مجله دانشکده پزشکی دانشگاه علوم پزشکی مشهد
سال پنجاه و پنجم شماره 1 (پیاپی 115، بهار 1391)

IntroductionChronic Obstructive pulmonary disease (COPD) is an important disease with high mortality rate worldwide. Nocturnal ventilatory changes and gas exchange disorder are common in COPD patients. These disorders do not correlate with bronchial spasm and airway resistance. Apnea – hypopnea Index (AH) represent the total Apnea and hypopnea in one hour. There are several risk factors for sleep Apnea. Obesity is the common causes. The aim of this study is the relationship between apnea-hypopnea index and body mass index in COPD patients.Materials and MethodsWe assessed 40 COPD patients with sleep disorder in sleep laboratory. Exclusion criteria were pneumonia, Ischemic heart disease, lung cancer, congestive heart failure, Diabetes mellitus, systemic hypertension, hypothyroidism, central respiratory disorders, sedative drugs and opium usage. Body mass index (BMI) and neck circumference were assessed. Next, in this cross-sectional study, patients were evaluated with total nocturnal polysomnography. AHI was recorded. The data were gathered and analyzed with standard statistical method.ResultsMedian BMI, AHI were 30.77+- 5.85110 and 15.05+- 16.50571 respectively. No significant correlation was found between BMI and AHI.ConclusionThere were no correlation between increasing weight and apnea – hypopnea in COPD patients. Thus, in Iranian population, sleep apnea may be occur in higher level of BMI.

IntroductionThalassemia major is a hereditary anemia that becomes blood transfusion dependent. Iron overload consequence leads to multiple organ dysfunction and endocrinopathy. So deferoxamine (desferal) is used for chelation therapy. The aim of this study was to evaluate the growth rate of these patients and its correlation with endocrine complications and determine the role of secondary iron overload in these situations.Materials and Methods This cross-sectional study was performed for a year (2010) on 280 patients (aged 3.5- 56 years) who received blood transfusion and chelation therapy at Amirkola Thalassemia Center. After basic evaluations, determination of height standard deviation, they were divided by serum ferritin level into two groups (good and poorly controlled). They were evaluated for hypothyroidism, diabetes mellitus, hypoparathyroidism and hypogonadism. Next, data were analyzed. A p <0.05 was considered significant.Results From 280 patients with mean age of 19.6 ± 8.5 years, 161 (57.5%) cases were female, short stature (<-2 SDS) was present in 90 cases (32.1%). Their mean height was 151.4±17.3 cm. 162 cases (57.9%) had endocrinopathy. There was a relationship between short stature and hypoparathyroidism (p= 0.009) and hypogonadism (p= 0.005) and also diabetes mellitus (p= 0.003); but no relationship was found between short stature and hypothyroidism (p=1.000) and serum ferritin level (p=0.091).ConclusionAccording to higher prevalence of hypoparathyroidism, hypogonadism and diabetes mellitus in short statured thalassemic patients, screening should be done for such disorders with more sensitivity in these patients.

IntroductionAn important consequence of chronic liver disease (CLD) is endocrine disorders. The main object of this study was to assess serum hormones in children with CLD.Materials and MethodsIn a cross sectional study between 2007-2009, 57 children with chronic liver disease were enrolled. Levels of serum triiodothyronine (T3), thyroxin (T4), thyroid stimulating hormone (TSH), parathormon (PTH), calcium(c), phosphor (P), alkalanephosphatase (ALP),growth hormone(GH) and insulin like growth factor-1(IGF-1), albumin (ALB) and total protein, triglyceride (TG) and cholesterol (CHOL), fasting blood sugar (FBS) and liver function tests were measured.ResultsIn this study, most patient's thyroid hormones and fasting blood sugar were at normal range. But there was a significant decline in serum IGF- 1 levels in this patients. 28 percent of children had PTH levels higher than normal range for age and 24 percent had serum phosphor levels lower than normal range. 1/3 of these patients were bone fracture. Overt diabetics did not obsereve in our children.ConclusionChildren with CLD are GH resistant and might be at risk of osteopenia and bone fracture. So serum hormone levels should be carefully monitored in children with CLD.

IntroductionDrug abuse as a frequent high risk behavior accompanies many different gastrointestinal complications. In this study we tried to evaluate the prevalence of gastrointestinal reflux among opium addicts.Materials and MethodsUsing a historical cohort design, 62 cases with dyspepsia as the chief complaint entered the study: 30 cases with history of regular use of opium over the last year (exposed group) and 32 cases with no history of addiction at all (unexposed group). Upper GI tract endoscopy was accompanied by 3 biopsy specimens taken from body and antre of stomach was performed for all the cases. Results2 cases in the exposed group and 3 cases in the unexposed group left the study with the diagnosis of malignancy. Mean age of the remaining cases in the exposed group was 48.1±13.2 and in the unexposed group, it was 37.8±13.9 years (p= 0.006). 16 cases (57.1%) in the exposed group and 5 cases (17.2%) in the unexposed group had endoscopic evidence of bile reflux into the stomach (p= 0.003). Pathologic evidence of bile gastritis including foveolar elongation was reported in 7 cases (25.0%) of the exposed group in comparison with 1 case (3.4%) of the unexposed group (p = 0.025). The frequency of "helicobacter pylori free gastritis" was 50% in the exposed group and 17.2% in the unexposed group (p = 0.012).ConclusionDuodenogastric reflux is not restricted to cases with a history of GI tract surgery and it seems that this problem is common among opium addicts.

IntroductionDiabetic nephropathy is the most important disease which often results in renal failure. Proteinuria is an important parameter which predicts progression of diabetic nephropathy. Gold standard method for protein measuring is collecting 24 hour urine. Instead of that, in several studies around the world, measuring level of urine protein in 24 hours of the day has been carried out. In this study, we intended to specify the relation between quantitative amount of 8 hour and 24 hour urine protein in patients with diabetic nephropathy.Materials and MethodsThe study population included 50 patients with diabetic nephropathy before ESRD We obtained the following samples: 1) 8-h urine, and 2) 24-h urine. We measured serum creatinine concentration, creatinine clearance, urine volume, urinary protein and creatinine concentration. Our statistic method of analysis was Pierson's correlation method. ResultsAge mean was 53±14 years old and diabetes duration mean was 13±4.10 years. The mean of nocturnal 8hr urine protein and 24 hr one were 24.20±42, 33.35±43, 71.26±84 mg, respectively. There was a direct significant correlation between 8hr and 24hr urine protein (r=0.8, p=0.001). A significant correlation was also detected between nocturnal 8hr urine protein and daily one with 24hr urine protein.ConclusionThere was a significant and direct relationship between 8hr urine protein (daily and nightly) and 24hr urine protein. This might be used for urine protein collection in patients with diabetic nephropathy to improve the compliance.

IntroductionHyperlipidemia is a risk factor for cardio vascular diseases (CVD), which may be protected by diet therapy and physical activity. The aim of the present study was the determination of the effects of diet therapy and nutritional education on lipid profiles in hyperlipidemic pateints.Materials and Methods73 subjects out of 183 subjects with hyperlipidemia were selected from our previous research for this semi-clinical trial study. Written consent forms were obtained and 5ml fasting blood sample was collected for TG, T-C, LDL-C and HDL-C analysis before and after intervention. Body composition was assessed using bioelectric impedance (Plusavis 333). All participants received low fat, low cholesterol and high fiber diet including a nutritional guide booklet. Subjects were followed up using phone call every two weeks and data was analyzed using pair T-test and SPSS16.Results45 subjects with average age of 45+8 year completed the study (16 female and 29 male). There was significant reduction in BMI and weight after two months diet therapy (p<0.05). Significant decrease was showed in LDL-C after two month intervention (104.2+2.3 vs. 90.1+2.9, p= 0.001). The study showed borderline reduction in diastolic blood pressure. There was no significant difference for TG, T-C and systolic blood pressure before and after intervention. ConclusionReduction in BMI, weight and LDL-C during short time revealed the effects of diet therapy and nutritional education. Screening for hyperlipidemia and improving public nutritional knowledge using appropriate media to prevent CVD is highly recommended.

IntroductionDue to multiplicity of tinnitus etiologies and the lack of accurate knowledge about its exact mechanism, it is still a challenge to find an effective treatment. The objective of this study was an evaluation of carbamazepine and oxcarbazepine effect on tinnitus in patients’ reffered to Amiralmomenin Hospital Rasht-Iran.Materials and MethodsIn a randomized double-blind clinical trial, a total of 57 patients (23 to 71 years old) with chronic nonpulsatile tinnitus were treated in three separate groups with carbamazepine (300-600mg), oxcarbazepine (450-900 mg) and placebo for 12 weeks. In the early stages of the study, physical examination and nessecary laboratory tests, audiometry tests, complementation of Visual Analogue Scale (VAS) and Tinnitus Severity Index (TSI) were performed. At the end of 8th and 12th weeks, VAS and TSI questionnaire were completed again.ResultsAmong 51 patients (28 male, 23 female) who completed the trial course, according to VAS, carbamazepine, oxcarbazepine and placebo decreased severity of tinnitus in 56.6%, 46.2% and 38.5% of cases respectively. Decrement in tinnitus severity on the basis of TSI in the three mentioned groups were 61.1%, 58.8% and 50% respectively. Carbamazepine and oxcarbazepine were not more effective than placebo in subsiding tinnitus on the basis of VAS and TSI. ConclusionCarbamazepine and its analouge, oxcarbazepine are effective in decreasing tinnitus severity, but they are not significantly more effective than placebo.

IntroductionThe world witnesses addiction crisis along with atomic bomb, environmental degradation and poverty. One of the most common problems in most of the addict clients is low self-esteem. Self-esteem increases flexibility against changes and reinforces positive attitudes in order to improve sense of self-sufficiency. The researches about addiction and its non-drug treatment strategies, specially increasing self-esteem, is a very important issue. The present study aimed to assess the effect of family-centered problem solving teaching method upon the self esteem in drug-dependent clients. Materials and MethodsThis research was an experimental, two-group pretest-posttest design. After approval of research tool's validity and reliability, 60 addictive clients were randomly divided into 2 tests and one 30-person control group. The participants completed the questionnaires before and after the intervention. The test group received family-centered problem solving teaching method in 8 45-minute sessions for 2 months in additional to common treatment.ResultsFamily-centered problem solving teaching method led to statistically significant increase in test group’s self-esteem. Self-esteem scores rate in test group was 4.5 times more than control group.ConclusionApplying the family-centered problem solving teaching method can be useful in improving and completing the treatment process of clients’ addiction quitting in these clinics as a non-drug method.

IntroductionNo reflow is one major side effect that occurs in angioplasty and makes prognosis poor. This article reported the vital role of utilization of new thrombus aspiration catheters in treatment of this phenomenon to succeed in rescue angioplasty. Case reportA 36-year-old man with failed response to streptokinase, 3.5 hrs after anterior STEMI was referred to cath-lab for rescue angioplasty. At angiography, LAD was totally occluded with thrombotic lesion. Because of high clot load, standard angioplasty failed to establish the flow aggravating hemodynamics, so we used the device to aspirate thrombus. This procedure was successful and normal coronary flow was restablished; chest pain terminated and blood pressure roseConclusionThe presence of new thrombus aspiration catheters in cath-lab is an essential treatment device for success of primary and rescue angioplasty.