Internal Medicine and Medical Investigation Journal <p>The <em>Internal Medicine and Medical Investigation Journal</em> is an international quarterly journal that publishes scientific articles on topics in internal medicine and any aspect of medical science. The journal is an open-access publication and is the official journal of Mehrabani Publishing, LLC. The <em>Internal Medicine and Medical Investigation Journal</em> publishes original research articles, review articles, case studies, and short communications.</p> <p><strong>Invitation for Article Publication</strong><br> <br>The <em>Internal Medicine and Medical Investigation Journal </em>is multi-disciplinary and open access. The editors welcome original research articles, letters to the editor, short reviews, case reports, and commentaries written by experts in their fields of specialty.</p> <p>Please let us know if you are interested in serving on our journal editorial board or being a peer reviewer.</p> en-US <p>Authors who publish with this journal agree to the following terms:</p> <p><br>1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a&nbsp;<a href="" target="_new">Creative Commons Attribution License</a>&nbsp;that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</p> <p><br>2. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.</p> <p><br>3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See&nbsp;<a href="" target="_new">The Effect of Open Access</a>).</p> (Mehrabani Publishing LLC) (Moein Ashrafi) Sun, 24 Feb 2019 00:00:00 -0500 OJS 60 Proton pump inhibitors and Gastric cancer correlation; Time to take it seriously?” <p>Proton pump inhibitors (PPI) are the most prescribed drugs globally, which are highly potent gastric acid suppressors, known for the management of numerous diseases. There is a notable correlation between Gastric cancer and PPI. It is highlighted that the underlying mechanism is in close association with a study conducted 30 years ago, which showed excessive inhibition of gastric acid secretion in rodents, with secondary hypergastrinemia, that led to enterochromaffin-like-cell (ECL) hyperplasia. In conclusion, based on the scarce literature, it is evident that the safety of PPI is under a dilemma. Developing countries like Pakistan, where there is an excessive prescription of PPI, often without justification, are a significant burden on the economy as well as a threat to life, keeping in view of the significant correlation between PPI and gastric cancer.</p> Aatera Haq, Syed Mohammad Mazhar Uddin, Uzair Yaqoob ##submission.copyrightStatement## Sun, 10 Feb 2019 20:28:03 -0500 Paternal Smoking May be Associated with Increased Risk of Miscarriage <p>This letter to editor discuss about Paternal Smoking and Increased Risk of Miscarriage</p> Syed Zawahir Hassan, Chantal Saberian, Sadaf Karrar Khan, Osama Salam ##submission.copyrightStatement## Sun, 10 Feb 2019 20:29:24 -0500 Preventive and Curative Effect of Omega-3 Supplementation on Bone Mineral Density in People Aged 60 Years and Older: A Review Article <p>Osteoporosis and osteopenia are common worldwide problems leading to potentially life-threatening consequences. Omega-3 supplementation for treating osteoporosis is less studied and less valued by physicians. We aimed to ascertain the appropriate dosage of omega- 3 supplementation to prevent osteoporosis. Google scholar database was searched in May 2017 using the keywords: n-3 fatty acids, omega-3 polyunsaturated fatty acids, essential fatty acids, eicosapentaenoic fatty acids, docosahexaenoic acid, docosapentaenoic acid, alpha-linolenic acid, linoleic acid, osteopenia, osteoporosis, bone density, and fracture. We reviewed English language reports of randomized controlled trials with intake of omega-3 polyunsaturated fatty acids, in which subjects were over 60 years and supplemented with a quantified dosage of omega-3; and outcome was indicated by bone mineral densitometry medical record of fractures and radiological imaging, and serum biomarker to evaluate bone metabolism. We reviewed 110 papers, which only eight articles met our conclusion criteria and concluded with curative effects. Three articles came up with no prophylactic or curative effect of omega-3 supplementation, three articles suggested a dosage of omega-3 supplement that non significantly increased bone mineral densitometry or decreased absorption, and thus, had prophylactic effects. One article just concluded the positive effects, not defining the exact results. It is suggested that a dosage of 4.5 to 6 g/d of eicosapentaenoic acid and docosahexaenoic acid can have curative effects, while 900-1000 mg/d can have prophylactic outcomes. N-3 fatty acids have positive effects on bone density, but to confine definitive dosage and formulation of omega-3 supplementation for reducing the risk of osteoporosis, further investigations are required.</p> Faezeh Fazelnia, Niloofar Khodabandehloo ##submission.copyrightStatement## Sun, 10 Feb 2019 20:30:25 -0500 Longitudinal Tissue Velocity and Deformation Imaging in Patients with Significant Stenosis of Left Anterior Descending Artery <p><strong>&nbsp;Introduction</strong>: Myocardial longitudinal tissue velocity imaging (TVI) and strain rate imaging (SRI) indices may have a role in the prediction of significant proximal stenosis of left anterior descending (LAD) by echocardiography. <strong>Materials And Methods</strong>: Total 20 patients with proximal LAD stenosis &gt;70% by angiography and ejection fraction ≥50%, without wall motion abnormality at resting echo (stenotic group) and 20 angiographically normal coronaries subjects with normal echocardiography (non-stenotic group) were included in the study. SRI and TVI were performed in nine segments of the LAD territory at rest. Parameters of interest included: peak systolic strain (ST, %), strain rate (SR, Second<sup>-1</sup>), and peak systolic velocity (Sm, cm/s). <strong>Results</strong>: Overal mean ST and SR showed a significant reduction in the stenotic group compared to non-stenotic group (<em>P</em>&lt;0.001), while the mean Sm had no significant difference. A segment-by-segment comparison revealed a reduction of ST in 4/9 (two apical and two anteroseptal) and SR in 5/9 (three apical, septal, and anteroseptal midportion) in the stenotic group (<em>P</em>&lt;0.05). Both ST and SR showed a significant reduction in three segments: anterior-apical, lateral-apical, and anteroseptal-midportion. When both ST and SR decreased in one segment, specificity and sensitivity for the diagnosis of proximal LAD stenosis was more than 80% and 55%, respectively, by Roc analysis. <strong>Conclusion</strong>: There is an overall reduction in the mean ST and SR in the segments of LAD territory with significant proximal stenosis and normal wall motion at rest and an acceptable specificity and sensitivity of SRI for the detection of stenosis in these segments.</p> Reyhaneh Zavar, Hakimeh Sadeghian, Masoumeh Lotfi-Tokaldany, Mohammad Moein Ashrafi, Mahmood Sheikh Fathollahi, Afsaneh Sadeghian ##submission.copyrightStatement## Tue, 19 Feb 2019 00:00:00 -0500 Usefulness of Cardiac Index to Predict Early and 30-Day Mortality in Non-Cardiac Patients Being Admitted to Intensive Care Units <p><strong>Introduction:</strong> Cardiac index is a hemodynamic parameter defined as the ratio of the cardiac output, i.e., the volume of blood ejected from the left ventricle in 1 min, to the body surface area. This study aimed to assess the cardiac index to predict early and 30-day outcomes of non-cardiac patients being admitted to intensive care units using a non-invasive approach.</p> <p><strong>Materials and Methods:</strong> This prospective cohort study included 31 non-cardiac patients who were consecutively admitted to the intensive care units of Rasoul-e-Akram Hospital, Tehran, Iran, in 2016. On admission, the simplified acute physiology score II to predict mortality and the cardiac output (by two-dimensional echocardiography) of each patient were determined. The cardiac index was calculated by dividing the cardiac output by the body surface area. In-hospital mortality and complications were assessed, and the association between simplified acute physiology score II and cardiac index was determined. The patients were followed-up 30 days after discharge by telephone to determine late death, occurrence of myocardial infarction, readmission, or re-hospitalization.</p> <p><strong>Results:</strong> The mean cardiac index was significantly lower among the patients who died in intensive care units than in those who survived (2.86 ± 0.63 versus 3.70 ± 0.49, p = 0.006). A significant inverse association was found between Simplified Acute Physiology Score II and cardiac index (r = −0.539, p = 0.002). The length of hospital and intensive care units stay was not associated with Simplified Acute Physiology Score -II or cardiac index. The receiver operating characteristic curve analysis revealed that the cardiac index was effective in predicting in intensive care units mortality (area under curve = 0.857, p = 0.007). The best cut-off value for the cardiac index to predict in intensive care units mortality was 3.35, yielding a sensitivity of 83.3% and a specificity of 80.0%.</p> <p><strong>Conclusion:</strong> Measuring the cardiac index during intensive care units admission using a noninvasive approach even in non-cardiac patients can predict in intensive care units mortality with high sensitivity and specificity.</p> Vahan Moradians, Seyed Ali Javad Moosavi, Mohammad Niyakan Lahiji, Maryam Izadi ##submission.copyrightStatement## Tue, 19 Feb 2019 00:00:00 -0500 Computed tomographic evaluation of angle and distance between superior mesenteric artery (SMA) and abdominal aorta in : Normal values in Iranian population according to different body mass index value <strong>Abstract</strong><p class="yiv3871675812amp-abstractcontent">The primary purpose of present study is to “prove” that the angle and distance between the superior mesenteric artery (SMA) and aorta are significantly correlated with the body mass index (BMI). This in turn indicates the strong etiological role of this factor for the causation of SMA syndrome. The superior mesenteric artery syndrome is characterized by the compression of the third segment of the duodenum by the mesentery at superior mesenteric artery level and a resulting duodenal (±gastric) dilatation. The disease is closely related with the depletion of the fat pad between the vessels narrowing the angle and reducing the distance between the vessels. A prospective study of 300 patients (163 males and 137 females) in the age range of 40-70  years (mean age 51 years) who had undergone multislice detector CT scan in Alzahra Hospital for various other complaints in the year 1395. CT scans had been performed with routine protocol comprising of plain phase followed by arterial and venous phases to measure the angle between the aorta and superior mesenteric artery,BMI was also calculated. Mean values for distance and angle were obtained with P value of 5%  and 95 % confidence intervals. Pearson coefficients and T test were also calculated and results were tabulated. A strong positive correlation was observed between BMI and the angle between the aorta and SMA. With increment in BMI, the angle also increases leading to a smaller chance of developing superior mesenteric artery syndrome<strong>. <br /></strong></p><strong> </strong> Saleh Jafarpisheh, Maryam Nasri, Hosein Ahrar ##submission.copyrightStatement## Tue, 19 Feb 2019 00:00:00 -0500 Correlation of Muscle Strength and Mass with Bone Mineral Density in Postmenopausal Women <p><strong>Introduction</strong>: Osteoporosis is a systemic disease of the bone, which entails an increased risk<br>of fracture, with high impact on morbidity, mortality and costs in the health system. Several<br>studies have shown a relationship between muscle mass and strength with bone mineral density.<br>Our objective is to determine the correlation between these variables in postmenopausal<br>women. <strong>Materials and Methods</strong>: For the correlation study, 100 postmenopausal women<br>older than 50 years were selected randomly and a sociodemographic survey was conducted,<br>and muscle strength was determined by manual grip strength, which was measured with a<br>digital dynamometer. Bone mineral density measurements and muscle mass were obtained<br>with densitometry. The correlation between strength, muscle mass, and bone mineral density<br>was determined by a Spearman correlation. <strong>Results</strong>: The average age was 62.8 ± 7.48. Femur<br>and column bone mineral density were significantly related to the muscle mass index, weight,<br>and body mass index. The prevalence of fragility fracture was 17%. The bone mineral density<br>of the femur was lower in patients with fragile fracture, and there was a negative and significant<br>correlation between femur bone mineral density and skeletal muscle mass index. <strong>Conclusion</strong>:<br>Bone health studies should include the study of muscle mass index and the skeletal muscle<br>mass index. The improvement of the muscle mass index can influence femoral and vertebral<br>bone mineral density with significant impact on fragility fractures. This is the first study of its<br>kind conducted in Colombia and South America.</p> Veline Martínez, Harold Saavedra, Mayra Rojas, Juan José Martínez, Marisol Posada, Guillermo Guzmán ##submission.copyrightStatement## Sat, 05 Jan 2019 00:00:00 -0500 Assessment of Central Venous Catheterization Using Electrocardiographic versus Landmark Techniques in Pediatrics Undergoing Open Heart Surgery; Which Technique is Superior? <p><strong>Introduction: </strong>Central venous catheterization has been usually performed during major surgeries in order of central venous pressure assessment and fluid therapy. Variety of techniques has been performed for central venous catheterization previously but the information in this regard about pediatrics is limited. In the current study, the comparison of electrocardiographic technique with landmark one for central venous catheterization performance has been done. </p><p><strong>Methods: </strong>This is a cross-sectional study conducted on 75 patients underwent central venous catheterization for elective cardiovascular thoracic surgery<strong>.</strong> In the first step, the location of catheterization was estimated based on body surface landmarks. Then catheterization was done using electrocardiography. Then by cardio-surgeon aid, during open cardiac surgery, the catheter tip location was found (gold standard). Finally, chest X-ray was taken and catheter place based on radiological markers was recorded.</p><p><strong>Results:</strong> In the current study, 75 children with age under 18 years and gender distribution of 42.7% females and 57.3% males were assessed. Mean of central venous catheter depth in gold standard method was 7.5±1.35 centimeters. Significant association between central venous catheter placement in gold standard technique and both landmark and electrocardiographic was seen (P-value&lt;0.001; r=0.94 and P-value&lt;0.001; r=0.77). Logistic regression showed a significant association between weight and placement of catheter tip in landmark technique (P-value=0.038) as following formula (Depth of central venous catheter= 5.33+0.07*weight).</p><p><strong>Conclusion:</strong> Our study showed that the use of ECG for CVC considering carina-to-tip as reference was superior to the landmark. In addition, catheter tip correct position was affected by weight but not height based on landmark technique.<strong></strong></p> Mojtaba Mansouri, Gholamreza Massoumi, Ali Akbar Shateri ##submission.copyrightStatement## Sun, 10 Feb 2019 20:45:57 -0500 Effects of Hip Exercises on the pain Severity in Patients with Patellofemoral Pain Syndrome <p><strong>Introduction</strong>: Patellofemoral pain syndrome is associated with a decrease in hip muscles strength, especially abductor and external rotator muscles. Hip abductors with femoral control have an effect on the frontal plane on the knee valgus, and the increased hip abduction capacity helps these patients. The aim of this study was to determine the effect of abductor and adductor exercises in addition to the knee exercises in knee joint pain in patients with Patellofemoral pain syndrome.</p> <p><strong>Method</strong>: This is a clinical trial study conducted on patients suffering from patellar-femoral pain syndrome who visited the Sports Medicine department of the Imam Khomeini Hospital Clinic. The NRPS questionnaire was used to evaluate the patients’ pain severity SPSS version 16 was used for statistical analysis of the data.</p> <p><strong>Results</strong>: The mean age of the patients in abductor group was 33.4±6.1 and in adductor group was 33.7±7.3, but this difference was not significant (P=0.1). The results of this study showed that in the abductor and adductor group, the results of all of the statistical tests on the change in the Scores of the questionnaires and tests after 6 weeks of training exercises were statistically significant (P&lt;0.05). the comparison of the scores between the two groups showed only the difference between the mean scores of Step down between the two groups of adductor and abductor, which was statistical significance after exercises (P=0.03).</p> <p><strong>Conclusion</strong>: Based on the presented study, 6 weeks of abductor and adductor muscle exercises, and specially abductor muscles, helps reduce pain and the improve joint function in patients suffering from patellofemoral pain syndrome.</p> Seyed Esmaeil Shafiei, Hamed Jafarpour, Zahra Madani, Hanieh Adib, Siavash Moradi, Parisa Islami Parkoohi, Zahra Safari ##submission.copyrightStatement## Tue, 19 Feb 2019 00:00:00 -0500 A Study on the Status of Error Reporting Cultures among Nurses in Medical Sciences Hospitals of Islamic Azad University <p><strong>Background</strong><strong>:</strong>One of the goals of nursing is to provide safe patient care and medical errors are one of the most important threats in this field.Therefore, the purpose of this study is to assess the status of error reporting culture and determine its relationship with demographic characteristics.</p><p><strong>Methods:</strong>This descriptive,analytical and cross-sectional study was carried out among 239 nurses of amiralmomenin and bouali hospitals. First,face validity and then content validity were performed by 15 nursing experts and the questionnaire was distributed and collected. The normal distribution of data was confirmed by Kolmogorov-Smirnov test. The reliability and construct validity were performed with Cronbach’s Alpha test and exploratory factor analysis by PCM.The status of reporting culture was determined by computing descriptive statistics and its relation with demographic variables with Pearson correlation test and logistic regression test with SPSS software version 16.</p><p><strong>Results:</strong>The content validity with CVR &amp;CVI of 0.820 and 0.920 were confirmed. The reporting culture was favorable with a mean and standard deviation of 2.674 and 0.475.The reliability with Cronbach's alpha of 0.747 and the construct validity with a KMO of 0.727 and Significance of the Bartlett test were confirmed and 3 subscales were extracted. The relationship between age and work experience with the reporting culture with a correlation of 0.009 and 0.013 with a significant &lt; 0.05 were rejected But with the variable of gender(=female) with a chance of 2.536 and the significant of 0.006 was confirmed.<strong></strong></p><p><strong>Conclusion</strong><strong>:</strong>Developing a safety culture in hospitals by implementing various health programs improves the reporting culture,but the mental climate is undesirable and requires major steps to reduce worries and negative outcomes after reporting.The presence of female nurses in comparison with men improves the error reporting culture.Perhaps the main reason is patriarchy in Iranian culture.</p> Abasat Mirzaei, Zeinab Abbasi, Sima Safarzadeh ##submission.copyrightStatement## Sat, 08 Dec 2018 00:00:00 -0500 Pyomyositis: A Complicated and Curious Case Report <div class="page" title="Page 1"> <div class="layoutArea"> <div class="column"> <p><span style="font-size: 10.000000pt; font-family: 'TimesNewRomanPS'; font-weight: bold;">Introduction: </span><span style="font-size: 10.000000pt; font-family: 'TimesNewRomanPSMT';">In the elderly (over the age of 50), the risk of urinary tract infections is estimated at 8% per year in men. Anatomic abnormalities such as prostatic hypertrophy, leading to urinary retention is considered as the main reason. Pyomyositis is an uncommon condition of optical urethrotomy, especially in patients who have received local radiation therapy in the past. Till date no cases of pectineus muscle abscess and only two cases of obturator externus muscle abscess have been reported in the literature, with only one developing as a result of genitourinary intervention such as urethrotomy. </span></p> <p><span style="font-size: 10.000000pt; font-family: 'TimesNewRomanPS'; font-weight: bold;">Case presentation: </span><span style="font-size: 10.000000pt; font-family: 'TimesNewRomanPSMT';">Here we are presenting a case of a very unusual and serious complication in an elderly man presenting with urosepsis several months after undergoing urethrotomy. </span></p> <p><span style="font-size: 10.000000pt; font-family: 'TimesNewRomanPS'; font-weight: bold;">Conclusion: </span><span style="font-size: 10.000000pt; font-family: 'TimesNewRomanPSMT';">Elderly men have an increased risk of sepsis, higher than that in women with UTI. </span></p> </div> </div> </div> Jinendra Satiya, Jacqueline Mulee, Daniel Baldor, Jason Yarsley, Daniel Lichtstein ##submission.copyrightStatement## Tue, 19 Feb 2019 00:00:00 -0500 Pleuritis in 25 year old Female with Systemic Lupus Erythromatosus: Case Report Systemic lupus erythematosus (SLE) is a complex and multi-faceted disease that affects various organs of the human body and is predominantly seen in young group and females. The patient was a 25-year-old woman, According to the history taking from the patient, she suffered from progressive weakness and narcosis so that she was unable to walk and perform daily work at the time of the visit. In our examination, the young woman was lean and pale, with Icterus, body mass index of 22 and normal thyroid tests. Vital signs on admission were as follows: BP:10/7, PR:92, RR:20, T:38.5. In the heart examination, the heart sounds were normal and there was no heart murmur and additional sounds. In echocardiography for the patient, EF was 60%. Chest X-ray revealed pleural effusion for the patient. CT scans did not confirm the involvement of lung parenchyma and bilateral mild pleural effusion and pericardial effusion for the patient. The pleural fluid was evacuated under ultrasound.. Autoimmune examination results determined the diagnosis of SLE for the patient Yaser Ghelmani, Salar Khazanifard ##submission.copyrightStatement## Tue, 19 Feb 2019 00:00:00 -0500 Pain: More than Meets the Eye, an Atypical Case of Ocular Squamous Cell Carcinoma <p><strong>Introduction</strong></p><p>  Eye pain is common and initially managed by primary care physicians. In the rare refractory case or atypical appearance, consultation with ophthalmology is needed. </p><p><strong>Case presentation</strong></p><p>A 35-year-old Hispanic male patient with a history of pterygium presented with complaints of worsening left eye pain for months .Over the past two weeks, the patient had also noticed more redness and soreness that occurred all day.  He noticed darkening in the medial vision of his left eye, persistence of left eye pain and visual changes. An excisional biopsy of the lesion was performed.  The final biopsy reports revealed an ocular surface squamous cell carcinoma <em>in situ</em> arising from pterygium.</p><p><strong>Discussion</strong></p><p>Topical application and injections of immunotherapy such as mitomycin C and 5-fluorouracil have been shown to be effective.  Recurrence is high and follow-up examination by ophthalmology is essential. </p> Jasmin Hundal, Madiha Ali, Kyle Ferguson, Norman Saffra, Benson Babu ##submission.copyrightStatement## Tue, 19 Feb 2019 00:00:00 -0500