Caspian Journal of Internal Medicine
Volume:11 Issue: 3, Summer 2020

There are many well-established factors that influence the risk of stroke including blood pressure, diabetes, low socioeconomic status and smoking, however, the shared genetic resource in members of a family effect on stroke predisposition. Genome-wide association studies (GWAS) have demonstrated evidence of a shared genetic source in stroke risk. This review considered the influence of family history as one of the main risk factors in stroke according to the literature.
literature review was obtained by searching for the key words "stroke", "family history" and "stroke gene" in PubMed. An overview has been made on the topics: relevance of stroke family history, family history assessment tools and specific candidate genes for stroke.
Family history of stroke is an important risk factor for the development of cerebrovascular diseases in addition to stroke subtypes in relatives who have reached the questionnaire and pedigree. While variation in a small number of loci showed Mendelian inheritance of stroke phenotypes, the genetic variations in several stroke risk loci are shared with multiple related vascular traits.
This study highlighted the importance of family history in stroke phenotypes and current related genetics information. Increasing awareness of the importance of family history in stroke has the advantage of preventing exposure to stroke with health care.

In December 2019, a new virus called coronavirus disease 2019 (COVID-19) causing severe acute respiratory syndrome emerged in Wuhan, China, and rapidly spread to other areas of China and other regions of the world. Since it was discovery, COVID-19 has spread to several countries and to this date, affecting about 2,329,651 people and caused about 160,721 deaths.  Since most COVID-19 infected cases were diagnosed with pneumonia and characteristic chest computed tomography (CT) scan patterns, radiological examinations have become an important tool in early diagnosis. Nowadays, CT findings combined with normal blood cells (WBCs), lymphopenia and a history of epidemiological exposure have been used as criteria for clinical diagnosis of COVID-19.  It is noteworthy that reverse transcription polymerase chain reaction (RT-PCR) test is still gold standard for the diagnosis. This review focuses on role of chest CT in the clinical evaluation of disease progression and more accurate diagnosis.

To determine the association between pre-conception obesity and screening results of pre-natal and post-natal anxiety in women referred to the health centers of Tabriz, Iran.

62 obese (class 2-3) and 245 normal-weight women were enrolled in the first trimester of pregnancy through the cohort study and followed up 1 year after childbirth from December 2012 to January 2016. The Beck anxiety inventory Scale (BAI-II) was completed in five time points: the first, second, third trimester of pregnancy, 6–8 weeks and 12 months after childbirth. Chi-square, Fisher’s exact tests, Independent t-test, Mann-Whitney, and multivariate logistic regression adjusted for confounders were used for data analysis. Statistically significant was considered as P<0.05.

The rate of moderate to severe anxiety in 1st, 2nd, 3rd trimesters of gestation, 6–8 weeks and 12 months after birth was 8.6%, 10%, 12.6%, 7.8%, 6.5% in normal weight women versus 18%, 17.9%, 19.2%, 12.5%, 19.4% in obese class II women, respectively. The odds of anxiety in the first trimester of pregnancy for class 2–3 obesity was 2.72-fold greater than normal weight group [adjusted odds ratio (aOR) 2.72, 95% confidence interval (CI) 1.14–6.47; p=0.023]. This odd was 3.30- fold (aOR 3.30, 95%CI 1.13-9.60; p=0.045) for 1 year after birth.

Obesity remained associated with positive screening for anxiety in the first trimester of pregnancy and one year after birth. Obese women more likely require specialist medical care during their pregnancy due to its impacts on mood.

High rate of repeat cesarean section and its complications are the results of cesarean tsunami in the last two decades in Iran. Vaginal birth after cesarean (VBAC) is an important alternative for repeat cesarean. However, the rate of VBAC in Iran is very low subject to some organizational and individual barriers. This study explored the clinician’s and women's perceptions of individual barriers to achieve VBAC.

In this conventional content analysis, 28 semi-structured interviews and one focus group discussion was conducted with health care providers including gynecologists, midwives and family physicians as well as  prior  cesarean section mothers in Mashhad in 2017. Participants were selected through purposive sampling considering the strategy of maximum variation. Data analyzed according to Graneheim and Lundman (2004) method using MAXQDA.10 software.

The theme of “obstacles to acceptance and committed actions” emerged from two categories of “psychological barriers” and “operational barriers and five sub-categories labeled as: 'sense of danger”, “financial displeasure",  "negative attitude", "barriers to decision making" and "indolence".

Attitude improvement by maternity care promotion and create supportive environment, informing mothers about choice of birth mode and empowering them in shared decision making, organization of VBAC care team and create motivation in persons and hospitals through report of research projects outcomes on safety and benefits of VBAC will be affected the VBAC rate and cesarean section rate.

Vitamin D is one of the known lipoprotein hormones with metabolic properties. We aimed to determine the serum 25-hydroxy vitamin D concentration in overweight/obese subjects with diabetes mellitus type Ⅱ (DM Ⅱ) in association with systolic and diastolic blood pressure and quality of life compared with healthy participants.

The current case-control study was carried out among 80 overweight/obese subjects with DM Ⅱ, and 77 healthy subjects matched by sex, age and body mass index (BMI). Serum 25-hydroxyvitamin D concentration was measured by ELISA method. In order to examine the quality of life, the Persian version of SF36 questionnaire was used.                   

There was significant difference between diabetic and healthy subjects considering serum 25-hydroxyvitamin D concentration (p-value = 0.012). Serum 25-hydroxyvitamin D concentration was inversely correlated with diastolic blood pressure (p-value = 0.02) and positively associated with physical function (p-value <0.001), social function (p-value <0.001) and general health (p-value <0.001) components of quality of life in diabetic subjects and physical health sub-scale (p-value = 0.004) in all participants.

Serum 25-hydroxyvitamin D concentration was significantly lower in diabetic subjects in comparison with healthy controls. There was a significant reverse relationship between serum concentrations of 25-hydroxyvitamin D with diastolic blood pressure and on the other hand, a significant positive relationship with physical function, social function and general health components and physical health subscale of quality of life in participants with DM Ⅱ.

To compare thyroid volume , thyroid stimulating hormone (TSH) , Free T4  and  prevalence of thyroid nodules between obese and  non-obese subjects .Also,  association  between BMI  and insulin resistance status with various parameters of thyroid gland was evaluated.

Fifty –two patients with obesity and 38 normal body mass index (BMI ) volunteers, aged 20-50 years , were enrolled in this cross-sectional study. Patients with diabetes, history of thyroid disorders, and patients who were taking medications that influence their blood glucose or insulin levels or modified thyroid function tests, were excluded. TSH,free T4, insulin and glucose and thyroid sonography were carried out and results compared between two groups. P<0.05 was considered as significant.

Thyroid volume was higher (p<0.001) and free T4 was lower (p<0.001) in patients with obesity but there was no difference in TSH between groups. Prevalence of thyroid nodules was 15.7% and 10.8% in obese and non-obese groups, respectively (p=0.51). Frequency of nodules was significantly higher in insulin resistant than non- insulin resistant subjects (22% vs.2%, p=0.01). BMI was associated with    thyroid volume ( r =0.44 , p< 0.001) and  freeT4 ( r = - 0.35 , p=0.001)  . HOMA-IR(Homeostatic Model Assessment for Insulin Resistance ) had no correlation with thyroid volume (p= 0.38), but associated  with  FreeT4 (r= -0.25 , p=0.01).

Free T4 was lower and volume of thyroid was higher in obese subjects, but TSH  and frequency of thyroid nodules had no significant difference between obese and non-obese counterparts. Insulin resistant individuals had more nodules but  thyroid volume was mainly associated with BMI.

Erythrocytes require an ability to deform and to withstand shear stress while negotiating the microcirculation. These properties are largely due to their excess surface area per volume and the characteristics of the membrane’s protein. Deficiencies of these proteins are associated with chronic haemolysis.

This was a cross sectional  study aimed at determining the prevalence of red cell membrane protein abnormalities as determined by sodium dodecyl sulphate polyacrilamide gel electrophoresis (SDS-PAGE) among patients with anaemia attending the out-patients clinics of the hospital.

A total of 823 participants were recruited into the study with a mean age of 34±14 years. There were 410 (49.8%) participants with haematocrit ≥ 36% and 413 with haematocrit ≤ 35.9% of which 192 participants (23.3%) had abnormal red cell indices. Following SDS-PAGE, 21 (10.9%) of the 192 participants had deficient PAGE tracing. Abnormal spectrin band was observed in 17 (81%) of the 21 participants. The haematocrit was significantly lower while the reticulocyte count and red cell distribution width were higher in participants with red cell membrane abnormalities.

 One in ten patients with mild anaemia and abnormal red cell indices in clinical practice may be having hereditary red cell membrane protein defect. Presence of raised reticulocyte count, family history of mild anaemia, increased red cell distribution width and red cell morphology may be used to screen for membrane deficiency.

To examine serum levels of vitamin D in newly diagnosed gastric cancer (GC) patients compared with normal subjects and any possible association with prognostic variables.

One-hundred subjects (50 GC and 50 controls) were enrolled and serum vitamin D levels were assessed using ELISA. Based on two definitions, vitamin D was classified as a sufficient level (≥30 ng/dL) and optimal level (25-80 ng/dL). The χ2and unpaired t-test was used for data analysis with a significance level of 0.05.

The mean serum levels of vitamin D in patients and controls were 26.86 (±14.6) and 31.72 (±13.4), respectively (P=0.09). The prevalence of vitamin D insufficiency and deficiency was higher in GC cases than controls (P=0.045 if sufficient level ≥30 and P=0.065 if sufficient level ≥25). According to histological grade analysis, grade 3 patients (poorly differentiated) were found with significantly lower vitamin D concentrations in serum than grade 1 and 2 subjects (22.25 vs 33.29 ng/dL, P=0.021).  No significant differences were observed between the two groups in Pathological tumor-node-metastasis(pTNM) stages, distant metastasis, and location of the tumor.

Higher prevalence of vitamin D insufficiency and deficiency in GC patients may reflect its role in malignancy; however, further studies are needed to confirm this relationship and any possible benefitsto the patients.

Diabetes mellitus (DM) is a chronic disease inducing short-term and long-term complications including sexual dysfunction (SD) which can consequently reduce patients’ quality of life. Given the limited literature on frequency of SD in men experiencing diabetes in northern Iran, the present study was conducted in the city of Sari in Mazandaran Province, with the aim of investigating SD in men with type II diabetes.

Using a descriptive cross-sectional research design, a total number of 350 male patients suffering from type II diabetes referring to endocrinology clinics in the city of Sari in. The patients were requested to fill out the demographic questionnaire, Depression, Anxiety and Stress Scale-21 Items (DASS-21) and the 15-question International Index of Erectile Function (IIEF). The data were analyzed using the IBM SPSS Statistics software (version 22).

The average period of time in which the patients were facing diabetes was 3.65±5.75 years. The IIEF mean score was equal to 16.98±43.79. Erectile dysfunction (ED) was also evident in 152 patients (62.2%). Moreover, increase in age had significantly decreased the IIEF scores (p<0.001). The chance of being affected with ED among diabetic patients above 50 was 11.21 times as much as those below 50 years of age (odds ratio (OR): 11.21, 95% confidence interval (CI): 6.40-19.62).

Concerning the high prevalence rate of ED in men suffering from type II diabetes, doctors are required to directly ask them about sexual disorders in follow-up visits. Furthermore, using screening questionnaires can be helpful in identifying this problem.

Gastric lavage has been one of the pillars of the classic treatment for upper gastrointestinal bleeding (UGIB) for many years. The present study investigated effect of gastric lavage with hemostatic powder on complications of UGIB.

This clinical trial study was performed on 54 patients who referred to the emergency department during the year 2017-2018. The subjects were divided into two groups (n=27 per group). Gastric lavage with saline and Hemostasis Powder® was performed in the control and intervention groups, respectively. Patients' information was collected and analyzed using SPSS ver. 18. The significance level was also considered as P<0.05%.

A total of 59.2% and 18.5% of patients in the gastric lavage with Hemostasis Powder® and saline did not require treatment during the initial endoscopy, respectively (p=0.002). The duration of endoscopy was lower in the intervention group (p=0.001) and there was much time for endoscopy (4.83±8.04 hours vs. 6.73±14.12 hours, respectively) (p=0.001). Also, gastric lavage with Hemostasis Powder® significantly improved the quality of endoscopy (4.1 vs. 2.3). There was no difference between the two groups in terms of the need for blood transfusion. (p=0.4).

Gastric lavage with Hemostasis Powder® is a useful measure in the primary care of patients with UGIB and can convert emergency therapeutic endoscopy to diagnostic elective endoscopy of better quality.

The present study was conducted to determine the prevalence of metabolic syndrome (Mets) in schizophrenic patients in a 6-month period of treatment with antipsychotic medication.

In this study, 60 volunteer schizophrenic patients were included.  At the onset and 6 month after treated with antipsychotic medication, fasting blood sugar (FBS), serum triglyceride (TG), high density lipoprotein (HDL), weigh, waist circumference (WC), and blood pressure   were determined. We defined Mets according to ATPIII criteria.

After 6 month treatment with antipsychotics drugs, the mean WC, serum TG, HDL, systolic and diastolic blood pressure increased but the changes of WC and HDL were statistically significant (P<0.05).  We found that percentage of patients with high WC, low HDL levels, and Mets increased after treatment which was statistically significant (P<0.05).

It is recommended that nutritional and life style changes intervention should be implanted for schizophrenic patients undergoing treatment.

Compared to past decades, humans are exposed to rapidly increasing levels of radiofrequency electromagnetic radiations (RF-EMF). Despite numerous studies, the biological effects of human exposure to different levels of RF-EMF are not fully understood, yet. This study aimed to evaluate the bioeffects of exposure to "900/1800 MHz" and “2.4 GHz" RF-EMFs, and x-rays as well as their potential for inducing simple additive, adaptive, or synergistic effects.

120 Wistar rats were randomly divided into ten groups of 12 each. The rats were exposed to either sham, EMF, 10 cGy, and 8 Gy x-rays or a combination of these exposures. The levels of liver enzymes in serum samples by an auto-analyzer. Moreover, the histopathological changes and the levels of Malondialdehyde, Nitric oxide, ferric reducing antioxidant power, total thiols, and protein carbonyl assays were measured.

Among the markers of liver function, GGT was not associated with irradiation but, AST, ALT, and ALP showed some levels of association. Lipid peroxidation and protein carbonyl assays after 8 Gy irradiation were increased, but pre-exposure to RF-EMF could modulate their changes. At the cellular level, the frequency of lobular inflammation was associated with our intervention types.

the exposure to both ionizing and non-ionizing radiations could alter some liver function tests. A short term pre-exposure to RF-EMF before exposure to an 8 Gy challenging dose of x-rays caused the alterations in oxidative stress markers and liver function tests, which indicate the possible involvement of oxidative stress in the process of adaptive response.

Prostate specific antigen (PSA) is an important biomarker to monitor patients after treated with radiation therapy (RT). The aim of this study is to evaluate the relationship between the PSA data and prostate cancer recurrence using the joint modeling.

This historical cohort study was performed on 422 prostate cancer patients. Inclusion criteria included: patients with localized prostate cancer referring to Cancer Institute in Tehran (Iran) through 2007 to 2012, and under radiation therapy. Joint model has two components or sub-model. We showed the results by parameter estimating the longitudinal sub-model and survival sub-model. EM algorithm, Newton-Gauss and Gauss-Hermit law were used for final model parameters. R software version 3.2 was used for statistical analysis.

In this study, considering the inclusion and exclusion criteria, out of 422 patients, the data on 314 cases were selected for analysis and the main result of joint model was obtained. PSA directly and significantly was associated with recurrence risk, therefore  increasing 2.6 ml/lit PSA (one unit in transformed PSA) increases 39% recurrence risk (95% CI for RR: 1.09-1.77). Also slope of PSA trend has significant association with prostate cancer recurrence risk (95% CI for RR: 1.05-1.41).

This study showed a significant relationship between PSA, and its slope with the recurrence risk by joint model, with regard to the pathological, demographic and clinical features in the Iranian population.

Inappropriate administration of antimicrobials has led to increased antibiotic resistance as well as burden of infectious diseases. Antibiotic stewardship programs (ASPs) help prevent resistance through improved utilization of antimicrobial agents while potentially decrease costs of treatment.

We reviewed 186 infectious disease (ID) consultations from two internal disease wards in a tertiary center where ID specialists were asked to confirm carbapenem use in patients within 48 hours of initiation. The records were reviewed in terms of age, gender, and final decision about carbapenem use. The crude mortality rates during the 5-month period of the study (May to September 2016) as well as hospital spendings were compared with the same time of the year before implementation of the ASP.

Of 186 consultations conducted by the ID specialists, 28 consultations (15%) led to antibiotic change, 46 (25%) led to discontinuation, while in 112 (60%) carbapenems were continued. An estimate of 14,000 € were saved based on annual hospital costs during the 5-month period of the study. Although antimicrobial resistance patterns could not be evaluated, the crude mortality rate in the two IM wards was calculated to be 2.6% with no significant change compared to previous year (CMR: 2.9%).

Based on findings of the present study. ASPs for carbapenems (as wide-spectrum agents) can lower costs with no increased mortality rates in a tertiary center located in a middle income country.

Foreign body insertion in the urethra and bladder are relatively rare. These patients usually insert foreign body in urethra for eroticism, inquisitiveness, or as a consequence of disinhibited or disturbed behavior.

Herein, we report a case of 41-year-old man presented with weak stream and suprapubic pain. Due to incontinence, he instilled superglue into his urethra. On perineal examination, a foreign body was palpable in the penile urethra. A 10 cm dried superglue block got out with incision of glance.

Urethral foreign bodies are mostly found by Physical examination and clinical history. Although imaging modalities are commonly used for FBs detection, the necessity of imaging modalities are still controversy.

Primary Mucinous eccrine carcinoma (PMEC) is a quite rare malignant tumor that typically involves the head and neck region in approximately 75% of patients and the periorbital area is the most common area.

 A 57-year-old man was seen with a  painless red mass involving the left lower eyelid for the past 7 months. Examination revealed a small mass measuring 0.6 cm with shiny red smooth appearance of the skin. H&E stained examination revealed a tumor mass was composed of polygonal cells in nests, lobules and islands separated by  large amount of mucin. The neoplastic cells showed eosinophilic cytoplasm and round nuclei with mild pleomorphism. There was no necrosis, no atypical mitosis, no lymphovascular and perineural invasion. Rare mitotic figures were found. Tumoral nests present on all surgical margins.

 Primary MEC is a slow-growing neoplasm that may recur after incomplete surgical excision.This tumor is often clinically mistaken for other cutaneous tumors due to its variable appearance.Recurrent tumor tends to be locally invasive with a rare metastatic rate of 9.6%.  As a result of the recurrence risk, patients should  be followed up regularly. Thus, our patient was recommended regular follow-up every six months.

Waldenstrom macroglobulinemia is a lymphoplasmacytic lymphoma with elevated serum immunoglobulin M and multi-organ involvement. Primary systemic amyloidosis usually develops due to immunoglobulin light chains depositions in different organs due to an underlying gammopathy.

Our patient was an 86-year-old man with macroglossia, ecchymotic patches and bullous lesions associated with a skin laxity on the periorbital, palmar, and glans penis areas. Skin biopsy confirmed dermal amyloid depositions. In serum immunofixation electrophoresis, prominent monoclonal immunoglobulin-M lambda light chains were detected associated with prominent lymphoplasmacytic infiltration in bone marrow biopsy which was diagnosed as Waldenstrom macroglobulinemia.

 Skin involvement presenting as cutaneous amyloidosis could be the first manifestation of Waldenstrom macroglobulinemia. We should think about an underlying gammopathy in an old patient with skin laxity and ecchymosis

Evans syndrome is an uncommon autoimmune disorder manifested by fatigue, jaundice, pallor, purpura and petechiae. The main characteristics of this rare disease are simultaneous or sequential existence of positive anti-globulin test, immune thrombocytopenia (ITP) and autoimmune hemolytic anemia (AIHA). Evans syndrome as an autoimmune disorder can be associated with other diseases. The concomitancy of Evans syndrome and multiple sclerosis (MS) has not been reported so far. In this case study a 21 years old male with concomitant Evans syndrome and MS has been reported.

A 21-year-old male of Iranian origin and known case of Evans syndrome, was referred to our hospital for better evaluation. Evans syndrome was presented with acute jaundice, purpura, petechiae, and easy bruising when he was 9.He was under treatment of corticosteroid and cytotoxic agents, and presented with left lower extremity paresis for 5 months before admission to our hospital. According to neuroimaging and pathologic results, multiple sclerosis (MS) was diagnosed. Hence, we decided to treat the patient with rituximab. The patient has been stable without any further exacerbation or increase in disability progression after 2 years from diagnosis.

Evans syndrome can be associated with other autoimmune disorders. For our case, we have reported this association with MS.