Caspian Journal of Internal Medicine
Volume:12 Issue: 1, Winter 2021

 There has been considerable development in the clinometric of stroke. But, researcher is concerned that some scales are too generic, inherently and the insight may not be provided. The current study was conducted to determine which scale or scales should be used in stroke survivors.

We selected 67 studies which published between January 2010 and December 2018 from Up to date, CINAHL, ProQuest, Scopus, PubMed, Embase, Medline, Elsevier and Web of Science with MeSH terms. Inclusion criteria were: clinical trials, prospective studies, retrospective cohort studies, or cross-sectional studies; original research in adult human stroke survivors. We excluded the following articles: non-adult population; highly selected studies or treatment studies without incidence data; commentaries, single case reports, review article, editorials and non-English articles or articles without full text available.

Face Arm Speech Test and Cincinnati Prehospital Stroke Scale scales because of easy to learning and rapidly administrating recommended to use in prehospital, but there is not gold standard in stroke diagnosis in prehospital. National Institutes of Health Stroke Scale valuable in the acute stage for middle cerebral artery, not chronic or long term post stroke outcome. The Barthel Index scores at approximately three weeks could predict activities of daily living disabilities at 6 months.

Every scale has advantage and disadvantage and we not able to introduce gold standard for each item, but some special scale was more used in studies, preferred for comparing with other studies to match the research results.

 Rheumatoid arthritis (RA) is the most common chronic inflammatory joint disease. Complications of RA can cause low quality of life and disabilities. Nowadays, despite all the medical developments, etiology of RA is unclear. Both soft and hard tissue damages occur in RA and periodontitis due to chronic inflammation and also since tissue damage presentation and pathogenesis of RA and periodontitis are the same, this study was done for evaluating the relationship between clinical and laboratory findings in RA patients with their oral status and disease activity.

 This case-control study was performed on 236 patients; 118 RA patients and 118 cases of normal people. Gingivitis, dental caries and plaques, oral hygiene and severity of periodontitis were measured based on gingival index, plaque index, clinical attachment level, Decayed Missing Filled index and oral hygiene index-simplified. Disease activity was assessed according to Diseases Activity Score-28. Blood samples were taken to evaluate the level of anti-CCP, RF, ESR, CRP, and CBC. Data were analyzed by t-test and chi-square.

 RA patients are more susceptible to periodontitis, plaque formation and dental caries. There is a relationship among RA disease and periodontitis, oral hygiene, gingivitis. There is also a reverse relationship between RF level and periodontitis severity likewise dental caries. There is no significant relationship between other laboratory findings and the oral status of patients.

 This is more likely for RA patients to experience periodontitis which can destruct alveoli bone and it can also cause early tooth loss. Regular examination and early treatment are highly recommended.

  Diabetic neuropathic pain (DNP) is a common complication of diabetes and has a profound effect on patients quality of life. Therefore. The purpose of the present study was to compare the analgesic effects of duloxetine and nortryptiline in the management of patients with diabetic neuropathy.

This was a randomized, double-blind, parallel-group, placebo-controlled trial in subjects with a proven diagnosis of DM and suffered from neuropathic pain. Patients were recruited in this study from 20 February 2016 (first patient, first visit) to 22 June 2017 (last patient, last visit), including 5 weeks follow-up. A diagnosis of DNP was based on history, clinical examination, Nerve conduction velocity and Diabetic neuropathy symptom score (more than one point).

Both drugs reduced pain when compared with placebo. A significant VAS reduction from 6.4 at baseline to 3.75 at endpoint was observed in the duloxetine group. However, there was no significant difference in the efficacy between nortriptyline and duloxetine based on patientchr('39')s visual analogue scale (VAS) (p>0.05). No clinically significant changes or serious adverse events were found among treatment groups including changes in vital signs, laboratory assessments, physical examination or electrocardiograms. The decrease in the mean pain intensity was significantly greater in the duloxetine and nortriptyline group compared to the placebo group both in the primary analysis and in the by-visit analysis (p<0.003)

The present study demonstrates the safety and effectiveness of both duloxetine and nortriptyline in the management of DNP.

Poisoning is a major public health problem that constitutes a significant share of the global burden of disease. Previous studies conducted in this area indicated the importance of such epidemiological studies. The most critical impact of these studies is their effect on changing current regulations and, therefore, decreasing poisoning cases. We aimed to evaluate all poisoning cases with regard to the patients’ demographics and the involved intoxicants.

The present study was conducted to investigate all poisoning cases who were admitted during a three-year period. Causes of poisoning, hospitalization, management procedures and outcome of the cases were surveyed.  A total of 1448 patients referred to Shahid Beheshti Hospital (Babol, Iran) from 2015 to 2018.

More than half of the patients were females (51.7%), and the majority of poisoning cases were seen in patients aged between 15 to 25 years (34.2%). It was found that suicide made a large part of poisoning cases (65.6%), and females tend to attempt suicide more than males (64.3% vs. 35.7%, respectively). Also, regular drugs followed by club drugs were the most abundant toxic agents (52.1% and 23.3%, respectively). Aluminum phosphide (AlP) was the most lethal intoxicant in our study, accounting for 68.2% of all deaths.

According to the results, it is concluded that the existing regulations for drug control and suicide prevention have not been efficient enough and further actions yet to be made to reduce the consequences of drug- and non-drug-related toxicities.

Coronary artery bypass graft surgery (CABG) may have systemic effects on the body organs as liver. The purpose of  present study was to evaluate changes in liver function tests(LFT) after on-pump CABG surgery and risk factors associated with LFT changes.Also, the incidence of acute liver injury after on-pump CABG is determined.

385 patients who underwent on-pump CABG surgery were randomly selected.Preoperative and intraoperative risk factors were obtained from their medical records .Postoperative liver function tests at 24, 48 and 72 hours following surgery and discharge time were compared with the preoperative ones. A univariate linear regression analysis was used to assess the possible relationships between these changes and the preoperative and intraoperative risk factors.

Statisitcal analysis revealed direct and significant relationship between LFT changes and  pump time, aortic cross-clamp clamp time and use of intra-aortic balloon pump(IABP). Also a medical history of previous myocardia infarction was significantly related to the changes in direct bilirubin in the first 48 hours following surgery.level of  preoperative left ventricle ejection fraction,smoking and using opium had  significant  correlation  with  postoperative AST changes in different days.In 12.9% of patients, the aminotransferases levels increased to more than three folds over normal upper limit but  the probability for incidence of acute ischemic liver injury (transient increase in aminotransferases to over 500IU/L) was 0.77%.

Using techniques to reduce clamp and pump time when possible is important during CABG. Probable liver injuries post inserting IABP should be expected for appropriate monitoring and treatment.

The aim was to describe, evaluate and document the prevention of medication errors by clinical pharmacologist consultations in patients with cancer.

We assessed the effect of clinical pharmacologist consultation by the acceptance of interventions recommended due to dosage, frequency, duration of therapy errors and drug-drug interactions (DDIs). All medication errors detected by clinical pharmacologist were reported in the format of medical consultation. A documentation template was designed to collect the patient’s data (sex, age, and diagnosis), prescriptions written, and drug-specific recommendations. For the descriptive analysis of medication errors, the unit of analysis was the number and percentage of errors.

A total of 296 patients included in this study with a median age of 48.67±19.76 years of which 47.30% were females. 936 prescribing errors were detected and recommended for their correction. The specialist physicians accepted 897 of prescribed errors. DDIs that were detected in 66.22% of patients, were the most errors in this group of errors (47%). Improper dose (17.41%) wrong frequency (16.67%) and drug-food interaction (10.26%) were after that.

Pharmacological consultation in the hematology-oncology ward revealed many medication errors. The trust of physicians in the views of the clinical pharmacologist led to a large part of these errors being accepted and resolved.

White blood cell count (WBC) is one of the objective parameters of systemic inflammation. The aim of present study was to evaluate the relationship between WBC count and metabolic syndrome.

In this study on Lor population in Borujerd province (West of Iran), from 2011 to 2013, 800 persons were enrolled. MetS was defined based on ATP III criteria. Differences among the quartiles of WBC were examined by one-way analysis of variance.

Only 14.7% did not have any of the five components and 43% of all subjects had metabolic syndrome. The means of WBC count in MetS group were significantly higher than the control group (p<0.0001). In subjects without any MetS components, the means of WBC was 5.321 /µL, and it was 5.664, 5.714, 5.961, 6.302, and 6.572 /µL in subjects with 1, 2, 3, 4, and 5 components, respectively. These differences show a significant increasing trend (p<0.0001).

WBC count was associated with clustered components of metabolic syndrome. It seems that WBC counts could be considered as a predictive factor for metabolic syndrome in preventive medicine.a

Multidrug resistance (MDR) in Enterobacter spp. has created therapeutic challenges all over the world. The present study was conducted for evaluating the prevalence of class I integron, determining the gene cassettes and antimicrobial resistance profile of Enterobacter spp. isolates from clinical samples in Babol, North of Iran.

During a 13-month period, 30 Enterobacter spp. isolates were collected from Ayatollah Rouhani Hospital, Babol, Iran. Various types of antimicrobial agents were used to determine the resistance pattern. Class I integron and associated gene cassettes were detected by PCR assay.

The resistance rates to AP, CPM, CTX, TM, NI, IMI, AK, CIP and GM antimicrobials were 100%, 93.3%, 33.3%, 33.3%, 30%, 20%, 20%, 20% and 13.3%, respectively. The distribution results of int genes showed that 63.3% of isolates carried the intI genes. Also, the prevalence of aadB, dfrA1, blaOXA30 and blaPSE1 genes were estimated at 36.6%%, 33.3%, 6.6% and 0%, respectively.

Our results showed that class I integrons have a widespread distribution among the Enterobacter spp. isolates and have clinical relevance to MDR isolates. The results confirmed the necessity for uninterrupted monitoring to prevent distribution of multidrug resistance among Enterobacter spp. strains in Iran

Intrauterine insemination (IUI) is a widely utilized method for treating the infertile couples. The aim of the present study was to determine the pregnancy and abortion rates after IUI and to examine the relationship of sperm parameters with these rates.

This retrospective study was performed on 911 infertile couples undergoing IUI treatment in Shahid Akbarabadi IVF Centre from May 2017 to May 2019. To evaluate the correlation of sperm parameters with the clinical pregnancy and abortion rates, odds ratio (OR) with 95% confidence intervals (CI) was calculated.

In this study, the pregnancy rate following IUI was 15.7% (143/911), and among women who achieved pregnancy, the abortion rate was 42.0% (60/143). According to the multiple logistic regression analysis, none of the sperm parameters was associated with the pregnancy rate. Couples with either male or female factor infertility etiologies were more likely to get pregnant than those with unexplained infertility. Regarding the abortion rate, multiple logistic regression analysis revealed that normal sperm count was related to a lower abortion rate (adjusted OR=0.25, 95% CI=0.07–0.91).

The present study did not reveal a significant relationship between none of the sperm parameters and pregnancy rate after IUI treatment. However, among women who got pregnant, continuation of the pregnancy was associated with the normal sperm count. Furthermore, analysis of all semen parameters together in comparison to one parameter alone might be more accurate to predict pregnancy or abortion. Further prospective cohort studies with a large number of couples are required.

Adherence to treatment is an important factor in the management of diabetic patients. The aim of this study was to examine the psychometric properties of the 8-item Morisky Medication Adherence Scale (MMAS-8) among type 2 diabetes.

This study carried out in Family Medicine Clinics (FMCs) in Tabriz, North West of Iran from May to September 2018. A total of 320 patients suffering from Type 2 diabetes were included. Content and face validity of the Persian version of MMAS-8 ‎ were quantitatively evaluated. The Cronbachchr('39')s alpha and intra-class correlation (ICC) were calculated to assess the reliability. Exploratory factor analysis (EFA) was used to assess the construct validity of the questionnaire.

Content and face validity of the Persian version of MMAS-8 were confirmed. Good internal consistency (Cronbach’s a = 0.83) and test–retest reliability (ICC= 0.87, P<0.001) were found. According to the results of the EFA, Persian version of MMAS-8 among diabetic patients had two dimensions: stopping to take medication due to the forgetfulness and for reasons other than forgetfulness.

The Persian version of the MMAS-8 is a high valid and reliable questionnaire to screen medication adherence of Persian-speaking patients with diabetes.

Coronary Artery Disease is one of the leading causes of death in the world. CAD usually progresses slowly during time and patients with normal or near-normal coronary arteries are also at risk of developing CAD. It is now believed that even mild atherosclerosis can increase the rate of CAD.

This is a retrospective, descriptive and analytic study. We selected patients who had undergone at least two diagnostic coronary angiographies at Tehran Heart Center and had normal coronary structure or mild CAD in initial angiography. The data was obtained from the Tehran Heart Center Angiography Databank. Predicting factors in the development of CAD were determined.

Data on 556 patients were reviewed. The median interval between the initial and final coronary catheterization was 37.6 months. On the final evaluation, 216 patients (38.8%) found to have developed some degrees of coronary artery disease. Based on the multivariate analysis, age, hematocrit, cigarette smoking, hypertension, and initial presentation with stable and unstable angina were found to be independent predictors of progression to CAD in patients.

In the end, 40% of patients who had normal coronary arteries or minimal CAD in the initial angiography report, developed some degrees of CAD and some clinical indices can predict the risk of CAD.

Cow’s milk intolerance can lead to chronic constipation in children. The present study seeks to determine the effect of cow’s milk-free diet (CMFD) on chronic constipation in children who are not responding to laxatives.

Seventy children suffering from chronic constipation (described as the Rome III criteria) were enrolled in an open-label randomized clinical study. Each group included 35 children aged 4-14 years treated with laxatives for at least three months with no improvements. The intervention group received CMFD plus calcium supplements for four weeks and the control group did not have any restrictions in consuming cow’s milk and dairy products. Also, both groups received polyethylene glycol (PEG; 1 gr/kg/day) and high-fiber foods (at least 10 gr/day) for four weeks. Responsiveness was described as a reduction in symptoms and signs according to the Rome III criteria after four weeks.

After four weeks, 25 (71.4%) children in the CMFD group responded to the treatment compared to four (11.4%) children in the control group (P<0.001). Significant differences were found between the CMFD and control groups in terms of the seven Rome III criteria post-intervention; history of large stools (25% vs. 53.6%), large fecal mass in the rectum during examination (17.1% vs. 50%), history of painful defecation (18.2% vs. 55.6%), history of retentive posturing (10% vs. 46%), ≥1 episode/week of incontinence (25 % vs. 50%, P=0.001), ≤ 2 defecations/week (17.4% vs. 52.3%) and history of thick stool with toilet obstruction (22.2% vs. 52.3%)

This study showed that children with functional constipation with no response to laxatives could benefit from a cow’s milk-free and dairy-free diet.

It has been confirmed that incidental silent cerebral infarctions (SCIs) found in healthy people may be risk factors for cerebrovascular diseases such as strokes and vascular dementia. The prospective study aimed to determine the utility of baseline serum white blood cell (WBC) counts to predict the emergence of new SCI after intracranial hemorrhage (ICH).

This is a prospective study. From January 2016 to December 2017, we recruited 171 patients admitted to the neurology department of the Affiliated Shuyang Hospital of Xuzhou Medical University with a first episode of ICH. Serum WBC count was measured on admission. SCI was detected by cranial magnetic resonance imaging (MRI) 14 days after the onset of the ICH. Receiver operating characteristic curve analysis was used to calculate the most appropriate cut-off values of the WBC count for differentiating patients with and without SCI at the end of the study period.

New SCIs were detected in 28.07% of patients by cranial MRI. Multivariate logistic regression analysis showed that cerebral microbleeds (CMBs), raised WBC counts, and leukoaraiosis were independent risk factors for SCI. The most appropriate cut-off WBC count differentiating the two groups was 7.65×109/L (sensitivity: 77.08%, specificity: 63.41%).

Elevated levels of serum WBC counts in patients with ICH are associated with SCI. There is potential value in using serum WBC counts to predict new SCI after an acute hemorrhagic stroke.

Loss of consciousness in children can be caused by a wide spectrum of factors, including infection, metabolic disorders, trauma, and poisoning which requires timely and accurate evaluation.

In this paper, we introduce a three-year-old boy who was first referred to the Emergency ward of Mashhad Imam Reza Hospital due to unconsciousness. Having spent a few days in a hotel, this boy, who was a visitor to Mashhad, lost consciousness. During evaluations, hypotension and severe high anion gap metabolic acidosis was observed. Finally, the patient was diagnosed with ethylene glycol poisoning.

Poisoning should be considered as one of the most likely diagnoses in children with loss of consciousness. The identification of the clinical symptoms and the use of appropriate diagnostic algorithms is essential for timely diagnosis and appropriate treatment of specific cases of toxicity.

Loeffler’s endocarditis is a rare disease, caused by endocardial involvement of esosinophils, which damages the heart and leads to endomyocardial fibrosis with consequent restrictive cardiomyopathy, mural thrombi or valvular dysfunction. The association between Loeffler’s endocarditis and Churg-Strauss syndrome (CSS) was also reported. Abnormal elevation of peripheral eosinophil counts in a heart failure patient is a hint of disease. Though echocardiography or cardiac magnetic resonance imaging (MRI) facilitates diagnosis, endomyocardial biopsy is still the gold standard. Treatments include immunosuppressive agents, anticoagulant and guideline-directed medical therapy for heart failure.

A 59-year-old man presented with progressive dyspnea for one week and he was referred to our hospital for surgical treatment evaluation because valve destruction by infective endocarditis has been suspected at the local hospital. Echocardiography revealed biventricular mural thrombus and limited aortic valve opening caused by abutting thrombus. Moreover, eosinophilia, bronchial asthma, lung infiltration, acute kidney injury and positive perinuclear anti-neutrophil cytoplasmic antibody (p-ANCA) test implied Churg Strauss syndrome. Eosinophil infiltrate with fibrin thrombus was revealed by endomyocardial biopsy. The patient was diagnosed of cardiac involvement of CSS and recovered after immunosuppressive and anticoagulant treatments.

Loeffler’s endocarditis should be suspected when physicians encounter restrictive cardiomyopathy accompanied by mural thrombus in a patient with eosinophilia. Prompt immunosuppressive and anticoagulant medication can bring the disease under control.

Extrapulmonary tuberculosis accounts for only 15% of new cases of tuberculosis. In extrapulmonary tuberculosis, usually affected areas include bone, pleura, lymph nodes, genitourinary system, joints, peritoneum and meninges. Tuberculosis epididymo-orchitis is an uncommon type of extrapulmonary tuberculosis.

We reported a case of tuberculosis epididymo-orchitis and involvement of the left testicle in a 37-year-old male patient. The left testicle had a heterogeneous parenchymal echo, and multiple hypo-echo and ill-defined areas were evident in the left testicle. In the color Doppler ultrasound, the left testicle with the epididymis on both sides was completely hyperemic. The findings were primarily in the favor of extrapulmonary tuberculosis. Therefore, after a 2-month first-stage treatment with four-drug therapy of anti-TB drugs such as rifampin 150 mg, isoniazid 75 mg, pyrazinamide 400 mg and ethambutol 275 mg, considering the weight of the patient (56 kg), 4 pills per day and the second phase with two-drug therapy, rifampin 150 mg and 75 mg of isoniazid, 4 pills per day for 4 months, extrapulmonary tuberculosis symptoms improved to a large extent.

To prevent epididymectomy and the effects that the disease may have on fertility, it should be tried to quickly diagnose and treat the disease at the same early stage of the disease.

Upper extremity intermittent ischemia due to non-aneurysmal, not occluded aberrant right subclavian artery (ARSA) is rare.

We describe a 30-year-old male who suffered from PFO and non-aneurysmal, not occluded ARSA, and presented by intermittent right upper extremity ischemia. He was treated by right carotid subclavian transposition for ARSA and antiplatelet medication for PFO.

Authors assume that intermittent limb ischemia can occur secondary to anatomical changes in a patient without aneurysmal degeneration or occluded ARSA and the existence of pure PFO without any evidence of venous thrombosis is not enough to prove the paradoxical emboli scenario.

Hexaflumuron is a benzoyl urea pesticide widely used in agriculture. This is the first case of severe toxicity of hexaflumuron.

A 51-year-old man was admitted to the poisoning ward of the Emam-Reza Hospital for loss of consciousness and hypotension secondary to pesticide toxicity. He had metabolic acidosis, bradycardia, and diffuse erythematous skin color change in the abdomen and legs. The results of toxicology tests were negative except positive test result for tricyclic antidepressants in immunochromatographic assay of urine. He was treated with normal saline, norepinephrine infusion and bicarbonate. His intoxication finally resulted to cardiac arrest and death on the 4th day of hospitalization, secondary to septic shock.

Acute poisoning with hexaflumuron can be life-threatening, thought its LD50 is greater than 5000 mg/kg. It may change the patient’s skin color to cherry and cause hypotension, loss of consciousness and metabolic acidosis, however, conclusive evidence to support these assumptions are required.