Caspian Journal of Internal Medicine最新文献

Background: Type 2 diabetes or non-insulin-dependent diabetes is one of the most common types of diabetes. The existing treatments for type 2 diabetes have not been able to completely cure this disease in affected cases. Sumac showed antioxidants, reducing blood sugar and serum cholesterol levels. In this study, according to the positive effects of sumac in diabetic diseases, it was tried that sumac capsules were prepared from the aqueous extract of this plant, and its effect on the factors of diabetes in patients was evaluated.

Methods: This double-blind randomized controlled clinical trial was conducted on sixty type 2diabetic volunteers. The volunteers were divided into two groups, control, and sumac supplement groups. Baseline venous blood samples were collected after overnight fasting before intervention and a second sampling was done in the 12th week. Hb1AC, FBS, TG, TC, LDL-C, and HDL-C were measured via commercial kits.

Results: FBS, HDL-C, and HbA1C measured in the sumac supplement group were significantly different (p<0.01) compared to the control group and baseline of the study. Moreover, there is no significant difference in levels of the sumac supplement group (CHOL, LDL-C, and TG) compared to the control group and baseline of the study (p>0.05).

Conclusion: Our data confirmed the anti-diabetic effect of sumac in patients. Because of sumac safety, it seems that sumac capsules can be used for the treatment of diabetic patients along with routine chemical drugs.

Background: Pulmonary alveolar proteinosis (PAP) is a rare disease caused by the accumulation of surfactant in the lung's alveoli, as a result of malfunction in the cleaning function of alveolar macrophages. The major symptoms include cough and dyspnea. Computed tomography scan usually reveals crazy-paving pattern. Lung biopsy confirms the diagnosis by showing accumulations of periodic acid-schiff-positive lipoproteinaceous materials.

Case presentation: In this report, we present a middle-age man with progressive dyspnea on exertion, and frequent cough with no noteworthy medical history. The results of initial examinations and laboratory tests were non-diagnostic, so imaging studies were requested for the patient. After imaging and suspecting PAP as a differential diagnosis due to results of high resolution computed tomography, a transbronchial biopsy was performed to confirm the diagnosis. Then, according to the histopathology reports, the diagnosis of PAP was made. During the biopsy procedure, the patient developed pneumothorax, and accurate treatment approaches were considered for this complication.

Conclusions: In patients with chronic progressive dyspnea and cough, appropriate and timely imaging and other paraclinic investigations must be considered by the physicians.

Background: Medication errors are a significant cause of adverse events in cancer patients. The study aimed to investigate unintentional medication errors during chemotherapy regimen prescription.

Methods: During the six months' follow-ups, 201 adult patients admitted to outpatients' chemotherapy ward of Omid Hospital, Isfahan, Iran were examined. An information checklist by the aim of data gathering including patients' demographic information, laboratory data, medications history, chemotherapy drug doses and protocol of administration, pre-medications drugs, and supportive treatment was prepared. The data was compared by standard guidelines and data were presented in percent and frequency.

Results: Among the enrolled patients, 327 errors were identified. Sixty-five percent of patients were females and the mean age of patients was 49.2±2.8 years old. Gastrointestinal and breast cancers were among the most frequently reported cancers. The highest frequency of errors (67.27%) was attributed to the prescription of pre-medication drug administration primarily in the management of chemotherapy-induced nausea and vomiting. Medication errors in selection and volume of infused serums (20.18%) and in adjusting the dosage of chemotherapy regimens (10.39%) were the most observed errors.

Conclusion: This study highlighted the important areas to improve cancer management at the medical center. By addressing these challenges and implementing necessary changes, the center can enhance the quality of care provided to cancer patients, ensure adherence to international standards, and improve patient outcomes.

Background: Multiple myeloma (MM) is characterized by reduced circulating adiponectin levels, a condition associated with various diseases such as diabetes mellitus, obesity, cardiovascular diseases, cancer, and plasma dyscrasias. Curcumin has been shown to inhibit adipogenesis and elevate serum adiponectin levels. Notably, limited studies investigating the relationship between adiponectin levels and curcumin supplementation in myeloma patients. This study is to evaluate the efficacy curcumin supplements on increasing the levels of adiponectin in myeloma patients.

Methods: Patients with myeloma were randomly to melphalan, prednisone, curcumin (MPC) (n=17) and melphalan with prednisone (MP) (n=16) groups. The MPC group was treated by melphalan 4 mg/m² and prednisone 40 mg/m² for 7 days (MP), and curcumin 8 grams daily for 28 days. The MP group received MP and placebo. Subjects were followed-up every 28 days and a total of four treatment cycles. Hemoglobin, albumin, white blood cell (WBC), platelets, urea, creatinine, calcium, protein M, and adiponectin evaluated before and after treatment. Mann Whitney test or the Independent T-test were used to analysis.

Results: Total subject (24 subjects) completed the treatment. Serum adiponectin levels after four treatment cycles in the MPC group were higher than in the MP group [(mean, 12227.1±5748.3) vs (11365.4±9175.5), P = 0.78].

Conclusion: Supplementing MP regimen with 8000 mg curcumin daily for 28 days increases the serum adiponectin level after four treatment cycles in myeloma patients. This research found that myeloma patients may benefit by taking curcumin supplementation.

Background: This study aimed to explore the patients' reactions when HAM/TSP was diagnosed. This qualitative content analysis study was conducted on HAM/TSP patients referred to an HTLV-1 clinic in Mashhad, Iran.

Methods: We selected a purposive sample of 16 HAM/TSP patients meeting the inclusion criteria to participate in semi-structured interviews to explore their reactions and emotions when they first learned about their diagnosis. A qualitative content analysis was utilized with MAXQDA 2020 software.

Results: Four categories and 14 subcategories were extracted, summarized in the main concept "Astonish yourself while worrying about another." The categories included threatened mental health, fear of falling into the path of ambiguity and darkness, fears and conflicts of deciding to expose the disease, and the double stress of threatening the health of others."

Conclusion: HAM/TSP is an incurable and progressive disease with several physical complications. Its first diagnosis can also cause severe psychological damage to patients and profoundly affect the patient's social and family relationships. Therefore, it seems that education and health policies should integrate multidisciplinary teams to minimize the effects of HAM/TSP on the patients' quality of life.

Background: Chemotherapy regimens with anthracyclines, widely used in treating breast cancer and lymphoma, are associated with significant cardiac toxicity. While previous studies have primarily focused on left ventricular (LV) function, limited research exists on right ventricular (RV) function. This study aimed to evaluate RV echocardiographic function in breast cancer patients undergoing anthracycline-based chemotherapy.

Methods: A cohort of 72 breast cancer patients receiving anthracycline treatment at Ghazi Tabatabai and Madani Hospitals from April to March 2022 participated in this study. Echocardiography was performed before treatment initiation, 15 days after the second chemotherapy session, and 15 days after the final session. Cardiotoxicity levels were calculated using SPSS V22 software with inferential statistical methods, including repeated measures analysis and the Friedman test.

Results: RV-free wall strain remained stable 15 days after the second treatment session compared to baseline but showed a statistically significant decrease 15 days after the final session (P = 0.044). The prevalence of abnormal RV-free wall strain increased significantly during the final assessment (P = 0.037). Tumor regression grade (TRG) also demonstrated significant changes over time (P = 0.003). Right ventricular systolic pressure (RVSP) increased significantly throughout the study (P = 0.035), while no significant changes were observed in other parameters such as LVEF, E/E', LAVI, or TAPSE.

Conclusion: Anthracycline-based chemotherapy leads to a decline in RV-free wall strain over time, highlighting the importance of monitoring RV function alongside LV function during treatment. Advanced echocardiographic techniques, including strain imaging, may help detect subclinical RV dysfunction earlier.

Background: Hyperglycemia caused by diabetes is closely related to long-term damage in organ functional disorders. The objective of the study was to determine the prevalence of uncontrolled glycemia and its associated factors in Iranian diabetic patients.

Methods: This cross-sectional study was conducted on 496 types 2 diabetic patients in the outpatient clinic of a referral hospital center affiliated with Babol University of Medical Sciences, North of Iran. The data of fasting blood sugar (FBS) and hemoglobin A1C were extracted from recent laboratory tests. The demographic, clinical data, and comorbidity were collected. The reliable and valid scales of self-care and self-efficacy were used to collect data through face-to-face interviews with patients.

Results: About half of the participants, 241(48.6%) patients had poor glycemic control (FBS≥152 mg/dl) and a higher proportion, 382 (79.6%) patients were found based on the criterion of HbA1C≥7%. There was no significant difference in poor glycemic control between genders. The adjusted OR for risk of poor glycemic control (FBS>152mg/dl) after controlling potential confounders was 2.37 (95%CI: 1.34, 4.12) for the duration of diabetes >15 years compared to 5 years or less. The higher level of self-efficacy prevented poor glycemic control (adjusted OR=0.50, 95%CI: 0.29, 0.87). While the high level of self-care tended to protect against poor glycemic control non-significantly (adjusted OR=0.65, 95%CI: 0.41, 1.11).

Conclusion: Our findings show that majority of diabetic patients have poor glycemic control. The high level of self-care and self-efficacy substantially reduced the risk of poor glycemic control.

Background: There is no evidence regarding the crucial topic of possible correlation between duodenal ulcer disease and mitral valve prolapse syndrome. We herein investigated the potential relationship between these two disorders.

Methods: Eighty-three hospitalized patients with active duodenal ulcer disease were compared with 31 healthy controls for the presence of mitral valve prolapse syndrome. All participants underwent cardiac examination and echocardiography. Heart rate, systolic and diastolic pressures were estimated in supine baseline and standing positions.

Results: Echocardiographic mitral valve prolapse was present in 36 (43.37%) of the patients and only in 1 (3%) of controls (P=0.001). Auscultatory findings of systolic murmurs (50% vs. 4%, respectively; P=0.001) and symptoms related to the cardiovascular system (i.e., chest pain: 75% vs. 30%, respectively; P=0.001) were more common in patients with mitral valve prolapse than those without it. Heart rate was lesser in patients with mitral valve prolapse in supine location (71.001.73 vs. 76.101.66, respectively; P=0.04), and was higher in the upright location in patients than those without mitral valve prolapse (91.542.73 vs. 83.422.71, respectively; P=0.04) and in normal controls (91.542.73 vs. 84.062.02, respectively; P=0.03). Moreover, blood group O and male gender were more common among the patients with mitral valve prolapse, compared to normal controls (67% vs. 39%, respectively; P=0.03, and 61% vs. 35%; P=0.05, respectively).

Conclusion: Our findings suggest a clinical and genetic relationship between active duodenal ulcer and mitral valve prolapse syndrome connected with autonomic dysfunction. Further studies are warranted to confirm this crucial topic.

Background: Olfactory changes connection to deteriorated quality of life in chronic kidney disease cases (CKD) and diabetes mellitus (DM). The nutritional status is altered in CKD and DM and it closely interconnected with olfactory function. We aimed to study the olfactory dysfunction in these populations.

Methods: We conducted a cross-sectional research on CKD and DM cases aged 20-50 (27 healthy controls, 77 CKD patients, and 36 DM patients). We used the Iran Smell Identification Test (Iran-SIT) version of the University of Pennsylvania Smell Identification Test (UPSIT) to evaluate the olfactory function. The significant level was set as <0.05.

Results: Our 140 cases included 51.4% of men (mean age of 46.7±10.6 years). The total score of the Iran-SIT test indicated that olfactory impairment in the CKD was higher (16.2±4.2) than in the DM (18.8±2.1) and control groups (20.4±1.2) (P=0.001). It was determined that 54.5% of CKD patients and 38.9% of the DM group had olfactory dysfunction compared to 7.4% of the controls (P=0.001). Multiple regression analysis indicated that being men and low-density lipoprotein cholesterol (LDL-C) were related to olfactory dysfunction in the total population (OR: 4.55, P=0.037, and OR: 0.94, P=0.037). Still, it was only associated with LDL-C in the CKD group (OR: 0.93, P=0.013).

Conclusion: Based on the findings of this study, CKD and DM patients had a higher prevalence of olfactory dysfunction than the controls, which could be associated with some preventive nutritional factors. This information may help perform a screening program and early intervention on olfactory dysfunction in these systematic diseases.

Background: The cost of anticancer drugs and their wastage has become a major concern for patients and health policy makers in developing countries. To date, no figures have been reported on the rate of loss of anticancer drugs in Iran. Therefore, we aimed to conduct a real-world analysis on the anticancer drug wastage in a public hospital.

Methods: During a 3-month time span, we observationally collected drug information of all patients admitted for receiving anticancer drugs in the inpatient or outpatient unit of chemotherapy center by two oncology nurses. The amount of drug wastage and its financial cost were calculated based on the price approved by the Food and Drug Administration (FDA) of Islamic Republic of Iran (IRI) during the survey period.

Results: A total of 626 patients were admitted for receiving twenty-four injectable anticancer drugs in 2023 infusions. The percentage of total drug wastage was 9.31% (95% CI, 5.90 -12.71%). Overall, these results indicated that the cost of drug wastage in this 3-month period was roughly 31,473 US dollars (USD) and estimated annual cost of wastage was nearly 125,894 USD (5,287,553,080 Iranian Rial).

Conclusion: This is the first report of investigating anticancer drug wastage in Iran. According to this real-world survey, it was shown that the amount of drug wastage in this center is substantial and imposes a heavy financial burden on patients and the health system that need to be taken into account by policy makers.