مجله دانشکده پزشکی دانشگاه علوم پزشکی مشهد
سال پنجاه و هفتم شماره 7 (پیاپی 131، دی 1393)

Chronic sinusitis is one of the most common causes of referring to physician and creates longterm discomfort for people. The common bacterial organisms include: Streptococcus pneumonia, Hemophillous influenza, Moraxella catarrhalis, Staphylococcus aurous, biofilm and superantigen produced by some of these bacteria should be considered. This study aimed to compare the efficacy of Doxycycline, Azithromycin and Clarithromycin in the treatment of chronic bacterial rhinosinusitis. In this clinical trial, 55 patients with a mean age of 36 years with chronic bacterial rhinosinusitis who were documented clinically and by imaging (CT Scan), were treated in three groups with Doxycycline (100mg BD), Azithromycin (8mg/kg BD), and Clarithromycin (500mg BD). The patients were followed by clinical signs, symptoms and imaging. Data were analyzed by SPSS software and Chi Square, Anova and T test. At the end of treatment, Doxycycline’s treatment success rate was higher than Azithromycin and Clarithromycin (the clinical cure rates respectively were 73 % versus 57% and 40%, and CT Scan cure rate results respectively were 70% versus 33% and 25%). The results of present study indicated that the Doxycycline in the treatment of chronic bacterial rhinosinusitis was more effective than Azithromycin and Clarithromycin in clinical response and improved CT Scan results.

The aim of this study was to give an overlook to the variety of chemotherapy regimens prescribed for colorectal adenocarcinoma and their side effects. Colorectal carcinoma is one of the mostly common cancers in our region and most experiences of physicians are based on non-native studies. To our knowledge this is the first such a study, although including a limited group of patients for reviewing the treatment. We selected a group of 109 patients having colon and rectum cancer undergoing chemotherapy with different regimens during the study period, that were referred and treated consecutively. Some of the side effects of treatments were followed-up and registered prospectively. After 468 courses of chemotherapy and recording the side effects during the first six courses of treatment, 55 cases (11.6%) had grade 3 or 4 of complications. The most prevalent regimen was FOLFOX4 (37.6%) and then CapeOX (26.9%). The most common major complication was neutropenia (5.3%) and then gastrointestinal complications including nausea (1.5%) and diarrhea (1.3%). In this study none of the factors of gender, age, ethnicity, performance status, the stage of disease, the tumor location and the kind of chemotherapy regimens had statistically significant effect on severity of the side effects.

Henoch Schönlein purpura (HSP) is a small vessel leukocytoclastic vasculitis that generally occurs in children, and 90 percent of cases are under 20 years old. The aim of this study was to examine the clinical manifestation in follow-up of Iranian children affected with Henoch Schönlein purpura (HSP). In a case study during 2012, 155 children with a diagnosis of HSP treated in children’s medical center hospital from September 2008 to September 2011 were included. All patients were re-examined for new symptoms as well as complications. the most cases of HSP aged among 3 and 6 yaers old and it was slightly more frequent in boys. At onset, the most common presenting symptoms, were purpura (85.5%), gastrointestinal manifetations (61.9%) articular involvement (61.3%), and in the course of disease were purpura (96.1%), constitutional symptoms (84.5%) and articular involvement (74.2%). Based on the follow-up conducted in 2012, a statistically significant correlation was observed only in renal complications and increasing age of patients (P=0.007) Because renal failure is a major complication of HSP, it is recommended that all patients with proteinuria in the acute phase, have a blood pressure examination and urine-analysis once a year.

Systemic lupus erythematosus is a common rheumatologic disease. Systemic Lupus Erythematosus disease activity index (SLEDAI) is a valuable and reliable scoring for lupus activity. Always clinical and paraclinical findings in SLEDAI don’t answer with disease progression, and also some factors including ESR, CRP, Anti-dsDNA and complements may be increased in non-active disease. Therefore, we decided to assess serum uric acid level as an index of disease activity. This cross- sectional study was carried out on lupus patients that referred to the rheumatology clinic of Imam Reza hospital in Mashhad. Serum uric acid level, Anti-dsDNA, ESR, C3 and C4 were measured with standard methods and SLEDAI determined for all patients. Pearson’s correlation coefficient ranking was used to evaluate the relation of serum uric acid level with SLEDAI and Anti-dsDNA. In this study, 82 patients (76 females and 6 males) with an average age of 32.02 ± 9.29years and mean disease duration of 4.49± 4.68 years were studied. Serum uric acid levels correlated directly and significantly with SLEDAI (P=0.001, r=0.35), Anti-dsDNA(P=0.0001, r=0.54), and Serum uric acid levels had indirect and significant correlation with C3 (P=0.04, r=-0.22), and C4 levels (P=0.02, r=-0.25). Our study demonstrated that high serum uric acid levels were correlated with lupus disease activity. Nevertheless, application of serum uric acid level, as an index of lupus disease activity, needed more studies.

Due to the elderly growing population, different types of social support are very important in promoting their mental health. The main aim of this study was to investigate the relationship between social support and mental health in the elderly. In this descriptive-analytical study, 200 elderly of Bojnourd city were selected through simple random sampling. To gather the data, General Health Questionnaire (GHQ) and Norbeck Social Support Questionnaire (NSSQ) were used as well as a questionnaire containing demographic variables. Data analysis was completed through SPSS-16. A total of 200 elderly participated in the study. The sample consisted of 90 females (44.6 %) and the mean age of the elderly was 68.91 ± 7.89 years. According to the results, mean of GHQ score in the sample was 24.09 ± 13.08, which indicateed a fairly good level of mental health. In addition, social function had a significant correlation with total social support and subscales of functional, emotional and material. Findings disclosed that increasing the social support of the elderly can put a significant impact on their mental health and social functioning. So, it is essential for the countries to consider the olderlys’ social network and necessities in their large scale plannings.

SPONTANEOUS subconjuctival hemorrhage is a self-limited disorder which was resorbed spontaneously without sequela.Most of them attributed to minor trauma or underlying systemic disease. This study was performed to evaluate the rate of systemic hypertension and other predisposing systemic factors in patients with spontaneous subconjuntival hemorrhages. This cross sectional study was performed on patients with spontaneous subconjunctival hemorrhages which referred to one teaching eye hospital. Complete ophthalmic exams were performed and history of hypertension, diabetes mellitus, valsalva maneuver, coagulation disorders, use of anticoagulant drugs, were taken. Systemic blood pressure measured in emergency ward and recorded. Overall 61 subjects were examined. 45 (74%) were male and 16(26%) were female. Their ages ranged from 5 to 71 years (mean =43.5 years). 41 of them (67%) had at least one of the considered associated factors. The history of hypertension was in 10% of cases, 15% of patients had high systolic or diastolic blood pressure measurement without history of hypertension (systolic greater than 135 or diastolic greater than 85 mmHg). 17% of patients had history of diabetes mellitus. History of valsalva maneuver and use of anticoagulant drugs were positive in 15% and10% of them respectively. spontaneous subconjunctival hemorrhage might be due to underlying systemic disease.Amoung predisposing systemic factors, Systemic hypertension, diabetes mellitus and valsalva maneuver are more common causatives.

Apolipoprotein M is a new protein located in HDL and has the ability to connect to the cholesterol. There is limited information available regarding the effect of exercise training on circulating levels of apoM. The purpose of this study was to investigate the effect of aerobic exercise on serum apolipoprotein M in normal weight and overweight women. A totallof twenty nine healthy women (31.86 ± 7.04 years) divided in to the two groups based on body mass index: Normalweight (BMI ≤24.9, n =15) and overweight women (BMI ≥25, n =14).The aerobic training program was carried out for 8 weeks, 3 sessions per week at 40-80% of maximal reserved heart rate. Duration of each session was 25 minutes in the first week and it increased up to 45 minutes in the 8th week of exercise. At the beginning and the end of training period, plasma level of apolipoprotein M, HDL, LDL, TG and TC were measured. Fainally 8 weeks of aerobic exercise in normal-weight and overweight women significantly increased the plasma levels of apolipoprotein M, LDL and total cholesterol. while the HDL and TG in both groups showed little change. In addition, after 8 weeks of exercise, there was negatively significant correlation between plasma apolipoprotein M level with, BMI and waisttine to hip ratio in all Subjects. The results of this study suggested that plasma level of apolipoprotein M increase after aerobic exercise training. However, diet control is necessary to determination the exact effect exercise, training on plasma apolipoprotein M levels alterations.

Hyperlipidemia is a major risk factor for atherosclerosis and cardiovascular incidents. Abnormalities in lipoproteins and lipids profile are common in patients with pediatric idiopathic nephrotic syndrome and may contribute to atherosclerosis. Prescription of lipid lowering agents such as statins because of myopathy and growth disorders, are not recommended in child-aged groups. However, there isn’t any investigation on carnitine effects on lipids profile of patients with childhood nephrotic syndrome which is the propose of our study. In this case-control study, case group included 16 patients in 2-12 years of age with steroid resistant nephrotic syndrome, receiving prednisolon, cyclosporine and carnitine (25mg/kg/day) within a 3 months period and control group included 17 age and sex matched patients, receiving standard treatment (prednisolon, cyclosporine), were compared. In both groups, biochemical parameters like triglyceride, cholesterol, VLDL, LDL, HDL, BUN, creatinine and serum albumin were measured. At the end of the study period, L-carnitine treated group showed no significant difference in the biochemical markers compared with the control group (P-values>0.05). Our study indicates that oral administrations of L-carnitine with the dose of 25 mg/kg/day did not have any effects on lipoprotein profile of persistent childhood nephrotic syndrome.

Nephropathy occurs in 20-40% of diabetic patients and diabetes mellitus is the most common cause of ESRD. the aim of this study was review the metabolism of glucose and treatment of diabetes in patients with this disease. Chronic renal failure is typically associated with insulin resistance, decrease of insulin secretion and, in advanced renal failure, decreased insulin degradation. Decrease of insulin degradation can lead to a marked decrease in insulin requirement or even the cessation of insulin therapy in type 2 diabetes and the development of spontaneous and severe hypoglycemia. Although, several large studies have found no significant correlation between glycemic control and survival of patients with ESRD, however, for prevention of diabetes-related damage to other organs, good glycemic control should be considered as a significant treatment goal.The goal of glycemic control in diabetic patients on chronic dialysis is the fasting blood glucose below 140 mg/dL, one-hour postprandial value of less than 200 mg/dL and the glycated hemoglobin level between 6 to 7 in type 1 diabetics, and between 7 to 8 in type 2 diabetics. Glipizide is metabolized by the liver and therefore is the oral hypoglycemic drug of choice in many patients with chronic renal failure.Repaglinide is also principally metabolized by the liver but hypoglycemia is common among patients with severe renal impairment and Initiation of treatment should therefore be with 0.5 mg daily and close careful monitoring of blood glucose levels is essential. Metformin should be avoided in patients with ESRD due to increased risk of rare but potentially fatal lactic acidosis.

Fibrous dysplasia is a benign skeletal lesion. It is related to McCune-Albright syndrome with patchy cutaneous pigmentation. Recent trials in pediatric patients with fibrous dysplasia have shown encouraging results. Bisphosphonate therapy may help to improve function, decrease pain, and lower fracture risk in appropriate selected patients. Index patient, a 12-year-old girl with history of limping and bone pain for 2 years that had no response to common treatment. After more evaluation, she referred to pediatric endocrinology department with the diagnosis of fibrous dysplasia and was treated using periodic intravenous pamidronate every three month. She showed good outcome and symptomatic improvement over 6 month duration of fallow up. Recent trials in pediatric patients with fibrous dysplasia have shown encouraging results. In our patient treatment with periodic intravenous infusion of pamidronate resulted in an improvement of pain and limping without important side effects.