Internal Medicine and Medical Investigation Journal (IMMINV)
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Limb-Girdle Muscle Dystrophy- Type 2C: Case Report
No full textLimb-girdle muscular dystrophy-2C (LGMD-2C) is an autosomal recessive disease caused by mutations in the SGCG genes, which encodes γ-sarcoglycan and characterized by a childhood-onset progressive muscular dystrophy. We report a 21 years old female of LGMD-2C with positive family history suffering from proximal muscle weakness started around age 8 and is now wheelchair-bound. Neurological examination revealed thinning of thighs, pseudohypertrophy of both calves, and hypotonia in all four limbs. Gower's sign was positive. Power was 2/5 at both shoulders, 3/5 at both elbows, 4/5 at both wrists, 2/5 at both hip joints, 3/5 at both knees, and 4/5 at both ankles. All deep tendon reflexes and superficial reflexes were present with flexor plantar reflex bilaterally. Electromyography (EMG) showed a myopathic pattern. She had elevated creatinine phosphokinase levels and muscle biopsy findings consistent with muscular dystrophy. Genetic testing revealed a homozygous deletion mutation of SGCG genes. The purpose of our case report is to bring into light this rare neurodegeneration disorder so that timely actions could be taken to improve the quality of life and to avoid complications in LGMD patients
Langerhans Cell Histiocytosis of Cranium: A Case Report
No full textLangerhans cell histiocytosis (LCH) is a rare idiopathic disease in which there is an accumulation of histiocytic cells in various tissues of the body. We present a 3-year-old boy who reported bilateral swelling of the skull from one year. Even though Langerhans cell histiocytosis can happen in bones throughout the body, it especially happens in the skull, with a high frequency in the parietal and frontal bone. Our investigation varies to some extent from this finding in that in our patient there was a joint association of various skull bone injuries, not a singular one
Evaluating Status of Asthma Control and Quality of Life Based on Demographic Variables in Patients with Asthma Referred to Lung Clinic in Yazd
No full textIntroduction: Asthma is one of the most common chronic diseases in the world. Poor asthma control leads to asthma exacerbation and increases the cost of treatment. This study aimed to investigate the status of asthma control, quality of life in asthmatic patients, medication adherence, and their association with demographic variables such as age, gender, and body mass index (BMI), smoking, and level of education. Materials and Methods: The current descriptive cross-sectional study was conducted on 200 randomly selected asthmatic volunteers referred to the Lung clinic in Yazd, Iran, from 2018 to 2019, who were examined by the Asthma Control Test (ACT). The asthma control association was checked with age, gender, BMI, educational level, and smoking. Data were analyzed by Fisher's exact test, independent t-test, paired t-test, chi-square, and ANOVA. Results: According to ACT data, asthma was uncontrolled in 28 (14%), partially controlled in 144 (72%), and completely controlled in 28 (14%) asthmatic volunteers. There was no significant association between asthma control and any of the variables. Based on the GINA 2016 guidelines, asthma was uncontrolled in 62 (31%), partially controlled in 105 (52.5%), and completely controlled in 33 (16.5%). There was a significant association between asthma control with age (P=0.037) and smoking in the last six months (P=0.029). The quality of life was reported as good in 2 (1%), moderate in 197 (98.5%), and poor in 1 (0.5%). The association between quality of life and smoking was significant (P=0.002). The adherence to asthma medication was good in 30 (15%), moderate in 166 (83%), and poor in 4 (2%). The association of medication adherence with demographic variables was not significant. Conclusion: The asthma was completely controlled in less than 50% of patients and partially controlled or uncontrolled in more than 50% of patients. Patients with asthma should be trained in the area of complete control
Ethical codes and challenges of Physiotherapy for Patients with COVID-19 at Loghman Hakim Educational Hospital
No full textCoronavirus disease (COVID-19) is our novel problem with “human-to-human” transmission, high transmissibility, and rapid global circulation many hospitalized patients in the acute phase of COVID-19 who are admitted to intensive care units, as well as chronic patients who are discharged from the hospital and even though People who are at high risk for disease, benefit from physiotherapy. The World Confederation for Physical Therapy (WCPT) has released an article that explained the recommendations for physical therapy management for COVID-19 in the acute stage of hospitalized patients. The field of physiotherapy is full of moral challenges, some of which are specific to this field. This study addresses only some part of the challenges and ethical needs of a physiotherapist as a member of the treatment team and not all the ethical needs that sometimes go back to the physiotherapist himself. Other studies on the professional ethics of team participation are also needed. By conducting further studies, the difficult conditions of the COVID Crisis could turn from a challenge to a health ethics system into an opportunity
Tramadol Toxicity Induced Neurological and Renal Complications Accompanied by an Alteration in Electrocardiographic Parameters
No full textIntroduction: In recent years, Tramadols' consumption has increased and is often associated with many serious complications which in some cases can also lead to death. In this study, we aimed to assess neurological and renal complications, and also assessed electrocardiographic changes linked to tramadol overdose. Methods: In this descriptive study, the data required was gathered from the patients history that had been admitted to the medical toxicology ward of Imam Reza hospital from 21 March, 2006 to 21 March, 2007. After the collection of data, it was registered and analyzed in SPSS software v 21. Results: 150 patients (64.70% male) with a mean age of 22.57 years qualified to be selected in our study. Out of these, 66% were drug addicts, and 23.30% suffered from seizures. Additionally, 44% displayed an increased BUN, 4% showed Cr increase, 3.3% were hypertensive and 36.70% had tachycardia. Electrocardiographic parameters such as PR Interval, QRS, QT, and QTC were prolonged in 3.30%, 5.30%, 32%, and 17% of the patients, respectively. Furthermore, an elevated creatine phosphokinase (CPK) was noted in 38% of them, and 4% suffered from bradypnea and respiratory depression. Also, an impaired consciousness was recorded from 56.70% of the patients. Death due to cardiopulmonary arrest took place in a young addict male who had ingested 5000 mg of tramadol. Conclusion: Tramadol intoxication is generally common among youth and can result in seizure, tachycardia, hypertension; central nervous system, and respiratory depression; increasing of BUN, Cr, and CPK. A regulated marketing control of tramadol can help to prevent its side-effects and the numerous complications associated with it
Left Ventricular Torsion, Rotation, Twist and Circumferential Strain in Patients with Left Bundle Branch Block versus Normal Individuals by Speckle Tracking Echocardiography
No full textIntroduction: To compare left ventricular torsion, rotation, twist, and circumferential strain in patients with left bundle branch block (LBBB) as compared to normal subjects. Materials and Methods: In this study 23 patients with LBBB and 14 normal subjects were enrolled. In short-axis view of the left ventricle, basal, midportion, apical and global circumferential strain were measured by off-line analysis. The basal, midportion and apical LV segments rotation were measured and subsequently, in both groups, LV twist and torsion were calculated. Results: The mean LVEF in the LBBB group was significantly lower than the normal group. The basal, midportion and global circumferential strain(GCS) were significantly lower in patients with LBBB as compared to normal subjects. The mean LV apical rotation in the LBBB group was significantly lower than the normal group ( -0.28±1.59 vs 0.78 ± 2.59 vs) and P was 0.04. As compared with normal subjects, the mean basal and midportion LV rotation in LBBB patients had no significant difference. LV torsion was lower in LBBB compared to the normal group but the difference was not statistically significant. Conclusion: LV apical rotation was significantly lower in the LBBB group compared to normal. Global, basal, and midportion circumferential strain were lower in LBBB than normal subjects
The The Relationship between Depression, Salivary Cortisol and Periodontal Diseases
No full textPeriodontal disease is an immune-inflammatory response of tooth-supporting structures which progress will lead to loss of teeth. It is important to identify risk factors that influence the development of periodontal diseases. Different studies tried to determine the possible role of stress in the development of periodontitis. Psychological factors susceptible patients to gingivitis and periodontitis through two mechanisms. Behavioral mechanisms that relate to lifestyle and physiological factors that directly affect the host defense. In addition, activation of the hypothalamus-pituitary-adrenal (HPA) axis leads to the secretion of corticotropin-releasing hormone (CRH) from the hypothalamus and as a result glucocorticoid from the adrenal cortex. The effects of stress on periodontal diseases can be related to the patients’ approach to deal with the stress. Different strategies that patients use to cope with the stress lead to different responses of the hypothalamic-pituitary axis that control the cortisol secretion. The effect of coping mechanism on the patients’ stress is one of the probable explanations for controversial results of studies about the relation of salivary cortisol level with stress. This study aims to review the relationship between depression, salivary cortisol, and periodontal diseases
Evaluating the Relationship between Daytime Sleepiness and Polysomnographic Indices in Patients with Obstructive Sleep Apnea
No full textIntroduction: Obstructive sleep apnea (OSA) has been a major subject of interest in medical science for the past 50 years. It is also a major cause of death and disability, and the most common pathologic cause of daytime sleepiness. Currently, the gold standard for the diagnosis of OSA is polysomnography, but researchers have long sought easier and more affordable alternative methods for the diagnosis of this condition. This study aimed to determine whether the results of the Epworth Sleepiness Scale (ESS) and the Berlin Questionnaire (BQ) are accurate enough to be recommended as alternatives to polysomnography. Materials and Methods: This descriptive-analytical study was performed on 90 patients with suspected OSA at Farrokhi hospital, Yazd, Iran. ESS and BQ were filled by the patients, and data was analyzed by ANOVA, chi-square test, and Fisher’s exact test SPSS ver.17. Results: Of the 90 patients being studied, 69 (76.6%) were male and 21 (23.3%) female. The mean age of patients was 48±12.4 years, mean BMI 31.5±5.6 kg/m2, mean neck circumference 40.8±5.1 cm, mean abdominal circumference 107.2±12.7 cm, mean night spo2 (peripheral oxygen saturation) 89.6±5.5, mean desaturation index 33.1±23.7, and mean total snoring duration 34.3±22.3. Also, the mean ESS score and AHI of the patients were 10.6±5.6 and 30.3±23.5, respectively. Conclusion: The results suggested that if used appropriately, and in combination with clinical evidence, ESS and BQ can serve as effective instruments for screening patients who need further examination with polysomnography
Personality Disorders in Patients with Acute Coronary Syndrome
No full textIntroduction: Physical factors predict up to 50% of the incidence of Coronary Heart Disease (CHD). Multiple influencing factors got analyzed but personality disorders have been noticed recently. Accordingly, we aimed to assess Personality Disorders (PD) in patients with Acute Coronary Syndrome (ACS). Materials and Methods: In this study, 82 hospitalized patients with ACS in the cardiac care unit and 85 patients of other units of two university referral hospitals in Kerman (southeastern of Iran) were recruited. The sampling method was a census and all hospitalized literate patients were evaluated during the study period. Demographic and background information were recorded. The Millon Clinical Multiaxial Inventory (MCMI-III) questionnaire was completely filled for each person. The SPSSver22 software was used to analyze the data.Results: On the basis of age, gender, marital status, education, and occupation, both of the groups were matched. Avoidant/depressive personality disorder was the most common disorder suchlike included 41% of the ACS group and 31% of the control group (P=0.19). Obsessive-Compulsive Personality Disorder (OCPD) was observed in 30% of the ACS group and 16% of the control group (P=0.04). Histrionic Personality Disorder (HPD) was seen in 28% of the ACS group and 23% of the control group (P=0.59). In total, 81% of the ACS group and 66% of the control group had at least one Personality Disorder (P = 0.02). Conclusions: High prevalence of personality disorders in patients with ACS and the significant difference in comparison to other hospitalized patients suggests serious psychiatric follow-up and treatments for them
Correlation of Insulin-like Growth Factor-1 (IGF-1) Level with Severity of Liver Involvement in Patients with Cirrhosis
No full textIntroduction: Serum Insulin-like Growth Factor-1 level decreases in cirrhosis due to reduced growth hormone receptors in hepatocytes and lowered hepatocyte synthesis ability. The purpose of this study was to investigate the correlation between Insulin-like Growth Factor-1 level and severity of liver disease in patients with cirrhosis. Materials and methods: The present descriptive cross-sectional study includes patients with cirrhosis who referred to the Department of Gastroenterology, Shahid Mohammadi Hospital, Bandarabbas, Iran. Liver disease and cirrhosis were diagnosed by a gastroenterologist on the basis of biopsy or clinical criteria. The International Normalized Ratio, Prothrombin Time, Alkaline Phosphatase, Alanine Aminotransferase, Aspartate Aminotransferase, Complete Blood Count, Albumin, Bilirubin, Creatinine, Blood Urea Nitrogen, Thyroid Stimulating Hormone and Insulin-like Growth Factor-1 tests were performed for all patients. A radiologist performed liver and spleen ultrasound and ascites examinations, and a gastroenterologist performed an endoscopy to examine esophageal varices. Data were analyzed by SPSS 21 software. Results: This study consisted of 101 patients with mean age of 52.11 ± 11.27 years. The most common etiology of cirrhosis was reported to be hepatitis C (36.1%). Splenomegaly and esophageal varices were reported in 97% and 86.1% of the patients, respectively. Moreover, 22.8% and 7.9% of the patients had moderate ascites and severe ascites, respectively. Mean duration of disease was 12.24±3.72 years. The mean Child, mean model for end-stage liver disease, and mean Insulin-like Growth Factor-1 scores were 6.64±1.76, 17.55±3.10, and 93.51±18.05, respectively. Spearman correlation coefficient was -0.472 between Child score and Insulin-like Growth Factor-1 (P<0.001) and -0.367 between model for end-stage liver disease score and Insulin-like Growth Factor-1 (P<0.001). The mean Insulin-like Growth Factor-1 level in the three classes of Child were compared with each other, and there was a significant difference between the three groups (P<0.001). Conclusion: Serum Insulin-like Growth Factor-1 level is an index to determine the severity of liver disease in patients with cirrhosis that is inversely correlated with disease severity criteria, namely Child and model for end-stage liver disease, suggesting that lower the serum Insulin-like Growth Factor-1 level, greater the severity of the involvement