مجله دانشکده پزشکی اصفهان
پیاپی 138 (هفته دوم تیر 1390)

Malnutrition is one of the most common complications among patients under maintenance dialysis which is related to systemic inflammatory processes. Decrease in serum albumin level, following malnutrition, is an independent risk factor for cardio-vascular diseases in patients under dialysis. We aimed to evaluate the effect of oral L-Carnitine supplementation on serum albumin and inflammatory factors (C reactive protein (CRP) and hemosysteine) in patients under peritoneal dialysis. This randomized, double-blind, placebo-controlled trial was conducted on 48 patients under peritoneal dialysis referring to Isfahan Peritoneal Dialysis Center from 2009-2010. Patients were randomized to carnitine and placebo groups and received oral carnitine (250 mg, 3 tablets /day) or placebo for 9 months. Serum albumin level was checked every 3 months and serum CRP and hemosysteine levels were checked before and after the study and compared between the two groups. Compared to placebo group, serum albumin level was increased significantly from 3.30 ± 0.51 to 3.70 ± 0.53 mg/dl (P = 0.044). In carnitine group, serum CRP level was increased from 2.35 ± 2.49 to 3.37 ± 4.80 mg/l (P = 0.304) while in the placebo group it was significantly increased from 1.37 ± 1.28 to 2.44 ± 2.68 mg/l (P = 0.039). In contrast, serum hemosysteine level was significantly increased in the carnitine group from 21.40 ± 8.08 to 25.70 ± 6.85 µgr/l (P = 0.019) while its increase in the placebo groop was not significant (P = 0.159). One patient in the carnitine group with history of hypertension experienced an increase in blood pressure that was controlled with a greater dose of anti-hypertensive drugs. In patients under peritoneal dialysis, oral L-carnitine can increase serum albumin level and prevent CRP rising, but has no beneficial effect on hemosysteine. According to several reports on beneficial effects of L-carnitine on anemia and lipid profile in patients under dialysis, its supplementation is recommended for these patients.

Multiple sclerosis is an inflammatory and degenerative disease of central nerves, in which myelin appears as several large and small plaques in cerebrospinal white matter. The aim of this study was investigate the familial prevalence of Multiple Sclerosis. This cross- sectional study was performed from the beginning to the end of 2007 on 539 MS patients in Isfahan, Iran. The patients were selected among all of the MS people who referred to the MS clinics of Isfahan University of Medical Sciences by the simple random sampling. Finally 593 patients were studied; their disease was proved based on the McDonald values by 2 neurologists. The average of patients’ age was 33.44 ± 0.9. 493 patients (83.1%) were female. 85% had partial disability and 83.3%of them had Relapsing Remitting kind of this disease. 53.5% of them had 2 or more hospitalizations. 119 of them (20.1%) had familial history of MS which among them in 47 (40.5%) patients it was in first degree relatives, in 26 (22.6%) was in second degree relatives and in 46 (36%) was in third degree. According to the achieved results it seems the familial prevalence of MS in Isfahan, Iran is more than other regions, so it is recommended to do more etiologic studies based on the genetic and environmental factors.

Pharmacological therapy is a critical step in the management of individuals with Metabolic Syndrome (MetS) when lifestyle modifications can not to achieve the therapeutic goals. However, it is well-documented that other than weight loss, there is no single best therapy, and the treatment should consist of treatment of individual components of the MetS. The objective of this study was to investigate treatment of individual components of the MetS among a population–based sample of individuals with the clustering of those components of the MetS. A cross-sectional population-based study, a randomly collected sample of men and women living in three counties in central Iran participating in the baseline survey of a community –based program in 2000-2001 were examined. A questionnaire was completed for all participants to collect data regarding their demographic characteristics, medical status and history of medication use. In this study we determined the association between clustering of MetS components and pharmacological treatment of cardiovascular risk factors. The most common pharmacologic agent received by individuals with MetS were beta blockers (72.8%) used for controlling high blood pressure, followed by lipid lowering agents (36%) without significant gender difference. Our results exhibited Beta blockers, statins, fibrates and glybenclamid are more prevalent drugs among subjects with metabolic syndrome. Further research is needed to better elucidate the compliance behavior of patients who have been diagnosed with MetS.

According to inconsistencies in the various studies about effect of statins on atherosclerosis and issue importance, the aim of the present research was review carried out in statins and atherosclerosis. By the use of atherosclerosis, statins and hyperlipidemia as keywords, we searched in PubMed through 1980 until 2011. Most studies showed the reduction of total cholesterol and Low density lipoprotein (LDL) by Statins, but there showed a little effect on increasing High density lipoprotein (HDL). In most studies mechanisms of action of statins were stabilization atherosclerotic plaques consequently inhibit oxidation, improve endothelial function by increase Nitric oxide and improvement thrombotic state by inhibiting platelet. Most Of Clinical trials had shown positive effect of statin on cardiovascular disease and atherosclerosis. Therefore, using of them for treatment of hyperlipidemia could be appropriate preventive for atherosclerosis and cardiovascular accidents. Although the exact mechanism of action is not clear, there is a need for further investigation.