Research/Original Article

Low serum vitamin D is associated with failure of Helicobacter pylori treatment

Mohammad Salehi, Shahriar Nikpour, Narges Bagherian Khoozani

School of Medicine Students' Journal, Vol. 3 No. 1 (2021), 1 March 2021 , Page 1-4

Background and aims: Helicobacter pylori are the most common gastrointestinal infection worldwide. Determination of contributing factors for successful eradication of Helicobacter pylori is important for better infection control. Therefore, this study was conducted to investigate the association between serum vitamin D deficiency and Helicobacter pylori eradication rate.

Results: The results of this study demonstrated that before-treatment vitamin D level was between 10 and 20 ng/dL in majority of unsuccessful cases (40.4%) and it was more than 30 ng/dL in majority of successful cases (83.7%) showing statistically significant difference (P < 0.001).

Conclusion: This study showed a significant association between vitamin D deficiency and Helicobacter pylori eradication and low vitamin D level resulted in failure of treatment; Hence in unsuccessful cases, assessment of vitamin D level and possible supplementation in those with hypovitaminosis D is recommended.

Evaluation of correlation of serum vitamin B12 with proteinuria in type 2 Diabetes Mellitus patients

Saeed Kalbasi, Narges Sadat Zahed, Shiva Samavat, Latif Gachkar, Zahra Davoudi, Fariba Haghverdilou

School of Medicine Students' Journal, Vol. 3 No. 1 (2021), 1 March 2021 , Page 5-8

Background and aims: Diabetic nephropathy is one of the leading causes of end stage renal disease (ESRD)  in the world. This study was conducted to investigate the correlation of  B12 deficiency with presence of proteinuria in patients with Diabetes Mellitus.

Materials and Methods: This study was performed on patients with type 2 Diabetes Mellitus. The inclusion criteria were: HbA1C ≤8%, absence of hypertension or controlled blood pressure (BP<140/90) in hypertensive patients, no smoking, absence of any recent stressful illness such as MI, CVA and causes of proteinuria other than diabetic nephropathy. The serum level of B12 and the amount of urine protein–to-creatinine ratio (UPCR) were measured, and correlation between b12 deficiency and presence of proteinuria was assessed using Spearman correlation test.

Results:  In this study 78 patients (44.87% women and 55.13% men) were examined. There was an inverse and weak correlation between the serum B12 deficiency and presence of proteinuria (r = -0 / 104), which was not statistically significant (p = 0.254). Due to the statistically significant difference between two groups with and without proteinuria in antiproteinuric drugs, as well as Metformin use and chronic kidney disease (CKD) stage, a subgroup analysis was performed in each of these subgroups. There was no correlation between the B12 deficiency and presence of proteinuria.

Conclusion: The findings  revealed no statistically significant correlation between the serum B12 deficiency and presence of proteinuria.

The Role of Diffusion Weighted MRI in Differentiation of Malignant from Benign Ovarian Tumors

Mehri Rashidzadeh, Hamidreza Haghighatkhah, Farahnaz Farzaneh, Mandana Barfei

School of Medicine Students' Journal, Vol. 3 No. 1 (2021), 1 March 2021 , Page 9-13

Introduction: Ovarian masses are common and due to the risk of dissemination, biopsy is not recommended before surgery; thus, imaging techniques can play a crucial role in differentiating benign from malignant lesions. Diffusion weighted magnetic resonance imaging (DW-MRI) is now considered a part of the standard evaluation of pelvis. The aim of this study was to investigate the role of DW-MRI in distinguishing between benign and malignant ovarian tumors and its comparison with pathology results.

Materials and Methods: In this descriptive analytic study, 85 non-pregnant women of childbearing age with an ovarian mass who were referred to Imam Hossein hospital in 2018 were evaluated. All patients underwent MRI before surgery and apparent diffusion coefficient (ADC) value was calculated for each. In addition, demographic data and postoperative pathology results were recorded. The acquired data were then entered into the SPSS software for statistical analysis.

Results: The mean age of the participants was 39.01 ± 6.98 years. Mean ADC value was calculated as 1.14 ± 0.67 × 10-3 mm2/s. Mean ADC value was significantly lower in malignant lesions compared to borderline and benign ones (P<0.001). There was a significant inverse relationship between ADC values and malignancy (r= -0.841, P<0.001); the higher the ADC value, the lower the probability of malignancy. Mean ADC value was the highest in cysts and the lowest in metastatic lesions (with the exception of serous cystadenocarcinoma (P=0.267) compared to other types of lesions (P<0.05). The optimal cutoff point for ADC to differentiate between benign and malignant ovarian lesions was 1.16 × 10-3 mm2/s with 95% sensitivity, 100% specificity, 100% positive predictive value (PPV), 98% negative predictive value (NPV), and 99% accuracy.

Conclusions: ADC value in DW-MRI is highly sensitive and specific in differentiation between benign and malignant ovarian tumors. 

Case Report

Surgical Technique for Femoral Intramedullary Bent Nail Removal: A Case Report and Review of the Literature

Farzad Amouzadeh Omrani, Ali Panjehshahi, Melika Alaedini, Naser Ghanbari, Seyed Mojtaba Jamali

School of Medicine Students' Journal, Vol. 3 No. 1 (2021), 1 March 2021 , Page 14-17

A 21-year-old male patient was admitted with a severe right thigh deformity following a car accident. He experienced a previous history of Intramedullary interlocking femoral nail three years ago.
The neurovascular examination was normal. The radiologic evaluation revealed a bent nail with 105° angular deformity in the sagittal plane.
With a lateral approach to the apex of the fracture site, the Bent nail was cut by an 8mm cobalt drill, two parts of nail extracted; then fixation was performed by a new intramedullary interlocking nail and autogenous cancellous graft.
The fracture healed properly without any complication 6 months after corrective surgery.

Letter to Editor

Persian literature course in the undergraduate medical curriculum

Zohreh Khoshgoftar, Minoo Yaghmaei, Leila Nazari

School of Medicine Students' Journal, Vol. 3 No. 1 (2021), 1 March 2021 , Page 18

A serious criticism of contemporary medicine is that it is dehumanized, meaning that it ignores the patient and his/her experiences, values, and priorities as an individual human and only seeks treatment based on the latest findings in the biomedical sciences. To modify and improve this situation, the field of "medical humanities" was formed, which seeks to include human considerations in clinical practice. One of the important domains of the field of “medical humanities” is "Literature and Medicine".

Literature and medicine are now taught in medical schools at all undergraduate (both in basic sciences and clinical periods) and residency levels. Broadly speaking, the reasons for this implementation are threefold. The first concerns the patient: such courses teach physicians how to listen more wisely to their patients’ narratives and how to emphasize with the patient’s and family members’ points of view on the experience of illness and treatment. The second reason concerns the physician: Reading literature enhances personal awareness and fosters the habit of self-scrutiny. The third concerns ethics: literature and literary skills empower physicians to think both empathetically and critically about moral issues and dilemmas in daily clinical practice.

By reviewing the texts in the field of literature and medicine, we come across various educational programs in medical schools around the world. One of the courses in the Doctor of Medicine (MD) curriculum of Iran is Persian literature (code: 16) which three theoretical units (51 hours). This course, for which a lesson plan has not been designed in the curriculum, is usually offered to students in one of the first year. Since the Persian literature course is in the general courses section, like other courses in this section such as philosophy of ethics, Islamic ethics, and familiarity with the Constitution of the Islamic Republic of Iran, – Cont.

Visual Practice

Right to Left Shunt in Agitated Saline Test

AmirHossein Aghdaee, Zhale Nahavandi, Mehrdad Jafari Fesharaki

School of Medicine Students' Journal, Vol. 3 No. 1 (2021), 1 March 2021 , Page 19

An 11-year-old girl was presented to the cardiology clinic with a history of atypical chest pain and nonspecific shortness of breath. The patient underwent echocardiography that revealed interatrial septum redundancy with signs of shunt flow in the color-doppler study (Video 1). The differential diagnosis included atrial septal aneurysm (ASA) associated with patent foramen oval (PFO) and atrial septal defect (ASD). Agitated saline test was performed via left cubital vein (Video 3) and significant leakage of contrast through interatrial septum was confirmed (Video 2). For further evaluation, the patient underwent the transesophageal echocardiography (TEE) to rule out the ASD. No left to right shunt was seen in TEE and the color-doppler study showed right to left shunt, hence the diagnosis of ASD was ruled out (Video 4). The final diagnosis was PFO. PFO is a congenital cardiac abnormality as a fetal blood communication tunnel between two atria (right to left) is remained open after one year of age. It has a high prevalence of about 25% in the general population. No intervention and follow up is needed; except for those who have large-sized PFO with significant right to left shunt and a history of neurological event especially in younger ages without other risk factors for atherosclerosis.