Internal Medicine and Medical Investigation Journal (IMMINV)
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A Hypertrophic Cardiomyopathy Patient with Post Exercise Gradient about 45; Should Coronary Artery Bypass Graft and Mitral Valve Replacement Accompanied by Septal Myectomy?
No full textIntroduction: Surgical septal myectomy has brought a considerable increased survival from all-cause mortality and even Hypertrophic cardiomyopathy related mortality in comparison with unoperated Hypertrophic cardiomyopathy. Case presentation: A fifty-five man who referred to Tehran Heart Center Hospital in April 2009 with dyspnea on exertion grade (NYHA class III) and chest pain (NYHA grade II) and occasional palpitation. Conclusion: The recommended treatments for patients with this problem varied from medical treatments to surgical myectomy and septal ablation
Association between HOXB13 G84E Mutation and Risk of Prostate Cancer in Iranian Patients
Full text linkIntroduction: Prostate cancer is the second most lethal cancer in men after lung cancer in world. Genetic predisposition is fast emerging as risk factor for prostate cancer. The HOXB13 gene is a tumor suppressor gene for prostate cancer and other cancers. The present study was conducted to evaluate G84E mutation of HOXB13 in patients with prostate cancer in Kurdistan and Kermanshah provinces of Iran. Materials and Methods: DNA was extracted from blood samples of cases of Benign Prostatic Hyperplasia and 75 healthy control. The G84E mutation of HOXB13 was determined by direct sequencing. All statistical calculations were performed using SPSS version17. Results: DNA sequencing results showed that the genotype of this site was GGA in all cases and controls. Conclusion: The results of this study showed that the GOXE position of the HOXB13 gene was not associated with prostate cancer in selected patients of west Iran. This finding showed doesn’t a statistically significant difference in carrier frequency highlights the genetic predispositions to prostate cancer with respect to G84E mutation of HOXB13 gene
Right Ventricular Systolic Function by 3D Echocardiography in Patients with Inferior Myocardial Infarction vs. without Right Ventricular Infarction; Compared with Normal Subjects
No full textIntroduction: We aimed to assess the effect of right ventricular myocardial segmental and global function by using conventional two-dimensional echocardiography (2D) and new available echocardiographic techniques including real-time three-dimensional echocardiography (3DE). Materials/Methods: Fifty patients with first inferior wall myocardial infarction (Inf MI) were divided into two groups, including 25 with RVMI and 25 without RVMI. Twenty-five age-matched individuals were included as a control. Right ventricular ejection fraction (RVEF) with 3DE, Tricuspid Annular Plane systolic excursion (TAPSE), RV fractional shortening area (FSA), strain (S), strain rate (SR), and systolic tissue velocity (S’) of basal and mid segments of RV free wall were measured. Results: By 3DE, RVEF was significantly lower in patients with RVMI than those without RVMI and controls (47±6 % vs. 55±5 % and 58±6 %, respectively, P<0.001). There was also remarkably larger RV end-systolic volume (RVESV) (44±8 ml vs. 31±6 ml, and 30±7 ml, respectively, P<0.001) and end-diastolic volume (RVEDV) (87±8 ml vs. 69±9 ml, and 69±8 ml, respectively, P<0.001) for RVMI group. In the entire population, RVEDV and RVESV by 3DE were correlated positively and significantly with the measurements by 2D (r= 0.80, p<0.001; r=0.84, p<0.001, respectively). There was positive significant correlation between 3DE RVEF and FSA (r=0.78, p<0.001), TAPSE (r=0.81, p<0.001), S, SR and S’ of basal (r=0.70, p<0.001; r=0.75, p<0.001; r=0.68, p<0.001, respectively) segment of RV free wall. Conclusion: RVEF by 3DE was significantly lower in patients with RVMI than those without RVMI and well-correlated with RV FSA, TAPSE, S, SR, and S’ of basal segment of RV free wall
Short Term Omeprazole Use and Markers of Calcium Homeostasis
Full text linkIntroduction: Several studies indicate a higher prevalence of fracture following long term utilization of proton pump inhibitors, among them omeprazole is the most widely used. However, the exact mechanisms lead to this complication are largely unknown. We studied short term effects of omeprazole on some markers of calcium metabolism. Materials and Methods: In thirty young adult patients with gastroesophageal reflux, omeprazole was prescribed at 20 mg twice daily for thirty days. Baseline characteristics as well as data after treatment with omeprazole were compared. We also measure important parameters in sixty age and sex match healthy individuals at baseline. Results: Mean age of patients was 31.8 year and there was no significant difference regarding age, sex, body mass index, serum calcium, serum alkaline phosphatase, and parathyroid hormone between cases and controls. Although, most of the patients were vitamin D deficient (mean = 29.7 nmol/l); compared to controls serum 25 OH Vitamin D was higher (P= 0.005) and serum phosphate was lower (P= 0.001) in patients. In addition, there was significant increase in alkaline phosphatase (P=0.01) and borderline decrease in serum calcium (P= 0.057), thirty days after treatment with omeprazole. Conclusions: High dose omeprazole after thirty days in the presence of vitamin D deficiency affects bone turnover probably by decreasing calcium absorption
Sodium-glucose co-transporter 2(SGLT2) inhibitors renal benefits and beyond
No full textBackground
Diabetes is a disaease of Insulin insufficiency or resistance which implications on almost every organ and tissue of human body. It plays a direct or indirect role in causation or progression of many chronic conditions like Coronary Heart disease, Cerebrovascular accidents, Chronic Kidney disaease, limb amputation and so forth. It increases the risk and frequency of infections and delays the recovery as well. Management strategies include dietary management,exercise, Oral Antidiabetic drugs,Insulin formulations, pancreatic transplantation. The goal of these management strategies, usually employed in combination, is good glycemic control so as to avoid development of diabetic complications in the long run.
Sodium-glucose co-transporter 2(SGLT2) inhibitors
There are various classes of Oral Antidiabetic drugs(OAD) which form the basis of management of Diabetes Mellitus type 2 in particular as Type 1 Diabetes Mellitus invariably needs insulin for glycemic control. Sodium-glucose co-transporter 2(SGLT2) inhibitors are a class of OAD, approved by FDA for management of adults with type 2 diabetes. There are many SGLT2 inhibitors currently which can be used in patients with diabetes notably dapagliflozin, canagliflozin, empagliflozin. These oral antidiabetic drugs act by locking the SGLT2 transporters in proximal tubule of nephron and hence lead to glycosuria. They improve glycemic control, reduce body weight, and improve blood pressure control. Furthermore, evidence suggests that SGLT2 inhibitors have renoprotective, Cardiovascular and hypouricemic benefits among others. These benefits of SGLT2i slow progression of diabetic kidney disease. There is some evidence of increased risk of genitourinary fungal infections, Ketoacidosis and Fournier,s gangrene with use of SGLT2i.
Conclusion
Considering the added benefits of SGLT2i like renoprotection, weight loss, bP control, decreased CV morbidity and mortality with its use has provided an option of retarding the progression of Diabetic Nephropathy and improved survival of Diabetic patients. As more and more information with the experience of using this drug is published many unanswered questions about mechanism of these benefits and adverse events will be answered
Investigating the Impact of Using Supply Chain Infrastructure on Advances in Patient Safety Given the Mediating Role of Healthcare Settings in Public Hospitals of Alborz University of Medical Sciences
No full textBackground: Using supply chain infrastructure in order to decrease medical . In addition, patient safety has become an important focus area within recent decades. Most of the studies about patient safety, which have been carried out so far, have particularly focused on safety in hospital environments. The current study aimed to determine the impact of using supply chain infrastructure on advances in patient safety given the mediating role of healthcare settings in public hospitals of Alborz university of medical sciences.
Material and Methods: Statistical population of the present research comprises all managers, nurse managers, and those responsible for medical records of all public hospitals of Alborz University of Medical Sciences. The number of managers and employees is estimated to be 150. The sample size is 108 people based on Morgan Table. Smart-PLS statistical software was used to test the hypotheses.
Results: According to the results, using supply chain infrastructure had a significant positive effect on advances in patient safety. Moreover, making use of supply chain infrastructure has a significant positive effect on advances in patient safety given the mediating role of healthcare settings.
Conclusion: If the infrastructure required in hospitals is created with the quality and safety care which leads to appropriate services, the patients will be valued
Proper lifestyle and nutrition due to premature aging prevention
No full textWith increasing life expectancies worldwide, it is an important public health issue to identify factors that influence the quality of aging. The changes in society dynamics in the last two centuries has led to an important increase in the worldwide life’s expectancy. It should be investigated the individual and combined roles of lifestyle factors at midlife for healthy aging (1).
The expanding advances in medical knowledge and technology, lifestyle changes, cultural and social structure, changes in disease patterns, people's medical needs, and the rapid growth of the population have led to new problems and barriers to medical care. In recent decades, the health of middle-aged people in developing countries has changed dramatically. This is largely due to changes in life habitude and social, cultural and economic variables.
In many cases, middle age can come to people without a crisis. According to the Ministry of Health, the age of 35 to 65 is regarded as the middle age. The aging process is different for everyone, but there are certain signs of aging that, if noticed before the age of 35, are considered "premature aging."
A healthy lifestyle allows people to be energetic and reduces the risk of various diseases. This behavioral habits are provided in the first place by having a healthy and balanced diet, adequate regular exercise and proper amount of work and sleep, as well as avoiding alcohol and tobacco.
Many people think that by entering the sixth decade of life and over the age of 50, they are getting older and sometimes they forget about themselves altogether. This age period, which usually coincides with the retirement of people, is called middle age, and ironically, it is the best time to look at things that may have never been possible before.
If a person is dissatisfied with these changes at any stage of life for any reason, he or she may experience a midlife crisis or similar symptoms. The most common symptoms of a midlife crisis are mild psychological problems, anxiety and depression. The aging process somehow reduces the immune system's ability to react, leading to more infections, more inflammatory diseases, and even cancer.
Aging theories emphasize the genetic regulation of this process and consider aging a result of changes in gene expression and the continuous effects of oxidation in the body. In fact, the disruption of the antioxidant defense system due to the free radicals produces high amounts of these substances in the body which causes many disorders in the body along with reducing the occurrence of gene signals that repair the body's damages. Today's healthcare challenges and tomorrow's opportunity can only be met by those who search out deeper explanations of the body processes that generate health and disease.
Middle age is an age in which a person goes through a wide variety of experiences; on the one hand, in this stage, life is chaotic and turbulent, and on the other hand, it is relatively peaceful. Middle-aged individuals become aware that they are no longer young and cannot perform many past activities. Middle age can also be associated with the onset of illnesses and retirement.
Due to life expectancy increases in developed countries, diseases related to middle age and old age are on the rise. Fortunately, much research on the aging process can benefit everyone. So, the presence of effective compounds to increase the expression of slow-acting genes in this process on the one hand, as well as increasing the production of antioxidants in the body on the other hand, is felt more than ever. Increasing or decreasing the expression of genes can lead to delayed aging. Also, reducing the expression of Nrf2 gene and free radicals from oxidation production resulting from damages to the neurogenic system, reducing the activity of antioxidant enzymes, and weakening the immune system induces premature aging.
Premature aging can occur at any age and has consequences such as depression, suicide, disability and a negative attitude towards old age. The most important causes of premature aging include poor nutrition, sedentary lifestyle and negative thoughts.
In fact, aging is an inevitable process, but there are some things to make it happen more slowly. Also, by observing these points, you can enjoy your old age with a higher quality.
Recent evidence is shaping a picture where low caloric regimes and exercise may improve healthy senescence, and several pharmacological strategies have been suggested to counteract aging (2).
The presence of effective compounds to increase the expression of slow-acting genes in this process on the one hand, as well as increasing the production of antioxidants in the body on the other hand, is felt more than ever.
As a result, it is essential to provide a combination of anti-aging and antioxidant effects against the production of harmful substances in the body due to aging.
Free radicals in small and controlled quantities are useful in everyday metabolism. They take part in several normal reactions within the body including breathing. These free radicals are mainly produced during oxygen metabolism within the cells. The problem starts when the production of these free radicals increases and goes out of control (3).
However, most people would not comply with such a rigorous dietary program, particularly in the long term. Therefore, recent researches is increasingly aimed at determining the feasibility and efficacy of natural and/or pharmacological mimetic molecules/ treatments without decreasing food consumption (4).
An herbal tea made of the combination of Stachys Lavandulifolia, Peperomia Magnoliiaefolia and Red-root Amaranth has a synergistic effect in preventing the signs of premature aging. On the other hand Cotinine acid in Stachys Lavandulifolia tea reduces LDL and triglyceride levels through direct and non-competitive inhibition of the Diacylglycerolacyl transferase enzyme. This decrease in hepatic triglyceride synthesis leads to the destruction of intracellular APO-B and ultimately to the reduction of LDL, which is one of the important factors in the processes leading to aging in the body. One of the most important processes in aging is the body.
The basic chemical process underlying aging was first advanced by the free radical theory of aging and oxidative stress is believed to be a primary factor in the normal process of aging (5).
This plant compound has been shown to decrease the rate of damage to cells and body tissues by increasing the expression of the Nrf2 gene, which also has been shown to delay the aging process and also improves the total levels of antioxidants in order to neutralize toxic compounds and free radicals. Explained anti-aging mechanism included up-regulating telomerase activity, decreasing oxidative damage, regulating SIRT1 pathway (6).
The most important risk factors for premature aging are created by "aging lifestyle" which include poor diet, sedentary life habitude, smoking, overweight and obesity, high blood pressure, diabetes and hyperlipidemia.
While some people have a healthy aging process, the results of many studies show that older, middle-aged, and older people are more likely to develop infectious diseases and even die from these diseases than younger people.
Eating proper food for one's height, weight and body type and activity level is the foundation for a better quality of life and greater longevity (7).
By the time many people are worried about gaining weight due to the slowing down of their metabolism. On the other hand, in middle age and old age, following less social relationships, a feeling of loneliness is created in people, which in addition to mental and social health, affects their way of life. People with high self-esteem are more likely to face external threats and stressful events without experiencing negative feelings. Elderly people who have high self-esteem value themselves and others and are highly satisfied with their social status, which in turn improves their mental and social health.
Self-efficacy is also a factor in health and the prevention of psychological disorders. People with strong self-efficacy beliefs choose tasks that are more challenging. They set bigger goals for themselves and are more proactive in dealing with various situations
Comparing the Conventional with Low Dose of Bupivacaine Plus Fentanyl in Spinal Anesthesia on the Neonate Apgar Score in Yazd City
Full text linkIntroduction: Spinal anesthesia is the preferred method of anesthesia in cesarean section, due to less complications. The augmentation of opioids to spinal anesthetics can improve the quality and increase the duration of analgesia. This study aimed to compare the conventional with low dose of bupivacaine plus fentanyl in spinal anesthesia on the neonate Apgar score in elective cesarean section. Methods: The present double-blind randomized clinical trial was conducted on 150 pregnant mothers undergoing cesarean section with the spinal anesthesia during 2017-2018. The mothers were randomly assigned to two groups of 75. The spinal anesthesia was performed in the first group with the injection of 15 mg of 0.5% hyperbaric bupivacaine plus 1 ml of normal saline, and in the second group with the injection of 12.5 mg of 0.5% hyperbaric bupivacaine plus 25 μg of fentanyl. For both groups, 1- and 5-minute neonatal Apgar scores were assessed. Finally, the data were analyzed by SPSS17 software using statistical tests. Results: The mean age of the samples was 30.1±5.19 years with a range of 18-42 years (P-value=0.246). The mean gestational age was 38 weeks, the mean 1-minute Apgar score was 8.88 and the mean 5-minute Apgar score was 9.89. Conclusion: With the augmentation of fentanyl to bupivacaine for spinal anesthesia, the conventional dose can be reduced, which not only reduces the common side effects of Marcainee, but also provides an appropriate level of anesthesia and does not affect the neonatal Apgar score
Reducing Treatment Cost in Cancer Patients with Providing Palliative Care: a Successful Experiment in Golestan Province
No full textIntroduction: Palliative care is fundamental to health and patient rights. The aim of palliative care is to improve the quality of life in advanced illness and reducing pain. It is characterized as a holistic approach which includes all aspects such as physical, emotional, social, and spiritual. Our purpose of this study is to report a successful experience of utilizing palliative care in Golestan province. Materials and Method. This qualitative research was conducted in Golestan province, Iran using the content analysis method. In this study, data was gathered from a 90-minute semi-structured interview with the founder of Golestan’s Mehr club. The interview was recorded and transcribed afterward. Results: Data analysis on the implementation of palliative care showed the themes ‘simplification of treatment, crisis management, cost reduction, home care, and barriers against palliative care’. Some codes were repeated in the interviews such as having a trustee, avoiding confusion and relief. The interview reported that cancer, in addition to physical suffering, causes social, familial, and financial trauma. Conclusion: Our findings demonstrated that palliative care will result in cost reduction in hospital and medical expenses for cancer and terminally ill patients in Golestan province. It is essential for health practitioners to utilize palliative care as localized guideline to improve quality of life in advanced illnesses such as end stage cancers
Is liver fibrosis in association with opium addiction and intravenous drug abuse among hepatitis C virus-infected patients?
No full textIntroduction: Hepatitis C virus (HCV) infection is a prevalent etiology that leads to cirrhosis. Various factors affect liver fibrosis progression. In the current study, we aimed to assess the probable role of opium consumption and intravenous drug abuse(IVDU) on liver inflammation and fibrosis.
Methods: This is a case-control study conducted on 58 patients with hepatitis C virus infection in 2012. Anti-HCV antibody and quantitative HCV-RNA burden were performed for all patients. Then, they underwent a liver biopsy for the determination of inflammation grading and liver fibrosis based on the Hepatic Activity Index(HAI). Regarding inflammation grade, patients were divided into two groups of 0-4 grade as controls and 5-18 as cases. Considering the fibrosis score, patients were divided into two groups of 0-2 score as controls and 3-6 score as cases.
Results: This study was conducted on HCV positive patients; among them, 74.1% were smokers, and 53.4% were opium addicts. Regarding liver inflammation grading, 52.2% of cases and 25.7% of controls were IVDU and 65.2% versus 45.7% were opium addict (P-value=0.04 and 0.145, respectively). On the other hand, regarding fibrosis score, 60% of cases versus 50% of controls were opium addicts, while 30% of cases versus 39% of controls were IVDUs (P-value>0.05).
Conclusion: Contrary to the previous studies, we found no association between opium addiction with either liver inflammation or fibrosis. Based on this study, IVDU was only associated with liver inflammation, but liver fibrosis