مجله پزشکی بالینی ابن سینا
سال بیست و پنجم شماره 4 (پیاپی 90، زمستان 1397)

The high ratio of neutrophils to lymphocytes is a predictor of the risk of myocardial infarction in people who have coronary artery angiography. The purpose of this study was to measure this proportion in the assessment of damage through interventions in patients with non-emergency angioplasty. A prospective cohort study was performed on 122 patients referring to Hamadan Farshchian Heart Center, Hamadan, Iran, during 2017 for selected angioplasty. Patients were divided into two groups according to the ratio of neutrophil/ lymphocyte. Data were collected through a checklist and blood test results, including neutrophil/lymphocyte ratio, erythrocyte sedimentation rate (ESR), C-reactive Protein (CRP), Creatine kinase-MB (CKMB), and troponin before angioplasty, as well as 6 and 12 h after angioplasty. The Chi-square test and independent t-test were performed using Stata software (version 14). There was no significant difference between the ESR levels in the two groups before the angioplasty (P=0.431). However, there were significant differences between the two groups 6 h (P=0.001) and 12 h after the angioplasty (P=0.011). There was no significant difference between the blood level of troponin in both groups before (P=0.310) and 6 h after (P=0.186). However, there was a significant difference between the two groups 12 h after the angioplasty (P=0.042). The results showed that an increase in the level of troponin elevated neutrophil/lymphocyte ratio and ESR. However, there was no significant difference in CRP and CKMB levels, although there were significant changes in clinical status.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe and potentially life-threatening reactions. In spite of the low prevalence of these conditions, they are of utmost significance due to their catastrophic complications and mortality. The SJS and TEN are mostly caused by a reaction to a drug; however, in some cases, they result from infections. The aim of this study was to investigate the epidemiologic, etiologic, and clinical characteristics of the patients admitted to Sina Hospital in Hamadan, Iran, due to SJS and TEN during a 16-year period. This cross-sectional descriptive study was conducted on the patients with SJS and TEN admitted to Sina Hospital during the last 16 years (i.e., 2002-2018). The data analyzed in the present study included age, gender, causative drug, length of hospital stay, received treatment, and complications. A total of 47 patients, consisting of 21 males and 26 females, were investigated in this study. Out of the 47 patients, 34, 9, and 4 cases were diagnosed with SJS, TEN, and SJS/TEN overlap, respectively. Regarding the etiology of these conditions, 45 cases (95.7%) were drug-related, while the remaining 2 cases were caused by reasons other than drugs. The most common causative drugs were antimicrobials (36.1%), followed by antiepileptics (27.6%) and nonsteroidal anti-inflammatory drug (17 %). Furthermore, there one case caused by reaction to allopurinol, and another case resulted from reactions to rabies vaccine. The remaining cases were either non-drug related or multi-drug related. The most common complications were infections (21.2%), followed by ocular problems (19.1%) and gastrointestinal bleeding (2.1%). As the findings indicated, antimicrobials were the most common causative drugs of SJS and TEN. The physicians should be aware of the clinical manifestations of SJS and TEN with regard to the severe complications of these conditions, including ocular damages, and their risk of mortality. Moreover, it is required to enhance public awareness regarding the avoidance of self-medication with antimicrobial drugs.

Keratoconus is a disorder in cornea characterized by constant thinning and prominence that can result in vision defect. Due to ultrasonic changes in the corneal structure caused by keratoconus disease, its rigidity and biomechanical properties are subject to some changes. In this regard, the present study was conducted to determine the correlation of biomechanical features of keratoconus patients with the severity of the disease. The case group was selected from the patients with keratoconus who referred to the Corneal Clinic of Nikookari Hospital in Tabriz and the controls had no eye diseases. Corneal biomechanics, corneal hysteresis, and corneal resistance factor were evaluated in all the samples using an ocular response analyzer device. The present study was carried out on 213 keratoconus eyes and 179 normal eyes. The mean scores of corneal hysteresis were obtained at 13.49±1.34 and 7.67±1.01 mmHg for normal and keratoconus eyes, respectively, which were significantly different between the two groups. The differences between the corneal hysteresis of mild (8.86 mm Hg), moderate (8.30 mm Hg), and severe (7.10 mm Hg) keratoconus eyes were also significant. The mean scores of the corneal resistance factor were reported as 12.68±1.15 and 7.36±1.07 mmHg for normal and keratoconus eyes, respectively, which were significantly different between the two groups. The differences between the corneal resistance factor of mild (8.55 mm Hg), moderate (8.05 mm Hg), and severe (6.76 mm Hg) keratoconus eyes were also significant. The obtained results of the present study showed that corneal hysteresis and corneal resistance factor were lower in keratoconus eyes, compared to those in normal eyes and decreased with the severity of the disease.

Esophageal cancer is the seventh cause of cancer deaths in the worldwide. Epigenetic changes including methylation of genes promoter can play an important role in the pathogenesis of esophageal squamous cell (ESCC). The aim of this investigation was to determine the PRSS8 gene methylation pattern in patients with ESCC. This case-control study was conducted on 150 paraffin blocks, including 75 paraffin blocks of cancerous tissues and 75 non-cancerous tissues paraffin blocks in ESCC patients. The Blocks in this study were from the archives of Noor-e-Nejat and Tabriz International Hospitals during 2013-2017. After DNA extraction and treatment with sodium metabisulfite, the PRSS8 gene methylation promoter was evaluated using High Resolution Melting (HRM) method. The findings revealed that there was a significant difference between the cancerous tissues and non-cancerous tissues regarding the level of PRSS8 gene methylation (P=0.026). In addition, the relationship between PRSS8 gene methylation and metastasis revealed no significant change in terms of clinicopathological parameters (P=0.007). The present investigation showed that the PRSS8 gene promoter hypermethylation can play a critical role in the carcinogenesis and metastasis of ESCC

Pterygium is a fibrovascular and wedge-shaped lesion that extends from bulbar conjunctiva to the cornea. Pathogenesis of pterygium depends on several factors and sunlight exposure is an important risk factor for this syndrome. Surgery is regarded as the key to successful treatment of pterygium. With this background in mind, the aim of this study was to determine the effect of amniotic membrane transplantation (AMT) for the treatment of pterygium. Moreover, this technique was compared clinically with conjunctival autograft transplantation (CAT). In this randomized clinical trial, 70 patients either referred to the ophthalmologic clinic of Farshchian Hospital in Hamadan, Iran, or diagnosed by an ophthalmologist with primary or recurrent pterygium were enrolled in this study. The patients were randomly divided into two groups, (n=35). One group underwent pterygium surgery using AMT and the other one was subjected to CAT. Furthermore, the inflammation and recurrence rates after surgery were compared in both groups. Data were analyzed in SPSS software (Version16) through the Chi-square and the independent sample t-tests. According to the results, the mean ages of patients in the AMT and CAT groups were 47.34±14.85 and 48.26±15.26 years, respectively (P=0.778). Moreover, inflammation was observed in 28.6% and 8.6% of patients in the AMT and CAT groups, respectively. The recurrence rates were 22.9% and 11.4% in the AMT group and CAT group, respectively (P=0.205) The AMT had a higher recurrence rate and postoperative inflammation, compared to the CAT. Although this difference was not statistically significant, the CAT is widely used as a treatment for patients with pterygium.

The preparation of the root canal (i.e., cleaning and shaping) is the main step in the endodontic treatment. The nickel-titanium rotary files result in fewer errors during the preparation of curved canals. This study aimed to compare the transportation of Neolix and Reciproc rotary systems in curved canals using cone beam computed tomography (CBCT). In this experimental study, 70 extracted curved premolar teeth from patients referred to dentistry faculty were assigned  into two groups (n=35). The preparation of the canals was performed by the Neolix and Reciproc rotary systems. Remaining dentin thickness, transportation, and canal-centering ratio were evaluated and compared using CBCT images before and after the instrumentation. The data were analyzed in SPSS software (version.19) through ANOVA, independent t-test, and paired t-test. There was a significant difference in terms of remaining dentin thickness in three sections of 3, 5, and 7 mm from the apex, before and after the instrumentation regarding the level of mesiodistal and buccolingual. However, no significant difference was observed in terms of the transportation in three sections of 3, 5, and 7 mm from the apex in both Neolix and Reciproc systems. According to the results, both Neolix and Reciproc rotary systems showed high efficacy in root canal shaping. The amount of transportation in these systems during preparation of curved canals was very low leading to the protection of canal-centering ratio.

Chronic pruritus is defined as an itching sensation lasting more than 6 weeks. This condition may cause sleep disorders, daily activity disturbance, depression, and eventually impaired quality of life. Several laboratory evaluations have been recommended for patients afflicted with chronic pruritus to find the underlying systemic diseases. However, the general prevalence of systemic diseases in these patients is not specified yet. Regarding this, the present study was conducted to assess the frequency of laboratory abnormalities in patients with chronic pruritus. The findings of the current study may help identify relative factors and diagnose the underlying diseases in these patients. This cross-sectional study was conducted on 30 patients suffering from chronic pruritus without skin lesions or a history of systemic diseases that may cause pruritus. The recorded data included demographic variables (e.g., age and gender) and laboratory parameters (e.g., erythrocyte sedimentation rate [ESR]), liver function tests, alkaline phosphatase, total and direct bilirubin, creatinine, blood urea nitrogen [BUN], fasting blood sugar [FBS], thyroid function tests, white blood cell count, hemoglobin, and lactate dehydrogenase [LDH]). The data were analyzed in SPSS software (version 20). The mean age of the patients was 50.4±15.4 years, and 60% of them were male. According to the results, 40% of the patients had laboratory abnormalities. The most common laboratory abnormalities included the increased levels of FBS (26.6%) and decreased levels of hemoglobin (16.7%), followed by increased levels of alkaline phosphatase (10%), leukocytosis (6.6%), and elevated levels of LDH, ESR, thyroid-stimulating hormone, BUN, bilirubin, and creatinine (each 3.3%). There was no statistically significant difference between the males and females regarding the prevalence of laboratory abnormalities. One patient had lymphocytosis, along with the elevated levels of LDH, and was finally diagnosed with lymphoproliferative disorder. Although the laboratory tests were normal in 60% of the participants, the identification of one case with lymphoproliferative disorder in these patients highlighted the importance of performing a thorough laboratory assessment in these patients.

Lung cancer is one of the most common types of cancer and the main reason of cancer-caused mortality in Iran. The awareness of cancer epidemiologic and pathologic characteristics helps to prevent the prevalence and incidence of cancer. This comparative descriptive study was conducted on patients with lung cancer referring to Ekbatan and Shahid Beheshti Hospitals during 2001-2016. Risk factors as well as clinical and demographic data were collected from medical records. The mean age of the patients was 61.11 ±12.23 years and 166 patients (83%) were male. A total number of 120 (66.7%) patients lived in urban areas. The frequency of patients who had a positive history for consumption of opioid, industrial drugs, cigarette, and hookah were 2%, 0%, 42.2%, and 1%, respectively. The most common symptoms were cough and dyspnea.  The time interval between the appearance of clinical signs and diagnosis was 5.32 months. The most common paraneoplastic symptom was bone pain (45.5%), and the most frequent pathologic form was squamous cell carcinoma (33.5%). The right upper lobe (27.5%) and left upper lobe (23.5%) were the most common lobes. Since the time interval between clinical signs and diagnosis was long and squamous cell carcinoma was the most common type of cancer, it is important to control risk factors, specifically smoking, to  prevent cancer.