مجله تعالی بالینی
پیاپی 2 (تابستان 1392)

Insulin has an important and vital role in control of blood glucose for all diabetic patients. With increasing the prevalence of diabetes mellitus، insulin consumption will be increased too. Different types of insulin are available، i. e short، rapid، intermediate and long acting insulin and also mixed insulins. The side effects of insulin may lead to the lack of a desirable control of blood sugar or discontinuing insulin injection by the patients. On the other hand sometimes the side effects of insulin can be serious and fatal. Therefore، information about these complications and how to deal with them are very important. Hypoglycemia، weight gain، antibody-mediated insulin resistance، lipodystrophy (atrophy or hypertrophy)، edema، postural hypotension and Allergic reactions to insulin are major side effects of insulin therapy.

Nowadays prevalence of diabetes mellitus (DM) is growing considerably، especially among young and obese people. It was estimated that nearly 7% of the people all over the world suffer from DM. Frequency of diabetes related complication such as diabetic foot may be enhanced by increasing longevity of diabetic patients. Foot ulcer is one of the most considerable complications of DM which may involve 15% of these patients during their life. Peripheral neuropathy، poor blood circulation and low resistant against infections are three main predisposing factors in development of diabetic foot. In the presence of these factors، deformity of the foot or any minor trauma may lead to ulceration and infection. Ulcer، infection، Charcot neuropathy and peripheral arterial disease in lower extremity may result in gangrene and amputation of limb. Foot ulcer and its complications associated with admission to hospital، increasing cost of treatment and finally disability of patients. Appropriate treatments for diabetic foot are infection control، reconstruction of blood supply if possible، decrease in pressure on the affected limb and enhancement of ulcer repair with surgical interventions. Although it is impossible to prevent all diabetic foot complications، but with establishment of appropriate therapeutic approaches، most of these complication are curable and also may decrease number of limb amputation.

Vesicoureteral reflux (VUR) is a relatively common and important entity in children. VUR can expose patient to risk of pyelonephritis، permanent renal damage or scar. VUR itself has no deleterious effect on kidney parenchyma until the development of infection or increased intravesical pressure. The diagnosis of VUR could lead to appropriate therapy and prevention of long term complications. There are several diagnostic procedures for diagnosis of VUR، Conventional Voiding Cystourethrography (VCUG) and Direct Radionuclide Cystography (DRC) are most popular of them. Although DRC has advantages such as higher sensitivity and lower radiation، conventional VCUG remain as a helpful diagnostic tool both for excellent anatomical image and quantitave subjective grading system. Most physicians suggest performing VCUG for male patient in first assessment and DRC for later studies. In females، some advice to follow same as male children but most clinicians tends to apply DRC at start of assessment. There are some limitations for two mentioned test despite such advantages. Insertion of urinary catheter had some potential hazards for patient and distress for parents and child. Two special studies microwave radiometry and indirect radionuclide cystography is newer tools that could diagnose VUR without catheterization. These two tests are not standardized yet and remained to be less popular. Another limitation is exposure even low dose to radiation. MR VCUG and Cystosonography are two new procedures that had lowest if any radiation exposure. However these two tests also need further investigation and subjective standardization.

Personalized medicine is a new insight of health care in which interventions is informed by each patient''s characteristics; including in genotype and phenotype. Nowadays، rapid advances in genomics، proteomics، and lipomics، which identified individuals differences may lead to produce new drug and diagnostic and screening biomarkers. These allow physicians to determine the type and dosage of drugs based on genetic and genomic characteristics of each patient. Genetic variants that identified by using molecular analysis can be used to screen at risk people on the particular disease، design and administer appropriate medications that are fit to the genetic background، and select the best treatment protocol. Actually، personalized medicine will be the bridge between current medicine and future medicine. In addition to a brief review of history of personalized medicine، this review focused on its required technologies، the role of personalized medicine in pharmacogenetics، prognostic، diagnostic، and target therapy of cancer، neurodegenerative، cardiovascular، allergic and infectious diseases

Depression after myocardial infarction (MI) is a common and debilitating condition that could increase mortality and morbidity in these patients. Depression in MI patients is three times more prevalent than general population and women are more susceptible to this event. Psychosomatic condition of MI patients could worsen with co morbidity of depression and therefore poor quality of life، inappropriate self-care behaviors and increased risk of recurrence and poor outcome. In addition lack of social support could expose them to more severe disease. Diagnosis of depression in MI patients is difficult because there are many overlap in symptoms of depression and cardiovascular disease. Therefore routine depression screening and management in MI patients should become one of the mainstays of their care. Medical and non medical management of depression in MI patients may improve their outcome، although it seems that combination therapy is associated with better response.

Dependence (addiction) and tolerance is acquired as a result of repeated drug use، its effects will gradually diminish and so after a while the person will tolerate toxic levels of the drug without causing discomfort. Structure of Morphine have five rings with profile A (Aromatic)، B (Cyclohexane)، C (Cyclohexane)، D (Piperidine) and E (Tetrahydrofuran)، all derivatives of morphine which have these cyclic structures would have addictive potential that were compatible with their analgesic effect. Thousands of years ago، opioid compounds were used for pain relief، analgesia، induction of anesthesia (Fentanyl)، alternative treatments for addiction، treatment of diarrhea (Diphenoxylate)، pulmonary edema and coughs (Codeine). The main side effects of these drugs are suppression of breathing and decreased response to carbon dioxide in the blood that can cause respiratory failure and subsequent death. There are different treatments for addiction including Acupuncture therapy (electro Acupuncture)، Sleep therapy، Ooccupational therapy، the placebo-treated through detoxification، Methadone، Buprenorphine or Alpha agonist receptor detoxification، Opioid antagonist drugs and treatment with herbal drugs

Imerslund-Gräsbeck Syndrome is an inherited disorder which present as a megaloblastic anemia followed by selective vitamine B12 deficiency and is associated with mild proteineuria. This rare disease is easily treatable if detected. In this paper two members of a family with Imerslund-Gräsbeck Syndrome are reported.