Caspian Journal of Internal Medicine
Volume:6 Issue: 1, Winter 2015

Recurrent aphthous stomatitis (RAS) is the most common oral mucosal lesions in the general population. Various treatment modalities have been used; but no specific therapy proved to be definitive. Ginger Officinale (ginger) indicated to have anti-inflammatory properties in herbal medicine. Thus, this study aimed to evaluate the efficacy of Gingerginger containing bioadhesive in treatment of aphthous ulcers. This was a double-blinded placebo randomized controlled trial. Fifteen patients enrolled in this study. The clinical efficacy of the mucoadhessive on pain, inflammatory zone and ulcer''s diameter in the test period was compared with that of the base treatment and no treatment periodss during 10 days of study. Significant reduction in pain as observed on day 5 between placebo (using base bioadhesives) and no-treatment periods at the first phase of the study (4.53 vs. 3.27; p=0.038.(Reduction in inflamed halo diameters was significant on day 1 between no-treatment and ginger containing bioadhesives)46.73 vs 28.67; p=0.044). Other variables such as ulcer''s diameter did not indicate any significant differences in both periods. This study indicated that ginger bioadhesive is capable to relieving pain of RAS. However, its efficacy on ulcer diameter, inflamed halo and healing time was not significantly different compared to the results of the placeb received period.

Cancers are the second most common cause of non-accidental deaths in Iran, after cardiovascular mortality. Although most cases of esophageal squamous cell carcinoma (ESCC) in the USA and western populations have been attributed to high levels of exposure to tobacco and alcohol, but in Iranian populations the other risk factors especially infectious agents have been postulated as possible causes, particularly human papillomavirus (HPV). This study aimed to determine the prevalence and the types of HPV infection in biopsy samples taken from non-cancerous esophageal lesions during upper endoscopy. A total of 80 non-cancerous esophageal samples were collected in parafinnated blocks of tissue archives in pathology. After DNA extraction, qualitative PCR (qPCR) was performed using the HPV L1 primer pairs MY09/MY11 and then genotyping was performed in HPV DNA positive by Real time PCR. From 80 cases, 29 (36.3%) were qPCR positive. Using the Real-time PCR method, a total of 14 HPV genotypes were assessed. We detected HPV-11 as a dominant type in this study and we did not find any type of HPV-16 and 18. In this study, HPV-II was the most common type in esophageal samples, in contrast we have found no oncogenic HPV like HPV 16 and 18 which are the most known responsible factors of ESCC in other countries

The combination of propofol-fentanyl for sedation during colonoscopy is characterized by the frequent incidence of side effects. Etomidate-fentanyl provides fewer hemodynamic and respiratory complications. The aim of our study was to compare the safety and efficacy of propofol-fentanyl and etomidate-fentanyl for conscious sedation in elective colonoscopy. This double-blind clinical trial was conducted on 90 patients aged between 18 and 55 years old who were candidates for elective colonoscopy. Patients were randomized to receive sedation with fentanyl plus propofol or etomidate. Two minutes after injecting 1 micro/kg of fentanyl, the patients received propofol (0.5 mg/kg followed 25 micro/kg/min) or etomidate (0.1 mg/kg followed 15 micro/kg/min). Pulse rate, mean arterial blood pressure, respiratory rate, and saturation of peripheral oxygen (SPO2) were monitored. Indeed, the patient and colonoscopist satisfaction, the recovery time, sedation and pain score in both groups were assessed. Sedation score in propofol group was higher. Pain score as well as the physician and patient satisfaction showed no significant difference in two study groups. Hemodynamic changes and arterial saturation were the same in both groups. The duration of recovery was 1.27±0.82 minutes in the etomidate group; whereas, it was 2.57±2.46 minutes in the propofol group (P=0.001). Hospital discharge in the propofol group was 5.53±4.67 minutes and in the etomidate group was 2.68±3.14 minutes (p=0.001). The combination of fentanyl and etomidate provides an acceptable alternative to sedation with fentanyl and propofol with the advantage of significantly faster recovery time, which are of relevance in the outpatient setting.

Inflammatory bowel disease (IBD) is a group of inflammatory conditions of the colon and small intestine that may have critical consequences on patient’s quality of life (QOL). Many disease-specific QOL tools have been developed recently. The McMaster Inflammatory Bowel Disease Questionnaire (IBDQ) is one of them. The aim of this study was to translate into Persian and evaluate the validity and reliability of this version of the McMaster IBDQ. 68 subjects with ulcerative colitis were recruited in this study. The original IBDQ was translated into Persian using back- translation method. The reliability of the subscales and the summary score of the Persian IBDQ was demonstrated by intraclass correlation coefficients, their validity was evaluated by their correlations with SF-36, visual analogue scale and colitis activity index. All dimensions of IBDQ met the standards of construct validity and were correlated well with SF-36, visual analog scale and colitis activity index. IBDQ was able to discriminate between different groups of patients. The intraclass correlation coefficient was very high and its value was close to one (P<0.05). All dimensional scores differed significantly between the baseline and the follow-up measurement. The findings of this study conclude that the Persian translation of IBDQ has satisfactory psychometric and cultural properties when applied to a sample of Iranian population with inflammatory bowel disease. This questionnaire is recommended for use in clinical trials and in the assessment of efficacy of interventions and therapy.

Recent studies have suggested that oxidative stress (OS) may have a contribution in the pathogenesis of endometriosis. However, the results of previous studies regarding OS in endometriosis are controversial. The objective of this study was to compare the serum levels of OS markers in endometriosis versus the control group. This case-control study was carried out on 30 women with endometriosis aged 20-38 from March 2011 to November 2013. These patients were admitted in Fatemeh Zahra Infertility and Reproductive Health Research Center, Babol, Iran. The serum samples of 40 women with same age were collected as the control group. The serum levels of malondialdehyde (MDA), carbonyl and iron were measured by photometric methods and compared between the patient and control groups using t-test. Also, we used ROC curve analysis to determine the discrimination ability of these markers. Serum iron in endometriosis patients was significantly higher than control (p<0.0001). Area under ROC curve (AUC) for iron, MDA and carbonyl were 0.899, 0.648 and 0.530, respectively. Serum iron at cutoff value of 173.3 µg/dl exhibited high discrimination ability to recognize endometriosis from control. These findings indicate that the high level of serum iron may promote OS in patients with endometriosis. Also based on the ROC curve results, iron showed high discrimination ability to distinguish the patients with endometriosis from healthy subjects

Thalassemia is the most common hereditary anemia in Iran. The aim of this study was to evaluate the humoral immune system and assess the effect of splenectomy on the serum level of immunoglobulins IgG, IgM, and IgA and complement components in patients with major thalassemia. This interventional semi-experimental study (before-after) was performed on 40 patients with major thalassemia that referred to the treatment centers of Babol for splenectomy from March 2011 to March 2013. The mean age of patients under study was 25.38±6.89 years. The results of this study showed that the rate of IgA and IgM had a significant decrease after splenectomy. While the increase of serum level in IgG in this study was not significant. The serum levels of C3 and CH50 were evaluated in all patients that its reduction was statistically significant, but the decrease of serum levels in C4 was not significant. The spleen plays role in releasing immunoglobulins and starter proteins of complement activation pathways and splenectomy causes reduction in serum levels of immunoglobulins and complement components.

A surgical site infection (SSI) is the most common nosocomial infection after surgery and is the third most common infection in hospitalized patients. The aim of this study was to asses minimum inhibitory concentration (MIC) of the causing agents of SSI and antimicrobial susceptibility patterns. This cross-sectional study was done in three referral hospitals in North of Iran during 2011-2012. The samples were taken one month after orthopedic, abdominal, cesarean section surgery and coronary artery bypass graft (CABG) in patients with scores compatible to SSIs criteria. The sample was sent for bacteriologic culture and MIC determination for positive cases by broth microdilution method. The data were collected and analyzed. From 103 positive cases S. aureus, E.coli and coagulase negative staphylococci were the most common isolated agents as 29.12%, 23.3% and 21.3%, respectively. S. aureus was sensitive to vancomycin (70%), amikacin (70%) and teicoplanin (76.6%) and cogulase negative staphylococci was sensitive to vancomycin (68.1%) and teicoplanin (72.6%) and E.coli to amikacin (95.83%) and imipenem and meropenem (66.66%). P.aeroginosa showed no sensitivity to cefepime and was sensitive to imipenem (93.75%) and meropenem (81.25%). The most important point is worrisome problem of the increased MIC of S. aureus to vancomycin that causes difficult use in the treatment of staphylococcal SSIs. In spite of resistance of micro-organisms to cephalosporins, gram negative organisms had low MIC to carbapenemes especially P.aeroginosa although the rate of its MIC is increasing.

Stphylococcus cohnii is an organism of coagulase negative species which is considered as normal flora. However, it has been isolated from urinary tract infections and surgical prostheses but its relation with staghorn stones has not been reported, yet. A 50-years-old woman presented with left renal staghorn stone in June 2014. She had bilateral staghorn stones 7 years ago. Staphylococcus cohnii subspecies urealyticum were detected from a removed stone. After 7 years, recurrence staghorn stone in her left kidney was diagnosed and patient underwent another surgery. The patient had several attacks of cystitis during these 7 years. The results of stone and urine cultures revealed staphylococcus cohnii subspecies urealyticum. This case report emphasizes a possible association between staphylococcus cohnii subspecies urealyticum infection and recurrence renal staghhorn stone.

Brugada Syndrome (BS) is an inherited ion channelopathy characterized by an electrocardiographic (ECG) pattern of a coved type ST segment elevation in right precordial leads with or without right bundle branch block. A 23-year old male presented with right lower quadrant abdominal pain. Further evaluation revealed a diagnosis of acute appendicitis. The patient developed a febrile episode on second post-operative day of laparoscopic appendectomy. ECG revealed features consistent with BS. Prompt control of temperature in the patient resolved the ST-segment elevation and prevented potentially life-threatening arrhythmias. Febrile episodes in susceptible patients may unmask a concealed BS. Prompt control of temperature is advocated to reduce the risk of life-threatening arrythmias