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Caspian journal of internal medicine, Volume 10, pp 25-35; doi:10.22088/cjim.10.1.25

Abstract:
C-reactive protein (CRP), creatine kinase-muscle (CK-MM) and aldolase A (AldoA) levels are predicted to be realistic biomarkers of osteoarthritic disorders (OADs). The objective of the study was to evaluate the levels of CRP, CK-MM, and AldoA and determine their correlations with risk factors such as inflammation, muscle degeneration, and skeletal muscle damage for OADs. Baseline data from 297 patients, average aged 60.17±7.19 years, suffering with OADs for 5.75±1.32 years and 315 participants, average aged 58.96±8.63 years, without OADs were collected in this cross-sectional study. Separate analyses were performed for the participants with and without OAD symptoms confirming with X-ray or MRI. Blood CRP, CK-MM, and AldoA levels were estimated. The receiver operating characteristic (ROC) curves, their respective 95% confidence intervals (CIs), and significance values were compared between participants with and without OADs to identify the risk factors for OADs in relation to biomarkers. In patients with OADs, who exhibited degenerative changes on musculoskeletal joints and risk factors based on the elevated levels of CRP, CK-MM, and AldoA having their mean±SD values, 7.22±6.09 mg/L,135.2±78.56 U/L and 8.09±2.15 U/L, respectively. Their respective values of areas under the curves (AUC) of ROC curves were 0.76, 0.68 and 0.91 respectively, of which all exhibited highly significant differences (p
Sciprofile linkMagdalena Baymakova, Georgi T. Popov, Radina Andonova, Valentina Kovaleva, Ivan Dikov, Kamen Plochev
Caspian journal of internal medicine, Volume 10, pp 102-106; doi:10.22088/cjim.10.1.102

Abstract:
Fever of unknown origin (FUO) is a perplexing medical problem. The causes for FUO are more than 200 diseases. The aim of the study was to present human clinical cases of Coxiella burnetii infection debuting as FUO. The following methods were conducted in the study: literature search, laboratory, imaging, and statistical methods. Criteria of Durack and Street were applied for FUO definition. For the etiological diagnosis indirect immunoenzyme assay (ELISA) for antibodies detection against Coxiella burnetii was used (cut-off = 0.481-0.519). From 2008 until 2015, nine patients with FUO caused by C. burnetii were hospitalized at the Military Medical Academy of Sofia. Male gender was predominant (male/female - 77.8% /22.2%), mean age was 48.78±14.52 years (range: 26-67), hospital stay was 9.78±2.95 days (range: 5-15), fever duration was 54.33±56.23 days (range: 21-180). Laboratory investigations estimated the elevation of erythrocyte sedimentation rate 49.11±31.74mm/h (95%CI = 13.09-111.31), C-reactive protein 37.68±37.62mg/L (95% CI = 36.07-111.42) and fibrinogen 5.69±1.59g/L (95% CI=2.57-8.81). The mean values of liver enzymes were in reference range. Among imaging tests, abdominal ultrasound and X-ray demonstrated 33.3% contribution to the final diagnosis. Transthoracic echocardiography found 22.2% contribution. Serological methods presented 100% contribution. C. burnetii infection was accepted as a final diagnosis among 9 patients with FUO based on the integrated information from the applied methods. Active search and establishment of this pathogen among FUO should lead to avoiding potential complications and consequences in case of untreated patients infected with C. burnetii.
Olga Visternichan, Sciprofile linkSeyed Farzad Jalali, Dana Taizhanova, Larissa Muravlyova, Gaukhar Igimbayeva
Caspian journal of internal medicine, Volume 10, pp 86-91; doi:10.22088/cjim.10.1.86

Abstract:
Cardiovascular diseases are global problems. They are causes of death in about 43% of people worldwide and may become the most widespread reason of death by 2020. The prognosis is directly dependent to immediate diagnosis and on time treatment. Introduction of new biochemical markers as the early diagnosis of complications after coronary revascularization is very important in this period. Herein, we assayed the changes of purine catabolites in patients with acute coronary syndrome (ACS) before and after percutaneous coronary intervention (PCI) in comparison with control group. Thirty five ACS patients (20 males and 15 females) were included (57±17 years old) in the study. The determination of intermediates of purine catabolism as guanine, hypoxanthine (GCS), adenine, xanthine (Kc) and uric acid (MK) were assayed before and 3 days after PCI. Conditionally, 35 healthy-matched persons were included in the control group. Purine catabolites were determined in plasma through the method of Oreshnikov E.V (2008). In ACS patients, prior to PCI, there was a tendency to increase the concentration of guanine (P=0.001), hypoxanthine (P=0.002) adenine (P=0.0003), xanthine (P=0.000003) and uric acid (P=-0.000001) relative to the upper limits of normal ranges. And on the third day after PCI, there was the second tendency to increase the levels of guanine (P=0.000001), hypoxanthine (P=0.000001) adenine (P=0.0000001), xanthine (P=0.000001) and uric acid (P=0.0000001) relative to upper limits of normal ranges. Increment of plasma purine catabolites can be a marker of inflammation and instability of coronary artery plaques and may be used as a restenosis marker in patients with history of PCI.
Hamidreza Norouzi, Naghmeh Ziaie, Mehrdad Saravi, Alireza Norouzi, Somayye Noei-Teymoordash, Fazilat Jokar-Darzi, Fateme Norouzi, Maede Rajabi-Fumashi, Sciprofile linkFarbod Zahedi Tajrishi, Shahram Norouzi
Caspian journal of internal medicine, Volume 10, pp 80-85; doi:10.22088/cjim.10.1.80

Abstract:
Evidence suggests hypovitaminosis D is associated with increased risk of coronary artery disease (CAD) and its extent and related risk factors. However, some investigations have produced contrary results. Therefore, we aimed to evaluate the association between serum vitamin D levels and the severity of premature coronary artery involvement. This randomized prospective, case-control study was conducted in Babol from April 2013 to June 2017. We collected the demographic data and measured serum 25-OH-D levels of 294 patients (age≤50 years) diagnosed with CAD with coronary angiography as case group as well as 438 age and sex-matched controls. CAD severity was assessed using the Gensini score. Statistical analyses were used to assess the associations and p0.05). The results showed that the lower levels of vitamin D is associated with increased risk and extent of coronary artery involvement as well as some of the risk factors of CAD, including male gender, hypertension and positive family history for CVD.
Sciprofile linkSimin Mouodi, Seyed Reza Hosseini, Robert Graham Cumming, Sciprofile linkAli Bijani, Haleh Esmaeili, Sciprofile linkReza Ghadimi
Caspian journal of internal medicine, Volume 10, pp 55-64; doi:10.22088/cjim.10.1.55

Abstract:
Considering the importance of healthy diet in the protection of cardiovascular diseases (CVD), this research aimed to assess the physiological risk factors for CVD in middle-aged adults and their association with dietary intake in the north of Iran. In this cross-sectional study conducted in the years 2016-2017 among the adults aged 40-60 years living in Amirkola, Babol, the participants´ physical activity, dietary intake, body mass index, fat mass, blood pressure, fasting blood glucose and serum lipid profile were reported. The International Physical Activity Questionnaire was used to assess physical activity and a structured 24-hour food-recall questionnaire was used to assess the participants´ dietary intake. Consumed foods and beverages on two separate days were analyzed and transcribed in 10 food groups (gram). Two hundred and ninety-one persons (96.7%) had complete participation, 96.2% with at least one CVD risk factor and 75.9% had overweight or obesity; 33% with hypertension; 6.2% had high fasting blood glucose; 64.6% with hypercholesterolemia, 47.8% had hypertriglyceridemia, and 8.9% with low HDL. Mean daily intake values of carbohydrate, protein and fat were all higher than dietary reference intakes for adults. Physical activity less than 1500 MET-minutes per week was significantly associated with having three or more physiological risk factors for CVD [adjusted odds ratio: 2.04 (1.08-3.85)] (P=0.029). Most of the middle-aged adults in this region had at least one of the physiological risk factors for CVD and daily intakes of carbohydrate and protein were higher than dietary reference intakes (DRIs) for adults.
Fatemeh Aghaeimeybodi, Katayoun Najafizadeh, Seyd-Kazem Razavi-Ratki, Sciprofile linkNasim Namiranian
Caspian journal of internal medicine, Volume 10, pp 7-10; doi:10.22088/cjim.10.1.7

Abstract:
Lymphangioleiomyomatosis (LAM) is a progressive lungs disease that affects women at reproductive years. Sirolimus inhibits mammalian target of rapamycin (mTOR) and its administration in past studies was hopeful in treatment of patients with LAM. The aim of this study was to evaluate sirolimus therapy on lung function in LAM patients. We conducted a trial to evaluate the effect of sirolimus on six patients with LAM who had severe or very severe obstructive lung disease, and one-year follow up. Maintenance level of Sirolimus was 10-15 ng/ml. Serial visits (including physical examination, evaluation of signs and symptoms of disease and adverse events due to treatment), spirometry, 6MWT done at baseline 3, 6, 9 and 12 months after. Spirometric parameters walk distance and O2 saturationbefore and after exercise at first and the end of treatment were measured. Four patients had TSC-LAM while the other 2 patients had S-LAM. The mean level of sirolimus was 13 ng/ml after one-year treatment. Mean FEV1 at enrollment and end of study was 1000cc (33% predict) and 1228cc (42% predict) respectively (P=0.674). The mean FVC at baseline and end of study was 1648cc (49% predict) and 1866cc (55% predict) (P=0.996). The mean FEV1/FVC at enrollment and the end of treatment was 58% and 62% respectively (P=0.753). The mean FEF25-75 at first and at the end of treatment was 16% and 26%, respectively (P=0.028). The mean walk distance in 6MWT at first and at the end of study was 315 meters (P=0.9). The mean percentage of O2 saturation at rest was 84% and 92% at first and at the end of study (P=0.104). In LAM patients, sirolimus has been shown stabilizeto or improve lung function, rest and exertional O2 saturation. Sirolimus was effective in LAM patients who had severe or very severe physiological disorders.
Babak Pezeshki, Sciprofile linkHossein Chiti, Peyam Arasteh, Saeedeh Mazloomzadeh
Caspian journal of internal medicine, Volume 10, pp 16-24; doi:10.22088/cjim.10.1.16

Abstract:
HbA1C has been a known predictor and diagnostic test for diabetes type 2. However, this test has not yet been widely studied in GDM and more importantly no cutoff point has been defined for HbA1C in GDM. We investigated the efficacy of screening during first and second trimester of pregnancy and defined appropriate cutoff points according to HbA1C and FBS for predicting maternal GDM among women with none to minimal previously known risk factors. This is a prospective multi-centered cohort study. Individuals were evaluated at first trimester, at 20-24 weeks and 24-28 weeks of gestation. GDM tests were done during visits and accuracy of each of these measurements was evaluated. Overall, 356 entered the study, among which 25 individuals and 30 individuals developed GDM during 20-24 and 24-28 weeks of gestation, respectively. HbA1C measured during first trimester at a cut-off of 5.35% predicted GDM of 24-28 weeks with an accuracy of 85.6%, sensitivity of 80%, and specificity of 80%. Furthermore, at a cut-off of 5.75% measured at 20-24 weeks, HbA1C predicted GDM with an accuracy of 94.5%, sensitivity of 97%, and specificity of 96%. Screening programs during first trimester and at 20-24 weeks of pregnancy, using HbA1C, can significantly aid in the early prediction of GDM, even among women with no to minimal previously known risk factors, which shows a need for revision in current guidelines.
Mohammadreza Salehi, Zahra Ghomi, Sciprofile linkReza Mirshahi, Seyed Ali Dehghan Manshadi, Sciprofile linkOmid Rezahosseini
Caspian journal of internal medicine, Volume 10, pp 73-79; doi:10.22088/cjim.10.1.73

Abstract:
Bloodstream infection with Candida, or candidemia, is the most common Candida systemic infection. In this study, we investigated the characteristics of patients with candidemia to provide appropriate perspectives on these patients and reduce the associated mortality and morbidity. In this cross-sectional study, all patients with at least one positive blood culture of Candida spp. were investigated from April 2015 to March 2016 in Imam Khomeini Hospital Complex, Tehran, Iran. A total of 74 patients (44 men and 30 women), with the mean age of 53.15±17.89 years, were enrolled in this study. Non-albicans Candida species was responsible for candidemia in 67.6% (50.74). The mean therapy intervals were 7 and 5.6±1.5 days in patients who died and were discharged, respectively. The differences in frequencies of urinary catheter and mechanical ventilation were statistically significant among patients who died and survived (P
Sciprofile linkVida Nesarhosseini, Hossein Mohsenipouya, Atieh Makhlough, Rozita Jalalian
Caspian journal of internal medicine, Volume 10, pp 36-41; doi:10.22088/cjim.10.1.36

Abstract:
Aldosterone has been assumed to be implicated in left ventricular hypertrophy (LVH). Preventing the progression of LVH in the early period of end-stage renal disease (ESRD) can increase patient survival. In this study, therefore, we analyzed the relationship between aldosterone level and LVH in ESRD patients who underwent hemodialysis at Fatemeh Zahra Hospital and Imam Khomeini Hospital in Sari, Iran from 2016 to 2017. This research is a case-control study involving 69 patients, divided into the case group (n=52, exhibiting LVH) and the control group (n=17, no ventricular hypertrophy observed in the echocardiography). The relationship between the patients' serum aldosterone levels and LVH was evaluated on the basis of relative wall thickness (RWT). Among the patients, 20.3% had normal cardiac conditions, 53.6% eccentric hypertrophy (EH), 4.3% exhibited concentric remodeling (CR), and 21.7% had concentric hypertrophy (CH). In other words, 24.6% of the patients belonged to the control group, and 75.4% belonged to the case group. The results indicated a significant difference (P=0.006) in average aldosterone levels between the case (165.11±80.8) and control (115.76±72.47) groups and a significant difference in aldosterone levels among the four subgroups (P=0.03), with the levels of the CH group being higher than those of the EH group. Based on the results of the study, a significant relationship exists between plasma aldosterone level and LVH in ESRD patients. Serum aldosterone level is therefore a predictor of LVH.
Fatemeh Montazer, Sciprofile linkAlireza Sanei Motlagh
Caspian Journal of Internal Medicine, Volume 10, pp 107-110; doi:10.22088/cjim.10.1.107

Abstract:
Neurofollicular hamartoma (NFH) is characterized histopathologically by fascicles of spindle cells that laterally delimited by hyperplastic folliculosebaceous units. It usually appears on face, near the nose or nasolabial fold. It does not manifest true neural differentiation and recently the term spindle cell predominant trichodiscoma (SCPT) has been used instead. We present a case of a 40-year-old male with co-incidence of NFH and basal cell carcinoma (BCC) that the mesenchymal components of NFH were similar to SCPT but these components highly expressed S-100 protein. We also discuss about the histological aspect of the neoplasia in this report and consider the findings of other reports in association with classification of NFH by means of cellular markers and morphological resemblance to other skin hamartomas. Neurofollicular hamartoma is a rare benign tumor that thought to represent the cellular end of a morphological spectrum with trichodiscoma. The morphological features and expression of S100 protein in neural element helped us to achieve the diagnosis of neurofollicular hamartoma. However, variable reports of S-100 protein expression in NFH are available and further studies are needed to determine the classification of this tumor.
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