فهرست مطالب

Caspian Journal of Internal Medicine - Volume:14 Issue: 2, Spring 2023

Caspian Journal of Internal Medicine
Volume:14 Issue: 2, Spring 2023

  • تاریخ انتشار: 1402/01/15
  • تعداد عناوین: 25
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  • Juan Quiroz-Aldave, María Durand-Vásquez, Elman Gamarra-Osorio, Jacsel Suárez-Rojas, Pela Jantine Roseboom, Rosa Alcalá-Mendoza, Julia Coronado-Arroyo, Francisca Zavaleta-Gutiérrez, Luis Concepción-Urteaga, Marcio Concepción-Zavaleta* Pages 153-169
    Background

    A sedentary lifestyle and an unhealthy diet have considerably increased the incidence of diabetes mellitus worldwide in recent decades, which has generated a high rate of associated chronic complications.

    Methods

    A narrative review was performed in MEDLINE, EMBASES and SciELO databases, including 162 articles.

    Results

    Diabetic neuropathy (DN) is the most common of these complications, mainly producing two types of involvement: sensorimotor neuropathy, whose most common form is symmetric distal polyneuropathy, and autonomic neuropathies, affecting the cardiovascular, gastrointestinal, and urogenital system. Although hyperglycemia is the main metabolic alteration involved in its genesis, the presents of obesity, dyslipidemia, arterial hypertension, and smoking, play an additional role in its appearance. In the pathophysiology, three main phenomena stand out: oxidative stress, the formation of advanced glycosylation end-products, and microvasculature damage. Diagnosis is clinical, and it is recommended to use a 10 g monofilament and a 128 Hz tuning fork as screening tools. Glycemic control and non-pharmacological interventions constitute the mainstay of DN treatment, although there are currently investigations in antioxidant therapies, in addition to pain management.

    Conclusions

    Diabetes mellitus causes damage to peripheral nerves, being the most common form of this, distal symmetric polyneuropathy. Control of glycemia and comorbidities contribute to prevent, postpone, and reduce its severity. Pharmacological interventions are intended to relieve pain.

    Keywords: diabetic neuropathy, diabetes mellitus, complication, treatment, glycemic control, Hb A1c
  • Sharareh Zabihi Afroozi, Soraya Khafri*, Aliasghar Manouchehri, Mahasti Emami, Hajar Alizadeh, Sussan Moudi, Sara Khaleghi Pages 170-178
    Background

    Deaths due to potential suicide are preventable and this phenomenon is costly for the health care system and contradicts the values and cultural standards of an Islamic country.

    Methods

    This study is a retrospective study. The research population includes all cases of suicide during the years 2011-2018 who were referred to the emergency department of Babol hospitals. The results were analyzed using SPSS v.23 and Joinpoint Trend Analysis software 4.9.0.0 to identify significant changes in the temporal trends of the outbreak.

    Results

    The highest percentage of suicides occurred in summer (27.8%), on Saturdays (13%) and at night (53%). A total of 1.9% of the cases were commit suicides (leading to death). The highest frequency of suicide was shown in 1397 (21.2%) and the lowest in 1392 (5.1%) and was more common in women (68.2% vs. 31.8%). Suicide-related deaths was higher in the second four years (63.5%), but suicide rate was significantly higher in the first four years (2011-2014) and the mortality rate due to suicide was higher in men than women.

    Conclusion

    Suicide attempts were higher in women than men but the death rate was higher in men which means that men attempt suicide more seriously than women. The model also predicted that suicide rates would rise in the coming years. For this reason, this important issue, along with a detailed analysis of the roots of suicidal ideation and preventive measures, should be considered by health officials and social institutions.

    Keywords: Epidemiology, Trend, Suicide, Joinpoint Regression, Iran
  • Manizheh Ebrahimzadeh Pirshahid, Khadijeh Haghshenas, Mehrdad Kashifard, Javad Shokri-Shirvani* Pages 179-184
    Background

    Helicobacter pylori infection is the most common cause of peptic ulcer disease. However, the prevalence rates of non-helicobacter pylori idiopathic peptic ulcers have increased over the past few years. This study aims to compare the characteristics of Helicobacter pylori-positive with idiopathic duodenal ulcers.

    Methods

    A cross-sectional cohort study was conducted on 950 patients which were excluded from the analysis process duo to the concomitant presence of gastric ulcer, malignancy, Zollinger Ellison syndrome, Crohn's disease, esophageal varices, history of taking anti-Helicobacter pylori therapy, and history of taking NSAID or aspirin. Eventually, 647 subjects were enrolled for the analysis process. In this case, these subjects were divided into two groups: (I) Helicobacter pylori-positive ulcer group and (II) Helicobacter pylori-negative and non-NSAID (idiopathic) ulcer group.

    Results

    The findings showed that 417 patients (64.5%) had duodenal ulcers induced by Helicobacter pylori, and 111 patients (17.1%) had Helicobacter pylori-negative and non-NSAID ulcers. The mean ages of patients in Helicobacter pylori-positive and idiopathic ulcer groups were 39±15 and 42±17, respectively. In this case, 33 patients (29.7%) with idiopathic ulcers and 56 patients (25.1%) with Helicobacter pylori-positive ulcers had upper gastrointestinal bleeding. Also, 22 patients (21%) with idiopathic ulcers and 31 patients (16.5%) with Helicobacter pylori-positive ulcers had multiple duodenal ulcers

    Conclusion

    The present study demonstrated that the idiopathic ulcers included 17.1% of duodenal ulcers. Also, it was concluded that patients with idiopathic ulcers were predominantly male with an age range older than the other group. In addition, patients in this group had more ulcers.

    Keywords: Idiopathic Ulcer, Helicobacter Pylori, Duodenal Ulcer, Endoscopy
  • Firoozeh Akbari Asbagh, Fatemeh Ghasemzadeh*, Mahbod Ebrahimi, Fatemeh Davari-Tanha, Elham Feizabad, Parvin Akbari Asbagh, Samaneh Hosseini Quchani Pages 185-191
    Background

    Assisted reproductive therapy (ART) has been developed remarkably in these decades; however, the rate of unsuccessful embryo implantation especially in the frozen-thawed embryo transfer (FET) cycles remains high and is reported up to 70%.  The current study was designed to compare the effect of intramuscular injection of hCG on endometrium preparation and embryo implantation, in women undergoing FET compared to the control group.

    Methods

    This clinical trial was done on 140 infertile women that underwent FET. The study sample was randomly allocated to the intervention group (two 5000 unit ampoules of hCG were injected intramuscularly before the first dose of progesterone administration) and the control group (without hCG injection). In both groups, 4 days after progesterone administration, the cleavage stage embryos were transferred. The study outcomes were biochemical pregnancy, clinical pregnancy and abortion rate.

    Results

    The average age of intervention and control group was 32.65±6.05 and 33.11±5.36 years, respectively. The basic information between two study groups did not differ significantly. The chemical (30% vs. 17.1%, P=0.073, relative risk (RR)=0.57) and clinical (28.6% vs. 14.3%, P=0.039, RR=0.50) pregnancy rates were higher in the intervention group compared to the control group; these higher ratios were only significant in clinical pregnancy rate. Abortion rate was not significantly (P=0.620) different between the intervention and control groups (4.3% vs. 1.4%, respectively).

    Conclusion

    This study showed that intramuscular injection of 10000 IU hCG before the endometrial secretory transformation phase in cleavage-stage embryo, improves IVF cycle outcomes.

    Keywords: In vitro fertilization, Human chorionic gonadotropin, Pregnancy outcome
  • Abbas Dabbaghzadeh, Javad Ghaffari*, Siavash Moradi, Davood Sayadian Separghan Pages 192-198
    Background

    Urticaria is a common itchy skin condition characterized by swelling and erythema. A variety of treatments is available today. The purpose of this study was to evaluate the clinical effects of probiotic use in patients with chronic resistant urticaria.

    Methods

    This four-way blind randomized clinical trial was conducted between June 2019 and June 2020. Study population consisted of patients with chronic urticaria who did not respond well to first line treatment with antihistamines. For the intervention group, antihistamine (cetirizine) and probiotics (femilact capsule) and for the control group, antihistamine (cetirizine) and placebo were administered twice a day for 8 weeks. The “Urticarial Activity for 7 Days” (UAS7) questionnaire was used to assess urticaria activity and the Dermatology Life Quality Index (DLQI) questionnaire was used to assess the quality of life of patients.

    Results

    Patients’ age range was 7 to 30 years with a mean and standard deviation of 23.6±9.2 years. 31 (81.57%) cases were females and 7 (18.42%) cases were males. Twenty patients were in the intervention group and eighteen patients were in the control group. The mean scores of UAS7 questionnaire were reduced in both groups, but it was more significant in the intervention group (9.6±6.4) compared to the control group (12.7±8.1) at the end of week eight of treatment (P=0.036). Also, there was no significant difference in the quality of life between the two groups after 8 weeks (P=0.805).

    Conclusion

    This study showed that probiotic consumption along with antihistamines significantly improved the activity of urticaria but not the quality of life of patients.

    Keywords: chronic urticaria, histamine antagonists, probiotics, therapeutics
  • Amene Aman-Mohammady, Payam Saadat*, Durdi Qujeq, Karimollah Hajian-Tilaki, Kiarash Saleki Pages 199-204
    Background

    The changes of plasma transcobalamin-II (TCII) and Zinc (Zn) Levels in epileptic patients are not clearly understood. The aim of the current study was to evaluate the plasma contents of TCII and Zn levels in newly–diagnosed epileptic seizure patients, long-standing grand mal epileptic patients following treatment with sodium valproate and healthy control group.

    Methods

    Thirty patients aged 36.76±12.91 years with newly–diagnosed and thirty long-standing grand mal epileptic patients aged 35.56 ±12.77 years were diagnosed based on the clinical symptoms. The control subjects were picked out from healthy individuals and matched to the patients, aged 36.30 ±12.80 years. Plasma Zn and TCN-2 was evaluated via spectrophotometry at 546 nm and 450 nm, respectively, using chimerical kits.

    Results

    Plasma level of TCII in the newly–diagnosed epileptic seizures patients and long-standing grand mal epileptic patients were significantly increased, compared to the healthy controls [14.89 ±3.24 and 21.84± 2.73 vs. 9.55±1.24, (n=30)], respectively. Plasma level of Zn was decreased in the newly–diagnosed epileptic seizure patients, while it was increased in long-standing grand mal epileptic patients compared to the control group [69.28± 6.41 and 80.56 ±6.12 and vs.75.80±1.59, (n=30)], respectively.

    Conclusion

    This study suggests that sodium valproate may disrupt the homeostatic balance of TCII and Zn, and cause abnormality of their serum level in newly–diagnosed epileptic seizure patients and long-standing grand mal epileptic patients. Further research is recommended to identify the underpinning for these changes.

    Keywords: Transcobalamin-2, zinc, newly –diagnosed, long –standing grand mal, epileptic
  • Mojgan Tansaz, Marjan Akhtari, Mohsen Naseri, Reza Majdzadeh, Mohsen Saberi Isfeedvajani, Mohammad Reza Shams-Ardakani, Fatemeh Nejatbakhsh, Abbas Ebadi, Morteza Mojahedi* Pages 205-212
    Background

    The process of diagnosis and treatment in Persian medicine (PM) are based on the concept of Mizaj (temperament). Among the indices of Mizaj determination, anthropometric indices are less influenceable regarding age change and other environmental factors. The purpose of this study was to investigate the relationship between anthropometric indices and Mizaj.

    Methods

    Four PM experts determined the Mizaj of 121 participants. Those who had ≥70% agreement in their Mizaj determination by the experts were selected and their anthropometric indices were measured. The best cutoff point of each index and its relationship with the defined Mizaj were extracted using Receiver Operative Characteristic Curve and Binary Logistic Regression.

    Results

    52 out of 121 participants entered the main study. The warm-Mizaj people had larger dimensions in height, shoulder, chest, palm and sole width, and head height. Cold-Mizaj people had smaller dimensions in weight, height, shoulder, chest and head. High levels of BMI, chest depth and head dimensions had the highest correlation with the wet Mizaj and lower dimensions of these indices had the highest correlation with the dry Mizaj. 

    Conclusion

    Among the anthropometric indices, chest, palm, sole dimensions, head height and weight had the highest correlation with warmness/coldness and BMI, head width and chest dimensions had the highest correlation with wetness/dryness. The BMI which is more closely related to the soft tissue, only correlates with the wetness/dryness, while, bone dimensions are associated with warmness/coldness. Further studies are needed to metricize the anthropometric indices for Mizaj determination.

    Keywords: Anthropometric indices, Mizaj, Persian Medicine, Personalized medicine, Temperament
  • Azar Shirzadian Kebria, Abolfazl Eftekhari, Khadijeh Ezoji, Soudabeh Tirgar Tabari, Zeinab Aryanian, Soraya Khafri, Mansour Babaei* Pages 213-216
    Background

    The Early Arthritis for Psoriatic Patients (EARP) questionnaire is a fast and simple way to screen psoriatic arthritis. This study was carried out to investigate the diagnostic accuracy of the Persian version of the Early Arthritis for Psoriatic Patients (P-EARP) questionnaire.

    Methods

    A total of 100 psoriasis patients responded to the questionnaire after the translation procedure (translation, back translation). After determining the validity of the questionnaire, the diagnostic accuracy of the P-EARP questionnaire was assessed using the ROC curve (receiver operating characteristic curve). Internal and external reliability of the questionnaire were also evaluated by statistical tests.

    Results

    In assessing the reliability of the questionnaire using test-retest, correlation coefficient (r=0.994, p <0.001) and Cronbach's alpha (α = 0.85) were obtained. The P-EARP questionnaire had a sensitivity and specificity of 90.48% and 96.55% in ROC analysis, respectively, and cutoff point 3 was regarded as the cutoff point of the P-EARP questionnaire like the original version of the questionnaire (EARP).

    Conclusion

    The results of this study showed that the P-EARP questionnaire had high sensitivity and specificity for the identification of psoriatic arthritis. The P-EARP questionnaire is an appropriate screening tool for the identification of psoriatic arthritis in the dermatology clinics.

    Keywords: Questionnaire, Psoriatic Arthritis, Reliability, Validity
  • Mohammad Haghighi, Soheil Soltanipour, Farnoush Farzi, Mandana Mansour-Ghanaei, Gelareh Biazar*, Azadeh Malekzadeh, Mahin Tayefeh Ashrafiyeh Pages 218-225
    Background

    Recently, the prevalence of cesarean section (CS) has been on the rise and the proper uterine tone is an important issue. We investigated the effects of intravenous (IV) ketamine on intraoperative bleeding and the need for oxytocin in CS under spinal anesthesia (SA).

    Methods

    This study, took place at Alzahra hospital during 2020. Pregnant women candidate for elective CS under SA were divided into two groups of ketamine and placebo. In group K, after umbilical cord clamping, 0.25 mg/kg ketamine and in group P 2ccs normal saline was injected. Mean arterial pressure and heart rate were recorded at baseline, before and 5 minutes after cord clamping and at the end of the surgery. The drop in hemoglobin values, the administrated units of oxytocin and side effects were also recorded.

    Results

    No significant difference was found in terms of patients’ demographic data (P ≥ 0.05). The mean units of administrated oxytocin in group K was 34.61±6.63 and in group P; 48.47±12.15, which was significantly different (P=0.0001). The drop in Hb was less in group K, however not statistically significant (P=0.094). The need for methergine was significantly higher in group P (P=0.0001). The mean HR was significantly higher in group P (P=0.027), however, no significant difference was observed regarding the MAP (P=0.064). The incidence of hallucination (4.8%) and nystagmus (21%) was significantly higher in group K (P= 0.0001), but nausea and vomiting were more significant in group P (P= 0.027).

    Conclusion

    Prophylactic administration of low-dose ketamine in CS under S.A could significantly reduce the administrated oxytocin units and the need for additional utero-tonics and was associated with less drop in Hb values.

    Keywords: Bleeding, Ketamine, Intraoperative Care, Oxytocin
  • Mehdi Yalmeh, Abdolreza Emami*, Javad Shokri Shirvani, Hassan Abedi, Mohamad Taghi Hamidian, Hemmat Gholinia Ahangar Pages 226-230
    Background

    Various factors, most notably the stone's features, determine the selection of an appropriate method to extract common bile duct (CBD) stones during endoscopic retrograde cholangiopancreatography. In this study, the efficacy and safety of endoscopic sphincterotomy with balloon dilation (ESBD) versus endoscopic sphincterotomy (EST) for CBD stone extraction with a diameter of 10 to 15 millimeters were compared.

    Methods

    This retrospective cross-sectional study included 154 patients referred to the Rouhani Hospital in Babol, Iran, with CBD stones. Consensus sampling was used. Each individual's demographic information and findings from the procedure were entered into the SPSS software (v. 26). A level of less than 0.05 was considered statistically significant.

    Results

    A total of 154 patients were included in the study, of which 81 (52.6%) were in the EST, and 73 (47.4%) were in the ESBD group. Complete stones removal rate was higher in the ESBD versus the EST group (79.5% versus 46.9%, P<0.001). No significant differences were observed between the two methods' overall side effects rate (P = 0.469).

    Conclusion

    For the complete extraction of CBD stones larger than 10 millimeters, the ESBD method outperforms the EST method.

    Keywords: Endoscopic retrograde cholangiopancreatography, common bile duct stone, efficacy, safety, Endoscopic Sphincterotomy, endoscopic sphincterotomy with balloon dilation
  • Nayyereh Saadati, Maryam Miri* Pages 231-236
    Background

    Lupus nephritis (LN) is a debilitating complication of systemic lupus erythematosus (SLE). Renal biopsy is the gold standard for evaluating LN. Serum C4d is a potential non-invasive method for evaluating LN. The purpose of this study was to evaluate the value of C4d in the assessment of LN.

    Methods

    This cross-sectional study was conducted on patients with LN who were referred to a tertiary hospital in Mashhad, Iran. Subjects were divided into four groups including LN, SLE without renal involvement, chronic kidney disease (CKD) and healthy controls. Serum C4d. creatinine, and glomerular filtration rate (GFR) were assessed for all subjects.

    Results

    Forty-three subjects (11, 25.6% healthy controls, 9, 20.9% SLE patients, 13, 30.2% LN and 10, 23.3% CKD patients) participated in this study. CKD group were significantly older than other groups (p>0.05). There was a significant difference in gender distribution between groups (p<0.001). Median serum C4d were 0.6 in healthy controls and CKD group and 0.3 in SLE and LN groups. There was no significant difference in serum C4d between groups (p=0.503).

    Conclusion

    The findings of this study indicated that serum C4d might not be a promising marker in the assessment of LN. These findings should be documented by further multicenter studies.

    Keywords: Lupus nephritis, Systemic lupus erythematosus, C4d
  • Nur Aklina Ramli, Salfarina Iberahim Sal Salfarina, Hasmah Hussin*, Ahmad Arif Che Ismail Pages 237-248
    Background

    Cancer-related anaemia is one of the main burdens in oncology, although the available data on its prevalence and treatment options such as blood transfusion are often contradictory. This study aimed to evaluate the prevalence of anaemia and the requirement for packed red blood cell (PRBC) transfusion among women with breast cancer (BC) and to determine the associated factors for chemotherapy-induced anaemia (CIA).

    Methods

    This cross-sectional retrospective study conducted in Kelantan involved 104 newly diagnosed female BC patients from 2015 to 2016 who underwent chemotherapy. For statistical analysis, chi-square was used to compare between CIA and non-CIA groups. In addition, simple and multiple logistic regression were used to determine the association of the CIA.

    Results

    Our study revealed that 34.6% (n=36) of patients had mild anaemia, and 59.6% (n=62) had normal haemoglobin at pre-chemotherapy. The prevalence of anaemia increased from 40.4% to 77% at the end of our study. About 30.8% of patients received PRBC transfusion during chemotherapy with mean haemoglobin before the first transfusion of 7.9 g/dl. CIA was observed in 54.8% of cases. There was no significant association between CIA concerning the patient characteristic, cancer characteristic, or cancer treatment.

    Conclusion

    We concluded that a significant proportion (40.4%) of BC patients was anaemic even before chemotherapy, with the red blood cell requirements up to 30.8% throughout chemotherapy. A larger prospective study is needed to determine the predictors for the CIA and subsequently improve patient management.

    Keywords: breast cancer, anaemia, red cell transfusion, chemotherapy
  • Dana Taizhanova*, Aliya Toleuova, Dmitry Babenko, Anar Turmuhambetova, Roza Bodaubay, Olga Visternichan, Akerke Kalimbetova, Ludmila Ahmaltdinova, Aigul Kurmanova Pages 249-256
    Background

    Surgical methods such as coronary artery bypass grafting and percutaneous coronary interventions (PCI) are widely used along with traditional conservative therapy in the treatment of coronary artery disease. The disease outcome directly depends on timely diagnosis and treatment. A significant role in predicting the effectiveness of treatment is given to personification of treatment and management of the patient. In this case, the determining component is its individual genetic status.

    Methods

    The study groups included persons of Kazakh nationality which identify themselves, their biological parents, and biological grandparents on the maternal and paternal side as Kazakh. Research groups included 108 people at the age from 45 to 65 years of both sexes. Blood samples genotyping was carried out by PCR using highly specific TaqMan samples. Thermo Fisher cloud application was used for genotypes determining on the base of an automatic algorithm.

    Results

    The article presents the results of the evaluation of gene polymorphisms associated with coronary artery restenosis in a population of Kazakh nationality. 3 SNPs were determined when searching for an association with stenting due to coronary artery thrombosis: rs7543130 (p=0.009324), rs6785930 (p=0.016858), rs7819412 (p=0.061325).

    Conclusion

    Four polymorphisms associated with the risk of developing coronary heart disease were revealed during the study of polymorphisms among the people of the Kazakh population. Three SNPs were determined when searching for an association with stenting due to coronary artery thrombosis. It should be noted that the Bonferonni correction for multiple comparisons did not reveal significant polymorphisms associated with coronary artery disease, which requires further research with more quantity of samples.

    Keywords: coronary, artery, restenosis, genetic, polymorphism, pre-test, probability
  • Fatemeh Yousefnia Babaki, Mahmood Khodadoost, Hossein Rezaeizadeh, Abdorreza Naser Moghadasi, Shirin Fahimi, Hamed Hosseini, Mina Movahhed, Kurosh Gharagozli* Pages 257-266
    Background

    The purpose of this study was to investigate the efficacy and safety of Jollab monzej (JMZ), a Traditional Persian compound medicine, on multiple sclerosis-related fatigue (MSRF).

    Methods

    We did a double-blind randomized controlled phase3 clinical trial on the JMZ syrup in fifty-six relapsing-remitting MS (RRMS) patients aged 18-55 years with moderate to severe fatigue using the Expanded Disability Status Scale (EDSS) score ≤ 6. We randomly assigned (1;1) participants to the JMZ syrup or placebo syrup groups treated for one month. Participants, investigators, and assessors were unaware of the assignments. The primary outcome was changes in the fatigue score on the Fatigue Severity Scale (FSS), at baseline and one month after treatment using the intention-to-treat (ITT) analysis. The secondary outcomes were changes in the score of Visual Analogue Scale (VAS), Beck Depression Inventory (BDI), and Pittsburgh Sleep Quality Index (PSQI). Outcomes were measured at baseline, one month after treatment, and 2-week follow-up. Safety was detected in all participants.

    Results

    We randomly assigned 56 participants to the JMZ group (n=28) and placebo group (n=28). Fatigue scores significantly changed in both groups; however, the JMZ group had a greater reduction in FSS score in the ITT analysis. The adjusted mean difference was 8.80 (Confidence interval (CI) 95%, 2.90-14.70, P = 0.00). The mean difference of VAS, BDI, and global PSQI scores were statistically significant (P=0.01, P₌0.00, P₌0.01; respectively). Regarding safety, mild adverse events (AEs) were reported.

    Conclusion

    The results of our study revealed that the administration of JMZ syrup alleviated MSRF and also could improve depression and sleep disorders.

    Keywords: multiple sclerosis, fatigue, herb, Persian Medicine
  • Abolfazl Mehdizadehkashi, Shahla Chaichian*, Samaneh Rokhgireh, Kobra Tahermanesh, Shahla Mirgaloybayat, Reza Saadat Mostafavi, Sepideh Khodaverdi, Marziyeh Ajdary, Mahin Ahmadi Pishkuhi Pages 267-355
    Background

    Endometriosis is one of the common gynecological problems during the reproductive years, affecting the quality of life, fertility, and sexual function of women. It is known that sexual dysfunction and quality of life are interrelated. Therefore, this study aimed to evaluate the effect of resection of endometriosis lesions via laparoscopic surgery on the improvement of sexual dysfunction in women with endometriosis.

    Methods

    This clinical trial was performed on 30 patients with endometriosis. The Female Sexual Function Index, Endometriosis Health Profile-30, and Visual Analog Scale were completed for the patients before laparoscopic surgery and three, six, and 12 months after surgery. The results were examined and compared before and after the intervention using the ANOVA test.

    Results

    The present results showed that the mean pain score of the patients (dysmenorrhea, dyspareunia, and pelvic pain) was significant after laparoscopic surgery (P<0.005). The female sexual function improved after laparoscopic surgery compared to the preoperative phase, and changes in the domains of psychological stimulation, humidity, and sexual orgasm were significant (P<0.005). Moreover, the female quality of life scores increased in all dimensions compared to the preoperative phase, although these improvements were not statistically significant.

    Conclusion

    The present results revealed that laparoscopic surgery is an effective treatment, leading to a considerable improvement in female sexual function.

    Keywords: Endometriosis, Laparoscopy, Sexual dysfunction
  • Kourosh Saki, Mahmoud Bahmani, Golnaz Zamanian, Naser Abbasi, Ali Aidy, Aliasghar Manouchehri*, Sudip Kumar Mandal, Paramita Ganguly, Samira Shokri Pages 356-364
    Background

    Every year, drug poisoning is the most prevalent reason for referring patients to medical centers. This study aimed to evaluation of morphine, methadone, digoxin, and dronabinol poisoning in Shahid Mostafa Khomeini Hospital in Ilam.

    Methods

    In this In this Cross-sectional study, patient samples suspected of morphine, methadone, digoxin, and dronabinol poisoning referred to the toxicology laboratory of Ilam University of Medical Sciences were analyzed using the HPLC method, and the results were analysed using SPSS software.

    Results

    Results showed that the percentage of drug use is greater in men than in women. The highest percentage of morphine and methadone poisonings were detected in those under the age of 40, whereas the highest percentage of digoxin poisonings were recorded in those over the age of 80. As a result, the average age of digoxin users was substantially greater in men than in women. Methadone consumers showed significantly greater blood levels than others. In addition, there was a significant difference (P<0.01) in blood levels between men and women who used morphine.

    Conclusion

    In general, it is important to understand the status of drug poisoning with drugs such as morphine, methadone, digoxin, and dronabinol, as well as the prognosis associated with the treatment process of such poisoning.

    Keywords: Poisoning drug, Dronabinol, Digoxin, Methadone, Morphine
  • Niusha Shahidi Sadeghi, Mohammadreza Maleki, Hasan Abolghasem Gorji, Soudabeh Vatankhah, Bahram Mohaghegh* Pages 365-370
    Background

    In recent years, there have been many non-teaching hospitals that have become teaching hospitals. Although the decision to make this change is made at the policy level; But the unknown consequences can create many problems. The present study investigated the experiences of hospitals in changing the function of a non-teaching to a teaching hospital in Iran.

    Methods

    A Phenomenological qualitative study was conducted using semi-structured interviews with 40 hospital managers and policy makers who had the experience of changing the function of hospitals in Iran through a purposive sampling in 2021. Thematic analysis using inductive approach and MAXQDA 10 was used for data analysis.

    Results

    According to the results extracted 16 main categories and 91 subcategories. Considering the complexity and instability of command unity, understanding the change of organizational hierarchy, developing a mechanism to cover client’s costs, considering increase management team’ legal and social responsibility, coordinating policy demands with Providing resources, funding the teaching mission, organizing the multiple supervisory organizations, transparent communication between hospital and colleges, understanding the complexity of processes, considering change the performance appraisal system and pay for performance were the solutions for decrease problems of changing the function of non-teaching to teaching hospital.

    Conclusion

    Important matter about the improvement of university hospitals is evaluating the performance of hospitals to maintain their role as progressive actors in hospital network and also as the main actors of teaching future professional human resources. In fact, in the world, hospital becoming teaching is based on the performance of hospitals.

    Keywords: teaching hospitals, Systems Integration, Health Systems Agencies, university hospitals‎
  • Hadise Heidarpour, Farnaz Hooshmand*, Fazel Isapanah Amlashi, Behnaz Khodabakhshi, Mahsa Mahmoudi, Taghi Amiriani, Sima Besharat Pages 371-375
    Background

    Anti-TPO antibodies are one of the characteristic factors in autoimmune thyroiditis (AIT). Previous studies reported a high prevalence of anti-TPO antibodies (Abs) in Iran. We have therefore assessed the prevalence of anti-TPO Abs in Gorgan, Iran.

    Methods

    This cross-sectional study, conducted from 2015 to 2018 in Gorgan city, Northeast of Iran. The Participants included women with Poly cystic ovary syndrome (PCOs), celiac patients, men with hepatitis C infection, and age and sex-matched controls. ELISA method was used for the analysis of laboratory tests.

    Results

    The number of enrolled subjects in PCOs, celiac disease, and Hepatitis C infection groups were 76, 67, and 60, respectively. Anti-TPO Abs positivity was significantly higher in patients with PCOS than in the control group (18.4% vs. 0.00%; p = 0.000). There were no significant differences in the frequency of anti-TPO Abs positive cases between CD patients and the controls (26.9% vs. 21.1% p =0.413). The incidence of anti-TPO Abs positivity was significantly higher in the control group (10% vs. 25%; P = 0.031).

    Conclusion

    Very high level of anti-TPO Abs was observed in both patients and healthy population in Golestan province. Considering this rate and its association with autoimmune disorders, it is suggested to prioritize screening programs for related disease in this area.

    Keywords: Anti-thyroid Peroxidase (anti-TPO), Autoimmune thyroiditis (AIT), Celiac disease, Hepatitis C infection, Iran
  • Meghdad Hosseini, Farhad Asarzadegan*, Erfan Shafiee, Shayan Alijanpour Pages 376-379
    Background

    Trigeminal neuralgia is one of the most disabling facial pain syndromes. In recent years' new therapeutic strategy, incobotulinumtoxin A has emerged. The aim of the current study was to determine the time and duration of pain in 3 cases with pharmacological treatment and incobotulinumtoxin A.

    Case presentation

    In three patients with different onsets, trigeminal neuralgia was diagnosed. Pain severity was assessed by the visual analogue scale. Patient demographics and clinical data were filled in a checklist. They were females with age ranging from 39 to 49 years. Two patients had normal MRI and one patient had no any recent MRI. One center and specialist injection Xeomin 50 units for one time. Despite long time oral treatment, their symptoms had no significant improvement, but after incobotulinumtoxin A injection, pain frequency, severity and duration decreased in patients.

    Conclusion

    Result showed that the frequency, severity and duration of pain attacks was efficiently decreased by incobotulinumtoxin A with low side-effects. Its complication and side-effect should be considered in the future.

    Keywords: Trigeminal, Neuralgia, Pain, Iran
  • Abdolreza Emami, Yasser Asghari, Hasan Abedi Valukalaei*, Mohammad Sakhaei Pages 380-385
    Background

    Despite the prevalence of intestinal malformation in Childs, late-onset during adulthood is rare and usually diagnosed incidentally. It may be present as subtle or vague abdominal pain following mid-gut volvulus. Computerized tomography may help diagnosis, but surgery remains the gold standard of diagnosis and treatment.

    Case Presentation

    We presented a 24-year-old woman who complained of chronic intermittent abdominal pain, progressive food intolerance, and severe weight loss. Magnetic resonance enterography revealed dilated jejunum and collapsed ileum with slight bowel rotation around its mesentery (whirlpool sign), which was suggestive for mal-rotation of the intestine complicated by midgut volvulus, then the diagnosis was confirmed by laparotomy. During six months of follow-up after surgery, the patient's appetite improved significantly with eight kilograms of weight gain and resolution of abdominal pain.

    Conclusion

    It may be a rationale to consider intestinal malformation as a differential diagnosis in a patient who complained of chronic abdominal pain with progressive weight loss, anorexia, and recurrent bowel obstructive symptoms.

    Keywords: Midgut Malrotation, Volvulus, Adult, Congenital Abnormalities, Case Report
  • Ali Jangjoo, Sina Norouzi Asl, Yeganeh Azadmanesh, Tooraj Zandbaf* Pages 386-390
    Background

    Echinococcus granulosus causes hydatid disease, which is found in various countries of the world, including Iran. The liver and lungs are prevalent involved structures in hydatid disease. One of the least common sites in hydatid disease seems to be the omentum. Seven cases of mesenteric, diaphragmatic, omental, pelvic, and retroperitoneal hydatid cysts have been reported in Iran within last 20 years. The appearance of hydatid disease as a primary mass in the greater omentum without hepatic involvement is very rare and no similar case was introduced in Iran in our searches.

    Case Presentation

    Our patient was a 33-year-old woman who underwent a diagnostic laparoscopy due to abdominal pain and an abdominal mass. During laparoscopy, there was a solid mass with a size of about 10 × 5 cm in the greater omentum that was resected. The histopathological examination of the mass showed the hydatid disease.

    Conclusion

    The hydatid cyst can appear anywhere on the body, and no part of the body is guarded. Since these uncommon locations often cause nonspecific symptoms, the hydatid cyst should be included in the differential diagnosing of omental cysts, particularly in endemic countries like Iran.

    Keywords: Hydatid disease, Hydatid Cyst, Echinococcus Granulosus, Greater Omentum, Echinococcosis, Case Report
  • Hafez Fakheri, Zohreh Bari*, Mohammad Yaghoobi, Parham Rabiee Pages 391-395
    Background

    Appendiceal mucocele (AM) is a rare disease, manifested by accumulation of mucus in appendiceal lumen. The role of ulcerative colitis (UC) in the occurrence of appendiceal mucocele is not known. However, it is suggested that AM may be a presentation of colorectal cancer in IBD patients.

    Case Presentation

    Here, we presented 3 cases of concomitant AM and ulcerative colitis. The first patient was a 55-year-old woman with 2-year history of left sided UC; the second person was a 52-year-old woman with 12-year history of pan-UC; and the third patient was a 60-year-old man with 11-year history of pan-colitis. They were all referred due to indolent right lower quadrant abdominal pain. Imaging evaluations suggested the presence of appendiceal mucocele and therefore, they all went under operation. Pathologic evaluation reported AM of mucinous cyst adenoma type; low-grade appendiceal mucinous neoplasm of appendix with intact serosa; and cyst-adenoma type AM for the three above-mentioned patients, respectively.

    Conclusion

    Although concomitant occurrence of AM and ulcerative colitis is rare, regarding the potential of neoplastic changes in AM, physicians must keep in mind the diagnosis of AM in UC patients with non-specific abdominal RLQ pain or bulged appendiceal orifice during colonoscopy.

    Keywords: Appendiceal mucocele, ulcerative colitis
  • Ulaş Aday*, Abdullah Oguz, Hikmet Özesmer, Mehmet Veysi Bahadır Pages 396-400
    Background

    Maintaining collateral circulation is highly important in the stenosis of celiac artery (CA), superior mesenteric artery (SMA), and inferior mesenteric artery (IMA). The SMA compression is commonly reported to be accompanied by the CA compression caused by the median arcuate ligament (MAL) while the synchronous compression of CA and SMA by other ligaments has been rarely reported.

    Case Presentation

    In this report, we present a 64-year-old female patient who presented with a postprandial abdominal pain and weight loss. Initial evaluation indicated a synchronous compression of CA and SMA caused by MAL. The patient was planned for laparoscopic MAL division due to the presence of sufficient collateral circulation between the CA and SMA that was facilitated through the superior pancreaticoduodenal artery. Following laparoscopic release, the patient improved clinically and postoperative imaging indicated that the compression on the SMA was still present and the collateral circulation was sufficient.

    Conclusion

    We suggest that laparoscopic MAL division can be the primary method of choice in cases with sufficient collateral circulation between the CA and SMA.

    Keywords: Multilagament compression syndrome, collateral circulation, laparoscopic treatment
  • Soheil Motamed, Maryam Amizadeh*, Shahriar Dabiri Pages 401-405
    Background

    Langerhans cell histiocytosis (LCH) or histiocytosis X is considered as a rare disease that may have effect on multiple organs. The initial presentation of LCH is varied. The signs and symptoms of otologic histiocytosis can be the same as the acute or chronic infectious ear diseases. Definitive diagnosis of LCH is confirmed by biopsy and immunohistochemically staining of S-100 protein and CD1a antigen. Chemotherapy is the main mode of treatment.

    Case presentation

    In this report, we explained the clinical manifestation, diagnosis and treatment of a case of 15 month-old girl with diagnosed of LCH that initially presented with otitis media with effusion (OME).

    Conclusion

    LCH is a rare disease that presented with variable sign and symptoms and have an effect on multiple organs. LCH should be regarded in cases with recurrent ear infection without response to medical treatments. Moreover, biopsy with IHC is the gold standard of diagnosis and chemotherapy is the main form of treatment.

    Keywords: Langerhans cell histiocytosis, histiocytosis X, otitis media with effusion, children
  • Stella Pravita, Sony Wibisono, Ivana Purnama Dewi* Pages 406-411
    Background

    Deep neck infection (DNI) is an infection that occurs in the deep neck fascia and spaces commonly found in diabetic patients. Impaired immune system due to hyperglycemic condition in diabetic patients leads to different clinical presentations, prognosis, and management and therapy in this group of patients.

    Case Presentation

    We reported a case of deep neck infection and abscess in a diabetic patient that resulted in acute kidney injury and airway obstruction. We have done CT-scan imaging that supported the diagnosis of a submandibular abscess. Prompt and aggressive treatment of DNI with antibiotics, blood glucose control, and the surgical incision has exhibited a favourable outcome.

    Conclusions

    Diabetes mellitus is the most common comorbidity found among patients with DNI. Studies showed that hyperglycemia impaired bactericidal functions of neutrophils, cellular immunity, and complement activation. Aggressive treatment, including early incision and drainage of abscess, dental surgery to eradicate the source of infection, prompt, empirical antibiotic administration, and intensive blood glucose regulation, will result in favourable results without a prolonged hospital stay.

    Keywords: diabetes mellitus, deep neck infection, abscess