Reviews in Clinical Medicine

152-159

Authors: Abbas Esmaeilzadeh; Azita Ganji; Ali Bahari; Ladan Goshayeshi

Introduction: Hepatitis E infection is caused by the hepatitis E virus (HEV) and is a self-limiting disease with moderate-to-high prevalence in various regions. Considering that HEV is endemic in Iran, the present study aimed to systematically review the prevalence of HEV in Iran. Methods: This systematic review was performed in May 2016 to investigate the prevalence of Hepatitis E infection in Iran via searching in databases such as PubMed, Scopus, and IranMedex using the following approach: (((Hepatitis E OR HEV)) AND (epidemiology OR frequency OR prevalence)) AND Iran. After collecting the proper documents, the required data were extracted and described. Result: In total, 24 relevant articles with 12,555 study populations were collected in this study. The results of the review indicated that the prevalence of HEV is relatively high in the Iranian population. In the reviewed literature, the prevalence of HEV varied from 2.3% to more than 40%. Conclusion: According to the results, the prevalence of HEV in Iran is similar to the rate reported in the other developing countries. Therefore, it is recommended that routine tests be conducted for the diagnosis of hepatitis E, especially in the suspected cases of acute non-A, non-B, and non-C hepatitis.

165-168

Authors: Zohre Khodamoradi; Maryam Poursadeghfard; Zahra Shamszadeh

Sneddon syndrome (SS) is characterized by chronic, progressive arteriopathy, which causes ischemic stroke and skin lesions. It seems that thrombotic or embolic processes in the vessels may be involved in the pathology of this syndrome. Neurological symptoms always occur due to the ischemic events of the cerebrovascular system, and the associated cutaneous manifestations include deep blue skin lesions with irregular margins, known as livedo reticularis and livedo racemosa. Despite the ischemic events, hemorrhagic cerebral accidents are unusual in SS. Our case was apparently a normal woman with negative medical history who, despite the normal ischemic cerebral manifestations, initially presented with intracranial hemorrhage, which progressed to new skin lesions (livedo reticularis) after a few days. In the follow-up, the patient was diagnosed with SS.

173-175

Authors: Ezzat Khodashenas; Alireza Ataei Nakhaei; Elahe Heidari

The purpose of this study is to report a case of severe back pain following lumbar puncture (LP), which was associated with an accidental tether cord syndrome (TCS) in MRI. The patient was a 10-year-old boy that was hospitalized in the pediatric ward for severe headache and to rule out meningitis. First, LP was performed for him, but he suffered very severe back pain after LP. Lumbosacral MRI was performed to rule out collection or abscess formation, but the evidence of the TCS was accidentally found; however, it was too unexpected before. In the short term follow up, the symptoms of the patient were completely resolved by using analgesics. It was shown that his pain was as a result of LP. In general, although sometimes severe lower back pain after LP may be overwhelming, if neurologic examination were normal, it is important to assure parents that it would be resolved.

180-184

Authors: Hassan Mehrad-Majd; Javad Akhtari; Yalda Ravanshad

Metabolic syndrome and its various manifestations are considered to be a significant health epidemic in the developed and developing countries across the world. Metabolic syndrome is characterized by a series of metabolic abnormalities, such as central adiposity, insulin resistance, hypertension, glucose intolerance, and dyslipidemia. Patients with metabolic syndrome are at a higher risk of major complications, including fatty liver, type II diabetes mellitus, and cardiovascular diseases. Nuclear receptors are the key regulators of gene transcription, as well as several metabolic pathways. Among these receptors, LXRα and β play a major role in the regulation of lipogenesis, cholesterol/glucose homoeostasis, and inflammatory pathways through the induction or repression of target genes. In addition to metabolic homeostasis and diseases, lipogenesis and hypertriglyceridemia are regarded as the most significant adverse effects of liver X receptor (LXR) activation. Given the importance of lipid and carbohydrate metabolism and inflammation in the development of metabolic disorders, the present study aimed to review the impact of LXR signaling on the risk of metabolic syndrome and its phenotypes, with an emphasis on their potential therapeutic applications in the treatment of metabolic syndrome. In general, growing evidence supports the notion that LXRs may represent the potential drug targets for the treatment of metabolic syndrome.

97-101

Authors: Ali Azari; leila Bigdelue; Afsoon Fazlinezhad; Marzye Farazandeh; Somaye Bakefayat

Introduction: The pathophysiology of ischemia involves the cellular effect of myocardial ischemia, reactive oxygen species, and reactive inflammatory enzymes. Left atrial (LA) ischemia has been shown to have several mechanisms through which it can lead to abnormalities in left ventricular filling in early diastole and thus reduces LA passive functional reserve. In this review, we evaluated the physiological mechanisms of LA during myocardial ischemia, as previously demonstrated in experimental and clinical studies. Methods: Several databases were searched in order to find related articles. The outcome of interest included LA function measurements (measurement of LA volume) during ischemia. By applying a standardized protocol, reviewers independently extracted and assessed the studies. Results: The literature review indicated 50 publications, among which 15 studies were eligible for analysis. Assessment of LA dimension and function is essential for clinical evaluation and prognostic purposes. Conclusion: The present article revealed that LA passive emptying volume and LA emptying volume significantly increased in myocardial ischemia. Further researches could provide a better understanding of pathophysiological mechanisms behind LA enlargement and help to predict clinical outcomes in many cardiovascular disorders.

124-127

Authors: Omid Mardanshahi; Jina Khayatzadeh; Soodabeh Shahidsales

Anthropometry is a science of human body measurement that could be used for manufacturing artificial limbs or prosthesis, investigating body differences between populations, utilizing in forensics and criminology, or even in the diagnosis of some diseases. Two of the most important anthropometric characteristics are dermatoglyphic patterns and finger length. Many studies have evaluated the relation between these two characteristics in different diseases such as cancers. It assumed that dermatoglyphic patterns and finger length could be used as predictors of some cancers such as gastric, ovarian, prostate, testicular, and breast cancers. In this review, we evaluated the relation between dermatoglyphic variability and finger length in different cancers more precisely.

131-135

Authors: Mina Erfani; Farah Ashrafzadeh; javad Akhondian; Hamid Reza Rahimi; Mehran Beiraghi-Toosi; Hashem Lashgari-Kalat; Ehsan Alaei; Monica Zeynalzadeh

Nearly 70 million people worldwide suffer from epilepsy. Despite administration of routine antiepileptic drugs (AEDs), nearly 30% of seizures are resistant to treatment called drug resistant epilepsy (DRE). Since the epilepsy treatment may result in consequences of multi-drugs administration or sometimes invasive surgical methods in DRE, herbal treatment can be a good alternative choice due to its easy accessibility, lower cost and fewer side effects. Although turmeric has been one of a very commonly used dietary spices and traditional herbal remedies, its derivation as a newly introduced medicine-curcumin has not been used to a large extent. In this literature, we have reviewed the available trial researches, which studied specifically antiepileptic effect of curcumin. We searched databases of Science direct, PubMed and Google Scholar (2008 to 2016) with key words of turmeric, curcumin, Diferuloylmethane, Epilepsy, and Seizure to find the related references. The major extract of turmeric curcumin has found to have antiepileptic effect according to recent surveys. It not only has no critical adverse effect, but also can protect patients from other AEDs severe side effects. It also makes it possible to gradually decrease the dose of AEDs in long-term combination therapy

140-142

Authors: Leila Pourali; Sedigh Ayati; Masoud Pezeshkirad; Mansooreh Sadat Golmohammadi

Postpartum hemorrhage (PPH) is one of the most common complications of delivery and is a major cause of maternal morbidity and mortality. The aim of this report is to introduce a case of therapeutic uterine artery embolization (UAE) in a life-threatening postpartum hemorrhage. A 26-year old G3P3 woman with severe postpartum hemorrhage after 50 days of delivery referred to the emergency unit of an academic hospital of Mashhad University of Medical Sciences, Iran with third episode of vaginal bleeding. Gynecological examination and sonography were completely normal. Hypovolemic shock that was managed by fluid and blood replacement-therapy with uterotonic medical agents including oxytocin infusion (40 unit/lit), injection of 0.2 mg methyl-ergonovin and 1000 µg rectal misoprostol. Uterine artery embolization was planned due to unremitting severe hemorrhage. Embolization resulted in successful control of hemorrhage and the patient was discharged. At 6 months follow-up, no adverse events pertinent to embolization were noted. Therefore, UAE is suggested as a useful method for controlling intractable bleeding due to postpartum hemorrhage.

50-56

Authors: Farzane Farzam; Masume Safaee; Mahsa Akbari Oryani; Hadi Razmara; Naveed Fathee; Vahide Farzam

Introduction: Endothelial progenitor cells (EPCs) are known as putative cells in neovasculogenesis during pathological conditions, which are derived from bone marrow. This study was performed to systematically review the EPCs frequency in patients with non-small cell lung cancer (NSCLC) by evaluating the expression of CD133 and vascular endothelial growth factor (VEGF) markers. Methods: We search the PubMed and Scopus databases for the following keywords; CD133 AND lung AND VEGF. Inclusion criteria were all the articles studied the expression of both CD133 and VEGF markers in patients with NSCLC. No language and date restrictions were imposed to the search strategy. All the articles that studied only one biomarker or those that investigated the markers expression and EPCs count in patients with other types of tumors except NSCLC were excluded from the study. Result: Totally 51 articles obtained following the primary search of both databases. Only 7 of them had the eligibility to be included in this systematic review. Six articles were case- control and one was a cohort type of investigation. Flowcytometry and immunohistochemistry were the most applied methods for estimating the EPCs count and evaluating the expression of markers in circulating peripheral blood and tumors tissue. The expression of EPCs markers was increased in patients with NSCLC compared to healthy control individuals; however, the frequency of EPCs was low in peripheral blood of patients. Conclusion: Although it is not clear that circulating EPC numbers are associated with lung cancer patients angiogenesis, EPCs and VEGF levels are elevated in patients with operable NSCLC. The ideal method for evaluating circulating endothelia cells (CECs) or EPCs levels in vivo is still a matter of debate and because of the low number of EPCs in peripheral blood, their detection is technically challenging.

62-68

Authors: Najmeh Malekzadeh

Rheumatoid arthritis (RA) is a common inflammatory disease affecting approximately 1% of the adult population worldwide. Before new treatments were available, unchecked RA caused notable inability and mortality .It is now accepted that primary diagnosis and treatment are essential and useful. Progress in therapy of RA has made it possible to deeply influence signs and symptoms as the period that joint destructed in inflammatory arthritis. Earlier and more efficient treatment becomes visible to significantly improve the prognosis of this disease. In this article, the old and new methods for treatment rheumatoid arthritis and their limitation and benefits were reviewed. These methods include nonsteroidal anti-inflammatory drug (NSAIDs), glucocorticoids(GC) that are a class of steroid hormones, disease-modifying anti-rheumatic drugs (DMARDs), biological agents that can be divided in two groups of monoclonal antibodies and teeny molecules, bisphosphonate therapy, nanotechnology, oral tolerance, photodynamic therapy, gene therapy, bone marrow transplantation, liposomes, superparamagnetic iron oxide nano particles (SPIONs).

73-77

Authors: Fariba Rezaeetalab; Fariborz RezaeiTalab

Restless legs syndrome (RLS) is a common chronic sensory motor disorder that prevents initiation and/or sleep staying. Patients with this syndrome have uncomfortable sensations in their legs (and sometimes arms or other parts of the body), with moving their legs to relieve this sensations. The symptoms of RLS are usually worse in the evening and at night. The diagnosis of RLS is primarily based on clinical evaluation and clinical history of the patient. International restless leg syndrome group study (IRLSSG) evaluates the symptoms and severity of RLS. RLS can be divided into two groups of primary and secondary. Iron deficiency, Parkinson’s disease, kidney failure, diabetes, peripheral neuropathy, and pregnancy may cause RLS. Antinausea, antipsychotic drugs, some antidepressants, and antihistamines may also worsen the symptoms. RLS is also observed in chronic obstructive pulmonary disease (COPD), which makes the outcomes worse. COPD is a main preventable health problem that can lead to morbidity and mortality. Thus, RLS in COPD causes excessive daytime hypersomnolence, fatigue, poor quality of life, disability and neuropsychological complications such as social isolation, frequent daytime headaches, anxiety and depression.

83-86

Authors: Aliasghar Moeinipour; Mohamad Abbassi Teshnizi; Babak Manafi; Hadi Yavari; Yasamin Moeinipour; Hamid Hoseinikhah

Herbal medicine is usually safe and popular in Iranian communities. Peppermint herbal products may interact with warfarin, which is an essential lifelong drug used in patients with prosthetic heart valves. Herein, we report a case of possible interaction between warfarin and peppermint herbal tea. We described a 68-year-old woman who was on warfarin treatment due to bileaflet mechanical aortic valve, and mitral valve replacement presented with severe dyspnea in the setting of large obstructive prosthetic mitral valve thrombosis diagnosed by echocardiography. Therefore, cardiac surgery was conducted in the emergent setting. Warfarin was started the day after the procedure. She developed melena with a volatile and elevated international normalized ratio (INR) of 4.8 and prothrombin time > 30 s on the 7th post-operation day. She reported no changes in drug or dietary habits except for drinking high amounts of peppermint tea the day before. After the discontinuation of warfarin and medical consultation for gastrointestinal bleeding, the INR level decreased to 1.8 within two days. Consumption of peppermint herbal products are usually safe; however, caution should be taken with patients under warfarin treatment. Full disclosure for patients on anticoagulant treatment is necessary before discharge and during clinical follow-up

7-13

Authors: Sona Sepahi; Bamdad Riahi-Zanjani; Adel Ghorani-Azam

Abstract Introduction: Valproic acid (VPA) is an acidic compound that is commonly used as an anticonvulsant and mood-stabilizing agent in the treatment of epilepsy, mania and bipolar disorders as well as the prevention of migraine headaches. But, it can affect metabolic and endocrine system resulting in hormonal disturbances and incidence of some metabolic disease, especially in pediatric patients. In this study, we aimed to systematically review the literature wherein metabolic and endocrine effect of valproic acid has been studied in pediatric patients with epilepsy. Methods: To evaluate the relationship between VPA consumption and metabolic diseases, a systematic literature search was performed through searching for related documents in the PubMed and Scopus as two known databases using the following key terms “valproic acid”, “metabolic disease” and “pediatrics” in the title, keywords, and abstract of literatures. Data were then extracted and described. Result: Nearly 934 documents were collected and reviewed based on the main purpose of this study. Of the collected articles, 918 documents were excluded in several step by step processes of article selection, and only 16 relevant documents were included for further data assessment. The results showed that VPA can cause significant increase in plasma concentration of thyroid hormones and therefore increase the risk of metabolic disease in patients with epilepsy. Conclusion:The results of included documents in this review showed that VPA may induce metabolic and hormonal disturbances in pediatric patients, who were on treatment with VPA.

20-25

Authors: Gholamreza Bahadorkhan; Omid Daneshvarfard

Abstract Introduction: Previous studies have indicated that administering erythropoietin (EPO) can have a beneficial impact on the clinical outcomes of patients with severe traumatic brain injury (TBI). This review examines the possible therapeutic effects EPO can have neuronal functions, neurological performance, and neurological recovery. Methods: The PubMed and Scopus databases were systematically searched on the 5th June, 2015, using the following search strategy: (“traumatic brain injury” OR “brain trauma”) AND (erythropoietin OR EPO) to identify relevant articles in which the effect of erythropoietin on patients with TBI was assessed. No time limitation was defined as the inclusion criteria. All available studies were extracted and categorized based on the purpose of this study. Result: Of the 908 articles in total that were identified during the initial database search, 901 documents were excluded from further examination because they did not meet the predefined inclusion/exclusion criteria. The total number of patients enrolled in the selected literature was 798. Of these, the use of EPO failed to show significant improvement in 113 patients. Discussion: Previous studies have shown that EPO may represent a valuable neuroprotectant that is useful in the treatment of neonatal brain injury, neurodegeneration, and TBI. Studies on animal TBI models have also found that recombinant human erythropoietin (rhEPO) reduces the development of post-traumatic brain edema. Conclusion: EPO may represent a potential therapeutic approach for the treatment of TBI. In addition, it can improve the patients› recovery prospects and reduce in-hospital mortality and morbidity.

31-34

Authors: Karim Nikkhah; Mohammad Taghi Farzadfard; Fariborz Rezaeitalab

Abstract Interesting phenomena of reflex epileptic syndromes are characterized by epileptic seizures each one induced by specific stimulus with a variety of types. Simple triggers, which lead to seizures within seconds, are of sensory type (most commonly visual, most rarely tactile or proprioceptive stimuli). Complex triggers, which are mostly of cognitive type such as praxis, reading, talking, and music, usually induce the epileptic event within minutes. It should differ from what most epileptic patients report as provocative precipitants for seizures (such as emotional stress, fatigue, fever, sleep deprivation, alcohol, and menstrual cycle). The identification of a specific trigger is not only important for patients or their parents to avoid seizures, but also it might help neurologists to choose the most effective antiepileptic drug for each case. In addition, research in this area may possibly reveal some underlying pathophysiology of epileptic phenomena in the brain. In this review, we briefly introduce reported reflex epileptic seizures, their clinical features and management.

39-44

Authors: Bentolhoda Sahebnasagh; Mohammad Javad Hosseinzadeh-Attar; Amrollah Sharifi

Abstract Findings have shown that low serum 25-hydroxy vitamin D level is a possible risk factor for incidence of preeclampsia during pregnancy. Vitamin D has important effects on multiple biological pathways, including angiogenesis. Some studies have shown that vitamin D deficiency is highly prevalent among women suffering from preeclampsia, influencing immune modulation and vascular function. Evidence has shown that an imbalance of pro-antigenic and anti-angiogenic proteins can be considered as a possible etiological factor in the development of preeclampsia. Besides, there is a series of studies linking the renin–angiotensin aldosterone system (RAAS) with preeclampsia. In this article, we review the current studies evaluating the association between maternal vitamin D status and vascular health, metabolism, placental immune function and the risk of preeclampsia. We provided evidence of the different factor involved in the metabolism of vitamin D and vitamin D receptor (VDR) expression, gene regulations, immune function, and chronic disease when vitamin D is used optimally.