فهرست مطالب

  • Volume:6 Issue:3, 2015
  • تاریخ انتشار: 1394/04/19
  • تعداد عناوین: 13
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  • Mohsen Pourghasem, Hamid Shafi, Zahra Babazadeh Pages 120-127
    Diabetes mellitus is the most common cause of chronic renal disorders and end-stage kidney disease in developed countries. It is the major cause of dialysis and transplantation. Failure in renal function causes wide disorders in the body. Diabetes results in wide range of alterations in the renal tissue. It is believed that early histological changes in diabetic nephropathy are detectable 2 years after diabetes is diagnosed. The glumerular alterations are the most important lesions in the diabetic nephropathy (DN). The Renal Pathology Society provides a new pathological classification for the detection of histopathology of DN. It divides diabetic nephropathy into four hierarchical glomerular lesions. Alloxan or streptozotocin induced diabetic rat is the one most widely used specie to study DN. Histological changes in the rat DN closely resemble the human disease and the most information of this review was obtained through the study of rat DN. All cell types of the kidney such as mesangial cells, podocytes and tubulointerstitial cells are liable to be affected in the event of DN. Severity of renal lesions is associated to the clinical aspect of renal outcome, but the aim of this article was only to review the histological changes of kidney in diabetes mellitus.
    Keywords: Diabetic mellitus, nephropathy, histological changes
  • Karimollah Hajian-Tilaki, Behzad Heidari Pages 128-133
    Background
    Background And Objectives
    The biological variation of body mass index (BMI) and waist circumference (WC) with age may vary by gender. The objective of this study was to investigate the functional relationship of anthropometric measures with age and sex.
    Methods
    The data were collected from a population-based cross-sectional study of 1800 men and 1800 women aged 20-70 years in northern Iran. The linear and quadratic pattern of age on weight, height, BMI and WC and WHR were tested statistically and the interaction effect of age and gender was also formally tested.
    Results
    The quadratic model (age2) provided a significantly better fit than simple linear model for weight, BMI and WC. BMI, WC and weight explained a greater variance using quadratic form for women compared with men (for BMI, R2=0.18, p<0.001 vs R2=0.059, p<0.001 and for WC, R2=0.17, p<0.001 vs R2=0.047, p<0.001). For height, there is an inverse linear relationship while for WHR, a positive linear association was apparent by aging, the quadratic form did not add to better fit.
    Conclusion
    These findings indicate the different patterns of weight gain, fat accumulation for visceral adiposity and loss of muscle mass between men and women in the early and middle adulthood.
    Keywords: Body mass index, Waist circumference, Waist to hip ratio, Quadratic form, Adults
  • Shahram Ala, Ozra Akha, Zahra Kashi, Hosein Asgarirad, Adeleh Bahar, Neda Sasanpoor Pages 134-140
    Background
    Levothyroxine is commonly used in the treatment of patients with hypothyroidism. Levothyroxine is often administered in the morning, on an empty stomach, to increase its absorption. However, many patients have trouble for taking levothyroxine in the morning. The aim of this study was to evaluate the effect of changing administration time of levothyroxine from before breakfast to before dinner on serum levels of TSH and T4.
    Methods
    Fifty hypothyroidism patients aged 18-75 years old were included in the study and randomly divided into two groups. Each group received two tablets per day blindly (one levothyroxine tablet and one placebo tablet) before breakfast and before dinner. After two months, the administration time for the tablets was changed for each group, and the new schedule was continued for a further two-month period. The serum TSH and T4 levels were measured before and after treatment in each group.
    Results
    Changing the levothyroxine administration time, resulted in 1.47±0.51 µIU/mL increase in TSH level (P=0.001) and 0.35±1.05µg/dL decrease in T4 level (P=0.3).
    Conclusion
    Changing the levothyroxine administration time from before breakfast to before dinner minimally reduced the therapeutic efficacy of levothyroxine.
    Keywords: Levothyroxine, T4, TSH, administration
  • Ahmad Rasoulinejad, Amin Zarghami, Seyed Reza Hosseini, Neda Rajaee, Seyed Elahe Rasoulinejad, Ebrahim Mikaniki Pages 141-147
    Background
    Age-related macular degeneration (AMD) is the leading cause of visual impairment and blindness in elderly population in the developing countries. Previous epidemiological studies revealed various potential modifiable risk factors for this disease. The purpose of this study was to evaluate the prevalence of AMD among elderly living in Babol, North of Iran.
    Methods
    The study population of this cross-sectional study came from the Amirkola Health and Ageing Project (AHAP), the first comprehensive cohort study of the health of people aged 60 years and over in Amirkola, North of Iran. The prevalence of AMD was estimated and its risk was determined using logistic regression analysis (LRA) with regard to variables such as smoking, hyperlipidemia, hypertension and diabetes.
    Results
    Five hundred and five participants with mean age of 71.55±5.9 (ranged 60-89) years entered the study. The prevalence of AMD was 17.6%. There was a significant association between AMD and smoking (P<0.001) but no association was seen with AMD and age, level of education, history of hyperlipidemia, hypertension and diabetes. Multiple LRAs revealed that smoking increased AMD by odds ratio of 5.03 (95% confidence interval 2.47-10.23 p<0.001) as compared to nonsmokers
    Conclusion
    According to our findings, the prevalence of AMD was relatively high and smoking increased the risk of AMD in the elderly population.
    Keywords: Aged, Smoker, Macular Degeneration, Risk factors
  • Elaheh Ferdosi-Shahandashti, Mostafa Javanian, Masoomeh Moradian-Kouchakssaraei, Babak Yeganeh, Ali Bijani, Elahe Motevaseli, Fatemeh Moradiyan-Kouchakssaraei Pages 148-151
    Background
    Urinary tract infection (UTI) is one of the most prevalent infectious diseases and Escherichia coli is its common cause. The aim of this study was to assess the resistance patterns of E.coli in urinary tract infections and to determine the susceptibility of E.coli to commonly used antimicrobials and also to evaluate the options for empirical treatment of UTI.
    Methods
    This study was conducted in the Ayatollah Rouhani Teaching Hospital of Babol Medical Sciences University in North of Iran. Between January of 2013 to December 2013, antimicrobial susceptibility tests were done by disk diffusion and microdilution method. Growth of >=105 cfu/ml was considered as positive urine test. Ten commonly used antibiotics were examined for susceptibility test. Data and the results were collected and analyzed.
    Results
    E.coli grew in 57 urine samples. Imipenem, ofloxacin, ciprofloxacin were the most sensitive antibiotics at 87.7%, 87.7% and 78.9% respectively. Whereas, cotrimoxazole, cefexime, cefotaxcime and ceftriaxone were the most resistant antibiotics. Antibiotic sensitivity of disk diffusion compared minimum inhibitory concentration (MIC) detected by microdilution had the sensitivity, specificity, positive predictive value and negative predictive value of 82%, 98%, 99% and 74%, respectively.
    Conclusion
    Imipenem, ofloxacin and ciprofloxacin should be used in empirical therapy of UTI.
    Keywords: Urinary Tract Infection, UTI, Escherichia coli, antibiotic susceptibility, antibiotic resistance, disk diffusion, micro dilution
  • Seyyed Mohammad Masoud Hojjati, Amin Zarghami, Seyyed Ali Hojjati, Mobina Baes Pages 151-155
    Background
    Multiple sclerosis (MS) is an inflammatory and demyelinating disease of central nervous system (CNS). The aim of the present study was to determine the type and the frequency of initial presenting symptoms in patients with MS and their relation with demographic characteristics in Babol, northern Iran.
    Methods
    All patients of this study were recruited over a ten year period from 2002 to 2012 from single neurologic clinic. Diagnosis of MS was confirmed according to the McDonald criteria, demographic and clinical features Then, all the clinical findings and demographic variables including: age, sex, marital status, age at onset, education, place of residence, disease duration, initiation pattern of disease have been collected. Expanded Disability Status Scale (EDSS) was used for the evaluation of disability at the onset of disease. Data analysis was performed by chi-square test.
    Results
    A total of 263 consecutive MS patients with the age range of 17 to 61 yr were examined. Optic neuritis was the most prevalent initial presenting symptom in 123 (46.8%) patients followed by sensory disturbances as the second common presenting symptom of MS. Significant difference was found between patients with or without optic neuritis and the onset age of the disease and EDSS (p<0.001). The mean EDSS score at the time of initial presentation was 1.67±0.77.
    Conclusion
    The findings of this study indicated that optic neuritis is the most prevalent initial presentation of MS in the geographic region of northern Iran. In patients less than 30 years, development of visual disturbances justifies neurologic examination.
    Keywords: multiple sclerosis, epidemiology, Babol
  • Alijan Ahmadi- Ahangar, Bahareh Bazouyar, Roughayeh Mortazavi, Moazzameh Jalali Pages 156-160
    Background
    Stroke is the most common neurologic disease and an important cause of morbidity and mortality. Headache is an initial presenting feature of ischemic stroke and sometimes preceedes the development of stroke and thus, provides an opportunity for offering preventive measures. The aim of the present study was to determine the association of new onset headache with stroke.
    Methods
    A total of 263 consecutive patients with stroke entered the study. Development of headache 24 have prior to admission lasting <3 days was considered the new onset headache. The intensity of headache was graded as mild, moderate and severe. Stroke was classified with respect to the localization of brain damage using magnetic resonance image (MRI). Chi-square test was applied for comparison of proportions.
    Results
    One hundred thirty-nine males and one hundred twenty-four females with mean age of 76.4±10 (40-89) years were analyzed. Ischemic stroke involving anterior circulation was diagnosed in 210 (79%) patients and vertebrobasilar ischemia in the remaining population. Diabetes, hypertension, hyperlipidemia and coronary artery disease were observed in 36%, 52%, 38% and 42%, respectively. New onset headache was found in 49 (18.9%) patients in who 81.6% was mentioned as new onset. Six out of 9 patients with severe headache had involvement of posterior circulation, whereas in the remaining population, anterior circulation was involved.
    Conclusion
    The findings of this study indicate no association of new onset headache with stroke. There was only a trend for severe headache toward the involvement of vertebrobasilar ischemia.
    Keywords: Ischemic stroke, Headache, Prevalence
  • Behzad Heidari, Hasan Taheri, Karimollah Hajian-Tilaki, Mehdi Yolmeh, Roghayeh Akbari Pages 161-164
    Background
    Inflammatory process has a substantial contribution in the development of anemia in chronic hemodialysis patients. Low serum albumin in hemodialysis patients is considered a marker of inflammation. The present longitudinal study aimed to determine the relationship between low baseline serum albumin and future development of anemia.
    Methods
    The population of this study consisted of all patients on standard maintenance hemodialysis for at least three months or longer. Patients were classified as high or low serum albumin level (≥ or < 3.9 gr/dl). All patients received the standard treatment of anemia. The main objective of this study was to compare the prevalence of anemia defined as hemoglobin levels < 11 gr/dl between the two study groups at the end of the study period.
    Results
    A total of 82 patients (50% females) with mean±SD age of 55±16.8 years and mean dialysis duration of 5.2±4 years were followed-up for an average period of 10±1 (range, 8-11) months, however 48 patients with high serum albumin and 24 patients with low serum albumin group completed the study. At baseline, the two groups were similar regarding hemoglobin (9.8±1.2 vs 9.16±1.6 gr/dl, P=0.95) levels. At endpoint, prevalence of anemia in high albumin group was significantly lower than the low albumin group (50% versus 83.3% P=0.005).
    Conclusion
    The findings of this study indicate that low serum albumin in hemodialysis patients is a predictor of anemia indicating unresponsiveness to conventional treatment of anemia.
    Keywords: Hemodialysis, Anemia, Serum Albumin
  • Hassan Teheri, Naser Ghaemian, Yaser Taghavi, Javad Shokry- Shirvani Pages 165-169
    Background
    Cholangiocarcinoma is an invasive biliary malignancy with poor prognosis. Diagnostic accuracy of conventional methods is low which is mainly due to the specific anatomy of the disease. The aim of this study was to evaluate the diagnostic value of biochemical profile and tumor marker of the bile in patients with malignant cholestasis compared to that of choledocholithiasis.
    Methods
    In this cross-sectional study, 46 patients with extrahepatic cholestasis were enrolled (20 patients with malignant cholestasis and 26 patients with choledocolithiasis) A definitive diagnosis of cholangiocarcinoma was made by imaging, cytology and biopsy. Bile fluid was obtained by aspiration through endoscopic retrograde cholagiopantreatography (ERCP) catheter or percutaneous drainage in patients with choledocolithiasis and cholangiocarcinoma respectively. Sex and age were matched in two groups. Data regarding the biochemical profile (triglyceride, (TG), cholesterol, billirubin and HDL) and CA19.9 level of the bile fluid were collected, then using the SPSS software, the data were analyzed.
    Results
    Bile fluid level of TG, cholesterol, high – density lipoprotein (HDL), direct bilirubin and CA19.9 were significantly higher in patients with benign cholestasis in comparison with malignant cholestasis (P<0.001, P<0.001, P<0.001, P=0.012 and P= 0.03, respectively).
    Conclusion
    Our study showed that the CA19.9 level of bile fluid in extrahepatic cholestasis due to biliary stone was significantly higher than those with cholangiocarcinoma, as is the biliary level of TG, cholesterol, high-density lipoprotein (HDL) and direct bilirubin. Thus they may help in the differentiation of benign versus malignant extra hepatic cholestasis.
    Keywords: Cholangiocarcinoma, Tumor marker, Biochemical profile
  • Alireza Heidarian, Seyed Ebrahim Jafari-Kelarijani, Reza Jamshidi, Mohammad Khorshidi Pages 170-174
    Background
    Health worker motivation has the potential to have a large impact on health system performance, and this depends on some factors. The purpose of this study was to determine the factors affecting this motivation.
    Methods
    From Winter 2013 to Spring 2014, 1046 employees and physicians (439 males and 607 females) with a mean age of 36 and 37.2 years in men and women, respectively were chosen in selected hospitals of Social Security Organization (SSO). They were randomly categorized into six different classes of service record, age education class of hiring (permanent and contractual), marital status, and gender. The variables assessed via the classification groups were as follows: interpersonal relations, working conditions, equity, pay, job security, supervision, advancement, recognition, responsibility, and attractiveness of job, educational and organizational policies.
    Results
    Bachelor’s degree (65%) or higher were the education degrees of most participants. Significant relations were observed regarding age, marital status, hiring, gender and years of service with promotion, recognition, responsibility, attractiveness of job, education, relations, working condition, equity, salary, job security, supervision and organizational policies. There were significant relations with hire status and degree with advancement and other variables. There were significant relations between marital status, gender, years of service and age with the above variables.
    Conclusion
    The results show that the important variables that influence motivational factors are academic degree, hire status, marital status, gender, age and years of service.
    Keywords: Motivation, hospital, motivational factors, social security
  • Ahmad Tamaddoni, Behnaz Yousefghahari, Afshin Khani, Mohammadreza Esmaeilidooki, Rahim Barari Sawadkouhi, Iraj Mohammadzadeh Pages 174-176
    Background
    Systemic lupus erythematosus (SLE) has various presentations in children. Hematologic abnormalities is common in childhood onset of SLE, however, isolated thrombocytopenia is relatively rare. Thus, we present a child with isolated thrombocytopenia as a rare presentation of SLE.
    Case Presentation
    A 12-year-old boy with chief complaints of loss of appetite, weight loss, decreased platelet count (8000/µL) and lymph node enlargement was referred to our hospital. Biopsy of lymph node showed reactive lymphadenopathy. Investigations regarding infectious disease was negative. Platelet count remained low after low dose steroidned therapy. Antinuclear antibody (ANA) and anti-double stranded DNA antibody screening tests were positive with titer of 1/62 and 1/54, respectively. Therefore, juvenile SLE was considered as the final diagnosis and raising the dose of prednisolone to 2mg/kg/day was associated with increasing platelet count to 40000/µL and a week later to 96000/µL.
    Conclusion
    The findings of this study indicate that in cases with isolated thrombocytopenia refractory to conventional dose of steroids, SLE should be considered. This study justifies serum ANA and anti DNA assessment in children with thrombocytopenia
    Keywords: Systemic Lupus Erythematosus, Thrombocytopenia, Pediatrics
  • Mahbouba Jguirim, Mondher Golli, Amira Mhenni, Walid Mnari, Naceur Bergaoui Pages 177-179
    Background
    Osteopoikilosis (OPK) is a rare inherited condition of the bones, transmitted as an autosomal dominant trait characterized by numerous hyperostotic areas that tend to localize in periarticular osseous regions. It is usually asymptomatic and is often diagnosed incidentally during x-rays made by other reasons. We present a case of 34-year-old man suffering from polyarthralgia and low back pain.
    Case Presentation
    A 34-year-old male patient, smoking 40 packs yearly and alcoholic was referred to our department of rheumatology, complaining of polyarthralgia which started 3 years ago and involving large and small joints. He reported the presence of pelvic pain mostly located at both hip joints and in the two ankles. On radiologic examination, numerous, symmetric, well defined, sclerotic lesions were identified on shoulder, wrist, ankles, pelvis, and on spine. The size of the lesions varied from 2 to 9 millimeters. These spots were located on spongious bone tissue, and in the inner bone cortex located bilaterally in the epiphyses and metaphyses. We concluded the diagnosis of OPK. His mother was found to have the same lesions without any symptoms.
    Conclusion
    OPK may be an isolated finding or associated with other pathologies, e.g. skin manifestations, rheumatic and/or skeletal disorders. The main differential diagnosis is osteoblastic metastasis.
    Keywords: Osteopoikilosis, Diagnosis, Osteoblastic metastasis, Treatment
  • Aliasghar Manuchehri, Ebrahim Alijanpour, Mohsen Daghmechi, Naser Ghaeminan, Seyed Hasan Abedi, Novin Nikbakhsh, Seyed Alimohammad Ghazi Mir Saeed, Neda Amani Pages 180-183
    Background
    Methanol is a colorless and poisonous liquid that is commonly used as an industrial and household solvent. Methanol poisoning is a rare but extremely hazardous form of in toxication that affects the central nervous system and causes visual disorder, drowsiness, seizures and coma.
    Case Presentation
    A 29-years-old man with methanol intoxication presented with drowsiness and acidosis with subsequent brain hemorrhage requiring prolong mechanical ventilation resulted in persistent visual impairment and disequilibrium.
    Conclusion
    Prolonged mechanical ventilation in patients with methanol intoxication may be assouated with irreversible brain damage.
    Keywords: Methanol Poisoning, Computed Tomography, Ventilation