclerotic stenosis and carotid artery occlusion; however, there are no clear opinions regarding the effect of CE on the course of the acute period of IS and chronic cerebral ischemia (CCI).

Methods: The study included 186 patients aged 45-81 years. The study population comprised two observation groups: group I included 131 patients with internal carotid artery (ICA) stenosis of more than 60% with unstable atherosclerotic plaque who underwent CE, and group II included 55 patients with ICA stenosis 60% with stable atherosclerotic plaque who did not undergo surgical treatment. The SPSS 21 package was used for statistical analysis.

Results: The results of the NIHSS, Rankin, and Rivermead scales after 12 months indicated a significant positive dynamic of the neurological status in patients in the first group (2.33±0.30 in the first group and 0.89±0.12 in the comparison group, p < 0.05). In the acute period of IS, CE performed according to indications led to a decrease in neurological symptoms (80.9% of patients scored 0-3 points on the NIHSS scale), a decrease in the degree of disability, and an increase in mobility in patients.

Conclusion: In patients who underwent the operation, disability was significantly lower 1 year after IS.

Background: Urinary tract infections (UTIs) are among the most prevalent infectious conditions, particularly in children. Vitamin D deficiency has been implicated in various infections, including UTIs. This study aimed to evaluate the association between serum vitamin D levels and UTIs in children at Amir Kola Children's Hospital.

Methods: This case-control study was conducted on 120 children, aged 2-18 years, diagnosed with UTIs and referred to Amir Kola Children's Hospital, Babol, Iran. Participants were divided into two groups: 60 UTI cases and 60 healthy controls. Peripheral blood samples were collected for vitamin D analysis, measured via ELISA assay. Statistical analysis was performed using SPSS Version 26.

Results: The mean serum vitamin D level was 17.70±8.35 ng/mL in the case group and 37.91±12.18 ng/mL in the control group, revealing a significant reduction in vitamin D levels among UTI patients (P<0.001). Additionally, pyelonephritis was associated with severe vitamin D deficiency (P=0.02). Female children aged 3-5 years exhibited a higher risk of vitamin D deficiency, although age and sex did not significantly influence vitamin D levels overall. Vitamin D status was not correlated with hospitalization duration.

Conclusion: Given its immunoprotective role, vitamin D screening and supplementation may serve as a preventive strategy against UTIs and contribute to improved clinical outcomes in affected children.

Background: Celiac disease (CD) is a gluten-induced autoimmune disorder that can present with gastrointestinal, extraintestinal, or no symptoms. The prevalence of CD in migraine patients and the nature of their potential association is not well established. Therefore, the purpose of this study was to investigate the prevalence of CD in migraine patients using a systematic review and meta-analysis.

Methods: PRISMA guidelines created a framework for the construction of this review article. Two investigators independently searched the electronic databases of Scopus, PubMed, Web of Science and Google Scholar search engine up to May 2024. To assess heterogeneity among the studies, we used Cochran's Q test and the I² index. The statistical analyses were performed using Stata software, version 14.2, and a p-value of less than 0.05 was considered statistically significant.

Results: This meta-analysis included a total of 6 articles, comprising 14,526 migraine patients. The overall prevalence of CD in migraine patients was estimated to be (2% (95% CI: 0%-5%, I²=75.37, P=0.001)). Also, the Odds of CD disease in migraine patients compared to non-migraine patients was estimated to be equal (2.20 (95% CI: 0.87-5.54, I2=48.4, P=0.121)). Additionally, the majority of the research was conducted in Europe.

Conclusions: Although the small amount of research accomplished in this particular situation, our data indicate a relatively low prevalence of CD in migraine patients. Therefore, more frequent and thorough research in this field is advised. Patients with migraines experienced fewer attacks when they received gluten-free diets and were screened for celiac disease.

Background: Evidence suggested that olive oil may alleviate constipation symptoms. This study compared the effectiveness of two types of extra virgin olive oil and refined olive oil on the treatment of patients experiencing constipation.

Methods: This double-blind clinical trial included 140 participants aged 18 years or older who were diagnosed with chronic constipation by a gastroenterologist using the Rome III questionnaire. Block randomization was utilized approach to divide patients into two groups of 70 individuals (Extra virgin olive oil as trial and refined olive oil as control) that consumed two tablespoons per day of olive oil for four weeks. Follow-up assessments were conducted using the Rome III and Bristol Stool Form Scale (BSFS) questionnaires.

Results: According to analysis of covariance (ANCOVA), after four weeks of the intervention, the mean score of Rome III decreased significantly from 11.37±2.25 to 7.74±2.53; and from 11.27±2.73 to 3.47±1.73 among refined olive oil and extra virgin olive oil consumers, respectively, (-4.22 (95% CI: 3.63-4.82), (F (_1,137) =197.67, p<0.001, η2P=0.591). In week 2,3, and 4, the mean score of BSFS were significantly higher among consumers of extra virgin olive oil than to the consumers of refined olive oil 0.53 (95% CI: 0.38- 0.68), p<0.001, 0.78 (95% CI: 0.60- 0.97), p<0.001 and 1.14 (95% CI: 0.94-1.35), p<0.001, respectively.

Conclusion: Extra virgin olive oil was more effective compared refined olive oil at alleviating constipation. These outcomes highlight the importance of extra virgin olive oil as a possible treatment for constipation.

Knee osteoarthritis (KOA) and cerebral small vessel disease (CSVD) are two prevalent and debilitating conditions that have traditionally been studied within distinct medical disciplines - rheumatology and neurology, respectively. However, emerging evidence suggests a deeper connection between these seemingly disparate diseases, transcending conventional boundaries and prompting a paradigm shift in our understanding of their pathophysiology and clinical implications. This narrative review explores the multifaceted crosstalk between KOA and CSVD, delving into shared risk factors, inflammatory cascades, and vascular mechanisms underpinning their co-occurrence. Beyond conventional etiological factors, we illuminate the role of systemic inflammation, aberrant biomechanics, and neuro-gliovascular interactions in shaping the complex interplay between KOA and CSVD. Furthermore, we scrutinize the bidirectional impact of these conditions on cognitive function, emphasizing the shared burden of neurocognitive impairment in affected individuals. Through a synthesis of cutting-edge research and theoretical frameworks, we propose a novel conceptual model that integrates musculoskeletal and cerebrovascular pathways, shedding light on previously unexplored avenues for therapeutic intervention and personalized management strategies. This comprehensive analysis not only advances our understanding of the interconnected nature of KOA and CSVD but also underscores the imperative for interdisciplinary collaboration and holistic approaches to patient care in the era of precision medicine.

Background: Lower urinary tract symptoms (LUTS) are common complications in patients with multiple sclerosis (MS). Different studies evaluated the effects of Onabotulinumtoxin on urinary findings in patients with MS. We designed this systematic review and meta-analysis to estimate pooled efficacy of intra-detrusor injections of botox for urinary symptoms in patients with MS.

Methods: A comprehensive systematic search was conducted on five databases of PubMed, Scopus, EMBASE, Web of Science, and Google scholar on February 2022. . We extracted data regarding the total number of participants, first author, publication year, the country of origin, mean age, F/M ratio, duration of the disease, duration of the treatment, mean Expanded Disability Status Scale (EDSS), maximum cystometric capacity (MCC), and maximum detrusor pressure (MDP).

Results: Preliminary search of databases retrieved 1618 articles, after deduplication, 934 studies remained. Five studies were included for meta-analysis. The most frequent country of origin was the USA, and the mean EDSS ranged between 2.9 and 5.1. Urinary tract infection (UTI) and urinary retention were the most prevalent complications. The SMD of MDP (MDP _{week 12}-MDP _baseline) was -1.32(95%CI:-1.77, -0.37) (I²=52.9%, P=0.1). The SMD of MCC (MCC _{week 12}-MCC _baseline) was 1.65 (95%CI: 0.44, 2.86) (I²=92.4%, p<0.001). The SMD of MDP (MDP _{week 4}-MDP _baseline) was -3.6 (95%CI:-7.3, 0.16) (I²=98.3%, p<0.001). The SMD of MCC (MCC _{week 4}-MCC _baseline) was 5.05 (95%CI: 0.14, 9.96) (I²=98.8%, p<0.001).

Conclusions: This systematic review and meta-analysis demonstrated that injection of intra-detrusor Onabotulinumtoxin had a positive effect on improving urodynamic findings in patients with MS.

Background: Early diagnosis of sepsis can lead to rapid initiation of treatment and reduced mortality. The aim of this study was to investigate the relationship between eosinopenia and neutrophil-lymphocyte ratio (NLR) with sepsis-related mortality in the intensive care unit.

Results: Out of 100 patients studied, 59 patients survived and 41 patients died and the mean age of the patients was 63.27±16.13 years. Out of 40 patients with eosinopenia, 19(46.3%) died and out of 60 patients with normal eosinophil, 22(53.7%) died (P=0.28). The NLR on the first day in died patients was significantly higher than in the surviving patients (P=0.009). The increase in SOFA Score (p<0.001 and OR=1.49) and the increase in NLR (P=0.02 and OR=3.38) has a direct relationship with the mortality rate.

Conclusion: The results of the present study in sepsis patients showed that patients who had a higher neutrophil-to-lymphocyte ratio had higher mortality and there was no relationship between eosinopenia and mortality rate.

Background: Opportunistic infection after transplantation is a serious problem, with Toxoplasma Gondii (T.gondii) and cytomegalovirus being the most concerning infections. The objective of this research was to examine the seroepidemiology of the T. gondii virus among kidney transplant recipients at Sina Hospital in Tehran from 2017 to 2021.

Methods: A total of 342 kidney transplant patients participated in this cross-sectional study using the census method after obtaining consent. Data were collected by reviewing medical records and the transplant database, including demographic characteristics and infectious tests related to kidney transplantation. The collected information was entered into SPSS18 software.

Results: The age of the subjects ranged from 10 to 73 years, with 125 patients having kidney failure due to ERDS. The rate of exposure to T. gondii in kidney transplant patients was 54.2%. 125 patients experiencing kidney failure due to ERDS. In kidney transplant patients, the exposure rate to T. gondii was 54.2%. There is a positive correlation between TOX IgG and age (r= 0.12, P = 0.02). There is a positive correlation between CMV IgG and the time elapsed since kidney transplantation (r = 0.11, P = 0.03) and TOX IgG (r = 0.13, p < 0.01). Gender was found not to predict EBV.IgG (β = 0.787, p < 0.21), CMV.IgG (β = 4.752, p < 0.071), TOX.IgG (β = 1.154, p < 0.256) based on regression tests.

Conclusion: Physicians should be aware of preventive measures and should consider early diagnosis in cases of compatible symptoms. Screening for anti-Toxoplasma IgM antibodies in potential donors is recommended.

Background: To study the association of plasma fibrinogen & total cholesterol levels, incidences, prevalence, and gender wise distribution in different etiologies of stroke.

Methods: Fibrinogen & total cholesterol levels, prevalence, incidences, comorbidities, and different etiologies were assessed along with routine investigations and radiology inputs as per investigator's discretion. The overall median values were represented in graphically format in MS-Excel.

Results: 292 Males: 218 females. Age 30 to 80 years. Among, 25.1% diabetic, 38.9 % hypertension (HTN) and 31% diabetes + HTN. 5 % diabetes + HTN + dyslipidemia and other comorbidities. Overall, 73% had ischemic stroke (IS) & 27 % have hemorrhagic stroke (HS). Hemiparesis in 76.5 %. Mean Fibrinogen elevated in 81% and range was 934±20 mg/dL. Total cholesterol level increased in 73.2% & range was 365±10 mg/dL. The HS patients were experienced headache 77 (19.60%) and vomiting 34 (24.6%) than IS patients. As per radiological finding, the territory of Middle Cerebral Artery was the ordinary location of arterial territory infarctions in the IS form that was present in 213 (57.2%) subjects following that in the anterior side of cerebral artery in 89 (23.92%) and posterior cerebral artery was 44 (11.82%). Arterial flutter found in 56 (10.9%), Structural heart disease present in 30 (5.88%), family history of stroke in 28 (5.49%).

Conclusion: Elevated fibrinogen & total cholesterol levels are independent significant primary biomarkers elevated with incidences of CV stroke. Stroke was higher in ischemic stroke group.