Caspian Journal of Internal Medicine
Volume:11 Issue: 1, Winter 2020

Some studies have investigated the effects of iron on breast carcinogenesis and reported different findings about the association between Fe and breast cancer risk. This study was conducted to estimate this effect using meta-analysis method.

A total of 20 articles published between 1984 and 2017 worldwide were selected through searching PubMed, Scopus, Embase, Web of Science, and Cochrane Library. Keywords such Breast Cancer, Neoplasm, Trace elements, Iron, Breast tissue concentration, Plasma concentration, Scalp hair concentration, toenail concentration and their combination were used in the search.

The total number of participants was 4,110 individuals comprising 1,624 patients with breast cancer and 2,486 healthy subjects. Fe concentration was measured in the various subgroups in both case and control groups. There were significant correlations between Fe concentration and breast cancer in breast tissue subgroup (SMD: 0.67 [95% CI: 0.17 to 1.17; P=0.009]). Whereas, there was no meaningful difference in Fe status between women with and without breast cancer related to scalp hair and plasma subgroups; (SMD: -3.74 [95% CI: -7.58 to 0.10; P=0.056] and (SMD:-1.14[95% CI: -2.30 to 0.03; P=0.055], respectively.

The present meta-analysis indicated a positive and straight association between iron concentrations and risk of breast cancer but because of high heterogeneity we recommend more accurate future studies

Different benefits of various herbal medicines in decreasing blood sugar have been reported in different clinical trials so far. Considering the growing tendency toward these combinations and the booming market, inappropriate advice is growing accordingly. Hence, it is necessary to evaluate the effects and possible complications of such combinations on health status and blood glucose control.

Two 38-subject groups were formed and a 12-week treatment program was administered for both groups. The inclusion criteria were failure to control blood glucose with two oral medicines, unwillingness to inject insulin. The medicine was prepared in capsules by Booali Company. Each capsule weighed 750 mg and contained nettle leaf 20% (w/w), berry leaf 10% (w/w), onion and garlic 20% (w/w), fenugreek seed 20% (w/w), walnut leaf 20% (w/w), and cinnamon bark 10% (w/w) all in powder.

At the beginning of the study, there was no significant difference between the subjects regarding the evaluated parameters, but after the intervention, the level of glucose was significantly lower in fasting (P=0.0001) and 2-hour postprandial(P=0.002) levels. The level of glycated hemoglobin A1c (HbA1c) (P=0.0001) also decreased from 0.33±9.72 % to 0.20±8.39 %. Finally, the level of insulin resistance reduced from 1.9±4.1 to 1.4±2.6 (P=0.001) after consuming herbal medicine.

According to the results of the current study, the herbal combination was effective in controlling blood sugar, and considering the reduction of HbA1c by 1.31 %, it seems that the herbal combination is an effective medicine to treat diabetes.

Left ventricular torsion is one of the most important biomechanical parameters of heart that routinely is measured in short axis view.  A review of the literature has indicated that assessment of left ventricular torsion in short axis view has some limitations. In the present study, we evaluated whether torsion angle assessment in long axis view can be used as a diagnostic biomechanical marker in patients with coronary artery disease (CAD).

We assessed 20 males and 15 females who suffered from CAD and 24 healthy males and females. Two dimensional echocardiography images were scanned in cine loop format position throughout four cardiac cycles at basal and apical levels in the long axis view (4CH). Peak torsion angle in long axis view was obtained by speckle tracking method under block matching algorithm.

In long axis view, peak torsion angle and time of peak torsion angle were similar in females (34.87±5.8˚, 287±18ms) and males (33.26±5.60˚, 295± 22ms) while they were significantly decreased and increased in CAD patients (females: 24.91±3.5˚, 345±26ms and males:  24.15±2.16˚, 358±24 ms) in comparison to healthy subjects. The peak torsion angle reduction in CAD patients was a subsequent of   reduced rotation angle of basal and apical levels (P<0.001).

The results showed that sex difference did not influence torsion angle of the left ventricle. It is concluded that left ventricular torsion assessment in long axis view has the potential to distinct patients with CAD from healthy subjects in routine echocardiography evaluation.

Parkinson’s disease (PD) is one of the most common neurodegenerative diseases (ND). Studies have demonstrated that biochemical markers have an association with PD. We aimed to investigate an association of biochemical markers including calcium, vitamin D, alkaline phosphatase (ALP), parathormone (PTH), and phosphorous with PD.

This study was conducted on 139 PD patients and 100 healthy individuals. Serum levels of calcium, phosphorous, ALP, PTH and vitamin D were evaluated. Furthermore, student’s t-test and logistic regression models were used by SPSS.

The mean levels of calcium (9.4±0.7 and 9.0±0.8 ) and vitamin D (29.7±22.1 and 25.8±23.7) were higher in PD patients as compared with healthy controls, which only status of calcium being significantly different in the two groups (P<0.001). Levels of ALP (202.4±96.7 and 242.9±142.4) and phosphorous (3.6±0.6 and 4.22±1.1) were significantly different comparing PD patients with healthy subjects (P<0.01, P<0.001, respectively). ALP and phosphorous were significantly different in the two groups (OR=0.996, [CI 95%, 0.994-0.999], P <0.001, OR= 0.475, [CI 95%, 0.325-0.694], P<0.001, respectively). Furthermore, increased levels of calcium resulted in an elevated risk of PD (OR= 2.175, [CI 95% 1.377-3.435], P <0.001).

Results show that mean levels of calcium are higher in PD patients relative to healthy controls. Thereby, higher levels of calcium may be associated with PD.

Several factors contribute to the effectiveness of phototherapy. The aim of this study was to compare the effect of kangaroo mother care (KMC) and field massage on bilirubin level of term neonates with hyperbilirubinemia under phototherapy in the neonatal ward.

This double-blind clinical trial was performed on 90 term neonates aged 48 hours with hyperbilirubinemia, hospitalized in Fereydunkenar Hospital during 2018-2019. The infants were randomly divided into 3 groups of massage with phototherapy, KMC with phototherapy and control (received conventional phototherapy without KMC and massage). The massage group used field technique for three 15-minutes in 3 days and the KMC group received KMC for five 30 minutes in 3 days as well. In three groups, the serum bilirubin levels were compared at baseline, 24, 48, 72 hours after the onset and at the end of phototherapy. Moreover, the mean duration of phototherapy and hospitalization was compared during the treatment.

Serum bilirubin levels at baseline in the control, field massage and KMC groups were (17±1.38, 17.01±1.46 and 16.97±1.27mg/dl) and at the end of phototherapy were (6.97±0.47, 5.56±0.48 and 5.91±0.52 mg/dl) respectively. There was a significant difference between the intervention and control groups (p<0.001). The mean duration of phototherapy and hospitalization had no significant difference between two intervention groups (p>0.001), but it was significantly higher in control group than intervention groups (p<0.001).

The use of massage or KMC with phototherapy, compared to the phototherapy alone, can reduce the bilirubin level, phototherapy duration and hospital stay.

Treatment of hepatitis C virus (HCV) infection with recently introduced direct-acting antiviral agents (DAA) is effective and safe, however there is little known regarding safety and efficacy of generic DAAs in the real-life clinical setting. This study aimed to evaluate the efficacy and safety of generic sofosbuvir/ledipasvir (SOF/LDV) in a real-life clinical experience.

In this prospective cohort study, patients with chronic HCV infection who referred to Middle East Liver Diseases (MELD) Center were included. Based on the patients’ condition, they were treated with SOF/LDV fixed-dose combination with or without ribavirin (RBV) for 12 or 24 weeks.

A total of 30 (M/F: 19/11) patients with chronic HCV genotype 1 infection with a mean age of 49.8 years were treated with generic SOF/LDV with (9 patients) or without (11 patients) RBV for 12 (27 patients) or 24 (3 patients) weeks. Ten (33.3%) had cirrhosis and 13 (43.3%) with a previous history of treatment with interferon (IFN)-based regimens. Among the 30 patients, 26 (86.7%, 95% CI=70.3%-94.7%) achieved a rapid virologic response, 30 (100%, 95% CI=88.7%-100%) achieved the end of treatment response and 30 (100%, 95% CI=88.7%-100%) achieved a sustained virologic response. No severe treatment adverse event was observed however, 6 (20%) patients experienced mild to moderate adverse events.

The treatment of HCV genotype 1 infection with generic SOF/LDV found to be safe and effective even in patients with cirrhosis and previous history of treatment with IFN-based treatments.

Smoking can cause thyroid disorders; the aim of the present study was to investigate the association between smoking status and changes in thyroid hormone levels among adult males during a decade long follow-up of in the Tehran Thyroid Study (TTS).

Data of 895 adult males (smokers=115, non-smokers=691, ex-smokers=89) participants of the TTS without any previously known thyroid disease were analyzed. To examine trends of changes in thyroid hormone levels in these three groups, generalized estimating equation models were used. The interaction between the smoking status and each phase of the study was checked in a separate model.

Age and BMI adjusted trends of free thyroxine (FT4) demonstrated a non-significant decrease in participants (P=0.121) and thyroid-stimulating hormone (TSH) gained a significant average increase value over time in the total population (adjusted marginal mean of TSH=1.15 mU/L in phase 1, vs. 1.75 mU/L in phase 4, P<0.0001). Of the three groups, non-smokers and ex-smokers showed statistically significant increases in TSH during the follow-up period, whereas the smoker group had lower increases in TSH levels, changes from phase 1 until phase 2 among smokers were 38.46%, vs 43.54% and 52.94% in the ex and non-smokers, respectively.

TSH was lower and FT4 was higher in smokers compared with the other smoker groups, although TSH level shows no decreasing trend over time in this group. The increasing trend of TSH in smokers was similar to ex and non-smokers. No difference was seen in FT4 trends among the smoking groups.

The superiority of TG/HDL-C and LDL-C/HDL-C ratios in predicting  CVD risk is a matter of debates. Thus, the objective of this study was to compare TG/HDL-C and LDL-C to HDL-C ratios in predicting the risk of CVD events.

In a population-based cross-sectional study, 567 representative participants aged 40 years or older were entered in the study in Babol, North of Iran. The demographic data, anthropometric measures, and the cardio metabolic risk factors were measured. The individual risk of CVD events was assessed by ACC/AHA risk model. ROC analysis was applied to estimate the diagnostic accuracy and the optimal cut-off points of TG/HDL-C and LDL-C/HDL-C ratios.

The AUC of TG/HDL-C and LDL-C/HDL-C ratios were rather similar and both parameters significantly predicted CVD risk in men comparably, and TG/HDL-C at optimal cutoff point of 3.6 produced 75% sensitivity and 39% specificity. However,in women TG/HDL-C with AUC of 0.65( p= 0.091) at optimal cutoff value of 3.4  produced a sensitivity of 82% and specificity of 51%. The LDL-C/HDL-C ratio had no discriminative ability in predicting CVD risk in women.
The adjusted OR of TG/HDL-C at 2nd quartile was significant (OR=3.22, 95%CI:1.25-8.29) and a greater association was found with 3rd and 4rth quartiles

Both TG/HDL–C and LDL-C/HDL-C ratios comparably predict CVD risk in men, whereas in women only TG/ HDL-C is a significant predictor but not LDL-C/HDL-C.

Candidiasis is one of the most common fungal infections in immunosuppressed patients. The condition is usually treated with local and systemic antifungal agents. Given the antifungal properties of propolis, it appears this natural resin material can be effective in treating this infection. The aim of the present in vitro study was to compare the effect of Iranian propolis with those of routine antifungal agents on Candida species isolated from the oral candida lesions of patients with cancer, who had undergone chemotherapy, and a standard strain of Candida albicans.

A total of 23 samples were collected from the oral cavities of patients with colorectal cancer, who had undergone chemotherapy with 5-fu. The fungal species were determined based on the results of culture in C. albicans chromagar medium, formation of the germ tube and formation of vesicles. The MIC of aqueous extract propolis (AEP) and ethanolic extract of propolis (EEP) and amphotericin B (AMP-B), fluconazole (FL) and nystatin (NYS) were compared.

A total of 23 oral C. albicans samples were isolated. The MICs of FL and AMP- B were similar and less than those of EEP, AEP and NYS (P<0.001). In addition, the MIC of AEP was higher than EEP (P<0.001). The MIC of AMP- B on the strains isolated from the patients was more than that of the standard strain (P=0.012).

The aqueous and ethanolic extracts of Iranian propolis exhibited antifungal activity, with a greater effect of the EEP compared to the AEP.

Delay in diagnosis and treatment of TB is a critical component in TB control program which thereby spreading illness in the community. Sicnce Golestan province has the high risk with high rates of tuberculosis in the country, therefore, the analysis of the factors associated with treatment delay in this province for effective interventions and proper planning is considered necessary.

689 patients documents of TB cases in the health department of Golestan University of Medical Sciences in 2016 were enrolled in this survey. The response variable in this study was having the delay or not (via determining the 34 day as cut-off point in the interval between the date of onset of the symptoms and the date of treatment start-up). The data were analyzed using SPSS 24 software and final significant level for multivariate logistic regression model was considered 0.05.

Median (mean) treatment delay was calculated 49(77.75) days. In the current study 60.4% of patients had total delay greater than 34 days. In final model variables such as type of PTB (OR=0.645), contact history (patients who had no contact with TB patients (OR=1.441)) and patients who their contact history were unknown (OR=1.654)) had significant relationship with delay in starting treatment after 34 days of onset of symptoms of PTB patients in Golestan (p<0.05).

It should beam emphasis on increasing the community's awareness of the symptoms of tuberculosis and effective collaboration should be made between the Infectious Disease Control Center and the private and public sectors.

Ovarian carcinoma is one of the leading causes of cancer-related death among females. K-ras codon 12 mutations are commonly occurring mutations in different types of cancers and leads to resistance against anti-EGFR therapeutics. Hence, determination of mutations in k-ras gene is crucial for predicting response to anti-EGFR therapies. This study aimed to evaluate the prevalence of k-ras gene mutations and CA125 tumor marker in patients with ovarian carcinoma in Tabriz city.

Genomic DNA was extracted from 67 tissues pertained to women with ovarian carcinoma. Mutations in codon 12 and 13 of k-ras gene were analyzed by Nested PCR and RFLP methods. Titer of CA125 tumor marker was determined by ELISA.

Among the 67 patients, 7 patients (10.4%) had mutation in k-ras codon 12 while none of them had mutation in k-ras codon 13. Based on the results, the frequency of various genotypes were 89.55%, 10.44%, and 0%, for GG, GA, and AA alleles, respectively. The p-value for stage I and Grade I tumors were 0.022 and 0.04, respectively, indicating a statistically significant correlation between codon 12 mutation and stage I and Grade I tumors. Furthermore, we found significant correlations among CA125 tumor marker titers and histological grade (p<0.000) and stage (p<0.000). The mean serum CA125 tumor marker levels in malignant carcinomas were 499.84 U/ml.

The results in this study indicated high prevalence of k-ras codon 12 mutations and high titer of CA125 tumor marker in patients with ovarian carcinoma in the study region.

Stroke is the third leading cause of mortality worldwide. One of the factors that affect the occurrence of stroke can be attributed to changes in the levels of trace elements. Accumulating evidence has been shown that magnesium, as an important element, is a new predictor of stroke. We aimed to determine the levels of Mg in ischemic stroke patients in comparison with those having the hemorrhagic type.

This study was conducted on 447 stroke patients. Demographic characteristics of patients, stroke severity, and risk factors such as hypertension, ischemic heart disease, diabetes mellitus, and hyperlipidemia were recorded. Stroke was diagnosed based on the neurological examination and neuroimaging findings e.g. computed tomography (CT) or magnetic resonance imaging (MRI). The colorimetric technique was used to determine the concentration of Mg at 450 nm according to the commercial kit.

The mean of magnesium levels in ischemic patients was significantly higher than that in the hemorrhagic patients (P=0.001). Difference in magnesium status was associated with gender in thrombotic patients (P<0.05), while hyperlipidemia was associated with the status of magnesium in embolic patients (P=0.012). Furthermore, magnesium levels were correlated with ischemic heart disease in embolic (P=0.011) and sub-arachnoid hemorrhagic (SAH) patients (P=0.012), and with diabetes mellitus in thrombotic patients (P=0.012). Magnesium status was associated with the severity of ischemic stroke at the time of discharge in ischemic patients (P<0.001). Mg levels had the best area under curve (AUC) for the discrimination of ischemic patients from hemorrhagic ones.

Magnesium levels were higher in ischemic patients compared to hemorrhagic ones, and these levels were associated with many risk factors contributing to a stroke. Magnesium may be used as a new predictor of stroke in ischemic patients as opposed to hemorrhagic ones.

Given that the world's population is aging, the problems associated with osteoporosis and related fractures are increasing. The aim of the study was to evaluate the effect of flaxseed extract on bone mineral density (BMD) in Wistar rats using digital radiography.

In this experimental study, 25 male and 25 female Wistar rats were randomly divided into 5 groups: 1. Control, 2. Calcium and vitamin D (Ca/VitD), 3. 100 mg/kg flaxseed, 4. 200 mg/kg flaxseed, and 5. 400 mg/kg flaxseed. Then, the animals were kept for thirty days. Maxillary and mandibular BMD as well as serum levels of calcium, vitamin D and phosphorus were measured at baseline and after 30 days of keeping the rats.

The results showed that serum levels of calcium and phosphorus were not significantly different in all five groups before and after 30 days. Serum levels of vitamin D were significantly higher in the group receiving Ca/vit D (with a mean of 61.6±15.8 in the male group and 85±12.9 in the female group) as compared with other groups (P<0.001). The highest level of change in maxillary and mandibular bone density was in 200 mg/kg flaxseed group with a mean difference of 24.5±6.1 and 26.5±3.1, respectively, which was significant in comparison with the control and Ca/vit D groups (p<0.001) .

Flaxseed extract is more effective in increasing bone density than the group receiving Ca/vit D. The mandibular and maxillary BMD was higher in the group receiving 200 mg/kg flaxseed compared to the group receiving Ca/vit D (p<0.001).

One of the complications of urodynamic study is urinary tract infection. The aim of this study was to determine the rate of urinary tract infection (UTI) after UDS in patients referred to the pelvic floor clinic with regard to the specific conditions of these patients, such as presence of pelvic organ prolapse and high post voiding residual volume (PVR).

In a prospective descriptive-analytic study, 146 female candidates for UDS from January 2016 to June 2017 entered the study. Patients were examined for urinary tract infection before UDS (up to 5 days before USD) and were enrolled in the study if they did not have bacteriuria or urinary tract infection. Patients did not receive antibiotic prophylaxis before performing UDS. The patients were asked to do U/A and U/C three days after the UDS test.

Among the 146 patients, 9 (6.2%) patients had considerable bacteriuria and 7 (4.8%) patients had UTI. The mean maximum detrusor pressure during urination and abnormal PVR before UDS had a significant correlation with positive urinary cultures after UDS (p<0.05).

The results showed that this diagnostic procedure is low risk and the prophylactic antibiotic therapy is not required before UDS in pelvic floor clinic. It seems that prophylactic antibiotic therapy is only appropriate in case of PVR greater than 50 ml and possibly of the high detrusor pressure.

Bernard-Soulier syndrome (BSS) is a rare, autosomal recessive platelet function disorder which is commonly mistaken for idiopathic thrombocytopenic purpura (ITP).The report includes seven cases of BSS that have been diagnosed and treated as ITP for a long time.

Between 2006 and 2016, data of seven BSS patients who have long been diagnosed and treated as ITP were collected and analyzed.

Two patients were males and 5 were females. The patient's age range was between one day and four years at the onset of symptoms. Easy bruising, nose bleeds and mucocutaneous bleeding   were the most frequent symptoms. Bleeding attacks of the gum, gastrointestinal tract and menorrhagia also occurred and in one case bleeding in the injection site of the first vaccination was reported. In 6 patients, parents were relatives and in three cases, there was a family history of low platelet counts. Variable thrombocytopenia, prolonged bleeding time (BT), and large platelets with increased bone marrow megakaryocyte were seen in all cases. Most patients were treated with steroids, Intravenous immunoglobulin (IVIG), and some with IV anti-D, Azathioprine, Danazol, Rituximab. Splenectomy was performed in one case. In supplementary tests the platelet aggregation to ristocetin was absent and GPIb expression level by flow cytometry method was lower than 10%.

BSS should always be considered in differential diagnosis of ITP especially in persistent and refractory ITP.

Persistent thyroglossal duct leads to a fibrous cyst formation named thyroglossal cyst which is the most common form of congenital cyst and usually located in the midline neck below the hyoid bone. Rarely the thyroglossal cyst is associated with thyroid cancer. Although the Sistrunk procedure is often considered adequate, currently there is no clear consensus on the optimal management of thyroglossal duct cyst especially duct cyst carcinoma. In addition, there is no consensus about concurrent thyroidectomy in patients with thyroglossal cyst duct carcinoma.

In this article, we present four patients with thyroglossal duct cyst and papillary thyroid cancer. Papillary thyroid cancer was located into the thyroglossal duct cyst (thyroglossal duct carcinoma) in two patients and two patients had thyroglossal duct cyst with thyroid carcinoma in thyroid tissue. Cervical lymph nodes were involved in one of the three patients. Sistrunk procedure and total thyroidectomy were performed for all. The thyroid lobes were not involved in patients with thyroid duct cyst carcinoma.  Tumor or thyroglossal duct cyst recurrence did not occur in any of the patients in follow-up.

The correlation between thyroglossal cyst and papillary thyroid carcinoma is high. In subjects with thyroglossal duct cyst, in addition to cyst assessment, thyroid gland and neck lymph nodes should be evaluated for malignancy.

Knowledge of variations in the origin of vertebral artery (VA) is indispensable to vascular surgeons. Aberrant origin of vertebral artery on either side is an uncommon finding. There are unilateral and bilateral variability in VA origin.

We present a case of vertebral artery dissection who was found to have bilateral VAs aberrant origin. The right VA took origin from the right common carotid artery (CCA) which is a completely a rare finding, and the left VA originated from the arch of aorta.

Unlike most similar reported cases, the VA diameter at origin was larger on the left than on the right side. The possible embryological mechanism is discussed.

Anatomically myocardial bridging (MB) consists of either superficial myocardial fibers that traverse over the LAD or deep fibers that encircle the coronary artery. In this study, we present a patient with myocardial bridging, who was primarily diagnosed with coronary artery disease which did not properly respond to full-dose medical treatment but benefited from coronary artery bypass graft (CABG).

In 2017, a 53-year old man was referred to Tehran Heart Center (THC) with complaint of typical chest pain (TCP). In 2003 he had TCP and underwent coronary angiogram (CAG), due to positive non-invasive tests. Muscle-bridge in LAD was diagnosed. In 2007, he was symptomatic and another CAG was done, and percutaneous coronary intervention (PCI) with stenting was performed. In 2008 he became symptomatic and his interventionist, decided to perform another CAG. At that time, he had CABG. He was asymptomatic until 2015, he referred to us with the same TCP and we decided to perform CAG for the fourth time. After two years, again another PCI was done due to in-stent restenosis.

Revascularization should be considered in MB refractory to medical treatment. However, coronary perforation, in-stent restenosis and graft failure are major concerns.