Caspian Journal of Internal Medicine最新文献

Background: Obesity is one the most prevalent diseases all around the world. Some studies have shown a relationship between obesity and the worsening of rheumatic disorders. Higher rates of surgical complications might also be seen among these patients.

Methods: This retrospective-descriptive study was performed on 25 patients with rheumatic disease referred to Loghman Hakim Hospital (Tehran- Iran) and candidates for bariatric surgery (laparoscopic Roux-en-Y gastric and laparoscopic sleeve gastrectomy) from 2018 to 2020. Duration of hospitalization after surgery and history of post-operation surgical and rheumatic complications were assessed. Patients were followed through 6 months after surgery.

Results: The age (Mean±SD) of recruited patients was (38.4 ±10.0) years. The mean body mass index was 45.54 kg/m2 with the minimum and maximum values of 37.5 kg/m2 and 56.5 kg/m2. Among them, the prevalence of rheumatic disorders was rheumatoid arthritis 32%, psoriasis 28%, gout 16%, lupus erythematosus 8%, and other rheumatologic disorders 16%, respectively. One patient had a surgical complication that was a port site infection. One patient had a relapse of gout and other patients had remission and also, their therapeutic drugs were discontinued or reduced.

Conclusion: Patients with rheumatic disorders revealed no higher surgical complication rate after bariatric surgery, and bariatric surgery helped disease remission among these patients.

Background: Elejalde syndrome is a rare neuroectodermal melanolysosomal disease with an autosomal recessive heredity. Patients usually present with silvery-gray hair, neurological abormalities, diffuse skin hypopigmentation and suntanned skin color.

Case presentation: A 3 1/2-year-old boy presented with hemiplegia since the day before admission. Durig hospital admission, he experienced episodes of status epilepticus and loss of consciousness and underwent mechanical ventilation. The patient had silvery-gray hair, consequently the pathologic evaluation of the hair shaft, revealed enlarged irregularly spaced melanin clumps characteristic for silvery-gray hair syndrome. No immunologic dysfunction was detected due to immunological evaluations, subsequently Elejalde syndrome was confirmed.

Conclusion: This study adds one new case to the known cases of Elejalde syndrome and confirms that Elejalde patients may not exhibit neurological symptoms until an older age.

Background: Flaxseed powder seems to improve bowel movements in these patients. Therefore, this study compares the effects of flaxseed powder and magnesium hydroxide on bowel movements of acute myocardial infarction patients hospitalized in ICU.

Methods: The population of the present parallel randomized controlled clinical trial included 70 acute myocardial infarction patients hospitalized in ICU who had no history of chronic constipation. The patients in the intervention group were given three sachets of flaxseed powder (each sachet was 3 g) twice a day for four days. The patients in the control group were given 20 cc of magnesium hydroxide syrup each morning. The Bristol scale was used to describe stool consistency.

Results: The mean and standard deviation of the number of bowel movements within five days after intervention are 1.86 ± 1.08 and 1.6 ± 0.65 in the intervention and the control groups, respectively. The frequency of normal stool consistency of the first bowel movement is 94.3% for the intervention group and 85.7% for the control group, which shows no significant differences between the two groups in terms of stool consistency and bowel movement frequency (P=0.510). The bowel movements started on average after 35.2±97.97 hours in the flaxseed group and 24.771±2.677 hours in the magnesium hydroxide group (P=0.023).

Conclusion: The results showed that flaxseed powder increases bowel movement frequency and improves the patients' stool consistency, but the differences between the two groups are insignificant. Finally, the time to the first defecation was shorter in the magnesium hydroxide group.

Background: Psoriasis is a common, chronic, immune-‌‌‌‌‌‌mediated inflammatory disease with a variety of skin manifestations. The aim of this study was to determine the prevalence of subclinical Achilles tendon disorder in cutaneous psoriasis patients and compare it with healthy controls.

Methods: This was a cross-sectional case-control study conducted on psoriasis patients that were referred to dermatology clinic. Thirty patients in the case group and 30 healthy controls were included in the study. Thickness of Achilles tendon enthesis was scanned by an expert rheumatologist using ultrasound equipped with a 5-14 MHz linear prob bilaterally.

Results: The mean age of the patient and control groups was 43.97±16.82 years and 38.87±12.71 years, respectively (P=0.190). The mean thickness of the Achilles tendon enthesis in the dominant limb was 4.31±0.86 mm in the patient group and 4.10±0.54 mm in the control group. There was no significant difference between the two groups in terms of thickness of the Achilles tendon enthesis in the dominant limb (P=0.276). The mean thickness of the Achilles tendon enthesis in the non-dominant limb was 4.44±0.91 mm in the patient group and 4.14±0.59 mm in the control group. There was no significant difference between the two groups in terms of thickness of Achilles tendon enthesis in the non-dominant limb (P = 0.134).

Conclusion: Although ultrasonography may be utilized for assessment of both structural and inflammatory changes, we revealed no difference in the mean thickness of Achilles tendon enthesis in patients with cutaneous psoriasis. Contradiction between clinical and ultrasonography features required further research.

Background: Although genetic mutations in additional sex-combs-like 1 (ASXL1) are prevalent in acute myeloid leukemia (AML), their exact impact on the AML prognosis remains uncertain. Hence, the present article was carried out to explore the prognostic importance of ASXL1 mutations in AML.

Methods: We thoroughly searched electronic scientific databases to find eligible papers. Twenty-seven studies with an overall number of 8,953 participants were selected for the current systematic review. The hazard ratio (HR) and 95% confidence interval (CI) for overall survival (OS), event-free survival (EFS), and relapse-free survival (RFS) were extracted from all studies with multivariate or univariate analysis. Pooled HRs and p-values were also calculated as a part of our work.

Results: The pooled HR for OS in multivariable analysis indicated that ASXL1 significantly diminished survival in AML patients (pooled HR: 1.67; 95% CI: 1.342-2.091).

Conclusions: ASXL1 mutations may confer a poor prognosis in AML. Hence, they may be regarded as potential prognostic factors. However, more detailed studies with different ASXL1 mutations are suggested to shed light on this issue.

Background: Percutaneous renal biopsy is the primary diagnostic tool for renal diseases. In this study, we evaluated renal biopsy complications and the timing of complications.

Methods: A cross-sectional study was performed on adult patients who underwent renal biopsy. The data gathering sheet collected patient characteristics. Complications were categorized as minor and major which needed an intervention. Data were analyzed using SPSS, and a p-value <0.05 was considered significant.

Results: This cross-sectional study was conducted on 215 patients (mean age: 33.1±16.4 and 54.4%: women) who underwent percutaneous renal biopsy in Shiraz Nemazi Hospital for one year. Of the 298 complications that occurred, 90.2% were minors (56.1%of them microscopic hematuria). Moreover, 2 (0.7%) patients developed major complications and received a transfusion. In addition, most of the complications (98.9%, 295 ones) developed within 8 hours post-procedure. Only hemoglobin drop was significantly higher in women (41.0% vs. 21.4%, P=0.003).

Conclusion: This study indicates that renal biopsy is a safe procedure; the results revealed that the significant post-biopsy complications were rare and occurred in the first 8 hours.

Background: Furosemide is a drug widely used for several medical conditions and could be used without medical prescription. Furosemide-related nephrocalcinosis can occur regardless of age, although the risk is higher in premature infants. The defining characteristic of nephrocalcinosis is generalized calcium deposition in the kidney. The most useful imaging studies for evaluation are ultrasonography and computed tomography (more effective in detecting calcification).

Case presentation: A 32-year-old woman with a history of depressive syndrome was admitted for evaluation of fortuitously discovered nephrocalcinosis and hypokalemia. The studies performed revealed the presence of a metabolic alkalosis with discrete hyperreninism/hyperaldosteronism but normal ratio, normotension and urinary study showed elevated sodium, chloride, potassium and calcium fluctuating in different determinations. Surreptitious diuretic intake was suspected and urine analysis revealed doses equivalent to 80-120 mg. The patient was advised to discontinue all diuretic treatment; she was adequately supplemented with potassium and she was followed-up in outpatient clinics. During the follow-up, clinical and analytical improvement was noted, which led to the discontinuation of supplementation.

Conclusion: Surreptitious diuretic intake is a clinical condition to rule out in patients with chronic hypokalemia, metabolic alkalosis with elevated urinary sodium and chloride. The relation between surreptitious diuretic intake and nephrocalcinosis has not been fully elucidated in adults.

Background: Doppler sonography parameters, particularly the resistive index (RI), have been identified as an essential tool for assessing renal transplant dysfunction (RTD). However, there is some ambiguity in the findings of previous research studies on this matter. Therefore, the objective of our study is to examine the relationship between changes in RI subsequent to RTD.

Methods: This was a systematic review and meta-analysis study. We searched three electronic databases PubMed, Web of Science, and Scopus, from the year 2000 to 10 May 2022. The main effect size was considered as the mean RI differences of cases with RTD confirmed by biopsy with control patients with no RTD. We used random effect models to pool the effect size.

Results: Thirteen studies were included in our review. The pooled mean (95% CI) for the control group was calculated to be 0.71 (0.67, 0.75) and for patients with renal transplant dysfunction was 0.73 (0.68, 0.78), under a random effect model with high heterogeneity for both analyses (I²=98% and 97%, respectively). The pooled mean was significantly different between the control group and patients with RTD (P= 0.05), based on a t-test of pooled effect sizes.

Conclusions: Based on the result of our study, we showed that there is a significant difference between RI in patients with kidney transplant dysfunction and the control group. However, RI cannot substitute kidney biopsy in the management and diagnosis of RTD.