مجله دانشکده پزشکی اصفهان
پیاپی 113 (هفته اول دی ماه 1389)

Circadian rhythm disorders (CRDs) are one of the manifestations of all types of sleep disorders in Multiple Sclerosis (MS) patients. Knowing about these problems and rationale approach to them can increase the health level and treat these patients. The aim of this study was to determine the frequency of circadian rhythm disorders in MS patients in compare with control group and ascertain its association with chronic fatigability. The case-control study was held on 120 Multiple sclerosis patients and 60 healthy people (as control group) in MS Clinic of Al-Zahra Hospital in Isfahan in 2009. The questionnaires of PSQI, FSS and EDSS was given to patients and for assessing the circadian rhythm disorders, the PSQI questionnaire was given to control group too. All the findings were analyzed in SPSS software. The amount of circadian rhythm disorders in MS patients was significantly higher than control group (P = 0.002). In this manner, these kind of circadian rhythm disorders in patients with severe fatigue was significantly higher than patients with mild fatigue (P < 0.05). This study showed that the rate of circadian rhythm disorders in MS patients with severe and mild fatigue was higher than control group. Increased distribution of these groups of disorders may empower the more susceptibility of biologic clock, which regulates the circadian rhythm, in the course of MS disease. More studies are required for confirmation of anatomic relationship between location of demyelinative plaque and types of sleep disorders.

Shoulder pain is one of the most common complications after stroke. However, information about risk factors and prevalence of it, is not enough. Surveying the association of shoulder pain with diabetes mellitus, hypertriglyceridemia and hypercholesterolemia was the aim of this study. This cross-sectional study was carried out at clinics affiliated to Shiraz University of Medical Sciences. From 191 referred patients, 152 patients were enrolled. Within a year, once every two months, shoulder pain assessed among them. In addition, diabetes, hypertriglyceridemia, and hypercholesterolemia were assessed in these patients. Among 152 patients with stroke, 103 patients did not develop shoulder pain and 49 developed it. Among participants with shoulder pain, 41 patients had diabetes mellitus, 10 had hypertriglyceridemia, and 39 had hypercholesterolemia. After analyzing data with logestic regression model, the relationship between diabetes and shoulder pain was significant, but the relationship between shoulder pain and hyperlipidemia was not. Shoulder pain is common after stroke and diabetes is a predictor it.

Atopic dermatitis (AD) is a prevalent medical condition in infancy with the prevalency of near 10 to 25% in western countries. Current standard of care for atopic dermatitis can lead to many complications. There is a need for alternative treatments with lower risks of side effects. Recent studies have shown a positive effect of prebiotics in prevention and treatment of the disease. The main objective of this study was to determine whether consumption of prebiotics can reduce the severity of atopic dermatitis in 7-24 months old children in Isfahan.

In a double blind controlled clinical trial study, 70 atopic dermatitis children were divided by simple random sampling into treated group receiving prebiotic (fructooligosaccharid + inulin) and control group receiving placebo (dextrin powder) for 3 months. At the beginning and at the end of intervention, SCORAD test questionnaire was completed for all children by a physician. The collected data were analyzed by SPSS software, using student-t and paired-t tests. P values less than 0.05 were considered statistically significant.

The difference between total SCORAD indices before intervention in the treated and control groups was not statistically significant (53.9 ± 23.6 and 43.4 ± 20.9, respectively). After intervention, these values were reduced in the treated and control groups, but the difference between the means of the two groups was statistically significant (4.3 ± 9.6 and 19.4 ± 13.0, repectively; P < 0.001).

Prebiotic substances have positive roles in adjutant treatment of atopic dermatitis.

Prediction of ventricular tachycardia (VT) inducibility through clinical and paraclinical predictors and ability of ventriculoatrial (VA) conduction can help to identify high risk patients easier. Fifty four patients suspicious for ventricular tachyarrhythmia underwent electrophysiologic study for basic measurements and programmed stimulation for ventricular tachycardia induction, electrocardiography and echocardiography during October 2007-October 2009. The mean age of participants was 59.4 13.9 years. Forty three patients (79.6%) were male and 39 patients (72.2%) had history of ischemic heart disease (IHD). ventricular tachycardia was induced in 30 patients (55.6%). Ventriculoatrial conduction was recorded in 38.9% of patients (21/54). Ventricular tachycardia was induced in 52.4% of patients (11/21) with ventriculoatrial conduction versus 57.6% (19/33) in ventriculoatrial dissociate patients (P = 0.3). Mean of ventriculoatrial Wenchebach point (VAWP) was 400 96.6 and 393 103.6 ms in ventricular tachycardia inducible and non inducible patients respectively (P = 0.4). Presence of ischemic heart disease and lower left ventricular ejection fraction (LVEF) were associated with increased probability of ventricular tachycardia induction (P = 0.008 and 0.04 respectively). Presence of ischemic heart disease predicts ventricular tachycardia inducibility independently. Patients with inducible ventricular tachycardia had slightly shorter atrial-His (AH) interval (97.33 30.4 and 112.1 42.6 ms, P = 0.07). Ventricular tachycardia induction was very slightly more common in ventriculoatrial dissociate patients but we could not prove it. Presence of ischemic heart disease independently and lower left ventricular ejection fraction dependently could predict ventricular tachycardia inducibility.

Ehlers-danlos syndrome is consisted of a group of heterogeneous and rare inherited disorders of connective tissue that is diagnosed by increased range of joint movements, friability, and increasing of skin elasticity. The diagnosis of this syndrome is often difficult and based on clinical criteria and family history. Many skin lesions are reported from the disease up to now and various and simultaneously skin lesions in this case is the main propose of this report. Case report: A 11-year-old male with cutaneous lesions on the right forearm, left elbow, and right knee was referred after a mild injury. Patient recalled history of similar lessions, delay in wound healing, easy bruising, and recurrent dislocation of wrist from childhood period. According to clinical manifestation, Ehlers-danlos syndrome was probable diagnosis for this patient. However due to the disavailability of specific diagnostic test in our country, there was no definite diagnosis. After sending biopsies of skin lesions to the pathology laboratory, spheroid nodule of forearm, organized hematoma in the elbow, and keratinous cyst in the right knee were diagnosed. Fat necrosis, traumatic hematoma, hernia of fat into the dermis with calcification and atrophic scars have been reported as various skin lesions in Ehlers-Danlos syndrome. Three synchronous skin lesions and perforated keratinous cyst with marked inflammatory of foreign body distinguished this case from other similar previous cases. This case is the first case of Ehlers-Danlos syndrome with mentioned cutaneous dermatologic manifestations in Iran.