Shiraz Emedical Journal
Volume:4 Issue: 3, Jul 2003

Diabetes Mellitus is a common disorder, affecting up to 7% of adults. Two categories of drugs have been used for the treatment of Diabetes Mellitus: the insulin and oral agents. In recent years human insulin has been administered to patients for control of diabetes. Insulin analogues are molecules that differ from human insulin in amino acid sequence but bind to the insulin receptors and act similarly in function.

The hospital is an organization that is made up of different operating units engaged in a variety of activities. The human resources of this organization are individuals with different educational and cultural backgrounds, as well as different experiences in educational and medical treatment fields, who are gathered to utilize technological and professional tools to provide the necessary services for the patients, doctors, and students. Hospital administration was identified as a distinct educational discipline when the University of Chicago established the first master''s program in 1934. It was followed by one year founding of the American College of Hospital Administration (A.C.H.A). In 1983 there were 51 programs accredited by the Accrediting Commissions on Education for Health Services Administration (ACEHSA). In Iran, although relatively a new field, 7 universities of medical sciences (Iran, Shahid Beheshti, Kerman, Isfahan, Ahwaz and Shiraz) at the bachelor''s level, and University of Iran, Tehran and Azad Islami at the master''s and Ph.D. levels are offering hospital administration programs. Hospital management fundamentals include: programming, human resources administration, leadership, controlling and decision making.

36 years old age woman, case of acute inferior wall myocardial infarction, received captopril due to impaired LV function. 3 days later she developed nonproductive cough and dyspnea. Wheezing was noted and CBC showed leukocytosis (WBC = 13000) and marked eosinophilia (73%). Bilateral alveolar infiltration and pleural effusion was noted in CXR. Pleural effusion was exudative (ESR= 73mm/hr). All of serologic, microbiologic and rheumatologic work ups were negative, and 2 days after discontinuing the captopril, all clinical and paraclinical findings were disappered. A non-productive cough (worse at night) can occur in 5% to 15% of all patients who use ACE inhibitors (especially Enalapril). It usually appears within the first several weeks to months of therapy but can also appear after one or even several years of treatment. This complication usually disappears 1-2 weeks after discontinuation of treatment and recurs within days of rechallenge. Changing to newer brands, discontinuing the drug, use of opiates, sodium cromoglycate or ipratropium bromide (Atrovent) can subside the cough. Manwhile other causes of cough should be ruled out. Triggering asthmatic attack, angioedma of head and neck, pulmonary eosinophilic infiltration and pulmonary hypoplasia are the other discussed complications.Angiotensin converting enzyme inhibitors (ACE) are widely used in treatment of hypertension and corgestive heart failure. These drugs like many other drugs may have major side effects. Here we present an uncommon but potentially disastrous side effect of these drugs.

Azathioprine (AZA) is a purine antimetabolite. It is a prodrug of 6-mercaptopurine (6-MP); both are widely used drugs for IBD. Sustained leukopenia (that may cause malignancy), acute pancreatitis, and allergy are the most common complications. 6-MP and AZA can take up to 3 months or longer. Leukopenic patients were more likely to respond, more likely to have their dose of steroids reduced, and more likely to be adequately treated for complications of IBD. By using newer technologies, clinicians can determine the safe / therapeutic dose of these agents. The clinical usage of AZA and 6-MP include: inflammatory bowel disease, refractory sprue, autoimmune hepatitis, primary sclerosing cholangitis, minimal change nephrotic syndrome, IgA nephropathy, Myesthina gravis, Henoch-Schonlein purpura, rheumatoid arthritis, sarcoidosis, acute lymphoblastic leukemia, refractory anemia with excess of blasts, liver, lung, renal,and pancreas transplantation, and some dermatologic disorders (e.g., eczema, pemphigus,etc.).

This patient has ventricular tachycardia because of prescience of fusion beat and AV dissociation. The ECG after conversion of VT showed anterior wall MI.