Caspian Journal of Internal Medicine
Volume:12 Issue: 4, Autumn 2021

Identification and control of the risk factors for hyperbilirubinemia can reduce the incidence and complications of this condition. Serum zinc level in newborns is reported to be one of the factors affecting the severity and incidence of neonatal hyperbilirubinemia. Therefore, the present study was conducted to compare hyperbilirubinemia incidence in neonates of zinc-taking and non-zinc-taking mothers.

In this observational study, we compared the incidence of hyperbilirubinemia during the first week of birth between newborns whose mothers had received zinc supplement during the third trimester of pregnancy (case group) with those whose mothers had not taken zinc supplement (control group). The checklist of newborns’ conditions in both case and control groups was completed based on the obtained data regarding the infants, mothers, and laboratory findings. Data was analyzed using chi-squared test and t-test.

The mean serum levels of zinc were 79.76±15 mg/dl and 70.93±15.67mg/dl in mothers who had received zinc during the third trimester and those who had not taken zinc supplement, respectively. The mean serum level of zinc in newborns who underwent phototherapy was 41.68±9.21 mg/dl, while it was 68.53±20.85 mg/dl in neonates who did not receive phototherapy. In addition, 36% of the neonates whose mothers had not received zinc required phototherapy, while only 11% of newborns whose mothers had taken zinc supplement received phototherapy.

Zinc consumption during the third trimester of pregnancy increased the serum zinc level in both newborns and mothers and reduced the incidence and severity of idiopathic hyperbilirubinemia requiring treatment.

Early repolarization (ER) is a common finding of the routine electrocardiogram (ECG). The ER usually considered a benign ECG finding, nevertheless a controversy. This study was conducted to investigate the relationship between early repolarization (ER) and the severity of coronary artery disease in patients with a diagnostic coronary angiography.

This case-control study included ninety patients (45 patients and 45 control groups) with a diagnostic angiography and was conducted in 2015. After obtaining informed consent, patients with angiography for ER were considered as cases and those for other purposes were as controls. Data were analyzed using SPSS software Version 16. A p-value lesser than 0.05 was significant.

The frequency of ER was higher in men (75.6%), and there was a significant relationship between sex and ER (P=0.003). The mean age of the patients in the ER group was lower than that of non-ER patients, but not statistically significant (P=0.1). Abnormal angiography was more prevalent in patients with ER than non-ER patients (59.6% vs. 40.4%). ER morphology showed a significant correlation to abnormal angiography and also stenosis severity (P=0.035).

ER was higher in men than in women. There was a significant correlation between the existence of ER morphology and atherosclerosis severity. Screening programs for ER detection may reduce the risk of arrhythmias and prevent related complications.

Via hemodialysis, viral infections can be transmitted in patients a new definition of this infection with no increase in liver enzymes, negative HCV-PCR in serum and presence of virus in the liver and peripheral blood mononuclear cell (PBMC) called occult hepatitis C virus (HCV) infection (OCI). We decided to examine the prevalence of occult hepatitis C infection on hemodialysis cases.

The current research is a cross-sectional study on patients with end-stage renal disease (ESRD) who were at three hemodialysis centers in Mazandaran province in Iran during 2012-2014. In this study of 356 patients who were undergoing hemodialysis, 54 patients were excluded due to positive HCV Ab, and the remaining 302 patients were enrolled. The test of all serum samples for HCV-RNA detection of plasma and PBMCs was done by real-time polymerase chain reaction (real-time PCR).

There was a significant association between the duration of dialysis with the prevalence of occult HCV infection (P=0.017). Eight (2.65%) patients were positive for HBs Ag and with OCI, but none of them was infected with both hepatitis C and B obviously. Also among the total number of patients, nine patients tested positive for HCV RT-PCR in PBMC in which one of them was positive for serum HCV RNA PCR and was excluded from the study.

The results showed that eight patients had an OCI. There was not any association found between age and sex with OCI, but there was a significant relationship between the duration of dialysis with the prevalence of OCI.

Pediatric patients feel significant fear and anxiety when undergoing surgeries. The ideal drug and its administration route have not been found yet. The aim of this study was to compare the efficacy and safety of intranasal (IN) ketamine and midazolam as premedication in children.

We studied 71 eligible pediatric patients undergoing elective urologic surgeries, aged 2 to 6 years. The degree of sedation and separation scores was compared between the two groups. Additionally, hemodynamic parameters, before premedication, after induction of anesthesia, and during surgery were documented and compared between two groups. Postoperatively, any side effect was recorded as well.

Finally, the data from 71 children were analyzed.  Recovery time was significantly longer in group K (ketamine) compared to group M (midazolam); 27.86±4.42 vs 38.19± 6.67 minutes respectively (P=0.01). No significant difference was observed in terms of sedation score between two groups of K & M; 3.29±0.78 vs 3 ±0.71 respectively (P=0.17), and not regarding separation score; 2.51±0.61 & 2.31 ±0.52 respectively (P=0.01). Vital signs were kept within the physiological limits in both groups with no marked fluctuations.

To produce sedation in young children, both midazolam and ketamine were effective and safe by IN route.

Autologous hematopoietic stem cell transplantation (auto-HSCT) has become an effective treatment for a wide range of hematologic and non-hematologic diseases. Patients undergoing HSCT might require multiple platelets and red blood cell (RBC) transfusions during aplasia phase until engraftment, which could profoundly affect patients’ conditions. Identification of risk factors associated with blood product requirements could help in decreasing transfusion-related complications. We evaluated the association of disease type, pre-transplant hemoglobin level, and pre-transplant platelet count with RBC/platelet transfusion requirement after auto-HSCT.

In this retrospective study, 324 patients diagnosed with multiple myeloma (MM), Hodgkin disease (HD), and non-Hodgkin lymphoma (NHL) and underwent auto-HSCT were included. The associations of disease type, pre-transplant hemoglobin level, and platelet count with post-transplant packed cell and single-/random-donor platelet transfusions were evaluated.

Our study results illustrated that the higher pre-transplant hemoglobin level significantly decreased the post-HSCT requirement for packed cell (IRR=0.81, [CI: 9.73-0.90], P=0.0001), while the pre-transplant platelet showed no significant relationship with platelet requirement after HSCT. HD was associated with increment in packed cell (IRR=2.04, [CI: 1.35-3.08], P=0.001) and single donor platelet (IRR=1.39, [CI: 1.09-1.78], P=0.008) requirement after transplant. The trends showed that a higher platelet level led to a lower need for platelet transfusion.

Pre-transplant hemoglobin level could be valuable markers for predicting post-HSCT RBC requirements and might be beneficial for better management of transfusion requirements to minimize the transfusion-related complications. Patients with HD seem to be more prone to blood product requirements post-transplant.

Dietary pattern is influenced by lifestyle, genetic, cultural, and socioeconomic factors. We investigated the status of prudent (PDP) and imprudent (IDP) dietary patterns and their relationship with demographic and anthropometric variables and health conditions in an urban population of Southeastern Iran.

The study was conducted on 9997 people aged 15-80 years randomly selected using one-stage cluster sampling. Demographic and anthropometric measurements were recorded through face-to-face interview, and their nutritional status was assessed by the food frequency questionnaire. PDP and IDP were identified based on scoring to the type and daily/weekly frequency of foods consumed and their production methods.

Fifty nine percent of the participants were females. PDP participants reported daily intake of whole grains (99.5%), fruits (66.5%), and unsaturated oil (88.6%). Daily intake of sweets and high fat dairy products were 55.7% and 46%, respectively. Women (64.8% vs 35.2 %) and people with diabetes (p<0.001), hypertension (p<0.01), and higher BMI (p<0.02) had healthier dietary status. People with lower education, cigarette smokers and opium users had a higher rate of IDP (all p<0.001). The dietary pattern improved with aging (AOR of IDP decreased from 1 in 15-24 years to 0.20 for 65-75 years) (p<0.001).

Younger people, men and those with lower education had unhealthier dietary pattern. It seems that dietary behavior is more related to the individualschr('39') tendencies and taste preferences. Modification of nutritional behaviors of the population and leading young people, men, and those with lower education to improve their dietary pattern is recommended.

Variations in placental thickness are associated with increased perinatal morbidity and mortality. However, only very few studies have been established on the correlation between placental thickness with birth outcomes. This study correlated placental thickness in 2nd and 3rd trimesters with neonatal outcome, maternal weight gain, and body mass index (BMI).

A total of 116 patients aged between 20 to 50 years with singleton pregnancy and regular menstrual history (and sure about their last menstrual period) were included. Placental thickness was measured at 24 and 36 weeks by ultrasound and was divided into three groups: Group A (normal placenta), Group B (thin placenta), and Group C (thick placenta); and correlated with neonatal outcome, maternal weight gain, and BMI.

Out of the 116 pregnant women, 55 (47.4%) were primigravida and 61 (52.6%) were multigravida. Six patients (3.6%) delivered pre-term before 36 weeks. In the 2nd and 3rd trimesters, most cases had normal placental thickness (Group A; 93.1% and 92.7%), followed by thin placenta (Group B; 5.2% and 7.3%) and thick placenta (Group C; 1.7% and 0), respectively. Two patients with thin placenta had neonatal death. A significant positive correlation was found between birth weight and placental thickness (at 24 weeks; 0.516r, P<0.00001 and at 36 weeks; 0.669r, P<0.00001) and maternal weight gain and birth weight (0.563r, P<0.00001).

Placental thickness on ultrasonography demonstrated well the correlation between birth weight in 2nd and 3rd trimesters and increased incidence of antenatal and postpartum complications resulting from thin placenta.

Systemic lupus erythematous (SLE) and rheumatoid arthritis (RA) are autoimmune diseases in which the antigen-antibody system plays an important role. As blood group and Rh are determined by the presence or absence of antigens on the surface of red blood cells (RBCs), we aimed to determine the distribution of ABO and Rh blood groups in SLE and RA patients and its association with disease manifestations.

This short communication is based on a study that was conducted on 434 SLE and 828 RA patients. We evaluated the distribution of ABO and Rh blood groups in RA and SLE patients.

This study projected that in lupus patients, Coombs-positive autoimmune hemolytic anemia and arthritis were more common among the B blood type and Rh-positive group, respectively. Furthermore, there was no relation between ABO and Rh blood group and rheumatoid factor (RF) and anti-Cyclic Citrullinated Peptide (anti-CCP) seropositivity. Moreover, there was no difference in distribution of blood groups in RA and SLE patients.

The higher frequency of blood group B in hemolytic anemia, and positive Rh in arthritis in lupus patients, develop the hypothesis of probable role of ABO blood group antigen in some manifestations of lupus.

We aimed to compare the diagnostic accuracy of mammography and ultrasonography and their breast imaging-reporting and data system (BI-RADS) classification versus breast core needle biopsy (CNB) findings in distinguishing the breast masses.

This cross-sectional study was conducted during 2016-2018 on female patients who were referred to a radiology center in Babol, northern Iran, for routine screening and/or for CNB. Patients underwent sonography and mammography by a senior radiologist. The breast lesions were also evaluated according to BI-RADS classification. CNB was performed on the breast masses by the same radiologist and pathological procedures were performed by an expert pathologist. Descriptive statistics were used to analyze the data.

In total, 213 breast masses were finally assessed, of which 107 (50.2 %) masses were benign and 106 (49.8 %) masses were malignant. The sensitivity for mammography and ultrasound alone was 72.6% and 68.9%, respectively. This rate for combined mammography and ultrasound was 84.9%. About BI-RADS classification, 28 masses were classified as BI-RADS 3, 99 as BI-RADS 4A, 4 as BI-RADS 4B, 18 as BI-RADS 4C, and 64 as BI-RADS 5. BI-RADS 4A had the highest sensitivity (70.1%) among BI-RADS categories. The highest specificity pertained to BI-RADS 3 and 5 (100%) among BI-RADS categories. Also, the highest accuracy was related to BI-RADS 5 (80.3%).

The results of the present study showed that combined mammography and ultrasound had a higher rate of accuracy than mammography or ultrasound alone. Furthermore, the imaging methods BI-RADS classification had an acceptable positive predictive value.

Septic shock is a critical medical condition and immediate intervention is required as well as hemodynamic stability using fluid and vasopressor. Direct relationship between changes in ETco2 and changes in the cardiac output. We evaluated the study by comparing the effect of using norepinephrine or dopamine on ETco2 of patients with septic shock.

A clinical trial study was performed on 138 patients with primary diagnosis of septic shock. 70 patients received norepinephrine and 68 patients received dopamine. Patientschr('39') end tidal carbon dioxide (ETco2), mean arterial pressure (MAP), pulse rate (PR), arterial blood gas (ABG) levels in two groups were measured and compared at baseline and after 30 and 120 minutes after inotrope infusion. Variables were compared by means of an unpaired student t-test, an unadjusted chi-square test.

138 patients, 70 treated with norepinephrine infusion and 68 with dopamine infusion were included in the study. ETco2 level significantly increased within 120 minutes of treatment in the norepinephrine group (31.10±9.65) compared to the dopamine group (23.71±9.66) (P=0.001). MAP significantly decreased in the group of norepinephrine 30 minutes after treatment (71.71±20.460) (P=0.014) and pulse rate also significantly decreased in the norepinephrine group compared to the dopamine group in 30 minutes (98.07±10.63 vs 106.43±13.54) and 120 minutes (91.15±6.18 vs 103.51±2057) after treatment (P=0.001).

Tissue perfusion and fluid responsiveness of the shock in the norepinephrine group showed improvement. Using ETco2 as a measure for determining volume assessment in patients undergoing mechanical ventilation by septic shock is applicable.

Few studies have used the 2016 American Society of Echocardiography/ European Association of Cardiovascular Imaging (ASE/EACVI) guidelines to detect left ventricular diastolic dysfunction (LVDD) among asymptomatic normotensive type 2 diabetes mellitus (T2DM) patients.

200 asymptomatic non-hypertensive diabetic cases and 281 controls matched for age and body mass index without evidence of arrhythmias, valvular, myocardial, pericardial or coronary artery disease underwent diastology assessment using 2 dimensional and M-mode echocardiography along with tissue Doppler imaging.

The presence of LVDD was seen to be significantly higher among the members of the diabetic group compared to the controls (35 vs. 14; P=0.001). The diabetics with LVDD had a longer duration of diabetes {8.04±7.75 vs. 5.27±5.49 years; P=0.04}, along with higher glycated hemoglobin (HbA1c) {8.40±1.38 vs. 7.80±1.60% ; P=0.05}, fasting blood glucose (FBS) {211.35±78.15  vs. 187.89±107.90 mg/dL; P=0.009, 2 hour post prandial blood glucose} (PPBS) {237.89±107.9 vs. 211.35±78.15 mg/dL; P=0.04}, serum triglyceride (TG) {246.91±171.82 vs. 163.44±99.37 mg/dL; P=0.008} yet had lower serum very low density lipoprotein levels (VLDL) {19.74±15.01 vs. 27.61±17.89 mg/dL; P=0.01}.

This is one of the few studies so far to have demonstrated a higher occurrence of LVDD specifically among asymptomatic normotensive T2DM patients using the 2016 ASE/EACVI guidelines.

Elderly people are in need of several drugs due to physiological changes and multiple chronic diseases. Studies have shown that anticholinergic drugs can cause cognitive impairment, reduced physical activity, and increased mortality in elderly population. Paying attention to the anticholinergic medication use in older adults can prevent the occurrence of adverse events and increase the quality of health care. This study was conducted to quantify exposure to anticholinergic medicines in older people in Amirkola.

This study is a part of the comprehensive cohort project that was being conducted from 2011 on the case patients of 60 years and above that referred to the Amirkola Health Center. A total of 1532 individuals were included, of whom 54.9% were men. The drug information was obtained by observing the patient’s prescription and self-report questionnaires and collected data were analyzed by SPSS software. Exposure to anticholinergic medications was measured using the drug burden index-anticholinergic (DBI-Ach) and the anticholinergic drug scale (ADS).

Among the 1532 elderly people with an average age of 69.21 years, 29% had DBI>0 and 36.3% had ADS>0. Also, there was a significant correlation between DBI and ADS (R=0.758). In addition, there is a significant relationship between sex variable with DBI and ADS (P=0.0001). So, women in comparison with men had higher values of DBI and ADS.

The findings of this study indicate that anticholinergic exposure is relatively high especially in older women, which posed special precautions to avoid inappropriate prescribing in the elderly.

Decreasing signal intensity of the spleen assessed by T2* MRI is a frequent finding in patients with beta-thalassemia due to iron deposition within the reticuloendothelial cells in this organ. This parameter can also be applied to determine the candidates for blood cell transfusion. However, the association between splenic siderosis and iron overload in other vital organs such as heart and liver remains unclear. The present study aimed to assess the correlation between iron deposition in splenic, hepatic and myocardial tissues by T2* relaxometry technique.

This cross-sectional study included 39 consecutive patients with a definitive diagnosis of beta-thalassemia major who underwent spleen, liver and heart MRI examinations for iron deposition and cardiac function.

No significant correlation was found between the heart and splenic T2* relaxation time (R=0.206, P=0.357). We revealed a strong correlation between the splenic T2* relaxation time and hepatic calculated T2*s (R=0.515, P=0.014). The liver T2* values can be predicted from the splenic T2*s by a new linear equation. According to the ROC curve analysis, the splenic T2* could significantly, but moderately predict moderate to severe from mild liver iron excess (AUC=0.667).

Our study demonstrated a significant linear correlation between the splenic and hepatic T2* relaxation time, probably indicative of the same iron deposition mechanism, and made us available to write a linear model that would predict the deposited iron density in the spleen with  the use of the magnetic resonance T2* values.

Dyslipidemia has been reportedly associated with an increased risk of atherosclerosis among psoriatic patients. Dietary intake can be a key factor in the pathophysiology of psoriasis. Herein, we assessed serum lipid profile and dietary intake in psoriatic patients, in comparison with healthy subjects.

In this case-control study, 45 psoriatic patients and 43 healthy controls were evaluated. We estimated the macro/micronutrient intakes and energy, using a food frequency questionnaire (FFQ). Anthropometric parameters and serum levels of triglyceride (TG), high-density lipoproteins (HDL), low-density lipoproteins (LDL), and very low-density lipoproteins were assessed. The case group was categorized by severity measured by PASI score (mild<10, moderate 10-20, severe >20). Diet plan 6.0 was used to analyze FFQs and data were analyzed in SPSS 16.0, with p<0.05 considered significant.

The case group had markedly higher body mass index (BMI), LDL, and cholesterol and significantly lower HDL compared with controls (p<0.05). Carbohydrate, energy, fat intakes were significantly higher in cases, while folate, fiber, and vitamin E intakes were significantly lower in the case group, compared with the control group (p<0.05). BMI, cholesterol, and triglyceride values and dietary intakes of fiber and vitamin E were significantly associated with severity of psoriasis (p<0.05).

Serum lipid profile and dietary intake are substantially important in psoriasis severity. Therefore, close monitoring of lipid profile and BMI during admission and follow-up and dietary modification can improve the severity of psoriasis.

Neurofibromatosis type 1 (NF-1) is a genetic disorder. A heterogeneous group of benign and malignant neoplasms are associated with NF-1. Adrenocortical carcinoma (ACC) is an extremely rare invasive malignancy. The association of ACC with NF1 is not well understood.

We report a case of ACC in the context of NF1 in a 39- year-old woman who referred with the chief complaint of a mass in left abdomen. A left adrenal lesion was diagnosed by CT scan. Biochemical tests showed no abnormality. Adrenalectomy was done and histological and immunohistochemical findings confirmed ACC. Due to the absence of metastasis, clinical stage II was considered for the tumor. On follow-up after six months, she was still alive and well and with no evidence of metastasis. The age of patient and lack of secretion of adrenal cortical hormones in this case were unlike most ACCs.

Also, modified Weiss score for malignancy of adrenocortical neoplasms, clinical staging system and different modality of treatment is discussed.

Although a nodular thyroid disease is higher in patients with pituitary adenoma, concurrent thyroid cancer with pituitary tumor is uncommon.

We report a young woman with discovered papillary thyroid carcinoma after 1-year transsphenoidal surgery for Cushing’s disease. Thyroidectomy was done and patient is well after three years follow-up.

We suggest the patient with functional pituitary adenoma be evaluated for thyroid tumor.

Lipomas are common harmless tumors that are created in the colon in the gastrointestinal tract. The aim of this study was to report a case study on gastrointestinal lipoma with GIB.

A 38-year-old man was admitted to the hospital because of gastrointestinal bleeding for two months in December 2017. He had abdominal pain, dyspeptic disorders, vomiting, melena, and intermittent hematemesis without significant weight loss. Upper gastrointestinal endoscopy indicated a large subepithelial lesion in the antrum of the stomach with near-normal mucosa. Endoscopic ultrasound (EUS) showed a large well-defined heterogeneous mass-like lesion in the antrum of the stomach. A subtotal gastrectomy was done in the patient. The histology results of the separated samples presented a gastric lipoma.

Gastric lipoma is often yellowish. It might ulcerate and bleed, but it does so, only rarely. It most frequently occurs as a solitary and smooth mass in the gastric antrum.