Caspian journal of internal medicine

Journal Information
ISSN / EISSN : 2008-6164 / 2008-6172
Published by: Babol University of Medical Sciences (10.22088)
Total articles ≅ 392
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Hossein Esfahani, , Mina Rezanejad, Saadat Torabian
Caspian journal of internal medicine, Volume 12, pp 243-248; https://doi.org/10.22088/CJIM.12.3.243

Abstract:
The most important prognostic factor in transfusion-dependent beta-thalassemia is cardiac involvement which is usually evaluated with echocardiography. In this cross-sectional study (April 2011 to April 2012), conventional echocardiography was used to assess myocardial performance and valvular involvement (through transvalvular Doppler study) for right and left heart abnormalities in transfusion-dependent beta-thalassemia. Among the 60 patients, 43 cases had heart problems, 26 (43.3%) of them had left myocardial dysfunction and 11 (18.3%) of them had right myocardial dysfunction, 3 cases had both RV and LV myocardial dysfunction, (based on LVMPI & RVMPI, respectively). In patients with right myocardial dysfunction, 4 cases had pulmonary hypertension (PH) and 3 had both sided myocardial dysfunction. LVMPI and RVMPI significantly increased in patients with cardiac involvement (p<0.001). Serum ferritin levels in patients with and without cardiac involvement were 2427±1788 ng/ml and 1573±592 ng/ml, respectively (P=0.008). All 4 patients who had PH, had been splenectomized. In splenectomized and non-splenectomized patients, LVMPI was 0.37±0.11 and 0.38±0.1 (P=0.589), RVMPI was 0.3±0.07 and 0.25±0.39 (P=0.004), and TR gradient (TRG) was 28±11.8 mmHg and 19.7±5.2 mmHg (P=0.033), respectively. Mean ferritin level in patients with a history of splenectomy (n=31), was 2525±1968 ng/ml and in patients without the history of splenectomy (n=29) was 1821±947 ng/ml (P=0.082). In addition to left-sided heart involvement, conventional echocardiography revealed right-sided heart involvement in transfusion-dependent thalassemia patients which did not correlate with serum ferritin level in splenectomized patients.
, Haerani Rasyid, Pendrik Tandean, Himawan Sanusi, Hasyim Kasim, Syakib Bakri, Makbul Aman, Arifin Seweng
Caspian journal of internal medicine, Volume 12, pp 323-326; https://doi.org/10.22088/CJIM.12.3.323

Abstract:
Both clinical and experimental evidence have been published over the past few decades supporting the existence of a close relationship between the elevated levels of serum uric acid with cardiovascular events and acute kidney injury (AKI). This study aimed to determine the effect of serum uric acid levels on the incidence of AKI in acute coronary syndrome (ACS) patients. A retrospective cohort study with a cross sectional design was performed. The research was conducted at Dr. Wahidin Sudirohusodo Hospital from October 2019 to December 2019. Nonrandom sampling was employed in the medical records. All patients who met the inclusion criteria were at > 18 years old and diagnosed with ACS with AKI. The demographic data of age, sex and serum uric acid levels were recorded. The data obtained were analyzed using the SPSS (Statistical Package for Social Sciences). There were 158 subjects of ACS patients with AKI and 135 without AKI. There was a significant correlation between high uric acid levels with the incidence of AKI in ACS (p<0.001). Patients with high serum uric acid levels were 9.5 times at risk of developing AKI compared to those with normal serum uric acid levels. High uric acid level is one of the risk factors for AKI in ACS and indicates 9.5 times at risk of developing AKI compared to normal serum uric acid level. Therefore, it is necessary to monitor serum uric acid level and kidney function in ACS patients.
, Ghasem Faghanzadeh-Ganji, Ali Baghaeian, Ali Bijani, Roghayeh Pourkia
Caspian journal of internal medicine, Volume 12, pp 299-306; https://doi.org/10.22088/CJIM.12.3.299

Abstract:
Atrial fibrillation is an arrhythmia that results from abnormal depolarization of the atrium. Atrial fibrillation occurs in 5–40% of patients with cardiovascular bypass surgery, usually occurs on 2 to 4 days postoperatively. The aim of this study was Effect of variability of central venous pressure values to prevent atrial fibrillation after coronary bypass grafting. The present clinical trial study was performed on 150 patients undergoing cardiac surgery referred to Ayatollah Rohani Hospital of Babol. Patients were divided into 3 groups, with normal range pressure (8 to 12 mmHg), low pressure (less than 8), high pressure (greater than 12) based on central venous pressure measurements. Patients were evaluated every 4 hours to 72 hours for central venous pressure, AF incidence and urine output. Finally, the data are analyzed by spss statistical software. In this study 79 (52.7%) patients were male and 71 (47.3%) were female. In examining changes in central venous pressure, the time effect also significantly increased central venous pressure. The results of independent t-test showed that the mean of central venous pressure changes in subjects with at day 16, second day at 16, 20, 24, third day at 4, 8, 12, 16, 20 and 24 hours Atrial fibrillation. Significantly more than those without atrialfibrillation (P<0.05). In the study, central venous pressure changes the effect of time significantly increases the central venous pressure. Individuals with atrial fibrillation also had significantly greater central venous pressure changes than those without atrial fibrillation.
, Nur Ahmad Tabri, Sahyuddin Saleh, Syakib Bakri, Hasyim Kasim, Andi Fachruddin Benyamin, Erwin Arief, Arifin Seweng
Caspian journal of internal medicine, Volume 12, pp 294-298; https://doi.org/10.22088/CJIM.12.3.294

Abstract:
Tuberculosis (TB) is an infectious disease caused by mycobacterium tuberculosis (Mtb). This infection causes the release of proinflammatory cytokines that affect hemostasis. Pulmonary TB infection causes an increased activation of procoagulant factors, decreased anticoagulant factors and suppresses fibrinolysis which causes hypercoagulable. Our study is conducted to assess the association between pulmonary TB infection (PTB) with hemostatic parameters before and after intensive phase treatment. This was an analytic observational prospective cohort design. The study was conducted at the Community Center for Lung Health in South Sulawesi. Studied subjects were recruited by consecutive sampling, in which the patients who met the inclusion criteria received intensive phase of ATD treatment. PT, aPTT, fibrinogen, and D-dimer were measured before treatment and after the intensive phase of ATD. These data were analyzed using the SPSS Version 22. In this study, 30 subjects are new cases of PTB. Prothrombin time, aPTT and D-dimer levels were higher in far advanced lesions and smear-positive sputum group (p<0.001). There was a significant level decrease in PT, aPTT, fibrinogen, D-dimer after intensive phase treatment (p<0.001). Pulmonary tuberculosis infection is associated with hypercoagulability which is characterized by an increase in hemostatic parameters and has significant improvement after intensive phase of ATD treatment.
Fatemeh Eshaghi Gorji, Maryam Seyedmajidi, Fariba Asgharpour, Hamed Tashakorian, Ali-Akbar Moghadamnia, Sohrab Kazemi, Homayoon Alaghehmand
Caspian journal of internal medicine, Volume 12, pp 342-349; https://doi.org/10.22088/CJIM.12.3.342

Abstract:
This study aimed to assess the effect of graphene oxide (GO) nanoparticles mouthwash on oral mucosa, Streptococcus mutans (S. mutans) count in the saliva of rats, and human enamel surface microhardness, in comparison with fluoride mouthwash. This study was conducted in two phases namely an animal study, and an in vitro experimental study. GO mouthwash (0.005%), sodium fluoride (NaF) mouthwash (0.05%), and a combination of both (0.05% NaF-0.005% GO) were prepared. The oral cavity of 36 rats was inoculated with S. mutans, and they were randomly divided into 4 groups according to the type of mouthwash. The control group received saline mouthwash. Fourteen days after using the mouthwashes, all rats were sacrificed, and the salivary S. mutans count was measured. The buccal and tongue mucosa were also histologically examined for the type and severity of inflammation, number of blood vessels, epithelial thickness, and epithelial keratinization. For microhardness testing, 40 sound extracted human premolars were randomly assigned to four groups (n=10) of culture medium with S. mutans and different mouthwashes. The enamel microhardness was measured at 7 and 14 days, and compared with the baseline value. The mean S. mutans count in the saliva of rats in GO and NaF-GO groups was significantly lower than that in other groups (p<0.001). Enamel microhardness in NaF and NaF-GO groups significantly increased at 7 and 14 days, compared with baseline. Addition of GO nanoparticles improved the antibacterial properties without causing adverse mucosal effects such as ulceration, acute inflammation or atrophy of the epithelium of the oral mucosa, but had no effect on surface hardness of the enamel.
Maryam Chehrehgosha, Mahtab Alizadeh-Khoei, Nasser Behnampour, Farshad Sharifi, , Reyhaneh Aminalroaya
Caspian journal of internal medicine, Volume 12, pp 307-314; https://doi.org/10.22088/CJIM.12.3.307

Abstract:
Frailty is accompanied by serious health complications in the elderly, especially during hospitalization. Visual scales have been designed for quick and easy evaluation of frailty in different cultures and settings. Therefore, this study aimed to define the accuracy of the Pictorial Fit Frail Scale (PFFS) for frailty screening in the hospitalized elderly in Iran. This cross-sectional study was conducted on 304 hospitalized participants, aged 65-85 years old admitted at Ziaeian Hospital (Tehran) were enrolled through the inclusion criteria from August to December 2019. All participants were evaluated based on the Minimum Data Set-Home Care, the Pictorial Fit Frail Scale, and the Quality-of-Life instrument, through face-to-face interviews by a trained nurse at the admission time. Spearman’s correlation coefficient, and ROC analysis were performed using SPSS at p<0.05. The highest correlation was obtained by Frailty Index (FI) and PFFS (0.770). FI had a negative correlation with QoL (-0.48). The optimal cut-points for PFFS according to FI ≤ 0.08 (robust vs. pre-frail) was obtained 0.10 with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy 100.00% and the best cut-point for PFFS based on FI ≥ 0.25 (pre-frail vs. frail) was obtained 0.29 with sensitivity and specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy 100.00%. It seems the Pictorial Fit-Frail Scale (PFFS) is a reliable scale with a high level of accuracy, and excellent sensitivity and specificity to measure the frailty level in hospitalized elderlies.
Alipasha Meysamie, Reza Ghalehtaki, , Mehrnaz Mohebi, Shirin Ghalehtaki, Fereshteh Salarvand, Zahra Hosseini, Seyed-Ali Sadre-Bafghi
Caspian journal of internal medicine, Volume 12, pp 327-335; https://doi.org/10.22088/CJIM.12.3.327

Abstract:
Theoretically, smoking status should be associated with metabolic syndrome. This relationship has not been studied in Iranian population so far. This study aimed to explore the association among cigarette smoking, metabolic syndrome (MetS) and its domains in a nationally representative sample of Iranians aged 25-64. Information of participants regarding demographic data and smoking habits gathered through WHO STEPS questionnaires in the frame of fourth national surveillance of the risk factors of non-communicable diseases in 2011 across the country. The fasting plasma glucose, triglyceride level, high-density lipoprotein cholesterol (HDL-C) level, blood pressure, and anthropometric indices in each patient were measured. Data of 4000 subjects were analyzed with complex sample survey method. The prevalence of metabolic syndrome was assessed according to two definitions: International Diabetes Federation (IDF) and Iranian definition. Herein, 38.4% of smoker participants and 36.6% of non-smokers met the IDF criteria for MetS (P=0.67). Similarly, 31.1% of smokers and 34.1% of non-smokers had MetS according to Iranian-IDF (P=0.427). Only in univariate analysis, using IDF criteria female smokers had lower prevalence of MetS than non-smokers (13.9% vs. 36.5%, P=0.01). Multivariate analysis determined the following odds ratios for the association of smoking with MetS defined by IDF and Iranian-IDF criteria, respectively: OR= 0.89 (0.53-1.47), P=0.638 and OR= 0.97 (0.59-1.58), P=0.901. There was no significant association between smoking and MetS overall and among men. However, smoking was associated with lower prevalence of MetS among women.
Seyed Mohammad Abedi, , Reza Zeinali
Caspian journal of internal medicine, Volume 12, pp 290-293; https://doi.org/10.22088/CJIM.12.3.290

Abstract:
In this research, we aimed to survey the added value of single photon emission computed tomography (SPECT) in comparison with planar whole body bone scan to visualize bone metastatic lesions in patients with breast cancer. A total of 80 patients with breast cancer (invasive ductal carcinoma) were examined with planar whole body bone scan and SPECT imaging using 99mTc-labelled methylene diphosphonate (99mTc-MDP). The patients with abnormal uptakes in SPECT imaging were also investigated with magnetic resonance imaging (MRI). Among these 80 patients with normal whole body bone SPECT scan, 19 (23.25%) of them revealed abnormal 99mTc-MDP uptake in skeleton. Furthermore, these 19 patients were subjected to MRI and 3 (3.75%) of them were confirmed with metastatic bone lesion. The obtained data suggest that SPECT possess the added diagnostic over planar whole body bone scan.
Razieh Ehsani, , Mohammadreza Salehiomran, Farzan Kheirkhah, Leila Moslemi, Faeze Aghajanpour
Caspian journal of internal medicine, Volume 12, pp 315-322; https://doi.org/10.22088/CJIM.12.3.315

Abstract:
Congenital hypothyroidism (CH) is one of the most common endocrine diseases and one of the major causes of mental retardation in children. So we aimed to evaluate the developmental outcome of children with CH. This case-control study was performed on two 3-6-year-old groups of 100 patients. The case group was children with CH, referred to Endocrine Clinic of Amirkola Children's Hospital (2011-2017) and the control group was healthy children and normal from other states. The Denver developmental screening test-II (DDST_II) was used to assess the developmental factors and disorders in four areas of gross motor, fine motor, personal-social and language. Data were analyzed by SPSS 21 using descriptive statistics, t-test and chi-square, and a p<0.05 was considered significant. The mean age of 200 children in the case and control groups was 54.62±15.72 and 59.68±15.64 months, respectively. In the case group, 45% and 55% of them had transient and permanent CH, respectively. All four criteria of DDST_II in the control group as well as gross motor in the case group were normal, but fine motor, personal-social and language were reported normal in 94, 95 and 93% of the case group, respectively. All subjects with abnormal DDST_II, had a negative neonatal screening tests. The results obtained from DDST_II indicated that 6% of children with CH had an abnormal development, all who had an onset of medical treatment over 30 days, which makes it important to screen the neonatal thyroid disease and diagnose this disease timely.
, Mozhdeh Sepaskhah, Akbar Safaei, Seddigheh Jashounia Hormozi
Caspian journal of internal medicine, Volume 12, pp 283-289; https://doi.org/10.22088/CJIM.12.3.283

Abstract:
Cutaneous pseudolymphoma can histologically and clinically simulate various types of cutaneous lymphoma. We conducted the current study to evaluate the clinicopathological and immunohistochemical (IHC) aspects of cutaneous pseudolymphoma (PSL). 30 cases of cutaneous PSL were selected from the archives of 2013-2017 in Shahid Faghihi Hospital pathology lab, Shiraz University of Medical Sciences. Available clinical data, histopathological features and IHC findings were statistically analyzed. The female: male ratio was 2:1 and the median age was 47±14.9 years. The lesions were located on the head and neck 26 (86.7%), trunk 2 (6.7%) and extremities 2 (6.7%). 23 (76.7%) cases had nodular pattern, while 7 (23.3%) showed diffuse pattern. The grenz zone was seen in 24 (80%) cases. Sixteen (53.3%) cases showed top heavy infiltration, 11 (36.7%) showed the same distribution of infiltration at the superficial and deep dermis, often involving the subcutaneous fat and 3(10%) showed bottom heavy infiltration. In IHC, 11(36.6%) cases showed the B cell type, 10 (33.3%) T cell type and 9 (30%) mixed type (B and T cells). None of the cases was suspicious for cutaneous lymphoma, applying IHC staining. Gender distribution, and the site of cutaneous lesions were similar to previous studies. The most common histological subtype was nodular, while the B-cell cutaneous pseudolymphoma was slightly more common compared to the T-cell type.
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