Internal Diseases and Pediatrics 1 2 2025 1 1 Evaluating the Relationship between Increased QT Interval and Non-alcoholic Fatty Liver Disease 0 0 FA Farahnaz Nikdoost Department of Cardiology Y Amir Anoushirvani Depertement of Gastroenterology and Hepatology N Department of Cardiology N Department of Cardiology N Background: Non-alcoholic fatty liver disease (NAFLD) has a relatively high prevalence and is associated with numerous complications. Cardiovascular complications are significant, as they can lead to mortality. Limited studies are available on the association between NAFLD and cardiac rhythm disorders. In this study, the association between prolonged QT interval with NAFLD was investigated. Methods: This analytical-cross-sectional study involved 200 patients who were referred for liver ultrasound at Shariati Hospital in Tehran in 2023 were selected according to the inclusion criteria. Demographic information, laboratory results and QTc intervals were compared between individuals with and without NAFLD. Results: The findings revealed that 69 individuals (34.5%) had NAFLD, with 56 (81.1%) classified as mild type and 13 (19.9%) as moderate type. The mean and standard deviation of QTc in patients with NAFLD was significantly higher  than those without NAFLD (446.46 ± 14.39 vs. 427.58 ± 14.49 milliseconds and p < 0.001). Moreover, the prevalence of increased QTc in patients with NAFLD was significantly higher than that of non-afflicted patients (73.9% vs. 21.4% and p < 0.001). After adjusting the existing independent and background variables, long QTc interval had a significant and positive relationship with NAFLD (p < 0.001, 95% CI: 1.21-4-86 and OR = 1.48). Conclusion: Considering the relationship between QT interval increase and NAFLD, appropriate measures and programs can reduce the risk of further complications in high-risk patients. Timely prevention via planning necessary interventions can avert the development of adverse effects. Arrhythmia, Non-alcoholic fatty liver, QTc interval http://idap.ir/article-1-32-en.html http://idap.ir/article-1-32-en.pdf

Internal Diseases and Pediatrics 1 2 2025 1 1 Relationship Between Fractional Exhaled Nitric Oxide (FeNO), Forced Expiratory Volume in One Second (FEV1), and Asthma Control Test (ACT) Score in Asthmatic Patients 55 62 FA Elnaz Ezzati Department of Internal Medicine N Keivan Gohari Moghadam Respiratory Disease Ward N Rasoul Aliannejad Division of Pulmonary and Critical Care N Mahnaz Pejman Sani Endocrinology and Metabolism Research Center Y Marjan Akhavan Department of Internal Medicine N Background: The primary goal of asthma management is to achieve and maintain clinical control of the disease. In patients with asthma, the presence of various factors influencing disease control highlights the importance of monitoring treatment response through measures beyond clinical criteria. Pulmonary function indices such as forced expiratory volume in one second (FEV1) and fractional exhaled nitric oxide (FeNO) play a role in assessing asthma severity and control. The Asthma Control Test (ACT) is also a validated tool for evaluating disease control levels in these patients. This study aimed to assess asthma control status based on ACT scores, spirometry results, and FeNO levels, while examining correlations among these indicators. Methods: This cross-sectional study was conducted on adult asthma patients visiting the spirometry unit at Dr. Shariati Hospital, Tehran. Patients completed the ACT questionnaire, and were categorized into three groups based on the Global Initiative for Asthma (GINA) criteria: well-controlled, partially controlled, and uncontrolled asthma. Subsequently, the patients underwent spirometry, and their FeNO levels were measured. Results: The study included 92 asthma patients (52 women and 40 men), who were categorized into three groups based on their level of asthma control: uncontrolled (n=38), partially controlled (n=27), and well-controlled (n=27). The mean age of participants was 46.18±14.58 years. There were no significant differences between groups in terms of age, gender, regular medication use, history of atopy, family history of asthma, smoking status, or corticosteroid use  (P > 0.05). Patients with well-controlled asthma had significantly higher FEV1 values than other groups (P=0.025), while no significant difference was observed in FEV1/FVC (P=0.141). FeNO levels were significantly higher in the uncontrolled asthma group compared with other groups (P=0.026), and were also higher in men than in women (P=0.007). Correlation analysis showed a weak but significant inverse correlation between FeNO and FEV1 (r=-0.262, P=0.019), as well as between FeNO and ACT scores (r=-0.230, P=0.028). A weak positive correlation was observed between FEV1 and ACT scores (r=0.229, P=0.041). Conclusion: An inverse correlation was found between FeNO levels and both FEV1 values and ACT scores, while a positive correlation was observed between FEV1 values and ACT scores. These findings emphasize the importance of spirometry in clinical follow-up of asthma patients. Additionally, FeNO levels can serve as a biomarker for asthma control alongside pulmonary function parameters. Asthma, Asthma Control Test, Fractional Exhaled Nitric Oxide, Forced Expiratory Volume in One Second, Spirometry http://idap.ir/article-1-33-en.html http://idap.ir/article-1-33-en.pdf

Internal Diseases and Pediatrics 1 2 2025 1 1 Factors Associated with Insomnia in Patients with Type 2 Diabetes: A Cross-Sectional Study 63 71 FA Asieh Mansour Endocrinology and Metabolism Research Center Y Atefeh Amrollahi Bioky Endocrinology and Metabolism Research Center N Athena Dehghan Najm Abadi Clinical Psychology and Family Research Institute N Background: Poor sleep quality and insomnia are common among individuals with diabetes. Sleep disturbances can negatively affect overall well-being and interfere with blood sugar control as well as diabetes management. This study aimed to identify factors associated with insomnia severity in patients with type 2 diabetes. Methods: This cross-sectional study included 229 patients diagnosed with type 2 diabetes who visited the diabetes clinic at Tehran University of Medical Sciences in 2022. Demographic information, laboratory results, and data from several standardized questionnaires were collected, including the Insomnia Severity Index (ISI), Patient Health Questionnaire-9 (PHQ-9) for depression, Generalized Anxiety Disorder-7 (GAD-7) for anxiety, and the Montreal Cognitive Assessment (MoCA) for cognitive function. Patients with an ISI score above 15 were classified as having moderate-to-severe insomnia. Multivariate logistic regression analysis was then used to identify factors associated with insomnia. Results: Among the participants, 179 had an ISI score below 15, while 50 had a score above 15. The mean age was similar between the two groups (P=0.328); however, the percentage of men was significantly higher in the insomnia group (70%, P=0.023). Multivariate logistic regression analysis identified several factors significantly associated with increased odds of insomnia in patients with type 2 diabetes. Specifically, higher platelet counts were associated with an increased likelihood of insomnia (odds ratio [OR] = 1.009, 95% confidence interval [CI]: 1.003–1.015). Furthermore, higher depression scores were significantly linked to increased odds of experiencing insomnia (OR = 1.161, 95% CI: 1.090–1.237). Conversely, lower cognitive function scores were significantly associated with an increased likelihood of insomnia (OR=0.918, 95% CI: 0.853–0.987). Interestingly, a longer duration of diabetes was negatively associated with insomnia, indicating that each additional year of diabetes reduced the risk of insomnia by 7% (OR=0.936, 95% CI: 0.883–0.992). Conclusion: This study identified several factors associated with insomnia severity in type 2 diabetes, including diabetes duration, platelet levels, depression, and cognitive function. Specifically, longer durations of diabetes were associated with a decreased risk of insomnia. Conversely, higher platelet levels, depression, and cognitive impairment were linked to an increased risk. These findings highlight the importance of screening for and managing sleep disturbances in patients with diabetes to improve overall health and diabetes management. Type 2 Diabetes, ISI Questionnaire, Insomnia, Depression, Cognitive Function http://idap.ir/article-1-34-en.html http://idap.ir/article-1-34-en.pdf

Internal Diseases and Pediatrics 1 2 2025 1 1 Comparison of WBC Counts in HIV Positive Patients with Sepsis and HIV-Negative Patients with the Same Condition Admitted to the Emergency Department of Imam Khomeini Hospital Complex, Tehran 72 77 FA Iman Abbaspour Department of Radiology Y Background: White blood cell count, and especially leukocytosis, is a key element in the diagnostic criteria for sepsis. Although HIV-infected patients usually have lower white blood cell counts due to decreased lymphocyte counts, no specific leukocyte count criteria have been established for sepsis diagnosis. Methods: This cross-sectional study was conducted in a university referral hospital and involved HIV-positive and HIV-negative patients who presented to the emergency department with sepsis and met the inclusion criteria. Demographic and clinical parameters of patients, white blood cell count, hemoglobin level, platelet count, serum ESR and CRP levels were collected and compared between the two groups. Results: A total of 60 HIV-positive and 60 HIV-negative patients, all diagnosed with sepsis syndrome were enrolled in the study. The mean white blood cell count was significantly lower in HIV-positive patients compared with the HIV-negative group (5327 cells/mm3 vs. 12627 cells/mm3; p-value = 0.000). Moreover, the mean hemoglobin level was lower in the HIV-positive group (9.3 g/dL, p. = 0.000), and HIV-positive patients had a lower mean platelet count (185,000/ml vs. 230,000/ml) (p-value = 0.033). The mean serum CRP level in HIV-positive patients was lower than in the HIV-negative group (56 mg/L vs. 77 mg/L, p-value = 0.015). The mean ESR levels and vital signs (blood pressure, body temperature, heart rate, and respiratory rate) did not differ significantly between the two groups. Conclusion: The findings of our study showed that white blood cell count is probably not a reliable variable for diagnosing sepsis in HIV-positive patients, but other clinical criteria of systemic inflammatory response syndrome (SIRS), including temperature, heart rate, and respiratory rate are more valid for this purpose.   AIDS, Inflammatory Factors, Sepsis, White blood cells http://idap.ir/article-1-35-en.html http://idap.ir/article-1-35-en.pdf

Internal Diseases and Pediatrics 1 2 2025 1 1 A 46-year-old Woman with A History of Multiple Sclerosis Presenting with Abdominal Pain: A Case Report and Discussion 78 82 FA Nazanin Nourbakhsh Hematology, Oncology & Bone Marrow Transplant Research Center Y A 46-year-old woman with a history of multiple sclerosis and aortofemoral bypass surgery presented with sudden pain in the left side of the abdomen. Physical examination revealed tenderness in the left hypochondrium, and abdominal imaging confirmed splenic infarction. Further investigations detected the presence of antiphospholipid antibodies in her blood, supporting the diagnosis of antiphospholipid syndrome (APS) as the likely underlying cause. APS is an autoimmune disorder that leads to abnormal thrombosis formation in vessels and can manifest as either arterial or venous thrombosis, recurrent miscarriages, and organ involvement, including the kidneys, brain, and heart. APS is more commonly seen in younger individuals and women, either as a primary condition or secondary to lupus. The cornerstone of treatment involves anticoagulation therapy, typically with heparin and warfarin, to prevent further thrombotic events. In acute cases, more aggressive interventions such as plasmapheresis or corticosteroids may be necessary. The patient was treated with anticoagulants, and after stabilization, she was discharged with recommendations to prevent future complications. Abdominal pain, Anticoagulation, Antiphospholipid syndrome, Autoimmune disease, Thrombosis http://idap.ir/article-1-36-en.html http://idap.ir/article-1-36-en.pdf

Internal Diseases and Pediatrics 1 2 2025 1 1 A Young Woman with Headache and Hypertension: A Case Report 83 85 FA Maryam Jahangiri Departement of Internal Medicine, Tehran University of Medical Sciences Y Hypertension remains one of the most prevalent chronic diseases worldwide, and is generally manageable through a variety of oral and parenteral anti-hypertensive agents. Nonetheless, distinguishing between essential and secondary hypertension is crucial, as the latter may be reversible if the underlying cause is identified and treated. Clues suggestive of secondary hypertension include poor blood pressure control despite the use of three anti-hypertensive drug classes, concurrent acid-base disturbances or hypokalemia, and a family history of early-onset hypertension or premature cerebrovascular events. This case report presents a young woman with elevated blood pressure and headache, highlighting the importance of evaluating for secondary causes of hypertension. Essential Hypertension, Hypertension, Hypokalemia, Secondary Hypertension http://idap.ir/article-1-37-en.html http://idap.ir/article-1-37-en.pdf

Internal Diseases and Pediatrics 1 2 2025 1 1 The Importance of Determining Accurate Sample Size in Clinical Trials 86 87 FA Masoud Imani Department of Biostatistics, School of Public Health, Iran University of Medical Sciences Y Determining the correct and accurate sample size is a crucial step in designing clinical trials, as it directly impacts the quality and reliability of the research outcomes. Selecting an appropriate sample size not only ensures sufficient statistical power to detect meaningful treatment effects but also helps in the optimal management of resources by reducing costs and addressing ethical considerations related to the recruitment of surplus participants. The primary objective of sample size calculation is to achieve an acceptable level of statistical power Clinical trial, Sample Size, Type I Error, Type II Error http://idap.ir/article-1-38-en.html http://idap.ir/article-1-38-en.pdf