مجله دانشکده پزشکی اصفهان
پیاپی 239 (هفته اول امرداد 1392)

During mechanical ventilation، atelectasis may appear. Atelectasis seems to be caused by reduced lung volume and small airway collapse. The collapse of healthy anesthetized and acutely injured lungs of patients is well described and the main mechanical treatment of such collapse conditions is built upon positive end-expiratory pressure (PEEP). The aims of this study were to investigate the hemodynamic and respiratory effect of the adding PEEP in patients with healthy and damaged lungs during mechanical ventilation. In 24 patients with healthy and 28 patients with damaged lungs at constant ventilation، PEEP was decreased from 5 to 0 cmH2O and then increased to 15 in steps of 5 cmH2O every 10 minutes. We prospectively evaluated the effects of PEEP on the respiratory and hemodynamic indexes of this patients during ventilation and then، SPO2، peak inspiratory pressure، plateau airway pressure، tidal volume، static and dynamic compliance، heart rate and blood pressure (systolic، diastolic، and mean) were recorded. Increasing PEEP levels from 0 to 15 cmH2O improved oxygenation in both patient with healthy and damaged lungs; but increasing PEEP levels decreased heart rate and systolic، diastolic and mean arterial blood pressure، although this changes were not significant. Increasing PEEP increased respiratory indexes with statistically significant difference between two groups (P < 0. 001). Because of increasing the respiratory indexes by increasing PEEP levels in both damaged and healthy lungs without significant hemodynamic effects، this maneuver can be propose to improve oxygenation and respiratory indexes during constant ventilation in both patients with healthy and damaged lungs.

Some observational studies show that the consumption of vitamin D is one of the preventive methods which may potentially be useful in the reduction of diabetes type ΙΙ development، insulin resistance، impaired glucose tolerance، and metabolic syndrome. The purpose of this study was to evaluate the effect of vitamin D on insulin resistance in patients with type II diabetes. This study was conducted as a comprehensive cohort design in Qom، Iran، in 2012. The participants were 120 patients with type II diabetes of whom، 58 agreed to be randomized into two groups and 62 patients were allocated to their preferences. For randomized treatment group، a pill of vitamin D which contained 50000 units was used weekly and orally for duration of 3 months. In the control group، the placebo pill of vitamin D was prescribed by the same method. In the preferential group، patients received neither vitamin D nor placebo. The value of insulin resistance was defined as a score greater than 3. 87 in HOMA-IR (Homeostatic model assessment -estimated insulin resistance) index. Vitamin D could significantly decrease the HOMA-IR index in the randomized group after controlling for the variables of sex، age، body mass index (BMI)، waist، duration of diabetes، heart disease، and HOMA-IR index at the beginning of the study. The reduction was not statistically significant in the preferential group. Vitamin D can affect the reduction of fasting blood sugar (FBS) and insulin resistance in the randomized group but in the preferential group it cannot.

Bovine tuberculosis، from the point of view of public health، is important in human societies. In this study، the prevalence of pulmonary tuberculosis caused by Mycobacterium bovis (M. bovis) in the central province، Iran، was reviewed. In this cross-sectional study، sputum cultures were prepared from all smear-positive patients during 18 months. A culture medium containing pyruvate، as well as، chemical and molecular tests for the detection of M. bovis was used. Data analysis was performed using SPSS16 software. During study، two strains of M. bovis were isolated. The molecular pattern of M. Bovis of the first patient by variable-number tandem repeat (VNTR) and spoligotyping methods was similar with most of M. bovis circulating in the population of cattle in Iran. But in the second case، despite being like a rare detected strain in the VNTR method، a different spoligotyping pattern was found. Eventually، it became clear that one of the isolates had not genotype similarity with the previously reported patterns. The curriculum of bovine tuberculosis combatting consists of proper planning in control and eradication، mainly on the basis of repeated tuberculin testing، removing infected animals from the herd and slaughter them، pasteurization of milk، and human vaccination with Bacillus Calmette-Guérin (BCG) vaccine.

Nephrotic syndrome (NS) is a common type of kidney disease in children characterized by massive proteinuria، hypoalbuminemia and edema. Response to therapy can be affected by factors like pathologic views، genetic and clinical manifestations. The incidence of genetic mutations is different in variant geographic locations and races. Response to nephrotic syndrome treatment can be influenced by some mutations in WT1 and NPHS2 genes. 49 children suffering from nephrotic syndrome participated in two groups of steroid-sensitive (n = 14) and steroid-resistant (n = 35) nephrotic syndrome. Mutations in WT1 and NPHS2 genes analyzed by polymerase chain reaction (PCR) and direct sequencing. Clinical and pathological reviews were done too. There was a significant relationship between both primary creatinine and hypertension in the first visit and resistance to therapy. Pthological views of focal segmental glomerulosclerosis (FSGS)، glomerular fibrosis، and glomerular sclerosis were significantly related to steroid resistance group (P < 0. 001). Genetic analysis for mutations of WT1 and NPHS2 genes among 29 children with idiopathic nephrotic syndrome showed 2 and 5 different mutations in WT1 and NPHS2 genes، respectively. All of the mutations were seen in steroid-resistant group. This study demonstrates the importance of WT1 and NPHS2 analysis and pathological study in Iranian children with nephrotic syndrome.

Dear Editor-in-Chief،Gastric complications are common in hemodialysis patients، and Helicobacter pylori (H. pylori) infection is found to have an important role in gastrointestinal diseases in these patients. On the other hand، magnesium is mainly excreted by kidney and magnesium metabolism is perturbed in chronic kidney disease. However، no significant correlation of serum anti-H. pylori specific antibody titer with serum magnesium level has been observed. The elevated serum magnesium in hemodialysis and its higher concentration in the gastric mucosa may promote the gastric colonization of H. pylori in hemodialysis patients، but not in patients with various stages of kidney insufficiency. More studies are needed to prove the association of serum magnesium level and the infection of H. pylori in hemodialysis and finding the clinical relevance of these results