Caspian Journal of Internal Medicine
Volume:1 Issue: 2, Spring 2010

Resistin and ghrelin are hormones that have roles in the glucose and lipid homeostasis and weight regulation. Human studies regarding resistin and ghrelin in diabetic patients are scarce, especially in the cases of normotensive and non-obese patients. This study was designed to illuminate some of the missing points.
Eighty diabetic patients and eighty healthy individuals participated in this study; according to the inclusion criteria [age, gender, body mass index (BMI), blood pressure (BP) and diabetes type]. Fasting and postprandial glucose, hemoglobin A1c (HbA1c), insulin, acylated-ghrelin and resistin were evaluated for all the participants while HOMA and QUICKI were calculated.
Fasting and postprandial glucose, HbA1c, insulin and calculated HOMA increased, while QVICKI decreased among the diabetic patients (p<0.001). All patients also had reduced acylated-ghrelin that was more predominant among type I cases (p<0.001), while resistin was significantly reduced among the female patients (p<0.001). Furthermore, a significant negative correlation between circulating insulin and resistin of older healthy subjects [female (R=-0.72, p<0.001) and male (R=-0.59, p<0.01)] was detected which was absent for the patient groups.
None of the diabetes indicators correlated with the circulating ghrelin or resistin that may indicate reductions in the results of protective phenomena due to excess glucose, increase insulin, or high circulating lipids usually observed among the diabetic patients. On the other hand, a strong negative correlation between the insulin and resistin among the older (38-55 years) healthy individuals that indicate the rise of resistin can be a sign of initiation of type II diabetes.

Artemisia is a herbal plant that its anticandidal effect has been investigated in different studies. The aim of this study was to assess the effect of Artemisia sieberi mouth wash on denture stomatitis.
This double blind clinical trial study was performed on 30 patients with denture stomatitis (type II, III). They were randomly divided into two groups. The patients in control group were asked to use Nystatin mouth wash 500,000IU qid and the patients of case group were asked to use Artemisia mouth wash 1% qid. The patients were visited weekly up to 1 week after complete resolution of stomatitis. In each visit, smears and cultures were provided, candida colony counts were performed and candida identification tests were done. Analyses of the data were done by Friedman, Chi-square and Mann Whitney tests.
All patients showed complete clinical healing after 1 week (in the second visit) except for 1 patient in each group who was healed after 2 weeks. There were no statistically significant differences in healing time between the two groups.
The results show that the extract of Artemisia Sieberi1% could be effective on the treatment of denture stomatitis.

To determine the possible sources for the transmission of Hepatitis B Virus (HBV) infection to children in Babol, North of Iran.
Forty-five boys and 35 girls with the mean age of 9.2±5.1 years were evaluated from 1993 to 2004. Hepatitis B viral markers in all the family members were assessed. The risk factors for other sources were also determined.
Sixty-five (81.3%) of them were HBeAg positive. Chronic HBV infection was found in the family members of 53 (66.2%) infected children. Chronic HBV infection was seen in 27 (33.8%) cases without any evidence of chronic HBV infection in their family members. Chronic HBV infected mothers were the most probable source of infection in 54.3% of the girls and in 24.4% of the boys (p=0.006). There was no evidence of chronic HBV infection in the family members of 48.9% of infected boys and in 14.5% of infected girls (p=0.002).
The results of this study show that more than one-third of children acquired HBV infection in the society.

The routine use of preoperative appropriate paraclinic testing is useful in patients scheduled to undergo elective surgery. The purpose of this study was to assess the prevalence of unnecessary preoperative evaluation performed for patients undergoing elective surgeries.
This descriptive analytic study was performed to assess the patterns of preoperative evaluation tests on 498 patients undergoing elective surgery at Shahid Beheshti and Yahyanejhad Hospitals, Babol; from January 2008 to January 2009. The patients'' data such as age, gender, preoperative medical histories, drug used, American Society of Anesthesiologists status (ASA), preoperative diagnosis, hospitals name, admission ward and type of surgery were collected. Then we compared these data to the national standards of preoperative evaluation tests presented with international guidelines as well as by the Health Ministry of Iran.
Four hundred ninety-eight patients [ 209 males (41.9%) and 289 female (58%)] with the mean age of 39.2 years were studied. Most of the patients (62%) were below 40 yea .Based on and in matching with A.S.A and Health Ministry standards for preoperative assessment, the most common unnecessary orders tested were ECG that was unnecessary in 77.3%. The frequencies of unnecessary tests for WBC, FBS, AST, ALT and chest X ray were 63.7, 40.4, 40, 33.3, and 32.8%, respectively.
The results show that the unnecessary preoperative orders evaluation tests had no indication in 32-77% of subjects.

Tiredness is one of the most common complaints among pregnant women, but little attention has been paid to its importance and a way to control it. Reflexology can be employed as a nursing intervention to reduce it. The purpose of this study was to determine the effect of reflexology on the tiredness intensity in pregnant women.
This study was carried out on 74 pregnant women outpatients in Health centers in Ramsar. These women were divided into two groups of test (36 people) and witness (38 people) which were matched according to their ages and jobs. The instrument for collecting data included sample choice form, individual characteristics, social support and a questionnaire for analyzing tiredness intensity. When the forms were filled up by the research units, the reflexology of sole was done in the test group for 5 weeks, two sessions a week, 30 minutes each session; then the tiredness intensity of both groups was analyzed again. The analysis was performed using the following tests: Chi square statistical test, student t, paired t and Pearson correlation coefficient.
In this study the average of tiredness intensity in pregnant women showed a significant difference before and after the reflexology, and after the interaction there was a significant difference in tiredness intensity between the two groups of witness and test (p=0.001). There is a significant relationship between social support and tiredness intensity (r=0.46, p=0.002). Likewise, ferros sulfate tablet had a significant effect on tiredness intensity (p=0.001).
According to the present study reflexology reduces tiredness in pregnant women significantly. The other variables such as social support and sulfate ferros tablet can reduce tiredness intensity too.

As yet migraine has been established as one of the risk factors for ischemic stroke. Some of the factors have been assessed for the explanation of this relation. Hyperhomocysteinemia is seen partly both in stroke and in migraine. This study was conducted to determine the mean plasma levels of homocysteine in ischemic stroke patients on the basis of migraine history.
This cross-sectional study comprised of 100 consecutive patients who were admitted in Neurology Ward of Zanjan Vali Asr Hospital with definite ischemic stroke diagnosis (during 2008). In each patient, the age, gender, history and type of migraine, the time interval from the last migraine attack to stroke and fasting total plasma homocysteine level were ascertained.
The mean level of total plasma homocysteine was 26.6±9.6 µmol/l. Fourteen out of 100 patients admitted with ischemic stroke had a history of migraine. The mean of plasma homocysteine did not differ significantly between the two groups with and without migraine (29.93±14.45 versus 26.1±8.6µmol/l, p=0.165). Overall, 83% of patients had hyperhomocysteinemia, wherea,s this state was observed for 92.9% of migrainous and 81.4% of nonmigrainous subjects. The proportion of hyperhomocysteinemia was not different between these two groups (p=0.29). There were not any significant differences regarding the mean plasma levels of homocysteine regarding age, sex, migraine type, the time interval from the last migraine attack to stroke and vascular territory of stroke between these two groups.
The results show that the mean levels of homocysteine in ischemic stroke patients who had migraine was similar to those without migraine.

One of the important etiologies for cryptogenic stroke is paradoxical embolization secondary to Patent Foramen Ovale (PFO). Foramen ovale can secondarily reopen due to Pulmonary Arterial Hypertension (PAH) which is common among the older age. PAH is known as a frequent and life threatening complication of COPD. The aim of this study was to determine the prevalence of PFO between COPD patients with PAH and compare it with the ratio of PFO in non PAH COPD patients by Valsalva Maneuver (VM) following the TCD test.
This study was performed on 55 patients with COPD exacerbation who were admitted to Rasul-Akram Hospital in Tehran, Iran. The patients with high PAH were considered as the case group and the others without PAH were the control group. All patients underwent Trascranial Doppler (TCD) to detect intracardiac right-to-left shunt (RLS) related by PFO. The data were collected and analyzed.
In the case group, among 45 patients 25 (55.5%) males and 20 (44.5%) females] with the mean age of 64.68±10.73 years, 31 (68.8%) subjects had PFO. In 10 control patients whose PAP were normal during TTE, we detected PFO in 2 (20%) patients during VM (p<0.001). There was a significant correlation with the number of microembolic signals (MES) and the increase in PAP (p=0.019).
Right to left shunting was significantly more frequent in COPD patients with high PAP. High pulmonary pressure had a cardinal role in increasing the prevalence of RLS among these patients.

Phenylketonuria (PKU) is an autosomal recessive disease of Phenylalanine metabolism that brings deficiency of the enzyme Phenylalanine Hydroxylase (PAH). Early diagnosis is very important to prevent complications. This study was designed to describe characteristics of patients with phenylketonuria in Mazandaran Province in northern Iran.
We studied 24 cases suffering from PKU in Mazandaran. We analyzed the variables like diagnosis age, current age of the patients, history of previous child (/or children) with PKU, sib of parents and level of education of patients.
The mean age of diagnosis was 20 months and most of the patients were diagnosed in the first year of their life. The mean current age is 90 months. Seventy percent of them were male. Ten percent had a history of PKU in previous child/children. Sixty percent of the patients had blood relationship.
There is no doubt of the efficacy of the early diagnosis of PKU with newborn screening, followed by dietary treatment in most patients. All of our patients had been diagnosed without screening only due to clinical symptoms.

Isolated talus osteomyelitis caused by Koch''s bacillus (BK) is extremely rare. In this paper we report an isolated talus bone tuberculosis in a 52 year-old man who presented a 2-month history of swelling, pain and functional disability of his right ankle. Surgical bone curetting and histo lo gical examination showed granuloma with central caseating necrosis. Acid fast stain and PCR examination of the sample showed Koch''s bacillus which confirms TB of the talus.