Caspian Journal of Internal Medicine
Volume:3 Issue: 1, Winter 2012

Ageing of population worldwide will be responsible for a major increase of the incidence of osteoporosis in elderly. For the individual, osteoporotic fractures result in great disability as well as loss of quality of life and also represent an enormous burden for healthcare systems. This study was conducted to determine the prevalence of osteoporosis and it's association with serum vitamin D level in elderly people in Amirkola, North of Iran. In this cross-sectional study, 193 subjects aged 60 years old and over were assessed in Amirkola. Using a standard questionnaire, individual characteristics and densitometry (with DXA) results were collected and the data were analyzed with SPSS, chi square tests and linear regression. The overall prevalence rate of osteoporosis was 32.1% in at least one measurement sites (28.5% in lumbar and 14.5% in femoral region), while 49.7% of elderly people suffering from decreased bone mass (osteopenia). Osteoporosis prevalence in women was 55.7% and this value in elderly men was 12.4%. Bone mineral density has negative association with age in femoral region (p<0.01, r=-0.3), but no statistical relationships were seen between bone mineral density and serum 25-hydroxy vitamin D level in this study. Our findings revealed higher prevalence of osteoporosis in elderly people especially in women compared to other studies in Iran, and also showed high prevalence rate of vitamin D deficiency. No relationships were found between serum vitamin D and bone density in this study.

Bone mineral density (BMD) changes during the course of rheumatoid arthritis (RA). The present study was designed to investigate the status of BMD in patients with RA treated with anti-rheumatic drugs. BMD at the femoral neck (FN-BMD) and lumbar spine (LS-BMD) were measured by dual energy x-ray absorptiometry (DXA) method using Norland densitometer. Disease activity (DA) was assessed by calculation of DAS28 score. The patients with at least twice BMD measurements were included and those who received treatment for osteoporosis were excluded. The mean FN-BMD and LS-BMD changes from baseline between the two BMD measurements was determined. Nineteen patients (17 females, 2 males) with the mean age of 54.5±7.7 years, with mean disease duration of 141.8±58 months were treated for an average period of 2.9±1.9 years. All the patients were treated with low-dose methotrexate (MTX) up to 15 mg/week alone or with combination of hydroxychloroquine and/or sulfasalazine and 5 mg prednisolone daily. At the end of study period, the value of FN-BMD gr/cm2 decreased by - 4.24% (p=0.12) and LS-BMD gr/cm2 by - 6.57% (p=0.009). The mean FN BMD Z-score increased by +7.66% (p=0.64) and LS-BMD Z-score decreased by - 14.7% (p=0.120). The findings of this study indicate that bone loss in RA continues despite anti-inflammatory treatment. The lower rate of bone loss from FN compared with LS may be attributed to suppression of hip synovitis with anti-inflammatory treatment.

Suppressive therapy with levothyroxine for reducing the size of thyroid nodules has not been really accepted. The purpose of this study was to assess the effect of levothyroxine on the size of benign thyroid nodules. Forty patients with confirmed benign nodule were randomly divided into two groups. Group I received 50?g/day levothyroxin for six months but group II did not take it. Sonography was used to measure the dimensions of nodules before and after six months. TSH serum levels were measured before and after treatment. This clinical trial study was registered as IRCT 201103185692 N3. The data were collected and analyzed. The mean age of levothyroxine group was 41.57±9.41 and control group was 44.45±10.9 years (p=0.386). The TSH levels and longitudinal and transverse dimensions in both groups were similar (p>0.05). The TSH levels before and after treatment were 2±1.65 and 0.52±0.67 mUI/L (p=0.001). The Longitudinal and transverse dimensions before and after treatment in case group were 1.9±1.11, 1.90±1.15 and 1.44±0.90, 1.49±1.02 cm respectively (p=0.74, p=0.7, respectively) but in control group, were 2.19±1.32, 1.97±1.4 and 1.57±0.95, 1.26±0.7, respectively (p=0.35 and 0.1, respectively). The results show that suppressive therapy with levothyroxine lead no alteration in the size of benign nodules.

Brucella species can cause infection in a wide range of animals and human beings. Oxidative events against brucella infection are not well elucidated. It is possible that brucellosis may be related to increased free radical production and antioxidant depletion. Thus, the aim of this study was to determine the total antioxidant capacity (TAC) before and after treatment of patients with brucellosis. In the present study, a total of 48 patients with brucellosis, 23 males and 25 females, were detected through Wright ≥1/160 2ME ≥1/80, in association with compatible clinical findings. All patients were treated with standard regimens of therapy. Total antioxidant capacity (TAC) was determined with ferric reducing antioxidant power (FRAP) using spectrophotometric method before and after treatment. TAC levels were significantly lower in pre-treatment than in post-treatment patients, 0.783±0.015 and 0.819±0.024 m mol/L respectively (p<0.01). There was not significant relation between plasma TAC levels and age or gender of the patients. TAC may be useful as an early marker of oxidative stress to monitor and optimize antioxidant therapy as an adjunct in the management of patients with brucellosis.

Pancreatitis is most common complication of post-ERCP and needs to admission at least for one day. The purpose of this study was to assess the efficacy of guide wire for better common bile duct (CBD) cannulation for reducing post-ERCP pancreatitis. From April 2010 through March 2011, the patients who needed ERCP and referred to Shahid Beheshti and Rouhani Teaching Hospital were entered into the study. Guide wire cannulation (65 subjects) as case group and 78 cases with standard cannulation as control group were performed on them randomly. Data from these cases were collected and analyzed. One hundred eighteen (82.5%) patients were females and 28 (17.5%) were males. The mean age of these patients was 56.5±16.8 years. Post- ERCP pancreatitis rate in guide wire group was 6 (9.2%) and in the standard group was 12 (15.4%) (p=0.269). Successful cannulation in these two groups was 67.7% and 67.9%, respectively (p=0.974). The results show that post- ERCP pancreatitis rate in both groups are similar. Other studies with large number of cases are required to confirm our results.

Allergic diseases including asthma, allergic rhinitis (AR) and eczema are common chronic diseases in children. The purpose of this study was to determine the prevalence of asthma, AR and eczema in Sari, Iran. This study was carried out on all elementary schools selected as a cluster from February 2010 to July 2010 in Sari, North of Iran. A questionnaire was provided according to International Study of Asthma and Allergies in Childhood (ISAAC) protocol. Asthma, AR, eczema and their combinations were recorded. Out of the 1818 cases, 646 (35%) subjects had allergic disorder; 223 (12%) had asthma, 318 (17%) had AR and 105 (6%) had eczema The prevalence of allergic disorder in boys (65%) was higher than the girls (40%) (p<0.05). The results show that around one – third of the elementary school children have allergic disorders. The prevalence in males is higher than the females.

The clinical manifestations and outcome of influenza infection differ between various patients in the world. The purpose of this study was to assess the clinical manifestations of patients with confirmed or suspected novel H1N1 flu infection in Sari, North of Iran. From September 2009 to January 2010, the patients’ data were collected by retrospective chart review of medical records. Laboratory confirmation included a positive RT–PCR (reverse transcriptase–polymerase-chain-reaction assay) from a nasal or pharyngeal swab sample. Nearly 80% of established patients were in age group of 15-45 years. Approximately 14.6% of female cases were pregnant There was no significant difference in clinical and laboratory characteristics of patients with confirmed H1N1 virus infection to total cases with Influenza Like Illness (ILI). Thirty nine (95.1%) of the established patients had a combination of fever plus sore throat or cough. Relative lymphopenia was reported in 36.6%. Pneumonia was the most common complication. Acute pericarditis evolved in one case and aseptic meningitis was reported in another. Precise collecting information of clinical manifestations, risk factors and other characteristics of flu, can help to the early infection detection, timely treatment of patients and proper preventive measurements.

Previous studies have demonstrated the value of serum procalcitonin (PCT) as a marker of bacterial infection, as well as the rapid decrease in its concentration with appropriate antibiotic treatment. The aim of this study was to determine the variation in serum PCT levels over time during the treatment of acute bacterial meningitis (ABM) in adults. In this prospective analytical study, 36 acute meningitis patients (26 males and 10 females) with mean age of 38.4±20.1 years were studied. Among them, 17 patients with fever and neck stiffness and CSF profiles consistence, ABM was treated by appropriate antibiotic regimen. We measured PCT serum levels before and after 24 and 72 hours after initiation of treatment. Decrease in the body temperature and feeling of well being were the clinical criteria for treatment response. The data were collected and analyzed. Serum level of PCT in the beginning of treatment, 24 and 72 hours after initiation of treatment was 2.58±4.62, 2.50±4.6 and 1.52±3.03 ng/ml, respectively. Difference in PCT initially and 24 h later was 0.044±0.08 (p=0.025) and after 72 h was 1.74±2.92 (p=0.013). The mean of PCT level was greater in patients not improving (5.34±4.42 vs. 2.08±3.46). Although decreasing PCT was low in 24 h after treatment, this decrement is more significant after 72 h. PCT serum level may be used as a follow up of treatment response in ABM.

The metabolic syndrome (MS) recognized as a major cause of type 2 diabetes and cardiovascular diseases, has become one of the major public health challenges worldwide. The pathogenesis of the metabolic syndrome is multiple and still poorly understood. No single factor has yet been identified as an underlying causal factor. There is a growing belief, however, that obesity, specially visceral obesity, may play an important role in the development of the syndrome. Visceral adiposity seems to be an independent predictor of insulin sensitivity, impaired glucose tolerance, dyslipidaemia and elevated blood pressure. An increasing number of studies confirm that oxidative stress, chronic inflammation and angiogenesis all play important roles in the pathogenesis of MS. Chronic hyperglycemia causes oxidative stress in tissues prone to complications in patients with diabetes. Oxidative stress occurs in a cellular system when the production of free radical moieties exceeds the antioxidant capacity of that system. If cellular antioxidants do not remove free radicals, radicals attack and damage proteins, lipids, and nucleic acids. The oxidized or nitrosylated products of free radical attack have decreased biological activity, leading to loss of energy metabolism, cell signaling, transport, and other major functions. These altered products are also targeted for proteosome degradation, further decreasing cellular function. Accumulation of such injury ultimately leads a cell to die through necrotic or apoptotic mechanisms.In conclusion, a puzzle of many pieces of evidence suggests that free radical overgeneration may be considered the key in the generation of insulin resistance, diabetes, and cardiovascular disease.

Tuberculosis of the larynx is a rare form of tuberculosis. Patients usually present with hoarseness or dysphagia and other nonspecific constitutional symptoms like fever or localized pain. In this study, we present a case of primary vocal cord lesion with tuberculosis. A 72 year old man presented with hoarseness of voice, low grade fever, and night sweating with in three month duration. Laryncoscopic study showed unilateral thickening of vocal cord and biopsy of the lesion showed granuloma with caseous necrosis. Chest x-ray was normal. The patient was treated with standard regimen of tuberculosis and was cured after 6 months of therapy. Laryngeal tuberculosis should be considered in the differential diagnosis of patients with hoarseness without pulmonary involvement in endemic regions of tuberculosis.