Thrita
Volume:2 Issue: 6, Dec 2013

Context: Considering the increasing prevalence of obesity and insulin resistance syndrome worldwide, non-alcoholic fatty liver disease (NAFLD) has become a major health concern. Early diagnosis and proper management might prevent disease progression. The aim of this article is to review the current knowledge on the diagnosis and evaluation of disease severity in NAFLD..Evidence Acquisition: After excluding causes of liver cell damage, the patients with persistent aminotransferase levels and well-defined criteria for fatty liver at ultrasonography are presumed to have NAFLD. When concomitant liver disease exists, the diagnosis of NAFLD is questionable without liver biopsy. Considering the limitations of diagnostic methods, selection of the best diagnostic approach has become a conflicting issue in NAFLD.. The review of literature showed that clinical findings, imaging studies, and laboratory investigations are commonly used for the diagnosis and the evaluation of disease severity in NAFLD. The results of non-invasive methods are sometimes inconclusive. The histological information is necessary for confirming the NAFLD diagnosis in this occasion. Meanwhile, invasiveness and possible complications make the liver biopsy an unacceptable method for most patients. It is not recommended routinely when the clinical and paraclinical findings are apparently in favor of NAFLD.. In view of the limitations of the above-mentioned modalities, liver biopsy remains the gold standard method for documentation of diagnosis and estimation of disease severity in NAFLD..

Ischemic heart disease is among the most important causes of mortality. Therefore, classification and existing ratings for myocardial damage by electrocardiography can assist predicting the prognosis in these patients.. Given the importance and high prevalence of cardiovascular disease and myocardial infarction in Iran, we investigated the relation between electrocardiogram damage rating and hospitalization outcome in Myocardial Infarction (MI)..Patients and During a 19 month period, 289 patients with unstable angina and non-ST Elevation MI who had inclusion criteria for entrance to our study were examined. All patients were evaluated by both Sylvester table rating (SSS) and Q-wave score. Other information was collected from their medical files.. The mean age of subjects was 60.61 ± 12.27 years, where 172 (59.5%) male and 117 (40.5%) female were included. Twenty three patients (7.96%) died during hospitalization. The difference of pathologic Q wave’s frequency and recurrent chest pain among patients who expired and those who survived during hospitalization were statistically significant. Also, the amount of Ejection Fraction (EF) and Q score and SSS were significantly different between expired and survived patients. Further analysis showed that EF has negative correlation with SSS (P = 0.032, r = 0.601).. It seems that usage of ECG rating systems such as SSS at the time of admission, in addition to showing the extent of the conflict in the myocardium, can provide valuable information about prognosis, severity of myocardial damage and ventricular function in hospitalized patients..

Increased intake of fruits and vegetables may reduce the prevalence of certain chronic diseases. Seasonality, may affect the availability and quantity of fruit and vegetable diet.. We aimed to assess the seasonal fluctuations in intake of fruit and vegetable as well as vitamin A and C among Iranian households.. We analyzed the existing data of the latest Iranian household food pattern study, collected by three consecutive 24 hours recalls. Totally 7158 Iranian households were selected by Iranian statistic center by a systematic cluster random sampling method. Calculation of energy and nutrients consumptions were made by an access program designed using Iranian food composition table and Modified by USDA and database. Cooking coefficient has been considered for vitamin C. Data were expressed as mean and SE. Intakes during different seasons were compared by one-way ANOVA test. A Newman-Keuls post hoc analysis was used to locate statistical significance in seasons, when an ANOVA was significant.. The highest consumption of vegetables was seen in summer (289 ± 3.4 g/day) while the lowest was in winter (224 ± 3.2 g/day) (P < 0.1). Fruit consumption showed a more dramatic variation, with a peak in summer (263 ± 6/1 g/day) (P < 0.1) and the lowest level in spring (143 ± 5.0). Energy intake showed a significant but not sharp variation (P < 0.01). Vitamin C had a dramatically significant variation (P < 0.01), with the lowest in the spring. Seasonal variations were not significant in vitamin A intake.. Due to seasonal variations in fruit and vegetable dietary intakes, the interventional and case-control studies should consider seasonality. Educational and price controlling programs may control such observed seasonality in the intake of fruit and vegetables..

Today, usage of weaning index is a controversial issue. Proper use of these indexes is beneficial for prevention of the losses caused by weaning failure, rapid and reliable identification of patients who are potentially ready for spontaneous breathing and accelerating the weaning of mechanical ventilation.. This study is to determine the validity of integrative weaning index as a mechanical ventilation discontinuation predictor in patients hospitalized in the Iranian intensive care units..Patients and This scale was evaluated on 124 adult patients who were on mechanical ventilation for more than 24 hours, in two 24-hour phases, in six ICUs (Surgery-Trauma-Medical-Poisoning) of selected hospitals in Tehran, totaling 60 beds, by the researcher as a single blind test. Inclusion criteria were: Patient 18 to 80 years old, none of them suffering from neurological and neuromuscular diseases, none or a minimal dose of sedative drugs being used (15 - 18 points based on Palma and Cook criteria), non-addict or heavy smokers, not admitted in ICU-OH. The study was conducted from November 2011 to December 2012. The ventilators used were from Rafael brand.. There were 80 successful and 44 unsuccessful as well as 72 successful and 8 unsuccessful weaning cases in the first and second phase of the study, respectively. The area under the ROC curves for IWI was 0.967, with standard error of 0.020, 95% Confidence interval of 0.899 to 0.993 and Significance level of P = 0.001, SE = 94.59, SP = 66.67, PPV = 97.22, NPV = 50, DA = 92.5 and likelihood ratio of positive test being 2.84 besides the lowest likelihood ratio of negative test equal to 0.08), with Diagnostic odds ratio being 97% and Confidence interval of 0.82 to 0.97.. Integrative weaning index has appropriate predictive validity for weaning patients from mechanical ventilation in Iranian intensive care units..

Stigma and discrimination are among the main barriers for health workers to provide appropriate and necessary services for People Living with HIV/AIDS (PLWHA).. We conducted this study in Iran, to evaluate Stigma Index and the correlates.. In this cross-sectional study, 289 HIV positive patients were recruited from six cities in Iran (including Tehran, Shiraz, Mashhad, Tabriz, Ahvaz and Kermanshah) to fill out the Farsi version of Stigma Index questionnaires through interviews that were arranged by two HIV infected persons for each city who were experienced data collectors.. Two hundred eighty nine HIV infected patients were interviewed by the trainers, out of which 90.3% and 9.7% were male and female, respectively. Most participants (47.8%) were in 30 - 39 years old age group. Sixty two point two percent of participants experienced external stigma and 98.62% subjects reported internal stigma. Significant associations between the cities and some items including external stigma, level of awareness regarding policies, rights and laws, feeling pressure to disclose HIV status and access to anti-retroviral therapy (ART) were observed.. HIV patients have limited access to occupation, educational and health services. Policies should be made to target the high level of both perceived and external stigma among Iranian PLWHA..

Most of the cancer patients may suffer from pain; therefore, music therapy -as a noninvasive method- is sometimes used to help reduce the pain of cancer patients.. To evaluate the effects of music therapy on pain in some patients with cancer.. This semi-experimental study was performed at Urmia teaching hospital in 2011. A total number of 60 patients with soft tissue cancer were randomly selected and allocated to control and intervention groups. Intervention group received 20-minute music for three consecutive days. The degree of pain was measured by Visual Analog Scale (VAS) before and after music therapy. Data were analyzed at the three times using SPSS and the information was described using mean, SD and analyzed by using t-test, ANOVA and Pearson.. The results showed no significant differences in demographic variable between intervention and control groups. Intensity of pain in intervention group in the three times showed significant diminution (P < 0.001); but in control group, pain intensity did not change during the study (P = 0.12). There was significant relationship between intensity of pain and stage of the cancer (r = 0.46, P = 0.008) and kind of cancer (r = 0.38, P = 0.002).. By considering positive effects of music on pain in patients with cancer, health care providers can use music and encourage patients to use it for enhancing the effects of analgesics, decreasing the pain and promoting quality of life..

Hemangiopericytomas (HPCs) are rare neoplasms which account for approximately 1% of primary vascular tumors.. We report a 73 years old woman with vague abdominal pain who did not have further significant symptoms and was diagnosed to have retroperitoneal hemangiopericytoma.. The tumor was initially diagnosed by ultrasound evaluation. MRI showed a lobulated mass at lower lateral quadrant of the abdomen, adjacent to left psoas muscle with small cystic components. Successful surgical resection of the tumor indicated a solitary large encapsulated 10 × 7 × 4 centimeter retroperitoneal multiloculated mass. Subsequent pathologic studies confirmed the tumor to be malignant hemangiopericytoma. The patient is currently well and is evaluated by periodic CT scans..

Robinow syndrome (RS) is an infrequent genetic condition that is characterized by a dysmorphic face, dental anomaly, short stature, mesomelic limb shortening, hand and foot anomalies, and hypoplastic genitalia. The Robinow syndrome has been reported from the Arab countries and other Asian countries, but has not been reported in Iranian population so far.. A new born (one day old) infant that had the signs of Robinow syndrome.. We describe an Iranian new born infant with Robinow syndrome signs in order to improve the science and epidemiology related to this disorder..