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A Rare Case of Intussusception in A COVID-19 Positive Patient with Nephrotic Syndrome
Full text linkBackground and Objective: Intussusception is one of the most common causes of intestinal obstruction in children 5 months to 3 years, which is the most common cause of acute abdominal pain and its prevalence increases as a result of viral infection. In this report, were present a case of intussusception in a 17-years-old boy following COVID-19.
Case Report: A 17-year-old adolescent boy with a known case of steroid-dependent nephrotic syndrome from the age of two has been referred to the emergency department with severe abdominal pain and vomiting. On ultrasound, renal mass and free fluids were shown. Ileocecal intussusception was observed and was repaired without any complications.
Conclusion: Based on the results of this study, intussusception should be considered in every patient with nephrotic syndrome with COVID-19 infection
Types of Human Papillomavirus (HPV) in Patients with ASCUS Pap Smear
Full text linkBackground and Objective: Human papillomavirus (HPV) is one of the common infectious and pathogenic agents, and some of its genotypes have the ability to cause malignant changes in the surface of mucous cells. By examining the prevalence of HPV in atypical squamous cells of undetermined significance (ASCUS) Pap smear according to the risk factors, we can make a more correct decision in choosing the evaluation method and directing the patient to report the ASCUS lesion. Therefore, the aim of this study is to investigate the types of human papillomavirus (HPV) in patients with ASCUS Pap smear.
Methods: This cross-sectional study was conducted on 200 patients with ASCUS pap smear results and HPV test referred to the colposcopy clinic of Babol Ayatollah Rouhani Hospital during the last two years. Demographic information, history of obstetrics, history of OCP use, history of STD disease and high-risk behaviors, cervical treatments, HPV typing, Pap smear, colposcopy and cervical biopsy results were recorded and analyzed.
Findings: The mean age of the patients was 33.83±8.09 years, and ASCUS pap smear showed 129 cases (64.5%) of high-risk papillomavirus, 16 cases (0.8%) of low-risk papillomavirus and 55 cases (27.5%) of both types. Cervical intraepithelial neoplasia grade 2 was in 18 cases (0.9%), cervical intraepithelial neoplasia grade 1 in 10 cases (0.5%) and cervical intraepithelial neoplasia grade 3 in 2 cases (0.1%). 17.1% of high-risk viruses caused cervical neoplasm. None of the low-risk viruses led to neoplasms and all of them were inflammatory. In both high-risk and low-risk cases, 14.5% neoplasm was seen. However, the relationship between the type of papillomavirus and the incidence of neoplasm was significant (p=0.058).
Conclusion: Based on the results of this study, the ASCUS pap smear needs more detailed investigation such as colposcopy and cervical biopsy under the supervision of experts because it is associated with the high-risk HPV virus in many cases
A Case Report of Neuroleptic Malignant Syndrome during Methadone Therapy
Full text linkBackground and Objective: Methadone is an opioid agonist used for the treatment of addiction to opioid drugs. Toxic leukoencephalopathy can cause serious problem and even be life-threatening. Methadone-induced leukoencephalopathy is a rare condition of this toxicity. Because of the importance of this situation and its treatment, we aim to report a case who is diagnosed as Methadone-induced leukoencephalopathy.
Case Report: A 63-year-old man referred with non-persistent fever, drowsiness, rigidity and suspected of neuroleptic malignant syndrome (NMS). He was addicted to opioid from young age. He was on maintenance therapy with 80 mg methadone syrup from 2 months ago. After the appearance of symptoms including delirium, impaired attention and consciousness, treatment was performed with half a tablet of haloperidol 0.5 mg twice a day before rigidity and fever. Multiple lesions were seen in baseline CT-Scan and MRI. Toxic laboratory examination showed methadone was positive and other toxins and opioids were negative. After two weeks, second MRI showed rapid progressive lesions in white matter. Thus, it was diagnosed as Methadone-induced leukoencephalopathy in addition to NMS. Hydration, bromocriptine tablets 2.5 mg twice a day, methadone tapering and haloperidol discontinuation were performed. After two months, the patient's consciousness was better and his CPK and LDH tests were normal.
Conclusion: Methadone-induced leukoencephalopathy is a very rare condition, but it is important for physicians to consider this diagnosis in patients using methadone, especially when they show neurological and psychiatric signs and symptoms. That’s because early methadone tapering can reduce and stop toxicity on the white matter of the brain
Evaluation of Interleukin- 6 Levels in Saliva of patients with Oral Lichen Planus
Full text linkIntroduction: Oral lichen planus (OLP) is a chronic mucocutaneous inflammatory disorder with an unknown etiology. Although a considerable body of evidence suggests that immunologic factors are involved in the etiology of OLP, the involvement of cytokines in the pathogenesis of the disease is not fully understood yet. The aim of the present study was to assess interleukin-6 (IL-6) levels as a proinflammatory cytokine in the saliva of OLP patients compared to healthy controls.
Materials & Methods: This case-control study was conducted on 30 OLP patients (12 males and 18 females) and 30 healthy control subjects, selected from individuals who were referred to the Department of Oral and Maxillofacial Diseases in Faculty of Dentistry, Babol University of Medical Sciences. Samples of unstimulated saliva were collected. Salivary IL-6 levels were measured using an ELISA kit and compared between OLP patients and healthy controls. The collected data were analyzed by Chi-square, independent t-test, and receiver operating characteristic (ROC) curve using SPSS 18. Sensitivity, specificity, positive predictive values (PPVs), and negative predictive values (NPVs) were calculated. A value of p<0.05 was considered significant.
Results: Mean salivary IL-6 values in OLP patients and healthy controls were 24.68±9.90 ng/L and 13.76±9.27 ng/L, respectively. The difference was statistically significant (P<0.001). The mean IL-6 values in reticular and erosive forms of OLP clinically were 24.35±9.26 ng/L and 24.91±10.64 ng/L, respectively. This difference was not statistically significant (P=0.87).
Conclusions: Higher levels of IL-6 in saliva of OLP patients compared with healthy controls support the role of IL-6 in the pathogenesis of the disease
Role of scaling combination of risk factors in clinical and imaging findings during pregnancy in predicting placenta accreta spectrum
Full text linkBackground: Placenta accreta is one of the known causes of maternal mortality and morbidity. If diagnosed before delivery, appropriate actions can be taken. The aim of this study was to investigate the role of scaling combination of risk factors in predicting placenta accreta spectrum (PAS). Methods: In this cross-sectional study, 120 pregnant women with two criteria and more of placenta previa in their ultrasound, underwent MRI. Clinical scores (history of surgery, cesarean section, previa, etc.) and paraclinical scores (ultrasound and MRI) were recorded and combined. In cases of hysterectomy, pathological examination was performed. The results were compared and analyzed using SPSS Version 22. The significance level was less than 0.05. Results: Of the120 studied patients, 90 (75) women were diagnosed with placenta previa in which, 32(36) patients had placenta accreta and 12 patients had placenta accreta without placenta previa. The mean ultrasound score in women without and with placenta accreta were 0.05±0.32 and 2.43±1.83 (p<0.001). The mean MRI score in women without and with placenta accreta were 0.05±0.27 and 2.07±2.02, respectively. The cut-off point, sensitivity and specificity were 0.50, 100 and 93.4, respectively. The mean clinical score without and with placenta accreta were 1.97±1.32 and 4.89±3.21, respectively. The cut-off point, sensitivity and specificity were 2.50, 70 and 80, respectively. The cut-off point of combination score, sensitivity and specificity were 3.50, 89, 83. Conclusion: The results of the present study showed that the most specific test to confirm the definitive diagnosis of placenta accreta is paraclinical score, alone
Incidence and investigation of Covid-19 trend in Babol, northern Iran: A Joinpoint regression analysis
Full text linkBackground: In December 2019, China released the first report of the coronavirus (COVID-19). On March 11, 2020 the World Health Organization (WHO) characterized the COVID-19 as “pandemic”. The rapid occurrence of positive cases motivated this study to examine the trend of incidence cases. Methods: We used the data from the database of the Deputy of Health of Babol City and in Iran, the country report of definite cases of the disease that was reported to the World Health Organization had been used. This study was a cross-sectional study and the data from period of 56 weeks (from February 24, 2020 to March 20, 2021) were gathered. Descriptive analysis with SPSS20 and data classification with EXCEL2016 and Joinpoint regression with Joinpoint trend analysis software 4.9.0.0 identify the significant changes in the temporal trends of the outbreak. Results: In this study, 11341 patients with a mean age of 53.56 years, of whom 5865(51.5) were males, were studied. Three waves of Covid19 were created. AWPC (average weekly percentage change) incidence rate with a slope of 2.7 was estimated for Babol and 6.2 for Iran. The incidence was higher in men in the first wave of 1887(55.6) and so is the third 2373(50.1), the average age in the third wave (50.92) was lower than the other waves as well. Conclusion: The incidence of coronavirus in men was higher in three waves and also the incidence was increasing in younger age groups. Also, due to the observance of health protocols and quarantine during the peak in Iran and Babol, we witnessed a decrease in incidence
Education and Control of Risk Factors for Cardiovascular Disease (CVD) in Elderly Patients with CVD in Amirkola
Full text linkBackground and Objective: With increasing age, the burden of chronic diseases such as cardiovascular disease (CVD) increases. Education seems to be effective in controlling the risk factors for cardiovascular disease to prevent the disease and to control the disease after its development. The burden of cardiovascular disease and its associated risk factors is higher in people with low education. The present study was conducted to investigate the effect of education on the control of risk factors for cardiovascular disease in the elderly in Amirkola, northern Iran.
Methods: In this cross-sectional study, which is part of the Amirkola Health and Ageing Project, 356 elderly patients with confirmed CVD were studied. Risk factors for cardiovascular disease including body mass index, waist circumference, physical activity, systolic and diastolic blood pressure, blood cholesterol, blood triglycerides, HDL, LDL, smoking status and blood sugar were compared in illiterate and literate elderly.
Findings: Out of 356 elderly patients with CVD (177 males and 179 females), 223 patients (62.6%) were illiterate and 133 patients (38.4%) were literate. Patients did not differ significantly except for controlling the risk factor of low physical activity. Education was effective in controlling the risk factor of physical activity in patients with cardiovascular disease (OR=2.295, CI=1.228-4.289) and these people were more active (p=0.009). In addition, 59.87% of risk factors in the literate group and 58.33% of risk factors in the illiterate group were controlled, which did not show a significant difference.
Conclusion: The results of the study showed that except for low physical activity, other risk factors were not associated with literacy in the elderly with CVD
The Effect of Omega-3 Intake on Colorectal Cancer
Full text linkBackground and Objective: Colorectal cancer is one of the most common cancers among men and women in the world. Of all the risk factors of colorectal cancer, nutritional factors are among the most important and preventable risk factors. Epidemiological studies as well as laboratory evidence have investigated the effect of omega-3 intake in the prevention of colorectal cancer, and considering the contradictory results in this area, the present study was conducted to investigate the effect of this nutrient on colorectal cancer.
Methods: In this systematic review and meta-analysis, eligible studies were carefully and independently searched by two researchers using the keywords “colorectal cancer” or “colon cancer”, “Omega 3 fatty acids”, “fish oil”, “n-3 PUFAs” and “ω-3” in ISI, PubMed, Scopus, ProQuest and Embase databases from 1993 till the end of 2017, and the search was restricted to English language. The abbreviations RR, OR, and HR were extracted with a 95% confidence interval and subjected to statistical analysis based on the random effects model.
Findings: Among 6554 articles, 15 prospective cohort studies were finally included in the research. Despite the lower rate of colorectal cancer in both genders (p=0.394, 95% CI: 0.85-1.06, RR: 0.95) as well as men (p=0.395, 95% CI: 0.79-1.09, RR: 0.93) and women (p=0.583, 0.74-1.17, 95% CI: 0.74-1.17, RR: 0.93) who consumed omega-3, no statistically significant difference was found between consumers and non-consumers.
Conclusion: The results of this study demonstrated that there was no significant relationship between the intake of omega-3 and its subtypes and the incidence of colorectal cancer
The Effect of Vitamin D Deficiency on Pregnancy Outcomes
Full text linkBackground and Objective: Supplying vitamin D during pregnancy is necessary for fetal calcium homeostasis and bone growth and its mineralization, and its deficiency can lead to pregnancy complications. The present study was conducted to investigate the effect of vitamin D level on pregnancy outcomes in pregnant women.
Methods: This cross-sectional study was conducted among 450 pregnant women referring to Ayatollah Rouhani Hospital in Babol. Mothers' information was collected using a questionnaire. Blood samples were collected from people to measure the serum 25 hydroxyvitamin D3 level by ELISA method using the EUROIMMUN kit. Patients were divided into two groups (vitamin D level 25) and were compared.
Findings: 247 people (54.8%) had vitamin D level 25. People with lower vitamin D levels had significantly more gestational hypertension (p=0.03) and premature rupture of membranes (PROM) (p=0.04) compared to people with higher vitamin D levels. The variables of labor pain, diabetes, fetal growth restriction and prolonged pregnancy did not show significant differences in people with high and low levels of vitamin D. Pregnancy complications including pre-eclampsia, preterm delivery, placental abruption and fetal growth restriction did not show any significant difference in people with high and low levels of vitamin D. In the evaluation of neonatal outcomes, infant weight, infant gender, fifth minute Apgar, head circumference and admission to the neonatal intensive care unit, no significant differences were found.
Conclusion: The results of the study showed that some pregnancy complications such as gestational hypertension and premature rupture of membranes (PROM) in pregnant women are related to vitamin D deficiency. Therefore, it is necessary to design plans to check the vitamin D level of mothers before pregnancy and correct it during pregnancy
Immunosuppressive regimens on conversion of cytomegalovirus infection to disease in liver transplant recipients
Full text linkBackground: Cytomegalovirus (CMV) disease is one of the most common infectious complications after liver transplantation. It is the cause of numerous morbidity and mortalities. Intensity of immunosuppression defined as overall immunosuppressive drug dosage seems to affect infectious complications. The main purpose of this study is to investigate the intensity of immunosuppression on conversion of CMV infection to disease in this population. Methods: In this cross-sectional study, we retrospectively evaluated and analyzed the data of all recipients who underwent orthotopic liver transplantation (OLT) between March 2014 and March 2016 and had positive serum PCR for CMV after transplantation in follow- up course. Of 134 recipients, only 66 adult liver transplant recipients were eligible to be studied.  Multiple variables such as MELD score, cold ischemic time, warm ischemic time, operative data, immunosuppressive drugs and regimen, plasma CMV viral load, donor and recipient CMV IgG serostatus were recorded and analyzed. Results: of the 66 patients, 50 (76) had CMV infection and 16 (24) had disease. There was significant association between donor CMV IgG serostatus, extra corticosteroid pulse therapy, acute cellular rejection, serum tacrolimus level and conversion of CMV infection to CMV disease (P=0.005, 0.001, 0.031, 0.031). Conclusion: It seems that the intensity of immunosuppression has influence on conversion rate of CMV infection to disease in liver recipients