Reviews in Clinical Medicine

165-175

Authors: Leili Zarifmahmoudi; Maryam Khalesi; Ramin Sadeghi; Seyed Ali Jafari; Mohammad Ali Kiani; Hamidreza Kianifar

Introduction: Hepatopulmonary syndrome (HPS) is known as a chronic liver disease associated with severe pulmonary deoxygenation due to intrapulmonary vascular vasodilation. Although liver transplantation is accepted as a main treatment of HPS, identifying effective drugs for recovery of HPS can be effective in postponing the transplantation and decreasing the mortality rate of patients before the transplantation. In this study we briefly reviewed the pathogenesis of HPS and also systematically reviewed the current pharmacological treatment of HPS. Method: Pubmed, Scopus, and Google scholar were searched for the relevant English language clinical and experimental articles about the medications used in the treatment of HPS. Results: A total of 38 articles were included in this study which mostly resulted in decreasing NOS expression, NO production, endothelin-1 activation, intrapulmonary angiogenesis and increasing oxygenation. Conclusion: Various drugs have been proposed in treatment of HPS but more large controlled trial studies, is necessary to determine the exact efficacy of each drugs for HPS recovery.

183-188

Authors: Naser Shoeibi; Mehran Mahdizadeh; Masoud Shafiee

Drug delivery to the inner part of the eye is still a problem in treatment of ocular disease. Iontophoresis has been used in the field of medicine for many years. This technique consists of applying a weak electrical current to drive charged drug molecules across tissue barriers. Transcorneal iontophoresis delivers a high concentration of drug to the anterior segment of the eye (cornea, aqueous humor, ciliary body, iris, and lens), for the treatment of anterior segment diseases. There are different types of iontophoresis such as ophthalmic, transdermal, transungual, oral, buccal, and transnasal. The benefit of iontophoretic drug delivery in ophthalmology lays in its capacity to provide high drug tissue concentration safely, while minimizing the systemic drug exposure. This review summarizes basics of ocular iontophoresis and iontophoretic device, trans corneal and transscleral iontophoresis, and the applications of iontophoresis in ophthalmology.

194-199

Authors: Farveh Vakilian; Fateme Tara; Fateme Moosavi

Heart failure (HF) is a serious and growing public health concern, which has many causes. Pregnancy is a critical condition with significant hemodynamic and immunologic changes. Peripartum cardiomyopathy (PPCM) is a disease of unknown cause in which left ventricular (LV) dysfunction occurs during the last trimester of pregnancy or the early puerperium. PPCM is known to be the most common cardiovascular cause of severe complications in pregnancy. Risk factors for peripartum cardiomyopathy include advanced maternal age, twin pregnancy, smoking, pregnancy-related hypertension and preeclampsia, multiparity, African descent, and long-term tocolysis. Oxidative stress and some inflammatory markers have been diagnosed in PPCM pathophysiology. Recent observations have suggested that bromocriptine might favor recovery of LV systolic function in patients with PPCM. Patients developed peripartum cardiomiopathy treated with bromocriptine showed significantly improved LV ejection fraction and heart failure symptoms. This article tries to have a short review on this clinical scenario.

207-210

Authors: Mirnaghi Moosavi; Mahdi Mokhtari; Masoud Shafiee

Central serous chorioretinopathy is a common cause of visual morbidity. It is characterized by idiopathic serous retinal detachment in macular or paramacular regions. The symptoms of the CSC include decreased vision, micropsia and metamorphopsia. The prognosis of the disease is good and almost 90% of patients obtain visual recovery in a few months. However, in less than 5% of patients the chronic disease with poor prognosis is developed. The acceptable approach is to observe patients with acute central serous chorioretinopathy, because central serous chorioretinopathy is self-limited. The pathophysiology of central serous chorioretinopathy is not clear and not well understood. Therefore, various medical treatments have been suggested such as propranolol, indomethacin, bevacizumab, acetazolamide, mifepristone, labetalol, etc. However, wait and watch would be the most recommended management of the central serous chorioretinopathy.

218-224

Authors: Shahaboddin Shabani; Navid Nourizadeh; Mohammadsaleh Soltankhah

Thioredoxin system comprised of thiorexin and NADPH dependent thiorexin reductase, is responsible for redox regulation of cells by controlling the apoptosis, proliferation and other vital processes of cells. The efficacy of thioredoxin system has been represented in a wide range of physiological and biological reactions in bacteria, yeast, plants, mammals and etc. including DNA synthesis, regulation of transcription factors, protein repairing, regulating the photosynthesis and controlling the apoptosis and preventing oxidative stresses, filamentous phage assembly, immune-modulating, neuronal survival, pregnancy and birth and many other physiological and biological functions. The up-regulation of thioredoxin has been observed in various malignancies, which was associated with tumor angiogenesis and development. In this regard, the thiordoxin system has become a putative target in new chemotherapeutic methods. In this study, we mentioned various features of thioredoxin system in malignant cells and reviewed the articles which have evaluated the expression rate of thioredoxin system in malignancies.

229-232

Authors: Somayyeh Hashemian; Ashraf Mohammad zadeh; Alireza Ataee nakhaei

Hyperbilirubinemia is a common disease and unconjugated hyperbilirubinemia has been seen mainly in neonates. Severe form of unconjugated hyperbilirubinemia may cause kernicterus and even death. Conventional treatment for severe unconjugated hyperbilirubinemia consists of phototherapy and exchange transfusion that have several known disadvantages; specially exchange transfusion is associated with a significant morbidity and even mortality. These harmful effects indicate the need to develop alternative pharmacological treatment strategies for unconjugated hyperbilirubinemia. One of these pharmacological agents is zinc salts. Zinc has been shown to lower the bilirubin levels by inhibition of the enterohepatic cycling of unconjugated bilirubin. Oral zinc has been shown to reduce serum unconjugated bilirubin in animals, adolescents and low birth weight neonates. However, studies in healthy term neonates given oral zinc showed no reduction in hyperbilirubinemia based on daily measurement. In order to improve the accuracy, hyperbilirubinemia may be determined based on measurements every hour. More studies are needed to know the effect of zinc in neonatal jaundice.

93-96

Authors: Ali Dehghani; Habib Jafari; Naser Shoeibi

Intravitreal injections of anti-vascular endothelial growth factors (anti-VEGFs) have become more popular quickly in recent years. Bevacizumab is an anti- vascular endothelial growth factor agent (anti-VEGF) used to treat choroidal neovascularization and retinal vascular disorders. Rare long lasting ocular adverse events are reported in the intravitreal injection of this drug that include intraocular inflammation, retinal tears, vitreous hemorrhage, endophtalmitis, and lens changes. One important concern about intravitreal injection of anti-VEGF drug is intraocular pressure (IOP) elevation. There are two kinds of IOP elevation. First one is an acute elevation of IOP (after few minutes) and the second is delayed IOP elevation (after few months). The prevalence of IOP elevation immediately after injection is significantly high and seems to have the potential risk for optic nerve fiber loss results in decreased vision but fortunately this IOP elevation seems to be transient in most of studies

105-108

Authors: Maral Sadrolodabaei; Behrouz Davachi; Mahdi Silanian Toosi

Liver metastatic disorders usually occur in patients with stomach, pancreas, breast, colon, and lung and etc tumor. About 30 percent of patients die because of malignancies, have liver metastases. Liver imaging examination is a fundamental preclinical test to predict patient’s prognosis and is required to monitor treatment. Despite recent advances in radiologic examination, liver metastases are still remaining as a challenge in human oncology. It seems that US is a reliable alternate for CT scan in metastases detection. CT scan should be considered in patients are highly suspension for liver metastases, who have normal or undetermined US findings. The aim of this study was a brief review of radiologic assessment in liver metastases.

115-124

Authors: Fariba Rezaeetalab; Daryush Hamidi alamdari; Asghar Dalili

Chronic obstructive pulmonary disease (COPD), characterised by partially reversible contracture of small respiratory airways seems to be among leading causes of death in the world. COPD is characterized by inflammation, protease/antiprotease imbalance, genetic variability and oxidative stress. The latter refers to a condition in which oxidative agents overcome against antioxidants. In this review literature, the consequences of oxidative stress in COPD, such as systemic and pulmonary neutrophil influx, hypersecretion, dual and reciprocal effects with inflammatory contributors and systemic manifestations are discussed. In addition, a review of oxidative stress biomarkers as well as therapeutic strategies based on recent researches for antioxidant supplementation therapy is provided.

131-134

Authors: Mohammad Imani; Mohammad Javad Yazdanpanah; Hoda Azizi; Touba Ahmadzadeh Sani; Mahnaz Banihashemi; Hamid Reza Bahrami-Taghanaki; Mohammad Khajedaluee

Psoriasis is an inflammatory and proliferative disease. Psoriasis clinical features vary from plaque-type psoriasis to pustular form. Psoriasis is an immune-mediated disease, which affects epidermal keratinocytes. Regard to serious side effects of chemical therapy in psoriasis patients, various projects were performed all around the world to find new therapeutic approaches for psoriasis. Various studies confirmed that Indigo naturalis treatment induced long-term remission in patients with psoriasis in all ages.

141-148

Authors: Marzieh Rahimzadegan; Farshid Abedi; Seyed Abodolrahim Rezaei; Reza Ghadimi

Human T-lymphotropic virus (HTLV-1) is an ancient pathogen for human being but arising and recognized recently. The routes of transmission are vertical (mainly by breastfeeding), unsafe sexual contacts and through contaminated blood components specially in whom need frequent and repeated blood transfusions such as permanent anemia due to blood loss in hemophilia and major thalassemia. Patients who should undergo hemodialysis in their lifelong are another instance for increased risk of HTLV-1 exposure. The main HTLV-1-associated diseases are tropical spastic tetraparesis (HAM/TSP), an inflammatory myelopathy and adult T-cell leukemia (ATL). Although HTLV-1 is scattered around the world, only in endemic areas where prevalence rate is more than 1%, viral burden of infection have accumulated. Japan, Southern and Central parts of Africa, Caribbean basin and Iran are examples of endemic areas of HTLV-1. In this article, a rapid and brief review of HTLV-1 virology, immunology and pathogenesis have emerged. In addition, a short debate has driven about current statues of HTLV-1 in Iran.

154-159

Authors: Elham Pishbin; Moloud Foogerdi

Blunt chest trauma accounts for the majority of mortalities and morbidities in traumatized patients. Rib fractures are one of the most common chest wall injuries due to blunt chest trauma, which is estimated to occur in 10% of all traumatic injuries. Conventional radiography and ultra-sonography are two commonly methods used for rib fractures diagnosis with different accuracy. In this study, we described different methods used in diagnosis of injuries related to blunt chest trauma and we aimed to review several studies compared the diagnostic value of these methods.

38-43

Authors: Mahnaz Banihashemi; Solmaz Nakhaeizadeh

Platelet-rich plasma (PRP) is an autologous concentration of human platelets contained in a small volume of plasma characterized by haemostatic and tissue repairing effects. Tissue repairing effects and being enriched by various kind of growth factors, has made them the focus of attention for different procedures. PRP has been effective in bony defects, wound healing and recently for aesthetic procedures in plastic surgery. The purpose of this review is to evaluate and summarize the applications of PRP in the dermatology literature, with particular focus on rejuvenizaton process, advances and limitations of current PRP therapies. We studied literature related to PRP therapy, these include regeneration of soft tissue, skin aging mechanisms, as well as wound healing. Some studies have shown promising results, with favorable outcomes about PRP clinical application for skin rejuvenization. This article summarizes our current understanding regarding photoaging process and the role of PRP in the skin rejuvenization process. PRP has been shown to be useful in skin rejuvenization. Further studies are needed to elucidate both basic and clinical aspects of PRP therapies. In particular, platelet preparation methods, different application methods, platelet mechanism of action in rejuvenation field, interactions with the skin components, long-term efficacy and safety are necessary to be determined

51-56

Authors: Masoud Pezeshki Rad1 ; Mahdi Momennezhad2 ; Shahrokh Naseri2 ; Mahsa Nahidi3 ; Abolfazl Mahmoudzadeh1 ; Behzad Aminzadeh* 1

During the last decades there has been an increasing interest in studying the differences between males and females. These differences extend from behavioral to cognitive to micro- and macro- neuro-anatomical aspects of human biology. There have been many methods to evaluate these differences and explain their determinants. The most studied cause of this dimorphism is the prenatal sex hormones and their organizational effect on brain and behavior. However, there have been new and recent attentions to hormone’s activational influences in puberty and also the effects of genomic imprinting. In this paper, we reviewed the sex differences of brain, the evidences for possible determinants of these differences and also the methods that have been used to discover them. We reviewed the most conspicuous findings with specific attention to macro-anatomical differences based on Magnetic Resonance Imaging (MRI) data. We finally reviewed the findings and the many opportunities for future studies.

61-65

Authors: Abdollah Banihashem; Hamid Farhangi; Mojtaba Mousavi Bazaz; Zahra Badiee; Ali Ghasemi; Sara Hesari

Different therapeutic options in children with immune thrombocytopenic purpura include observation alone, periodic treatment with corticosteroids, intravenous immunoglobulin (IVIG) or anti-D, chronic administration of immunosuppressive agents, and splenectomy. Preference of the type of therapy depends on the degree of thrombocytopenia and clinical bleeding manifestations. Dexamethasone is safe but its side effects are the main disadvantages for its usage. Anti-D is more expensive than dexamethason but the side effect is rare and not dangerous and response to treatment is assessed in approximately 3 days after infusion.

71-74

Authors: Masoud Pezeshki Rad; Mina Taghavi; Jahanbakhsh Hashemi; Farzaneh Sharifipour; Abbasali Zeraati

Glomerulonephritis (GN) is responsible for 25-30% of end-stage renal disease (ESRD) among all causes. Renal biopsy is important to determine the GN treatment method and its prognosis. In some cases, renal biopsy is required for definitive diagnosis. Biopsies were used as a diagnostic method in different disease from 1930. They were performed blindly and at bedside. Complication rate varies from 2 to 20% in different reports. Percutaneous renal biopsy is a routine diagnostic procedure in nephrology nowadays, and it should be individualized for each patient depending on their age, BMI, coagulation status and the availability of skilled radiologist. In this paper, we review image-guided renal biopsy in glomerulonephritis.

82-85

Authors: Abolfazl Mahmoudzadeh; Yasamin Davoudi; Hossein Haghir; Maryam Salehi; Farah Ashrafzadeh; Behzad Aminzadeh; Sara Mehrnoosh; Mohammadreza Mehrnoosh

Many children with hippocampal sclerosis underwent surgery for treatment. Early childhood convulsion occurs in 2 to 4% of population and its prognosis is good in majority of cases. It seems that hippocampal anomalies are common in patients with neocortical epilepsies. The theory of hippocampal sclerosis association with temporal lobe epilepsy has been proposed 100 years ago. Recent studies demonstrated that there was a correlation between memory impairments and prolonged febrile convulsion (PFC), which might be a result of hippocampal injury. Transient hippocampus swelling might happen in complicated early childhood epilepsy or status epilepticus and result in hippocampal sclerosis.

1-1

Authors: Hamid Reza Kianifar

The Journal of Reviews in Clinical Medicine (RCM) is the leading journal of its type at Mashhad University of Medical Sciences covering all aspects of the natural and clinical sciences, which may be a matter of concern for the related specialists. The scope of the journal defines the RCM Publishing Group’s ambition to take a considerable step forward in constructing a valuable medical resource for both authors and readers. It offers the practical and the professional support for clinicians to spread the critical and constructive analysis in a specific field through extended explanations on the topic. In other words, it pragmatically provides the readers with recent advances and discoveries by means of previously published literature or data. Furthermore, the journal expects to generate the ideas of where the researches might go in the future. The RCM Publishing Group hopes to be a gateway to the positive outlook of research in any medical discipline. In this issue, we present the wide range of researches in different fields of medicine, which describe briefly below. Acute lymphoblastic leukemia (ALL) is one of the most common pediatric disorders that affected the large number of patients. Along with the high rate of treatment success, a modified and individualized diagnostic test can significantly increase the survival rate. Therefore, cytogenetic and molecular tests might play an important role in the prognosis of ALL by detecting the special genetic polymorphism affecting drug metabolism and its subsequent effective level and toxicity. Differential diagnosis between benign and malignant brain tumors has been a dilemma for appropriate management and treatment for years. Magnetic resonance spectroscopy is now addressing the need for noninvasive methods of measuring human brain function. Chronic kidney diseases such as renal failure are considered as the devastating medical problems in different age group. The longterm appropriate medical care especially nutritional support can exert a positive effect on patients` health. Furthermore, the use of tranexamic acid in cardiac surgery and its complications such as bleeding, the use of herbal medicine in the treatment of refractive seizure in children, the different causes of coma in pediatric medicine and also peripheral nervous system destruction occurred in systemic vasculitis has been discussed. Finally, we focus on cyclooxygenase 2 (COX2) as a major overexpressing enzyme in cancers. Thus, clinicians may consider COX 2 inhibitors as one of the therapeutic agents. The previous studies evaluated this role are reviewed in Wilms` tumor. Above all, we want to express our appreciation to all those who have submitted their manuscripts to RCM journal, all the Editorial board members and all the dedicated staffs for their loyal and precious cooperation. We look forward to attracting more specialists, residents and medical students to make RCM a really international and multicultural journal. Frankly, this has promised to be a far more difficult task than we anticipated. However, we will continue our efforts to take the first steps in this evolution more effectively.

7-11

Authors: Mohammad Esmaeelzadeh; Shahram Amini

Serious bleeding in cardiac surgery leads to re-exploration, blood transfusion and increases the risks of mortality and morbidity. Using the lysine analogous of antifibrionlytic agents are the preferred strategy to suppress the need for transfusion procedures and blood products. Although tranexamic acid has been very influential in reducing the transfusion requirement after operation, tranexamic acid induced seizures is one of the common side effects of this drug. Due to inhibiting the fibrinolysis, thrombotic events are other possible side effects of using tranexamic acid. There are no certain results regarding decreasing the mortality rate by using the drug but it is identified that tranexamic acid does not increase the mortality. In this article, we aimed to review the literature on using tranexamic acid in cardiac surgeries.

17-20

Authors: Sirous Nekooei; Bahareh Haratizadeh

The ability to differentiate between neoplastic and non-neoplastic focal brain lesions is critical for appropriate management of patient. Due to low specificity of magnetic resonance imaging (MRI) adequate data for differentiating would not be provided. Magnetic resonance spectroscopy (MRS) is one of the newly supplementary methods for determining molecular structures and better differentiation among brain lesions. The applicability of MRI plus MRS in changing the histopathology is undetermined. In order to evaluate the benefits of magnetic resonance spectroscopy combined with the conventional magnetic resonance imaging, we reviewed related literature till 2013.

25-28

Authors: Mona Amini; Reza Boostani; Maryam Sahebari

Primary systemic vasculitis in pre-capillary arteries is associated with peripheral neuropathy. In some types of systematic vasculitis about 60 % of patients have peripheral nervous system (PNS) involvement. In vasculitic peripheral neuropathies (VPN) a necrotizing and inflammatory process leads to narrowing of vasa nervorum lumen and eventually the appearance of ischemic lesions in peripheral nerves. Some features might be suggestive of VPN, like: axonal nerve degeneration, wallerian-like degeneration, and diameter irregularity of nerve. Peripheral nervous system (PNS) destruction during systemic vasculitides should be considered, due to its frequency and early occurrence in vasculitis progression. The first line treatment of non systematic VPNs is corticosteroid agents, but these drugs might worsen the VPNs or systemic vasculitis.

33-37

Authors: Sara Hashemi

Cyclooxygenase 2 has become an important pharmacological target in anticancer therapy due to the over expression of COX 2 in pathological conditions. Wilms’ tumor is a common kidney cancer in children which has shown an increase in COX 2 enzyme level. Here we reviewed various articles that considered the cyclooxygenase 2 changes specifically in Wilms’ tumor regarding the mechanisms of action and inhibitors of COX 2.