مجله دانشکده پزشکی اصفهان
پیاپی 93 (اردیبهشت1388)

Celiac disease may be presented with dyspepsia. This study was done to evaluate the prevalence of celiac disease and its association with different types of dyspepsia and also the need for duodenal biopsy in patients with non-ulcer dyspepsia.Metods:All patients with dyspepsia were classified as ulcer dyspepsia (duodenal ulcer and gastric ulcer) and non-ulcer dyspepsia (dysmotility-like non-ulcer dyspepsia and ulcer-like non-ulcer dyspepsia). Distal duodenal biopsy was done for all patients. Then, specific serologic factors for celiac disease (Anti-Gliadin Antibody and tissue Transglutamines Antibody) were checked in patients with villous atrophy. Finally, the prevalence of celiac disease and its association with different types of dyspepsia were evaluated.

Of the 810 patients with dyspepsia, 703 had non-ulcer dyspepsia and 107 had peptic ulcer. Six (5.6%) of the patients with peptic ulcer and 54 (7.7%) of patients with non-ulcer dyspepsia had villous atrophy and positive Anti-Gliadin Antibody or tissue Transglutamines compatible with celiac disease, but there was no significant deference between celiac disease and different types of dyspepsia (P > 0.05). In non-ulcer dyspepsia, odds ratio for Celiac disease was 1.4, in comparison with the peptic ulcer

During endoscopic examination for non-ulcer dyspepsia, if indicated, endoscopists should carefully inspect the duodenum for CD findings. Although, routine serologic screening can not be recommended; it may be appropriate for the patients with refractory dyspepsia.

Albuminuria is one of the abnormalities which occur in diabetics. Different studies have shown its relationship with cardiovascular diseases but few studies have been performed to show the relationship between albuminoria level and coronary artery disease (CAD) severity. This study was designed to asses the relationship between albuminuria and coronary artery disease severity. In this cross-sectional study, the 164 Non-Insulin Dependent Diabetes Mellitus patients with angina pectoris who hospitalized for diagnostic or therapeutic angiography in Isfahan Chamran hospital were included. Urine Pr/Cr ratio has been calculated in all patients, using the first sample of morning urine. The standard angiography video has been assessed by three cardiologists through Seldinger method. CAD score has been given from 0 to 21 based on Extent method. The relationship between CAD severity and urine Pr/Cr ratio has been assessed with bivariate correlation methods and multivariate analysis. In 164 patients (males = 80 & females = 84) morning urine protein mean was 22.77 ± 30.99 and morning urine creatinin mean was 0.07 ± 0.04. Urine Pr/Cr ratio was 760.94 ± 401.56 mg/g and its median was 181.02. The CAD score was equal to 13.34 ± 6.24. There was no correlation between urine Pr/Cr ratio and CAD severity (P = 0.778, r = 0.022). In multivariate analysis, increased urine Pr/Cr ratio led to increased CAD severity by control of the age, FBS, gender, Captopril use, history of HTN and hyperlipidemia variables (P = 0.021). The amount of albuminuria which measured based on morning urine sample Pr/Cr ratio may be an independent risk factor for severity of CAD and can predict it. These findings signify the importance of albuminuria diagnosis and treatment.

Helicobacter pylori (H. pylori) is a gram negative curved bacilli colonized in the human stomach. It causes duodenal ulcer, gastritis and is associated with adenocarinoma. There might be a possible relationship between cagA, vacA and ice a genes and clinical outcomes. The aim of this study was to identify the frequency of vacA genotypes of H. pylori isolated from the upper gastrointestinal.One hundred H. pylori strains were isolated from patients with different gastrointestinal disease who admitted to Isfahan Al-zahra hospital. Vac A alleles were typed using PCR with specific primers.There were four Vac A mosaicsms, including 28 for s1a/m1 (28%), 23 for s1b/m1 (23%), 26 for s1a/m2 (26%) and 23 for s1b/m2 (23%), s2 form was not found.The results showed there is no significant relationship between different genotypes of vacA and the related diseases.

Multiple Sclerosis (MS) is a demyelinating disease of central nervous system with an unknown etiology. Beta-Interferon is now widely used for treatment of MS which is believed to slow down the disease progression. This study was designed to compare the side-effects of Avonex and the Iranian 1-a Beta-Interferon, Cinnovex, which are biosimilars.This was a clinical trial study in which fifty one MS patients were recruited from the neurology departments of Al-Zahra and Shariati hospitals in 2007. Twenty one patients were receiving Avonex and thirty patients were receiving Cinnovex. These patients were followed for 3 months to compare the side-effects of the drugs between two groups.The most prevalent side effect observed was influenza like symptoms in all patients receiving Avonex and in 83.3% of patients receiving Cinnovex. There were no cases of seizure or diarrhea in any of groups. In this study, there were no significant differences between two groups in respect to experienced side-effects.This study with a short duration follow-up of 3 months demonstrated no significant differences between the two groups in case of experienced side-effects.

As epidemiologic studies show migraine is one of the most common headache syndromes in the general population. The lifetime prevalence is usually between 9% and 13%. Several psychiatric conditions are co morbid in migraine patients. Among the psychiatric illnesses, mood and anxiety disorders have been to be most strongly associated with migraine. The prevalence of migraine in people with bipolar disorder, panic disorder, generalized anxiety disorder, obsessive compulsive disorder and phobia is also elevated. This study was designed to evaluate the relationship between migraine and bipolar disorder.

In a descriptive-analytical study on 213 migraine patients and 164 healthy individual's a 15 item mood disorder questionnaire was completed. We matched group in the case of gender and age. This study was performed from March to spring 2006. The prevalence of bipolar spectrum for two groups was compared by SPSS.

The prevalence of bipolar spectrum was significantly different in migraine and control group (66.5% versus 8.1%). The prevalence of bipolar spectrum was 68.4% among men who have migraine and 11% among healthy men. The prevalence of bipolar spectrum was 65.4% among women who have migraine and 5.3% among healthy women.

The prevalence of bipolar spectrum in migraine population is more than healthy individuals. It seams that physiologic overlap between migraine and bipolar spectrum is considerable. The recognition of increased co morbidity between migraine and bipolar illness has important clinical implications and can improve treatment of these disorders.

Carpal height is a radiographic ratio with clinical significance in rheumatologic diseases and Kienbock disease, which is measured with different methods. The purpose of this study was to assess the two popular methods of measurement of this angle with respect to inter- and intra-observer variability.Good quality photographs were made of ten radiographs and two experienced orthopedists, in two separate occasions measured the length of third metacarpal bone, the longest length of capitates, and the distance between the base of third metacarpal bone and the articular surface of the radius. The remainder of the calculations was made by computer.Intra-observer reliability of the Youm and Nattrass ratios were calculated as “high” and “fair”, respectively. With regard to inter-observer reliability, the accuracies of both indices were poor. Intra- and inter-observer agreement for detection of wrist collapse was “substantial” for Youm ratio and “fair to moderate” for Nattrass ratio. The ratios had poor agreement with each other, in regard to detection of collapse of the wrist joint.Although neither of the ratios had perfect or high reliability with regard to the subject of the study, it seems that the accuracy of Youm index is higher than the other method.

Smoking is one of most important problems of health situation in the entire world. Oxidant materials in cigarette have a positive role in increasing risk of atherosclerosis and other maleffects of such ingredients. The objective of this study is to evaluate the effects of cigarette smoking on lipid peroxidation, values of HbA1C, quantitative CRP and conjugated CRP and conjugated dienes (CDs) in smoker and non-smoker men.

In this descriptive analytical study, fifty healthy male smokers and fifty male non-smokers were selected by a convenient sampling method. The smokers had history of at least 6 pack/year cigarette (about 10-20 cigarette/day) uses. Measurement of fasting plasma glucose, quantitative CRP, HbA1C, lipid peroxidants, conjugated dienes, cholesterol and triglyceride were done for all patients.

Study showed the values of the HbA1C, Lipid oxidants and CRP were significantly higher in the smokers than non-smokers. There was a positive relation between duration of smoking and the number of cigarettes smoked per day and HbA1C. There was also correlation between fasting blood sugar and the number of smoked cigarette per day and this correlation was significant.

Our results confirm the effects of smoking on lipid oxidation, hemoglobulin glycation and CRP as possible contributor of atherosclerosis, although further studies are recommended to verify the exact mechanisms.

Case Report:We report a case of atypical facial pain in a 16-year-old girl who was admitted to the kashani clinic because of pain in the left side of face, weight loss, and depression. In physical examination, left nasal cavity was wide, inferior turbinate was absent, and a large amount of crust was seen. Brain MRI was normal. In coronal CT-scan of Para nasal sinuses, middle turbinate was not seen in the left side, but a small part of inferior turbinate was seen. The diagnosis was empty nose syndrome (ENS) and surgery was done.