مجله دانشکده پزشکی دانشگاه علوم پزشکی مشهد
سال پنجاه و پنجم شماره 3 (پیاپی 117، پاییز 1391)

The prevalence of obesity continues to rise all around the world (1، 2، 3). Obesity is associated with important complications such as coronary heart disease and diabetes (3،5). Obese children because of their inappropriate diets and consumption of energy dense foods which lack adequate minerals، may be at increased risk of micronutrient deficiencies. So in this study we tried to figure out if there is any association between low levels of micronutrients such as iron، calcium and phosphorus and obesity. A total of 280 obese and 280 non obese children ranging between 2-16 years old were evaluated. BMI>= 85% was defined as overweight. Serum iron، ferritin، TIBC، MCV، hemoglobin، hematocrit، calcium and phosphorus levels were evaluated in both groups. Then the data were compared. In obese children 94. 3% had hemoglobin in the range of anemia where this was 60% in control group. Serum iron was low in 56. 1% of obese children vs 10. 4% in control group. Serum level of calcium and phosphorus was significantly lower than normal in obese children. This study''s results show the significant impact of healthy nutrition on the overall health of the society and also show the effect of healthy nutrition on preventing obesity and it''s complications.

Antipsychotic drugs are the cornerstone of schizophrenia treatment. Glucoregulatory abnormalities have been associated with the use of antipsychotic medications. There are some reports of weight gain and glucose intolerance in patients with schizophrenia receiving atypical antipsychotic medications. The purpose of this study is to compare the effect of various antipsychotic therapies on glycemic control in patients with schizophrenia.

Eighty-one patients with schizophrenia were enrolled in the study and underwent glucose-tolerance test. Patients were divided in to two groups، with one group (n=43) receiving typical and the other group (n=38) receiving atypical medication. Demographical and historical data were collected with a questionnaire.

There was a marginally significant difference in the first hour glucose level between typical and atypical drugs (mean 132. 12 vs. 151. 76، respectively، p=0. 07). Also، marginal significant difference was present comparing the first hour glucose level between typical antipsychotics and clozapine consumers (mean 132. 12 vs. 153. 67، p=0. 06). This difference was not present when typical antipsychotics were compared with risperidone (mean 132. 12 vs. 149. 41، p=0. 230). Fasting blood sugar and second- hour glucose tolerance results did not show a statistically significant difference. The increased GTT of the first hour blood sugar in patients who received clozapin may indicate the early stages of insulin resistance in this group.

This study suggests that patients under atypical antipsychotic treatment are more vulnerable to diabetes mellitus (DM). Across atypical medications; we observed a greater glycemic effect from clozapin compared to risperidone.

Obesity is a public health problem that has raised concern worldwide. Numerous epidemiological Studies have showed the relationship between excess weight، abdominal fatness and risk of a wide range of illnesses (i. e. diabetes)، People who are obese experience health-related quality-of-life impairments. The purpose of this study was to demonstrate the Comparison of Living Quality obese with normal weight women in Qazvin. A case-control study was performed on women of Qazvin who were obese and normal-weight. Total of 115 women with obesity and 114 controls (with normal-weight) were randomly selected. Obesity was determined based on BMI and SF-36 questionnaire using for quality of life. Data were analyzed using soft ware of SPSS and 95% confidence Interval. The results showed that obese women were significantly more impaired than normal weight women in six of eight Domains: domains such as physical Functioning (p<0. 001)، physical Role limitation (p=0. 01)، bodily pain (p=0. 05)، general health perception (p=0. 012)، vitality (p=0. 014)، and social Functioning (p=0. 045). Women with obesity had experienced poor levels of health، particularly poor levels of physical and social well-being.

Infectious diseases have always been considered as a serious public health concern. In particular،the elderly are more vulnerable to infection due to physiological changes of aging and alteration of host defense mechanisms. The aim of this study was to assess the final diagnosis and outcomes in old patients referred to the infectious diseases ward of 5th of Azar hospital of Gorgan

In this cross-sectional study، patients aged 65 and above admitted to 5 Azar hospital between March 2009 and June 2010 with the impression of an infectious disease were selected by looking at the medical records. Moreover، information on chief complaints، underlying diseases and past drug history were collected. Data were entered to computer using SPSS (v. 13) and Chi-square and One-Way ANOVA tests were used for analysis.

A total of 128 patients were recruited with the mean age of 75 years. Final diagnosis in most of participants was pneumonia. About 85% of patients were recovered and eight deaths were reported. The cause of death in most of cases (62. 5%) was unknown and sepsis was the second frequent cause (25%). Final diagnosis in most of recovered patients (33. 3%) showed that، after the unknown causes، pneumonia was the most common cause (24. 8%). The proportion of recovered cases was reduced with increasing age. There was a significant relationship between final diagnosis and outcome (P-value= 0. 01).

We found a lower proportion of recovery in older patients. This may negatively affect the disease outcome. Therefore، more attention should be paid to appropriate diagnosis، treatments and follow-up in these patients.

Infectious diseases have always been considered as a serious public health concern. In particular،the elderly are more vulnerable to infection due to physiological changes of aging and alteration of host defense mechanisms. The aim of this study was to assess the final diagnosis and outcomes in old patients referred to the infectious diseases ward of 5th of Azar hospital of Gorgan

In this cross-sectional study، patients aged 65 and above admitted to 5 Azar hospital between March 2009 and June 2010 with the impression of an infectious disease were selected by looking at the medical records. Moreover، information on chief complaints، underlying diseases and past drug history were collected. Data were entered to computer using SPSS (v. 13) and Chi-square and One-Way ANOVA tests were used for analysis.

A total of 128 patients were recruited with the mean age of 75 years. Final diagnosis in most of participants was pneumonia. About 85% of patients were recovered and eight deaths were reported. The cause of death in most of cases (62. 5%) was unknown and sepsis was the second frequent cause (25%). Final diagnosis in most of recovered patients (33. 3%) showed that، after the unknown causes، pneumonia was the most common cause (24. 8%). The proportion of recovered cases was reduced with increasing age. There was a significant relationship between final diagnosis and outcome (P-value= 0. 01).

We found a lower proportion of recovery in older patients. This may negatively affect the disease outcome. Therefore، more attention should be paid to appropriate diagnosis، treatments and follow-up in these patients.

In cases of acute Appendicitis with vague symptoms، the diagnosis maybe delayed and during this interval، most patients receive fluid therapy. Az a result the patients'' symptoms declines and even sometimes they refuse to operate. The purpose of this study was evaluation of effect of fluid therapy on symptoms and signs of acute appendicitis. In a prospective comparative clinical trial study 130 patients were studied. Patients in two groups of 65 people who qualified were studied In one group 6 hours before the surgery fluid therapy had been done and in the other group no medications or fluids were prescribed and information recorded. Finally 6 hours after the admission، patients were operated and pathological records collected. Data classified and analyzed by SPSS software and P value of more than 0. 05 considered valuable. Based on our data، the abdominal pain، the most important sign of appendicitis، decreased meaningfully in the fluid therapy group in comparison with non rehydrated group. (p= 0. 0001). The anorexia changes (improving appetite)، reducing the tenderness and rebound tenderness were obviously different in two groups (p>0. 05). These results mean that fluid therapy has effect on signs and symptoms of appendicitis. This may result in delay or misdiagnosis of appendicitis. Thus the physician should be aware، especially in patients that have received fluid therapy. Although، we could not find any physiopathologic reason for this effect.

The prevalence of celiac sprue increases in patients with IDDM. This relation between type I diabetes mellitus and celiac sprue is important with respect to too presence of diarrhea in both diseases. When a patient with type I diabetes mellitus complains from diarrhea, physician should be alert about the presence of celiac sprue and may need to do some workup to rule out celiac sprue.

This is a cross sectional and discretional study. There were 87 type I diabetes mellitus patients referred to endocrine clinic of Mashhad Qaem hospital between1384-1387. According to inclusion criteria each patient referred to selected laboratory for checking tTG-IgA Antibody, and if it was positive she or he referred to endoscopy ward of Qaem hospital for doing endoscopy and taking biopsy from distal part of the second potion of duodenum.

In this study, 87 patients with type I diabetes mellitus having the mean age of 19.78 years (lower limit of 15 and upper limit of 30) were under study (41 males and 46 females). Positive anti tTG-IgA antibody reported for 28 patients (32.2%). There were 9 individuals with biopsy proven celiac sprue in these 87 patients (10.3%). Also 24 persons (27.6%) suffered from diarrhea and or abdominal pain among 87 patients.

Prevalence of celiac sprue is different in different geographical areas. This prevalence in type I diabetic patients in east of Iran was about 10.3%. This study shows the necessity of screening among patients with type I diabetes mellitus.

A 46 years old gentleman was admitted to hospital following a 10 months history of sever diarrhea. On examination، the patient appeared as mildly dehydrated though his vital sings were within normal limits. important result tests were: Bun=55 mg/dl Na=149 mEq/dl WBC=11. 6*103/ml Hemoglobin=16. 2 g/d Cr=3 mg/dl K=3. 9 mEq/dl HCT=49. 7% Plt=324*103 Tbo/ul Neutr=74% After ten days administration of IV fluid، BUN and createnine gradually became normal (Cr=1. 1mg/dl، BUN=14mg/dl). There was no macroscopic or microscopic gastrointestinal pathology in upper and lower endoscopy. We took biopsies even from ileum terminal. We suspected endocrine tumors and pancreatic disorders، so we requested abdominal and pelvic CT scan (IV and oral contrast) and hormonal tests such as serum cortisole، metanephrin، normetanephrine، which were all normal. We therefore did an octrotide scan which was again normal. Because almost all organic etiologies of chronic diarrhea were excluded، we focused on neurological and psychological causes of chronic diarrhea. Therefore we consulted with neurologist & psychiatrist and they recommended brain CT scan and EEG which were normal. After complete interview، the psychiatrist diagnosed PTSD and depressive disorder NOS and prescribed imipramin 25mg/day. After 10 days the chronic diarrhea improved. As we excluded all the organic causes، we concluded likely the patient had IBS with PTSD and depressive disorder NOS.

Fungi are rare causes of meningitis. Cryptococcus neoformans is the most common cause of fungal meningitis. Although meningitis is the most common form of cryptococcal disease but cryptococcal infection almost always originates from lung. Case report: We present a 13 –year- old boy with sarcoidosis that developed fever، headache and vomiting He was hospitalized and treated with clinical diagnosis of acute bacterial meningitis، However، the treatment was not effevtive and due to hydrocephalus in brain CT، anti-TB therapy was initiated. Finally both CSF the culture and smear tested positive for cryptococcus neoformans، and the patient was successfully treated by Amphotricin and then fluconazol in a period of one year. In differential diagnosis of aseptic meningitis and hydrocephalus، Cryptococcus neoformans must be considered in adition to TB meningitis.