مجله دانشکده پزشکی دانشگاه علوم پزشکی مشهد
سال پنجاه و هفتم شماره 7 (پیاپی 125، فروردین و اردیبهشت 1393)

The prevalence of obesity is increasing worldwide as a warning. There are some evidences that show a relationship between thyroid hormones and weight changes. The aim of this study was to determine the relationship between thyrotropin and body mass index، in euthyroid people with different weights. This study was conducted on healthy women who were referred to the endocrine clinic. After taking a thorough history، doing a complete physical examination، checking for signs and symptoms of hypothyroidism or hyperthyroidism and measuring their height and weight، thyroid function tests were done. Overall 283 women participated. The mean age and BMI were 35. 88±12. 75 years and 26. 18±6. 25 Kg/m2، respectively، 11% of them were underweight، 35. 5% were normal and 29. 3% were overweight and 24% were suffering from obesity. The mean serum TSH level was 2. 29±0. 07. The lowest serum TSH levels was in people with normal BMI، but there was no significant relationship between TSH serum levels in different BMI groups. There wasn’t significant relation between BMI and TSH (r=0. 108، P=0. 071). Based on the results of this study، there was no relationship between BMI and TSH serum levels in euthyroid women.

Treatment resistance is common in acute mania، so the role of augmented therapies، including nutritional factors and vitamins have always been considered. This study aimed to assess the effect of addition of folic acid to sodium valproate in treatment of acute mania. Subjects & This double blind randomized clinical trial study was done in Mashhad Avicenna psychiatric hospital، in 2011 and was registered with IRCT201112188106N1 code in Iranian registry clinical trials site. Twenty nine manic patients، divided into two groups randomly. They received sodium-valproate+folic acid or sodium-valproate+placebo. The severity of mania، by Jung Mania Rating Scale (YMRS)، and cognitional improvement، by Mini-Mental State Examination (MMSE)، were determined at baseline، after 3 and 6 weeks. Data analyzed by SPSS-16، к2 and t-student tests. The mean scores of YMRS at baseline، after 3 and 6 weeks، in the folice acid group were 22±2. 44، 8. 26±4. 86 and 3. 13±1. 64 respectively، and in placebo group were 21. 14±1. 95، 14. 14±4. 31 and 13±5. 21 respectively. The mean scores of YMRS significantly decreased in the folic acid group compared to the placebo group after 3،6 weeks (P=0. 005، PP=0. 068، P=0. 068). Our study showed that adjuvant treatment by folic acid in addition to standard treatment with sodium-valproate during manic phase in patients with BMD-I after 6 weeks of treatment was effective.

Most patients with irritable bowel syndrome (IBS) do not respond to existing treatments. It seems that the pathogenesis is not fully understood. Trying to clear this condition، scientists have focused on the role of mast cells in the pathogenesis of IBS and many gastrointestinal disorders.

After taking history including demographic، clinical، familial and personal history of 57 patients with diarrhea-predominant IBS (criteria ROME III) colonoscopy done and in case of normal colonoscopy، samples of left and right colon were taken. Overall 48 samples could be retrieved. Immunohistochemical staining for mast cell tryptase was done and mast cells were counted. The prevalence of patients with mast cells > 20 / HPF was determined. The patients were divided into three categories: < 10/HPF، 10- 20 and > 20 / HPF and symptoms of three groups were compared. In addition to their traditional treatment regimen، all patients received Ranitidine and Cetrizine. Clinical responses were also compared in the three groups.

A total of 3 out of 48 patients (5. 8%) had >20 mast cells in each HPF (mastocytic enterocolitis). Distribution and severity of clinical symptoms of the patients in three groups were not significantly different. Respond to treatment with antihistamines was not significantly different in each of these groups of patients.

Mastocytic enterocolitis in our patients was not as frequent as other studies. Mast cells count was not associated with clinical symptoms.

Local anesthesia is a new method that in comparison with general anesthesia has fewer risks but metabolic response to stress of surgery in addition to increase of stress hormones in pregnant women causes increase in blood sugar. By starting analgesia with spinal anesthesia suddenly reducing catecholamines and cortisol concentration causes reduction in serum level of blood sugar. Following taking history of mothers and obtaining satisfaction، monitoring and hydration (5ml / kg ringer solution)، the mother''s blood sugar level with glucometer controlled. Spinal anesthesia done with needle Quinke No. 24 by 3cc of bupivacaine 0. 5% in sitting position and then glucose was measured 15 min after spinal anesthesia and in recovery room. Ninety pregnant had a mean age of 29/93±5/9 years old with an average weight of 74/04±8/9 Kg، and the mean gestational age of 39/0±0. 74 weeks. Mean changes in blood glucose during the first 15 minutes and the mean change between before spinal and in recovery room in the three groups that have different NPO time was not significant. (P 0. 713 and 0. 87). Average glucose before anesthesia 90. 74±19 and after it 88. 42±18. 9 were not significantly different (P=0. 103)، but difference between mean blood glucose before-anesthetic and in recovery room 96. 16 ± 21 was significant (P=0. 001). In comparison between blood sugar before anesthesia and in recovery room، significant increase of blood sugar in recovery existed not in hyperglycemic range. Therefore، during spinal anesthesia with bupivacaine، monitoring of blood sugar was not necessary.

Tuberculosis is the most common cause of death due to bacterial diseases in the world. Uncontrolled diabetes، via weakening the immune system cause TB bacilli proliferation. Due to high prevalence of tuberculosis in our Region، this epidemiological study Was performed to Evaluate Epidemiology of tuberculosis in patients with diabetes mellitus. In this retrospective study by convenience sampling، medical records of 150 patients with tuberculosis، referred to Mashhad health centers،Within 2007 to 2012، whom simultaneously had diabetes،were assessed. The demographic data، type of TB، clinical symptoms، laboratory and radiographic findings were Collected by data review check lists. Data were analyzed finally by descriptive statistics of frequency distribution. All patients were Iranian، with 64/65 years as the mean age. The mean fasting blood sugarwas 93/181mg per dL. The incidence of both diseases، in women and Urban patients was higher. Overall 76% of patients had pulmonary tuberculosis (58. 7% smear-positive and 17. 3% smear-negative). The most common clinical symptom was persistent cough for more than two weeks. In radiographic examination،the most common image was the pulmonary opacity (66. 6%) and the upper zone was the most conflicted Region (52%). The findings implies that the Clinical، laboratory and radiological results of TB patients in our study were similar to other studies of non-diabetic TB patients. which can demonstrate the appropriate control of diabetes in these patients and no significant effects on their tuberculosis treatment. Nevertheless It is recommended that، the possibility of infection should be considered in patients with diabetes، and an annual review of the risk of tuberculosis should be taken into consideration.

The serum level of 25-hydroxyvitamin D deficiency has a role in the regulation of insulin secretion and suspected as a risk factor for gestational diabetes. The aim of this study was to investigate the relation between 25-hydroxyvitamin D concentrations and gestational diabetes and to compare it with healthy pregnant women. Subjects & A Case control study was conducted on 130 pregnant women (24-28 weeks) referred to Shahid Ghodsi health center in Mashhad (2011). First participants filled questionnaire forms including demographic data and obstetrics history، then Glucose challenge test was performed for them (GCT). In those with abnormal GCT، Glucose tolerance test (GTT) was performed. The subjects with abnormal GTT selected as case group and pregnant women who had normal GCT selected as control group. The concentrations of 25-hydroxyvitamin D، was measured in two groups. Data were analyzed by using SPSS software version 11. 5، chi square test and T student test. P value less than 0. 05% was considered as significant. Mean value of glucose of GCT was 158. 68±22. 70 mg/dl in case group and 106. 13±22. 48 mg/dl in control group and the difference between the two groups was significant (P<0. 001). Vit D concentration in case group was 8. 06±3. 85 ng/dl and in control group was 17. 75±5. 38 ng/dl and the difference between the two groups was significant (P<0. 001). Vitamin D deficiency is more prevalent in women with GDM than normal pregnant women and this is related to gestational diabetes.

Nowadays، traumatic injuries of the spinal cord affect young population and impose an enormous burden on both the patient and society. Therefore، detecting the best treatment is of major importance and spine decompressive plays a critical role in its treatment. As the time of performing the surgery is a great discrepancy، this study was designed to compare the neurological outcomes، rate of complications and duration of hospitalization in early and late surgeries in acute spinal injury. Subjects & In this non-randomized clinical trial، 30 patients with spinal injury referred to Emdadi center in Mashhad in 2011 were included. Fifteen patients were operated within 24 hours of the trauma and the rest of the patients were operated after 24 hours. Patients were also assessed using a checklist regarding the duration of hospitalization، rate of complications and neurological improvement، 3 and 6 months after the operation. The results were compared between 2 groups using independent t، Mann-Whitney and Chi-square tests. In early surgery، duration of hospitalization (P=0. 031) was significantly less and neurological improvement and rate of various complications were similar to the late surgery. Age، gender، location of an injury in spine and existence of additional trauma were similar between 2 groups and did not affect the study outcomes. Early decompressive surgery reduces the duration of hospitalization in patients with spinal injury، however، does not affect the neurological improvement and rate of complications. Nevertheless، it should be considered in all patients.

Backgrounds & Enteral nutrition (EN) is crucial for patients that cannot feed orally. Different mixtures have been used for EN and several advantages and limitations have been mentioned for each. Home-made، hospital blenderized liquids have long been used in clinical setting. Hospital prepared formulas (HPF) are still preferred in Iran. There is no standard method for preparing these feedings. The purpose of this study was to analyze the nutritional quality and viscosity of standard hospital prepared formula in Kamyab hospital. This was a descriptive study which analyzed macronutrients، osmolality and viscosity of standard hospital prepared formula samples based on exchange list. To compare mean values and standard deviation one sample t test was used. Caloric density of samples ranged from 77-96 kcal/100 g and the percentages of total weight for carbohydrate were 10. 7، 11. 3، and 6. 5; for Protein and fat were 4. 1 and 3. 8 g/100 ml. The average variability of the viscosity was 35-110 centipoise، and osmolality ranged from 145-345 mosm/kg. The results showed that exchange list was reliable. This standard formula had an acceptable level of macronutrient and if it prepared like the recipe، it would supply energy requirement of patients.

Femoral head fracture-dislocations are rare، while irreducible cases are even less frequent. Truly irreducible fractures such as the two cases in this report must be differentiated from incomplete reduction due to incarcerated bone or soft tissue interposition. Opinions vary on the surgical approach to be used once the hip is reduced and the fragment of the femoral head yet remains to be stabilized. The smith-peterson approach with the patient in the supine position provides a direct anterior view of the fracture site.

We reported two cases of Brumback-type 4، who were treated with this approach. Postoperatively we allowed weight-bearing after 3 months. After 14 and 10 months they had good results.

It seemed that Smith-Petherson approach was a good choice for this type of injuries.