Reviews in Clinical Medicine
Volume:6 Issue: 3, Summer 2019

Cancer is defined as uncontrolled cell division, which could spread or invade various tissues. There are more than 200 types of cancer, including breast, skin, lung, colon, and prostate cancer, and lymphoma, the symptoms and indications of which vary depending on the type of tissues. Cancer has several treatments with different applications. For instance, chemotherapy, radiation therapy, surgery or their combination are common treatment modalities for cancer. However, a complete cure for cancer has not been achieved yet. On the other hand, novel drugs for cancer treatment are not efficient due to the ability of cancer cells to develop resistance against chemotherapeutic agents. Recently, natural compounds have been reported to improve the efficiency of cancer treatment. Polyunsaturated fatty acids (PUFAs) are natural compounds that could be used as dietary supplements in cancer patients. PUFAs are classified into two main categories, including n-3 and n-6 PUFAs. According to the literature, n-3 PUFAs exert protective effects against cancer through the induction of apoptotic pathways and suppressing cell proliferation, while n-6 PUFAs cause tumor formation by inducing cell growth and proliferation. Using PUFAs in combination with chemotherapeutic agents is considered to be an effective approach to the treatment of cancer patients through increasing cancer cell death. This review aimed to discuss the interactive effects of the structure and function of PUFAs on cancer and cell processes through various signaling pathways.

Cutaneous leishmaniasis is a prevalent parasitic infection in humans. According to the reports published in several localities across the world, leishmaniasis is an endemic disease in certain regions in Iran. Leishmaniasis is transmitted through sandfly bites and is often diagnosed through the smear examination of the affected area using a microscope. The treatments of choice for leishmaniasis involve the use of pentavalent antimony compounds, such as meglumine antimoniate and sodium stibogluconate. However, other medications have been proposed for the treatment of leishmaniasis, and there is ongoing research for effective, less harmful treatments. This narrative review aimed to summarize various systemic treatments for leishmaniasis.

According to statistics, at least four percent of people experience one or more nonfebrile seizures in their life span. Continuous Electroencephalography (cEEG) Monitoring is a useful diagnostic tool for seizure detection. The purpose of this study was to investigate EEG findings in first-time seizure patients referred to emergency department (ED).

The present cross-sectional study was conducted on 80 first-time seizure patients admitted to ED, who were selected by convenience sampling method. The inclusion criteria were all patients aged more than 17 years with first-time seizure and informed written consent to participate in the study, and the exclusion criteria were cases where the seizure was not confirmed by a neurologist. An EEG was taken in the ED from the patient within 24 hours of the first attack. Finally, the frequency of pathological changes in EEG findings was determined in these patients. The statistical data were analyzed by SPSS software using descriptive statistics (measures of central tendency and dispersion and frequency distribution) and inferential statistics.

The patients consisted of 35 (43.8%) males and 45 (56.2%) females. The patients had a mean age of 52.54±19.33 years and a median of 53 years. Among the patients, 46 (57.5%) had normal EEG findings, and 34 (42.5%) had abnormal (pathological) EEG findings.

According to the results of this study, 42.5% of patients had abnormal EEG findings, but it seems that accurate examination would require the use of other diagnostic tools along with EEG to diagnose patients with epilepsy and seizure more precisely.

Lower-limb varicose is a common disorder, which is caused in some occupations and is exacerbated over time, imposing direct and indirect costs on individuals and the community. The present study aimed to validate the Persian version of Aberdeen varicose vein questionnaire (AVVQ). This cross-sectional study was conducted on 75 patients with varicose veins referring to Imam Reza Hospital in Mashhad, Iran in 2014. The subjects were selected via census sampling. The AVVQ was translated into Persian, and its reliability and validity were assessed using face, content, criterion, and construct validity and Cronbach’s alpha coefficient for reliability. To evaluate content validity, the content validity ratio (CVR) was calculated, and the criterion validity was determined based on Pearson’s correlation-coefficient. In addition, the correlation of the obtained score of each questionnaire item with the total score was verified. The mean age of the patients was 43±16 years. Content validity was assessed based on Lawshe’s method and CVR index of >0.7. The mean score achieved in the AVVQ was 62.3± 8.8, and significant correlations were observed between the total score of AVVQ and physical domain (P<0.001; r=-0.62), mental domain (P<0.001; r=-0.39), and mean total score of SF-36 (P<0.001; r=-0.56). Moreover, the Cronbach’s alpha for the internal consistency of the questionnaire was estimated at 0.71. According to the results, assessment of the score of quality of life in varicose patients could be an effective approach to the development of proper interventions to improve their quality of life.

Tuberculosis (TB) is a chronic bacterial disease and a leading cause of mortality among single-agent infectious diseases following the human immunodeficiency virus infection across the world. Logistic regression is a method of statistical analysis with predictive capability. This multivariate statistical method could be used to evaluate the correlations between independent variables (albeit confounding) and a dependent variable. The present study aimed to assess the influential factors in the incidence of TB based on the estimations of a logistic regression predictive model.

This cross-sectional study was conducted on two groups consisting of 189 TB patients and 189 controls. The influential factors in TB were compared between the groups, including age, gender, marital status, risk of acquired immunodeficiency syndrome (AIDS), smoking habits, history of asthma, organ transplantation, body mass index (BMI), vitamin D3 level, diabetes, and rate of hemoglobin and malignant diseases. In addition, the predictive potential of the logistic regression model was determined based on various indices, such as sensitivity, specificity, and receiver operating characteristic (ROC) curve.

The sensitivity and specificity of the regression model were estimated at 78% and 68%, respectively, and the area under the ROC curve was calculated to be 0.821. Among the available influential factors in the dependent variable (i.e., TB), the variables of vitamin D3 and hemoglobin levels and BMI were considered significant.

According to the results, the logistic regression model is appropriate for the prediction of TB considering the accuracy and predictive power of its criteria, as well as the area under the ROC curve (0.821), which could provide the test accuracy for the diagnosis TB.

This study aimed to describe the case of a young woman presenting with abdominal pain, nausea, and vomiting three month after intragastric balloon placement. The patient was diagnosed with acute pancreatitis based on clinical findings, laboratory data, and imaging results. During endoscopy, the balloon was dislodged and obstructed in the second portion of the duodenum. After the removal of the balloon, all the symptoms of the patient were resolved, and she was discharged.

The pericardium may have various phenotypic manifestations in assorted disease states, such as acute pericarditis, effusive constrictive pericarditis, and constrictive pericarditis. The variety in the phenotypic expressions of pericardial inflammation requires unique clinical and physical examinations and is associated with specific imaging features. The present study aimed to review the normal pericardium and variations of the pericardial disease based on the previously described cases and discuss the clinical manifestations, etiology, diagnostic tools, and treatment methods.Case Series: A case series of three patients with various phenotypic expressions of pericardial disease have been described. The first patient presented with chest and abdominal pain for three hours. Electrocardiography (ECG) revealed inferior-lateral ST elevation, which was interpreted as an acute coronary syndrome. However, coronary arteriography revealed no obstructive coronary artery disease. Blood tests and ECG post-cardiac catheterization confirmed pericarditis. The second patient had ablation of the cavotricuspid isthmus on the right side of the atrial flutter. After the procedure, the patient had cardiac tamponade and required pericardiocentesis. After two months, the patient presented with tachycardia and hypotension, as well as cardiac tamponade; therefore, pericardiocentesis was performed again. Two years after the second pericardiocentesis, the patient presented with progressive dyspnea. Perfusion imaging revealed anterior wall ischemia, and coronary arteriography revealed three-vessel coronary artery disease. During the bypass surgery, the surgeon was unable to dissect the right and circumflex coronary arteries due to the densely thickened pericardium of the patient. In addition, CT-scan revealed a fibrotic pericardium (thickness: 12 mm). The third patient received chemotherapy and radiation for breast cancer, which resulted in a cancer-free state. However, breast cancer was recurrent, and the patient received treatment with biological Optivo, resulting in cancer remission. After several months, the patient presented with palpitations, dyspnea, and abdominal and leg swelling. Moreover, she had elevated troponin and ECG changes leading to cardiac catheterization with normal coronaries, which were fixed in a dense, thickened serosal pericardium. Subsequent echocardiography revealed evident signs of constrictive pericarditis, and cardiac MRI showed a densely thickened pericardium with diffuse late gadolinium enhancement. The Phenotypic expressions of pericardial disease are enigmatic and challenging diagnostically. Various forms of pericardial disease may mimic acute coronary syndrome and acute/chronic heart failure. Since each phenotypic presentation of the disease is unique, a rational, linear approach is considered essential to the accurate diagnosis.

 To date, several randomized trials have compared calcineurin inhibitors, especially tacrolimus, with cyclosporine in patients with steroid-resistant nephrotic syndrome, proposing conflicting results. Use of immunosuppressive therapy for the treatment of resistant nephrotic syndrome remains a matter of debate, and the evidence on its efficacy and safety is inconclusive.The present study aimed to compare the benefits and limitations of tacrolimus and cyclosporine in the treatment of steroid-resistant nephrotic syndrome.

 This systematic review and meta-analysis was conducted via searching for the relevant trials performed until January 2018 in electronic databases such as PubMed, Scopus, ScienceDirect, Cochrane Library, and Web of Science. In total, 285 potentially relevant articles were identified, and four articles were selected for the review. A random effects model was used to analyze data, and the heterogeneity of the articles was assessed using Chi-square-based Cochran’s Q and I2 statistics, and heterogeneity was considered statistically significant with I2>50%. The outcomes were presented as relative risk with 95% confidence interval, and P-value of less than 0.05 was considered statistically significant. In addition, meta-analysis was used for further data analysis. 

 Four eligible randomized controlled trials were evaluated in this systematic review. In terms of partial and complete remission, no significant differences were observed between tacrolimus and cyclosporine. However, lack of response to therapy was significantly lower with tacrolimus (RR=0.289; P=0.02) compared to cyclosporine. No significant differences were observed between the drugs in terms of the infection rate, hypertension, ALT/AST elevation, and gastrointestinal symptoms, while nephrotoxicity (RR=0.395; P=0.004) and hypertrichosis (RR=0.018; P<0.001) were significantly lower with tacrolimus.

In conclusion, Tacrolimus is superior to Cyclosporine in treating in patients with steroid resistance nephrotic syndrome in terms of no response to therapy, nephrotoxicity and hypertrichosis.