Caspian Journal of Internal Medicine
Volume:5 Issue: 4, Autumn 2014

Soil dust has been debated about its effects on public health and the challenge is brought about tuberculosis (TB). The purpose of this study was to investigate the effect of dustsoil on pulmonary tuberculosis (PTB) prevalence and its control indices. The medical files of patients in Khuzestan Health Center were reviewed. The control group included the PTB patients registered from 2005 to 2006 (before soil dust), and the PTB patients who were registered from 2007 to 2010 (after soil dust occurrence) as the case group. The diagnosis of tuberculosis was based on National Tuberculosis Program (NTP). The mean age of control and case group was 42 (18-80) years and 40 (13-99) years, respectively. The prevalence of pulmonary TB in control and case group was 537 (12.5 per 100000 population) and 465 (11.0 per 100000 population), respectively. The dust did not increase the prevalence of TB. More women than men (298, 41.8% vs. 336, 48.2%), more children than any other age group (31, 4.3% vs. 53, 7.3%), more urban habitants than rural settlers (448, 63% vs.496, 71.1%) and more family contacts (60, 8.4% vs. 97, 13.9%) have become ill. The rate of treatment failure, TB relapse, and MDR-TB in controls and cases were (1.4%, 1.4%, 1%) and (7%, 5.5%, 4.6%), respectively. Dust had significant effect on treatment outcome. Although soil dust had no significant effect on TB prevalence, but showed a significant effect on age, sex, residential area and closed contact. Dust was associated with more treatment failure, development of MDR TB and relapse.

Postendodontic pain (PEP) has always been a major problem for patients and dentists and NSAIDs are being used to relieve PEP and it is supposed that some benzodiazepines may facilitate the analgesic effects of the NSAIDs. This study was conducted to evaluate the effect of alprazolam on the analgesic effect of ibuprofen in PEP treatment. This randomized double-blind clinical trial was conducted on 45 patients aged 20-45 years who were subjected of root canal treatment. A written informed consent was obtained from each patient. The subjects were randomly divided into three groups; placebo, ibuprofen (400 mg) and alprazolam (0.5) mg + ibuprofen (400 mg). The intensity of pain was recorded using visual analog scale (VAS) at 4, 6, 12, 24, 48 and 72 hours after drug administration. Of the participants, twenty six (57.8%) were males and 19 patients (42.2%) were females. Four hours after starting treatment, the VAS scores in the placebo and ibuprofen -treated groups were significantly higher than ibuprofen and alprazolam+ibuprofen groups (4.93±1.16, 3.67±1.88 and 2.67±1.11, respectively, p<0.0001). The VAS scores in alprazolam + ibuprofen group (2.33±1.05) were significantly lower at 6 hours after treatment when compared to the other groups (Ibuprofen: 3.00±1.36 and placebo: 3.08±1.74, P=0.002). This decrease in VAS score was observed at 12 hours after the start of alprazolam + ibuprofen treatment when compared to ibuprofen or placebo receiving group alone (p<0.003). The average pain score in female patients who received alprazolam + ibuprofen was significantly lower than males at 12 hours (1.3±0.6 v.s 2.14±0.9, P=0.002) and 24 hours after treatment (0.88±0.6 v.s 1.86±0.9, P=0.003). According to the results, it can concluded that alprazolam may enhance the analgesic efficacy of ibuprofen in postendodontic pain.

Prevalence of polycystic ovary syndrome (PCOs) is increasing particularly among the female adolescents and young women. It has been hypothesized that disturbance in calcium and vitamin-D metabolism may effect on the effect of the symptoms of this syndrome. This study was designed to investigate the relationship between vitamin-D and calcium with metabolic parameters and other characteristics of the PCOs. The study included 192 Iranian girls (16-20 years old), of whom 104 had PCOs and 88 were non-PCOs controls. Serum 25(OH) D and calcium level was measured. Anthropometric components, endocrine, metabolic components and insulin resistance were determined in PCOs subjects. Mean 25 (OH) D was significantly lower in cases (9.7±4.8) than controls (12.3±11.9) but calcium level did not differ between the two groups (9.3±0.3 vs 9.4±0.4). No significant correlations were found between 25(OH) D levels and lipid profile, FBS, fasting insulin endocrine parameters such as testosterone, free testosterone, FSH, LH, and prolactin. Although hypovitamionos D, was common is PCOs there was no correlation between vitamin-D deficiency and its severity with some features and complications of PCOs including obesity, insulin resistance in this age group.

Erectile dysfunction (ED) is common in cardiovascular disease (CVD) and indicates a complication of coronary artery bypass graft surgery (CABG). This study was designed to evaluate the status of erectile dysfunction in patients with CAD before and after CABG surgery. We designed a prospective cohort study on male patient candidates for elective on-pump CABG between June 2006 to October 2012 in 3 hospitals in Sari, Iran (Fatemeh Zahra, Shafa and Nime-Shaban Hospitals). Patient’s primary data were collected based on the International Index of Erectile Function questionnaire (IIEF-5) at baseline 6 months after surgery. The severity of dysfunction was categorized as, normal, mild to moderate and moderate to severe based on HEF score. Four hundred twenty-six male patients with mean age of 58.69±12.49 years participated in this study. 166 patients had DM (38.96%) 230 patients with HTN (54%). 307 patients had three-vessel impairment (72.07%) and 119 patients with one or two vessel impairment (27.93%). The severity of dysfunction results were at 15.02%, 18.07%, 23%, 31.92% and 11.97%, at base changed to 16.90%, 19.95%, 23.71%, 32.22% and 8.21%, respectively (P=0.01). Also, the mean ±SD of IIEF-5 score before and after surgery was 13.95±5.44 and 14.20±5.69, respectively (P=0.001). The result of our study shows that on-pump CABG surgery has a positive effect on the improvement of erectile dysfunction 6 months after surgery.

Postmenopausal onset rheumatoid arthritis (post-RA) is expected to have greater bone mineral density (BMD) loss than premenopauasal onset (pre-RA) due to estrogen deficiency and aging. This study aimed to compare the BMD status of the two RA groups with age-matched non-RA controls. The patients with RA on follow-up examination were stratified according to age of onset. Femoral neck and lumbar spine BMD (FN-BMD and LS-BMD) were assessed by DXA method. The patients of the two groups were compared with non-RA controls in regard to BMD gr/cm2 and the risk of osteoporosis (OP). Forty-eight post-RA and 94 pre-RA were compared with 31 and 57 age-matched controls. FN-BMD gr/cm2 and LS-BMD gr/cm2 in both groups of RA was significantly lower than the controls (P=0.001 for all). In post-RA, FN-BMDgr/cm2 was 16% lower than controls versus 21% in pre-RA, whereas, LS-BMD reductions were 5% and 12%, respectively (P=NS). FN-OP was observed in 32(68%) and 9 (29%) post-RA and controls (P=0.001) versus 29 (30.8%) and 4 (7%) pre-RA and controls, respectively (P=0.001). Corresponding percentages for LS-OP in post-RA and controls were (37.5% vs 35.5%, P=0.52) and in pre-RA and controls were (21.3% vs 3.5%, P=0.002), respectively. Risk of osteoporosis at either measurement sites of FN or LS in post-RA increased by the adjusted odds of 1.54(95% CI, 0.60-3.9, P=0.36) and in pre-RA by the adjusted odds of 5 (95% CI, 1.78-14.5, P=0.002), respectively. These findings indicate that BMD loss in post-RA is not greater than pre-RA as expected. It is possible that estrogen deficiency by modulating immunologic reactions compensates the negative effects of estrogen deprivation on bone mass in post-RA patients.

Different factors like age, sex, route of infection, initial viral load, levels of liver function tests and genotypes may influence in the response to treatment in patients with chronic hepatitis C. The purpose of this study was to determine the role of these factors in the treatment of these patients. From 2004 to 2012, different genotypes of chronic HCV (Hepatitis C virus) patients in Babol, North of Iran who were treated with pegylated interferon plus ribavirin with standard doses (48 weeks for genotype 1, and 24 weeks for genotypes 2 and 3) were entered in the study. HCV RNA was measured during and after treatment based on genotype and protocol. Treatment was defined when sustained virological response (SVR) (negative HCV RNA after six months of therapy) was achieved. The data were collected and analyzed. The mean age of the patients (61 males, 5 females) was 33.82±9.64 years. Twenty seven (40.9%), 37 (56.1%) and 2 (%3) were genotypes 1, 2 and 3, respectively. Twenty one (77.8%) with genotype 1, and 34 (91.9%) with genotype 3 had SVR (P=0.045). Fifty-five of 61 men (90.2%) and 2 out of 5 females (40%) had SVR (P=0.01). SVR was seen in 22 (88%) of 25 IV drug patients versus in 35 (85.4%) of the non-addict cases (p>0.05). There were not significant differences regarding age, viral load, and liver aminotransferase levels with treatment. The results show that genotypes 2 and 3, and the male sex had better SVR. Further studies with large number of cases are recommended.

Interleukin-6 (IL-6) has a major role in hematopoiesis, immune and acute phase response and seemed that it had influence on the mode of delivery. The purpose of this study was to compare the level of IL-6 in mothers who delivered via cesarean section and vaginally. This cross-sectional study was done on 40 mothers with vaginal delivery and 40 mothers in elective cesarean delivery in 2012 in Ayatollah Rouhani Teaching Hospital in Babol, northern Iran. Five ml blood samples were taken from each mother. Blood samples were examined by enzyme-immune assay for the determination of IL-6 in both neonates. Other information, such as the mother's age, the newborn sex, gravity, parity, the number of live births of each mother, and the status of infants in terms of being term or pre-term, was recorded. The mean age of cesarean section and vaginal delivery patients was (29±5.01) yrs and (27.3± 4.93) yrs. The maternal IL-6 concentration in vaginal birth (170.13 ±15.9) was significantly (p<0.05 (higher than cesarean section (33±29.94) The result shows that serum IL-6 levels in patients with vaginal delivery was higher than those with elective cesarean section delivery. So, we recommend that vaginal delivery should be performed for all patients except for those whom vaginal delivery is contraindicated contraindicated.

The antibiotic resistance of nosocomial organisms is rapidly increasing. The purpose of this study was to determine the frequency of bacterial agents isolated from patients with nosocomial infection. This study was performed in the different wards of teaching hospitals of Mazandaran University of Medical Sciences (northern Iran). The study population consists of the patients with the symptoms of nosocomial infection admitted in these hospitals in 2012. The patient data (including age, sex, type of infection, type of isolated organisms and their antibiotic susceptibility) were collected and analyzed. The total number of hospitalizations of our hospitals was 57122 and the number of nosocomial infection was 592. The total prevalence of nosocomial infection was 1.03% that was mostly in Burn unit intensive care unit ICU respectively. The most common nosocomial infection was wound infection (44.6%). The most common organisms were Pseudomonas aeruginosa and Acinetobacter. Given the increasing numbers of nosocomial infection in our region, especially infection with Pseudomonas aeruginosa, it is necessary to make a precise reporting and improve the procedures of infection control in hospitals.

Patient satisfaction is affected by hospital services and may have an effect on the cultural, social and personal conditions of the people living in the region. This research aimed to evaluate the patient satisfaction in social security hospitals in Mazandaran province. From Spring 2012 to Summer 2013, all patients admitted to social security hospitals in Mazandaran province were entered in the study. Location, sex, income and patient’s educational level and satisfaction with the hospital services were noted. Seven hundred seventy-six patients with the mean age of 47.35±7.41 years were assessed.Patient's location, educational attainment and income level had a significant relationship with patient satisfaction level (p<0.05). There was no significant difference regarding patient’s gender. The results show that the patient's location, educational attainment, and income level are effective in changing patient satisfaction.

The thyroid hormones (T4 and T3) affect all tissues and impact all metabolic pathways. After heart surgery using cardiac bypass, serum T3 decreases and remains low for at least 24 hours. Several studies on pediatric patients have reported a reduction in the thyroid hormones after heart surgery. This study aimed to investigate the status of thyroid function tests in children with cardiopulmonary bypass surgery. This study was carried out based on the available data on 132 children aged 1 to 1 month to 15 years suffering from congenital heart disease. The patients underwent open heart surgery in Rajaie Cardiovascular, Medical and Research Center in Tehran, Iran from January 2010 to November 2010.The thyroid hormone levels of the patients were measured shortly after admission, immediately postoperatively in the intensive care unit (ICU), and thereafter at 12, 24, and 48-hour intervals. The patients’ gender, age, weight, body mass index, heart disease details, previous cardiac surgeries, and cardiac surgery-related data such as pump time, aortic clamping time, hypothermia duration, postoperative hemodynamic status in the ICU, and postoperative use of inotropic drugs were recorded and statistically analyzed. All patients showed a decrease in T3, T4, and TSH and an increase in T3 resin uptake (T3RU) after surgery. Eventually, 3 (3.2%) patients died after surgery. Preoperatively, there was a significant association between the reduction in the thyroid hormone levels and inotropic drugs administered following surgery as well as the type of the heart disease (p<0.05). There is an important possibility to decrease the thyroid hormone levels of children with congenital heart disease undergoing cardiopulmonary bypass surgery; due to inotropic drugs administered following surgery and the type of heart disease. Therefore, it is recommended that thyroid hormone levels be measured pre-and postoperatively.

HELLP syndrome is one of the important complications in pregnancy which increases the maternal mortality rate from 1.1 to 25% and the fetal mortality from 7.4 to 34%. This disease usually remits with supportive treatment which includes prescription of corticosteroid, magnesium sulfate, stabilization of mother and pregnancy termination. Plasmapheresis is a treatment of choice which improves clinical outcomes in complicated cases. A 22-year-old woman with coagulopathy and respiratory distress and 33-year-old woman with a history of cerebellar medulloblastoma and at 32 weeks of gestation developed thrombocytopenia who were treated with plasmapheresis are described. Plasmapheresis can significantly improve the patients with HELLP syndrome who are unresponsive to conservative therapy.

Human infestation to ectoparasites such as ticks, lice, cimex, fleas, mites and others causes an intense allergic itching, skin infection and severe irritation. In this case report, we present a dermatitis case caused by cat flea. A three-member family referred to dermatology clinic in Babol due to dermal complications. They complained of irritation and the unrest caused by intense itching. Samples of tiny live insects were detected from their clothing recognized as C. felis (cat flea). This report highlights the importance of ectoparasites causing dermatitis.