Caspian Journal of Internal Medicine最新文献

Background: The maturation of the arteriovenous fistula (AVF) is necessary for successful hemodialysis treatment. However, the role of antihypertensive drugs in influencing AVF maturation remains uncertain. This study investigated the AVF maturation in patients with renal failure treated with antihypertensive medications.

Methods: A prospective cohort study was conducted on 73 patients who needed to be treated with hemodialysis through AVF. Demographic information, medication, underlying diseases, blood pressure changes, surgical information, and the time of AVF maturation were collected during the study. Descriptive statistics and survival analysis were employed to assess the outcomes.

Results: The mean age of patients was 53.96±13.65 years, with 38 (52.1%) males and 35 (47.9%) females. The mean AVF maturation time was 104.87±1.02 days, and the rate of AVF maturation was 87.7%. Among the comorbidities, the rate of AVF maturation in diabetic patients (78.4%) versus non-diabetic (97.2%) exhibited a notably diminished effect (P = 0.028). There was a significant association between mean intraoperative arterial blood pressure (123.45±2.89 mmHg) and AVF maturation time (P = 0.033). Furthermore, there were not any significant differences in the use of antihypertensive medications on AVF maturation time or rates.

Conclusion: Our study findings suggest that the administration of antihypertensive medications did not demonstrate a significant correlation with either the AVF maturation outcome or the time required for maturation.

Background: The cause of thyrotoxicosis can be determined through the thyroid uptake of 99mTc-pertechnetate. The goal of the study was to calculate the cut-off value of 99mTc-pertechnetate of the thyroid gland for the differential diagnosis of Graves' disease from subacute thyroiditis.

Methods: A total of 60 patients were included in the study. Based on thyroid scan findings, 30 patients were in the Graves group and 30 of them had been diagnosed as subacute thyroiditis. Biochemical parameters, thyroid scintigraphy, and the percentage thyroidal 99mTc-pertechnetate uptake results were thoroughly assessed.

Results: The mean percentage 99mTc-pertechnetate uptake in Graves group was much higher than that of the subacute thyroiditis group, which was statistically significant (P <0.001). Receiver operating characteristic (ROC) analysis revealed that the uptake cut-off value of 1.1% had the sensitivity and specificity of 97% and 95%, respectively.

Conclusion: The findings depicted that the cutoff value of 1.1% for 99mTc-pertechnetate uptake could be a helpful index to differentiate Graves' disease from subacute thyroiditis, especially when it is difficult to distinguish between the two diseases using conventional diagnostic methods.

Background: Dietary patterns based on plant foods are proposed as a means of controlling blood pressure. This study aimed to assess the adherence to Dietary Approaches to Stop Hypertension (DASH), Mediterranean, and plant-based dietary pattern and their association with systolic (SBP) and diastolic (DBP) blood pressure among patients with hypertension participated in the SUMS Employees Health Cohort Study (SUMS EHCS).

Methods: This cross-sectional study included 226 adults with hypertension, enrolled in the SUMS EHCS. The score of DASH, Mediterranean, and plant-based dietary patterns were measured, using a- 116 item food frequency questionnaire (FFQ). Plant-based dietary indices were measured and comprised of total (t-PDI), healthy (h-PDI), and unhealthy (u-PDI) plant-based dietary index. The association of each dietary score with SBP and DBP were analyzed by multivariate linear regression after adjusting for age, sex, educational level, marital status, smoking, BMI, energy intake, physical activity, having other diseases, and family history of hypertension.

Results: The means of SBP and DBP were 127.82±15.87 and 83.51±11.22 mmHg, respectively. No significant association was seen between DASH or Mediterranean score with SBP and DBP after controlling the confounders. Although, t-PDI was significantly associated with both SBP (β; -0.53, 95% CI; -0.91, -0.15) and DBP (β; -0.30, 95% CI; -0.54, -0.03), h-PDI and u-PDI was not significantly associated with blood pressure after taking all the potential confounders into account.

Conclusion: No significant associations could be found between DASH, Mediterranean, and healthy or unhealthy plant-based dietary index, and blood pressure levels among hypertensive individuals.

Background: Numerous studies have demonstrated that improving anthropometric indices through a healthy diet and exercise can aid individuals with high blood pressure. Additionally, research suggests that consuming Spirulina, a type of microalga, could positively impact body composition and anthropometric indices. The purpose of this study was to determine the effects of spirulina-fortified salad dressing on anthropometric indices and body composition in patients with hypertension.

Methods: Forty-eight (19 men and 22 women) patients with hypertension randomly received either spirulina-fortified salad dressing containing 2 gr spirulina (SSD, n = 22) or a placebo salad dressing (PSD, n = 19) daily for eight weeks. This study was registered at https://www.irct.ir/ (the Iranian registry of clinical trials identifier: IRCT20200404046940N1).

Results: There was a change in body composition and anthropometric indices from baseline to 8 weeks. We observed that the mean change±SD of waist circumference after the SSD intervention (-2.86±4.02 cm) was significantly different from that of the PSD intervention (0.38±9.47 cm). Although no between-group difference was observed, a statistically significant reduction in body fat-free mass (FFM) occurred in the PSD group after the intervention. Meanwhile, within-group mean change±SD of body fat-free mass (FFM, 1.04±5.39 kg) and body fat mass (FM, -0.73±1.83 kg) was significant only in the SSD group. However, no significance between-group difference was observed in terms of FFM and FM changes.

Conclusion: The present study's findings suggest that consuming spirulina-fortified dressing can improve the status of risk factors associated with hypertension and cardiovascular diseases.

Background: Poor adherence to treatment is an obstacle to reach the target level of lipids. The purpose of the study was to investigate the impact of patient-oriented intervention with primary focus on patients' adherence to lipid-lowering therapy on low-density lipoprotein cholesterol (LDL-C) in patients with dyslipidemia and receiving statins for primary prevention of cardiovascular diseases (CVD).

Methods: A prospective, open-label, randomized, multicenter study in parallel groups. Data was collected from 11 study sites. 2,912 patients were recruited between June 2018 and August 2019. Test Intervention: extended consultation on drug compliance, patient-oriented printed materials about CVD prevention, SMS- and phone reminders. The primary endpoint was LDL-C. Chi-square test or Fisher's exact test was used for qualitative variables. Paired Wilcoxon test was used to compare the variables between patient visits. The odds ratio (OR) at 95% confidence interval (CI) was defined as the ratio of the chance of fulfilling the criterion in the group or subgroup (subpopulation).

Results: At 12 month, the number of patients achieving target levels of LDL-C, total cholesterol (TC) and blood pressure (BP) was significantly higher in the intervention group vs control (LDL-C: 80% vs. 70%, OR: 1.68, 95% CI: 1.40 to 2.01, p<0.001; TC: 80% vs. 67%, OR: 1.92, 95% CI: 1.60 to 2.29, p<0.001; BP: 85% vs 79%, OR: 1.49, 95% CI:1.22 to 1.83, p=0.0001).

Conclusion: Proposed patient-oriented intervention helps to achieve the target level of LDL-C, TC and supports better control of BP in patients receiving statins for primary prevention of CVD.

Background: Treatments for osteoarthritis, including steroids and nonsteroidal anti-inflammatory drugs, are not very satisfactory. Therefore, we decided to compare the therapeutic results of intra-articular injection of hyaluronic acid and methylprednisolone.

Methods: In this single-blind clinical trial, 132 patients with osteoarthritis of the knee were randomly assigned to two treatment groups; hyaluronic acid and methylprednisolone. Treatment results were measured based on the standard McMaster Universities Arthritis Index (WOMAC) questionnaire.

Results: Although the desired level of satisfaction was higher in the short-term in the methylprednisolone group and in the long-term in the hyaluronic acid group, however, these differences were not significant.

Conclusion: The recovery of patients is better with methylprednisolone injection in the short term and hyaluronic acid in the long term. However, since methylprednisolone has complications, it is recommended to consider hyaluronic acid as a suitable drug in the treatment process.

Background: The trend of measles and rubella has changed over the last two decades, with the increase in vaccination coverage and the establishment of the surveillance system. This study aimed to demonstrate the current status of the surveillance system and the epidemiological trend of measles and rubella.

Methods: This cross-sectional study retrospectively investigated the status of the surveillance system and the epidemiological patterns of measles and rubella in Babol Mazandaran, during 2014-2023. The study included 348 patients diagnosed with rubella and measles (suspected and definite). Their information was obtained and analyzed from the health department's information registration system.

Results: Out of 348 suspected cases (272 suspected cases of rubella and 76 suspected cases of measles), 2 cases were identified as rubella and 1 case as confirmed measles. 108 (31.03%) cases of suspected cases were in the age group below one year and 153(43.97%) cases were in the age group of 1 to 6 years. The age-specific incidence has decreased with increasing age (p <0.001), and the incidence of suspected cases has increased from 2014 to 2023 (p <0.001). The proportion of appropriate laboratory sample collection before and after COVID-19 was 100%. However, the source of infection remained unknown for all confirmed cases.

Conclusion: The quality of data, timeliness, and sensitivity of the health surveillance system in the region under study are acceptable. However, continuous training for healthcare providers and upgrading the equipment and facilities at the regional level are needed to maintain and improve this situation.

Sweet's syndrome, also referred to as acute febrile neutrophilic dermatosis, presents a constellation of clinical features including fever, tender erythematous skin lesions, peripheral neutrophilia, and a predominant dermal infiltrate of neutrophils. This uncommon condition may arise through drug-induced mechanisms, as a secondary condition to malignant diseases, or idiopathically. Importantly, extracutaneous manifestations, including cardiovascular involvement such as arteritis, acute myocarditis, or coronary artery disease, frequently contribute to the intricacy of the clinical presentation. Despite its significance, the literature on Sweet's syndrome with cardiovascular implications remains sparse, leading to ambiguity in clinical management. In this context, we highlight the need for a heightened index of suspicion to establish a diagnosis of Sweet's syndrome with concurrent cardiovascular involvement, alongside considerations for treatment approaches and post-diagnostic monitoring strategies.

Background: Tako-tsubo syndrome (TTs) is relatively young cardiovascular entity, being initially described in the 1991 by dr Hikaru Sato. Most patients with TTs are admitted to the hospital with the suspicion of acute coronary syndrome or present signs and symptoms typical for acute heart failure. Atrial arrhythmias are thought to complicate almost 10% of all TTs cases. The most prevalent among them is atrial fibrillation (AF). Our aim in this study was to systematically evaluate results of observational studies to assess the incidence and prognostic relevance of supraventricular tachyarrhythmias in TTs patients.

Methods: We performed systematic search of the Cochrane Central Register of Controlled Trials, PubMed, and EMBASE databases for research evaluating the incidence and prognostic relevance of atrial fibrillation(AF)/atrial flutter(AFl)/atrial tachycardia(AT) in patients hospitalized due to TTs. Odd ratio (OR) with a 95% confidence interval (CI) was estimated using a random effect model.

Results: 10 studies comprising 4183 patients were included. The incidence of atrial arrhythmias ranged between 7% to 33%. In our research, supraventricular tachyarrhythmias were associated with significant increased risk for all-cause death (OR 2.99; 95% CI: 2.36- 3.80; p < 0.05), intra-hospital mortality (OR 2.46; 95% CI: 1.30 - 4.63; p < 0.05) and long-term mortality (OR 3.01 95% CI: 2.33- 3.90; p < 0.05).

Conclusions: Our meta-analysis suggests that atrial arrhythmias are associated with an elevated risk for short and long-term adverse outcomes in patients with TTs.

Background: Cognitive impairment (CI) is a disabling complication in patients with multiple sclerosis (MS). Fampridine is used to improve walking abilities in subjects with MS while it is also used for improving cognition, although the results are heterogeneous. Therefore, we aimed to conduct a systematic review and meta-analysis to investigate the effect of fampridine on cognition in patients with MS.

Methods: We performed a comprehensive search in PubMed, EMBASE, Scopus, Web of Science, google scholar, and also gray including references of the references and conference abstracts on January 1^th 2020. We extracted data regarding the number of participants, first author, publication year, and country of origin, age, disease duration, Expanded Disability Status Scale (EDSS), duration of follow up, type of cognition test, and scores before and after the treatment.

Results: We identified 4972 studies in the preliminary search. After deduplication, 2607 articles remained. Two researchers screened the title and the abstracts, removing 2590 studies. Finally, 15 studies remained for meta-analysis. The included studies were published between 2013 and 2021, and the most frequent country of origin was Denmark. The mean age of participants of the studies ranged between 39 and 53 years and the mean EDSS ranged between 4 and 5.8, respectively. The SMD (standardized mean difference) of Symbol Digit Modalities Test (SDMT) (after-before treatment) was 0.45(95%CI: 0.06-0.84) (I²=75.3%, p<0.001). The SMD of Paced Auditory Serial Addition Test (PASAT) (after-before treatment) was 0.25 (95%CI: 0.13-0.37) (I²=84.3%, p<0.001).

Conclusions: Fampridine has a significant role in decreasing cognitive impairments is MS patients.