Volume 55 (2017): Issue 1 (March 2017)

Background. The association between obesity and different types of anemia remained uncertain. The present study aimed to assess the relation between obesity parameters and the occurrence of iron deficiency anemia and also megaloblastic anemia among Iranian population.

Methods and Materials. This cross-sectional study was performed on 1252 patients with morbid obesity that randomly selected from all patients referred to Clinic of obesity at Rasoul-e-Akram Hospital in 2014. The morbid obesity was defined according to the guideline as body mass index (BMI) equal to or higher than 40 kg/m². Various laboratory parameters including serum levels of hemoglobin, iron, ferritin, folic acid, and vitamin B12 were assessed using the standard laboratory techniques.

Results. BMI was adversely associated with serum vitamin B12, but not associated with other hematologic parameters. The overall prevalence of iron deficiency anemia was 9.8%. The prevalence of iron deficiency anemia was independent to patients’ age and also to body mass index. The prevalence of vitamin B12 deficiency was totally 20.9%. According to the multivariable logistic regression model, no association was revealed between BMI and the occurrence of iron deficiency anemia adjusting gender and age. A similar regression model showed that higher BMI could predict occurrence of vitamin B12 deficiency in morbid obese patients.

Conclusion. Although iron deficiency is a common finding among obese patients, vitamin B12 deficiency is more frequent so about one-fifth of these patients suffer vitamin B12 deficiency. In fact, the exacerbation of obesity can result in exacerbation of vitamin B12 deficiency.

Introduction. Cardiovascular events represent an important cause of morbidity and mortality in the entire population. Arterial stiffness is currently considered one of the most important risk factors for the development of cardiovascular events. The gold-standard for evaluating arterial stiffness is pulse wave velocity (PWV). Recent studies have demonstrated that PWV is an independent risk factor regarding the development of cardiovascular events, especially in certain categories of patients.

Material and Methods. The development of cardiovascular events was assessed in 174 patients admitted in the Center of Internal Medicine, Fundeni Clinical Institute, between January 2011 – May 2012. Arterial stiffness was evaluated by measuring PWV using the Sphygmocor system (AtCor, Australia), which is based on the principle of applanation tonometry. The patients were monitored for the development of cardiovascular events (ischemic heart disease, heart failure, stroke, acute myocardial infarction) and for death of cardiovascular cause, over a median period of 51.5 months (43-60 months).

Results. Of the 174 patients, 81 (46.6%) were women and 93 (53.4%) were men. Mean age was 55.96 years. 93 of the 174 patients had chronic kidney failure in different stages (47.3% in stage V). Regarding PWV in the patient group, we obtained a mean score of 9.382. We observed a significant difference regarding the PWV level only for acute myocardial infarction and death between patients who developed these events and those who did not.

Conclusions. Our study demonstrates that PWV increase can be positively associated with the occurrence of cardiovascular events, particularly in certain groups of patients

Introduction. Alexithymia is related to poor emotion regulation strategies as well as higher rates of somatic disorders. The aim of the present study was to assess the relationship between alexithymia and the general symptoms experienced by the pregnant women.

Material and Methods. In a cross-sectional study, a total number of 350 pregnant women, attending the antenatal clinics, were randomly selected. A standardized Toronto Alexithymia Scale (TAS-20) was used to elicit responses from participants with alexithymia. The general symptoms scores were measured using the Iranian version of the Symptom Checklist-90-Revised, 90 items. The statistical associations between alexithymia and the general symptoms were then investigated through liner regression.

Results. A total number of 186 of pregnant women with alexithymia were compared with the 164 cases without alexithymia. The high scores on Total Toronto Alexithymia Scale-20 and the difficulties to identify feelings emerged as major predictors for the current psychopathology on all SCL-90-R subscales. The difficulty in describing feelings features of alexithymia is positively associated with interpersonal sensitivity and paranoid ideation, but it is inversely associated with the phobic anxiety dimension.

Conclusion. This study showed that the pregnant women with difficulty in describing feelings features of alexithymia are likely to show a broad range of psychopathology. Therefore, it is necessary to emphasize the benefits of specific psychotherapeutic techniques to improve self-differentiation so that we can reduce the likelihood of mental illnesses in pregnant women.

Introduction. Stroke is one of the leading causes of morbidity and mortality. Cardiac troponins have been found to be increased in other conditions apart from the cardiac diseases, such as stroke. The aim of the study was to assess the correlation between elevated troponin I levels and stroke outcome.

Methods. This retrospective study included 198 acute ischemic stroke patients in whom troponin I levels have been obtained at admission. Exclusion criteria were concomitant acute coronary syndrome, congestive heart failure, pulmonary embolism, renal failure, rhabdomyolysis and septic conditions.

Results. There was a statistically significant difference in the proportion of deaths during hospitalization (p = 0.041) and modified Rankin Scale scores (p = 0.016) between the group of patients with elevated troponin I levels and the control group. Prior ischemic strokes were more common in the group with elevated troponin I levels (p = 0.032). No other differences were observed.

Conclusions. Our study showed that patients with elevated initial troponin I levels are associated with unfavorable outcome or death. Stroke may be associated with mild elevation of troponin levels, contrary to higher levels which are usually related to other conditions.

Background. Recent studies have confirmed the essential and paramount role of the L-Citrulline on the nitric oxide regulation and the endothelial function improvement.

Materials and Methods. In this cross-over clinical trial, thirty patients, diagnosed with coronary artery disease (CAD) and flow mediated dilation to nitroglycerin dependent vasodilation (FMD/NMD) ratio less than 1, were included. The patients were randomly divided into two groups of 15 patients and underwent treatment by L-Citrulline or placebo for 15 days, in 2 step protocol. The indicators of assessment in the current study were the ratio of the FMD/NMD and FMD value.

Results. In the current cross-over clinical trial, the mean of FMD to NMD ratio and mean FMD value of all patients before starting the protocol were 0.91 ± 0.08 and 4.04 ± 0.51 mm, respectively. The final results of study showed that following L-Citrulline administration, mean FMD to NMD ratio and mean FMD value were enhanced to: 1.03 ± 0.09 and 4.96 ± 0.72 mm, respectively, which were statistically significant (P<0.001 and P<0.001, respectively). However, following placebo administration, mean FMD to NMD ratio and mean FMD value were receded to: 0.92 ± 0.09 and 4.06 ± 0.22 mm, respectively, which were not statistically significant (P = 0.75 and P = 0.89, respectively). Moreover, the improvement of mean FMD to NMD ratio (0.12 ± 0.02) and mean FMD value (0.92 ± 0.16 mm), following L-Citrulline administration, were statistically significant in comparison with the change of mean FMD to NMD ratio (0.01 ± 0.002) and mean FMD value (0.02 ± 0.003), following placebo administration (P<0.001 and P<0.001, respectively).

Conclusion. L-Citrulline treatment can lead to improvement of the endothelial function in patients diagnosed with CAD which are assessed via FMD to NMD ratio FMD value enhancements.

Introduction. Traditionally, the body mass index (BMI) is used to describe anthropometric measurements and to assess weight-related health risks. However, the abdominal circumference (AC) might also be a valuable parameter to estimate this risk. This study aims to describe an association between the BMI and the AC.

Material and Methods. Participants were recruited during the Brussels Food Fair in 2014. They completed a questionnaire with their medical history, and health related parameters such as blood pressure, weight, height and AC were measured.

Results. In total, 705 participants were analyzed. Men had a mean BMI of 27.3 kg/m² and a mean AC of 98.7 cm. Women had a mean BMI of 26.0 kg/m² and a mean AC of 88.2 cm. The Pearson’s correlation coefficient between the BMI and the AC was 0.91 for men and 0.88 for women. There was a strong positive correlation between the BMI and the AC. In the identification of patients at high risk for weight-related diseases, the use of the AC identified more patients than the BMI. Especially more women were ranking in a higher risk class with the AC than with the BMI classification. Both the BMI as well as the AC identified most diseases with an increased relative risk.

Conclusion. There is a strong correlation between the BMI and the AC. There are too few arguments to prefer the use of AC above the BMI to detect people at high risk for weight-related diseases.

Background. Optimal bowel preparation is one of the most important factors affecting the quality of colonoscopy. Several patient-related factors are known to influence the quality of bowel cleansing but randomized trials in this area are lacking. We aimed to compare an individualized bowel prep strategy based on patient characteristics to a standard preparation regimen.

Material and Methods. We conducted an endoscopist-blinded multicenter randomized control-trial. The Boston Bowel Prep Score (BBPS) was used to assess quality of bowel preparation and a 10 point visual analogue scale to assess patient comfort during bowel prep. Patients were randomised to either the standard regimens of split-dose 4L polyethylene-glycol (group A), split-dose sodium picosulphate/magnesium citrate (group B) or to either of the two depending on their responses to a 3-item questionnaire (individualized preparation, group C).

Results. 185 patients were randomized during the study period and 143 patients were included in the final analysis. Patients in the individualized group had a median BBPS of 7 compared to a median of 6 in the standard group (p = 0.7). Also, there was no significant difference in patients’ comfort scores, irrespective of study group or laxative regimen. However, on multivariable analysis, a split-dose 4L polyethylene-glycol was an independent predictor for achieving a BBPS>6 (OR 3.7, 95% CI 1.4-9.8), regardless of patient-related factors.

Conclusion. The choice of laxative seems to be more important than patient-related factors in predicting bowel cleansing. Comfort during bowel prep is not influenced by the type of strategy used.

Background & Aims. Considering the ability of anti-TNF alpha drugs to lower the burden intestinal inflammation in patients with inflammatory bowel disease (IBD), and the similarity between IBD and ankylosing spondylitis (AS) regarding inflammatory intestinal involvement, we aimed to investigate the impact of anti-TNF alpha biologic therapy on subclinical intestinal inflammation in AS patients.

Methods. Between January 2008 and December 2013, 38 AS patients and 23 controls were enrolled in the study and investigated with small bowel videocapsule endoscopy examination and ileocolonoscopy. Each tertile of the small bowel (proximal, mid and distal) was assessed by calculating the Lewis score based on the image stream.

Results. The Lewis scores were significantly higher in the AS group compared to controls (580.9 ± 818 vs. 81 ± 121, p<0.001). 16 patients (42.1%) were on anti-TNF alpha therapy (Adalimumab (n = 5), Infliximab (n = 5) or Etanercept (n = 6)).31.3% of them used NSAIDs simultaneously, compared with 77.3% of the other patients (p<0.01). Their Lewis scores were lower compared to the other patients for the entire small bowel (306 ± 164 vs. 790 ± 1038, p = 0.015), its proximal and distal tertiles (238 ± 154 vs. 560 ± 543, p = 0.021, and 140 ± 189 vs. 300 ± 220, p = 0.027, respectively). The Lewis score was also lower in patients receiving Adalimumab/Infliximab compared to those on Etanercept for the entire bowel and its distal tertile (262 ± 165 vs. 380 ± 148, p = 0.069 and 62 ± 101 vs. 273 ± 236, p = 0.060, respectively).

Conclusion. Anti-TNF alpha therapy in patients with AS reduces the subclinical intestinal inflammation, but the magnitude seems to depend upon the class anti-TNF alpha agent used (Clinical Trials. gov NCT00768950).

Objective. Histiocytic sarcoma (HS) is an extraordinary rare tumor and it has an offensive clinical course. HS of the uterine cervix is a far uncommon tumor with just a few cases described so far. Here we presented a case of primary HS of the uterine cervix in a 62-year-old female initially misdiagnosed as large cell non-keratinizing squamous cell carcinoma. To the best of our knowledge, this is the first reported case of HS of the uterine cervix from Iran.

Case report. The patient presented with post-menopausal vaginal bleeding. Further evaluations revealed the presence of a relatively large cervical mass that was sampled. Under the preliminary diagnosis of large cell non-keratinizing squamous cell carcinoma, the patient underwent radical surgery. Postoperative pathological examination confirmed the diagnosis of HS of the uterine cervix. The patient received chemotherapy.

Conclusion. Clinical presentations of HS of the uterine cervix are very similar to more common cervical tumors; as a result its diagnosis relies on immunohistochemical methods. A correct diagnose could lead to the proper and timely treatment.

The femoral artery pseudoaneurysm is a disturbing groin complication associated with the femoral arterial access site used for invasive cardiovascular interventions. We present a 39 year old man who developed a huge right common femoral artery pseudoaneurysm, following diagnostic coronary artery catheterization, which was successfully managed with stent-assisted coiling, an emerging and narrative option in invasive percutaneous approaches to femoral artery pseudoaneurysm.