Caspian Journal of Internal Medicine最新文献

Background: Sleep disorders frequently affect end-stage renal disease patients on dialysis. However, the relationship between sleep quality and residual kidney function is still unclear. Therefore, this study aimed to investigate this relationship.

Methods: In this analytical cross-sectional study, 225 patients who were referred to dialysis centers were studied, and based on renal function, they were classified into two groups with and without residual kidney function. The study employed the Pittsburgh Sleep Quality Index questionnaire to evaluate sleep quality. Multiple linear regression was utilized to determine the factors affecting sleep quality with a significance level consideration at p<0.05.

Results: The mean age of patients was 58.23 ± 13.50 years. 58.7% of patients were males. The problem of serious and very serious sleep in the Sleep latency and sleep duration has been more than other components. 72% of hemodialysis patients had poor sleep quality. In the multiple linear regression model, age (β = 0.442, 95% CI: 0.096, 0.788), sex (β = -0.847, 95% CI: -1.641, -0.054), Body mass index (β = 0.153, 95% CI: 0.058, 0.249) and dialysis duration (β = 0.097, 95% CI: 0.002, 0.192) were independently and significantly associated with sleep quality score. However, there was no statistically significant relationship between sleep quality and residual kidney function.

Conclusion: In conclusion, poor sleep quality is very common in patients undergoing hemodialysis. Therefore, sleep disorders in hemodialysis patients should be considered as one of the most challenging problems by healthcare providers, and early diagnosis and intervention are essential to improve sleep quality.

Background: The simultaneous involvement of the pleura and peritoneum with tuberculosis in the absence of pulmonary foci is an uncommon condition that may lead physicians to misdiagnose.

Case presentation: Herein, we present a Persian male adult who manifested with epigastric pain, weakness, and a history of pleuritic chest pain two months prior to admission. The findings of the physical examination included vital signs within the normal range, unilateral fine crackle in the lung, abdominal distension with positive shifting dullness, and fluid wave test. Analysis of the ascitic fluid revealed a Serum-ascites albumin gradient (SAAG) of less than 1.1g/dl, indicating a non-portal condition. The results of the acid-fast bacilli (AFB) staining as well as the TB polymerase chain reaction (PCR) test were negative. However, the adenosine deaminase (ADA) level was 44 IU/L. A chest CT scan revealed mediastinal lymph node enlargement and pleural thickening with loculated pleural effusion. Three acid-fast bacilli smear of morning sputum were sent, and all three were negative. An abdominopelvic CT scan showed multiple periaortic and mesenteric lymph nodes of varying sizes with mesenteric haziness and accumulation of effusion in the peritoneal cavity. Eventually, peritoneal biopsy, the gold standard, was performed, which revealed multiple granulomatous lesions and areas of caseous necrosis surrounded by Langerhans giant cells and epithelioid cells.

Conclusion: It is worth noting that in cases of ascites and pleural thickening, especially in patients with poor socioeconomic status, simultaneous pleural and peritoneal TB should be considered, especially in third-world countries.

Background: Diabetes (primarily type 2) is linked to a higher risk of breast cancer. Insulin-like growth factor (IGF) is one of the most important factors that affects mitosis and thus inhibits apoptosis. The purpose of this study was to compare the pre-treatment insulin-like growth factor (IGF) levels in breast cancer against normal population.

Methods: In this case-control study, 60 patients with breast cancer and 60 healthy controls were enrolled in 2017 and 2018 at Tehran's Shahid-Modarres Hospital. In this study, the blood sugar of the patients was examined before entering the study, and the age of the patients was also within the age limit of 18 to 70 years. They were studied to determine the relationship between insulin-like growth factor (ELISA method) and breast cancer.

Results: Both groups have similar IGF-1 levels (Ctrl and Case) (P= 0.188). But, IGF-2 levels were significantly higher in breast cancer patients (373.4 vs. 317.3 ng/ml), (P=0.0001).

Conclusion: According to our study, IGF-2 may serve as a prognostic biomarker and potential therapeutic target for breast cancer. However, further investigation is needed to validate this claim.

Background: Acne vulgaris is a chronic, inflammatory disease and one of the most common skin diseases. Isotretinoin is the best treatment for severe nodulocystic acne compared to other systemic medicine. Although serum lipids elevation is one of the side effects of this medicine; recent studies have shown controversial results. This study aimed to assess the serum lipid profile in adolescents and adults with acne vulgaris receiving isotretinoin.

Methods: This is a cross-sectional study on 65 adolescents and adults older than 16 years old (55 females and 10 males) with moderate to severe degrees of acne vulgaris under a fixed low dose of 20 mg/day Isotretinoin treatment for 120 days. We analyzed the data using the SPSS software Version 16 using paired sample t-test, Wilcoxon, and ANCOVA test.

Results: In this study, 65 records of patients with a mean age of 22.21±6.25 years were assessed. There was a significant elevation in Cholesterol and LDL levels, but in HDL and triglyceride levels no significant change occurred. A significant change in cholesterol levels was noticed in the adolescent age group, the female sex, and the normal weight group. Triglyceride had a significant change in the female sex and normal weight group and HDL significantly increased in male patients.

Conclusion: Although a low dose of isotretinoin can be used with minimal concern for changes in lipid profile in acne vulgaris patients, in the long-term follow-up and treatment, it seems that we have to administer it cautiously.

Background: Bleeding during nose surgery is very important, because it can cause a problem in the surgeon's field of view and lead to an increase in the probability of surgical complications. The aim of this study was to compare the local effects of tranexamic acid and phenylephrine on bleeding in rhinoplasty.

Methods: The present study is a double-blind clinical trial in which 98 patients who were candidates for rhinoplasty Shiraz were randomly divided into 49 groups of phenylephrine and tranexamic acid. In the first group, 1 cc of phenylephrine and in the second group, 1 cc of tranexamic acid was used locally and then the variables in the two groups were compared. The current study was approved by the Iranian Clinical Trial Registration Center with code IRCT20201205049602N1.

Results: The average blood pressure and heart rate in the phenylephrine group first increased and then decreased, but in the tranexamic acid group decreased from the beginning to 30 minutes. Based on the results of the test, there was a difference between the two groups in terms of the amount of bleeding, and a statistically significant relationship was observed. The average bleeding volume was lower in the phenylephrine group (p<0.0001).

Conclusion: Results of this study showed that the amount of bleeding in the phenylephrine group was lower than that of tranexamic acid. It is recommended to use phenylephrine in rhinoplasty surgery to reduce bleeding and improve the surgeon's vision.

Background: Our study discusses the probable etiologies and characteristics of pulmonary cavities in post-COVID-19 patients. A pulmonary cavity is a late complication of the disease, yet it has led to multiple referrals to our tertiary hospital in Tehran, Iran.

Methods: We conducted a retrospective case-series study on 20 patients who were admitted to our center between April 2020 and September 2021. They were all diagnosed with COVID-19 and concomitantly developed pulmonary cavities. We assessed their electronic medical records in 2021 and compared their characteristics with other studies based on the available literature.

Result: Of the 20 patients with cavities, 12 (60%) had been diagnosed with prior COVID-19, and 9 (45%) had type 2 diabetes mellitus. 9 patients (45%) had bacterial superinfections while 4 (44%) had fungal infections. All patients received corticosteroids, but only 4 (20%) were additionally administered Tocilizumab.

Conclusion: COVID-19 patients can develop pulmonary cavities during recovery; however, this infrequent radiologic finding depends on specific risk factors.

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: 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: 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.