مجله دانشکده پزشکی دانشگاه علوم پزشکی مشهد
سال پنجاه و هشتم شماره 5 (پیاپی 138، امرداد 1394)

Many studies have shown that microalbuminuria is a strong and independent predictor of progressive kidney disease, cardiovascular events and all-cause mortality and morbidity in diabetic Patients, ADMA has been implicated as a possible modulator of inducible NOs during inflammation, In addition, it is reported that high serum levels of C-reactive protein (CRP) is a novel cardiovascular risk factor that impairs endothelial function. The aim of this study was to evaluate the relationship between ADMA, hs- CRP and albuminuria in Type 2 Diabetic Patients. _This is a cross sectional study on 80 patients with type II diabetes who were normally distributed in two groups: those with albuminuria and those without albuminuria. For all patients, levels of ADMA, CRPand serum levels of fasting blood sugar (FBS), HbA1C, and creatinine were measured. _hs-CRP was significantly higher in group with albuminuria than without albuminuria (p<0.05); age and sex-adjusted ADMA values were significantly (p<0.05) correlated with hs-CRP(r=./35) and GFR (r=./39)in normoalbuminuric group. We evaluated The relationship between ADMA and CRP levels in the two groups with and without albuminuria at different CRP levels (cut point:3.5mg/dl); In the albuminuric group, the ADMA level was high at both low CRP (CRP<3.5) and high CRP (CRP>3.5) conditions. in the normoalbuminuric group, ADMA level was low at low CRP conditions but high at high CRP conditions; in the other words, ADMA level increased parallel with the CRP level. positive correlation between hs-CRP and ADMA in normoalbuminuric group and the difference of ADMA levels between albuminuric and normoalbuminuric groups were only significant at low inflammatory state; suggested thatADMA could contribute to development of albuminuria possibly via independent hs- CRP.

Diabetes has so many complications. Metformin is widely used in diabetics that have complications like reduction of Vit B12 and increasing the homocysteine. High levels of homocysteine can be a risk factor for cardiovascular disorders. Complementary therapy with folic acid can prevent homocysteine increament. Also this medicine can increase the vit B12. Method and

A total of45 patients with typeⅡdiabetes that were on metformin devided into two groups: Folic acid & Placebo. 24patients received 1mg folic acid per day for three months and 21 patients as a witness received placebo. This patients intered in the study if had GFR> 60. We checked CBC, Vit B12, Homocysteine & Biochemistary at the base and after treatment the levels of Homocysteine, Vit B12 and CBC were checked again and the drug effects were examined.

In folic acid group Homocysteine decreased from 12.8 to12.4 (P = - 0.6)and average of Vit B12 levels increased from 244.87 to285.54 (P = 0.025). In this group we had reduction in WBC from 7.27 to6.62 (P=0.005) and increase in MCV from 86.64 to 88.81 (P= 0.002). Treatment with folic acid didn’t have significant effect on, Hemoglobin, & Platelets. In placebo group homocysteine increased from 14.4 to 17.1 (P= 0.007) and Vit B12 decreased from 211.8 to 187.04 (P = 0.063). Also, in this group there was no significant change in WBC, MCV & plateletes. But we had reduction in hemoglobin level form 14.94 to 14.72 in this group. (P = 0.036)

Complementary treatment with folic acid in patients with typeⅡ diabetes that are on metformin can prevent increasing Homocysteine levels. Also, this treatment can increase B12 levels. Therefore, it is useful to use folic acid for these patients.

Disorders in the blood’s hemostatic system, the excessive platelet aggregation and a lack of proper platelet functioning are connected to the occurrences and advances in cardiovascular disease.. Thus, the current study focused on evaluating the platelet index response of professional soccer players to a simulated soccer training session. The participants of this study were 10 professional soccer players with an average age of (21±5). The subjects were present at a sports physiology lab to perform the sports protocol and control sessions in two separate periods. The applied protocol consisted of a 46 minutes and 11 seconds of simulated soccer session performed on a treadmill. During each session, the blood samples were taken from the participants (before, precisely after and 30 minutes after the activity). To compare the average parameters, an ANOVA with repeated measures 3×2 was used at P<0.05. The statistical analysis showed significant differences in PLT (p=0.0001), MVP (p=0.001) and PCT (p=0.004), while no significant difference observed in the PDW. Because platelets have a pivotal role in the hemostasis of blood in healthy and ill people, intense aerobic exercise leads to an increase in the platelet count, the mean platelet volume and plateletcrit. Because of this and due to the platelet aggregation, obstruction resulting from thrombosis can increase.Acknowledgments: This article is sponsored by Shahid Beheshti University in Tehran, and there is no conflict of interest.

Introduction Hypertension is one of the main public health problems and is associated with increased risk of cardiovascular diseases. The incidence of hypertension is growing in all age groups including younger people.Studies have been reported various pattern of hypertension among adolescents in different populations. So we tried to find prevalence [M.KH.R.1] of hypertension in young adults in north-east of IRAN during2010-2011. Population-based descriptive analysis was done in 3612 people between 20-29 years old who were coming to medical centers for pre-marriage routine evaluation in Mashhad. Blood pressure was monitored in all of them, and patients with high blood pressure controlled again after two weeks. In follow a standard protocol for assessing elevated blood pressure consisted of 24-hour ambulatory monitoring; and biochemical laboratory tests were performed for all subjects with elevated blood pressure. Prevalence of high blood pressure was 1.4% (49) at the first visit that hypertension confirmed only in 1% (35) of patients at the next evaluation. Twenty-four-hours ambulatory monitoring revealed white coat hypertension in 40% (14) of them. There was significant association between blood pressure and body mass index (BMI), alcohol abuse, and smoking (P<0.05), but we didn’t find any correlation between sleep pattern,amount of daily tea and coffee drinking and family history of hypertension and blood pressure (P>0.05). While the prevalence of hypertension was low in young adults compared to older age groups, it remained important to detect patients earlier, as behavioral improvement may help them for better control of blood pressure and survival.

One of the most wide spread of all bacterial diseases in the world is Typhoid. Asymptomatic carriers are the main source of typhoid. Thereby the present investigation aimed at screening and identification of S.typhi isolates from typhoid asymptomatic carriers. A total of 200 stool samples were collected from food stuff producers and distributors,, culture characterization,biochemical tests and nested-PCR were done. Among 200 food stuff producers and distributors, 171(85%) were males and 29(15%(were Females. Stool culture results indicated the growth of normal flora but no growth of S.typhi were seen.In nested PCR technique one of the 200 samples was positive for the S.Typhi capsular gene(Vi gene). Due to the improvement of health status of country and the low typhoid carriers, it is recommended that efforts should be focused on other hygienic issues.

The inappropriate use of Broad- Spectrum antimicrobials in ICUs is a universal problem. The main goal of this study was to implement antibiotic stewardship program (ABS) concentrated on vancomycin and carbapenems, in ICU of Sheikh hospital. As an accessory purpose we also looked for the effect of ABS on the rate of antibiotic (AB) administration, length of hospital stay and mortality This study was performed in 2 stages, at the first phase; we determined the causes of nosocomial sepsis and their AB resistance pattern in the ICU, and then according to those findings a guideline for administration of vancomycin and carbapenems was performed. In the second stage the files of ICU patients were reviewed every other day (for 3 months), and recommendations about the compatibility of the prescriptions with the guideline were given to the responsible doctor. At the end, we compared the effects of the intervention with one month of prospective record of AB prescriptions without any recommendation. We recorded 1676 and 673 patient/days during 3 month of ABS and 1 month of control. During ABS period, vancomycin use decreased from 294 to 178 for 1000 patient/days (P=0.001), carbapenems administration changed from 433 to 193 for 1000 patient/ days (P=0.001), the LHS decreased from 11.4 to 8.4 days (P=0.06) and mortality rate decreased from 10.2% to 7% (P=0.4). In a situation like Dr Sheikh ICU, implementation of ABS for vancomycin and carbapenems hasafavorable effect on AB usage rate.

sarcoidosis is a multiorgan granulomatosis disease with unknown origin. Lofgren syndrome is an acute form of it that consists of ankle periarthritis, erythema nodosum and bilateral hilar adenopathy.Patients & in this study we evaluated 100 participants whose sarcoidosis confirmed clinical and paraclinical data. All participants answered to a general questionnaire regarding disease manifestations and epidemiologic data. acute sarcoidosis was more common in females than males (71% vs 29%) and most commonly occured in the age of 40-50 year. Among those patients, 93% had acute course of disease, 91% presented with arthritis. 67% developed erythema nodusom,10% uveitis. and 41% constitutional symptoms. Positive family history of sarcoidosis was found in 2% of them. Moreover a Abnormal chest radiography (para-hilar lymphadenopathy) was found in 94% of patients. ESR was increased in most of patients but the blood cell count remained unchanged. The most common presentations of sarcoidosis in its acute subtype were ankle peri-arthritis and erythema nodosum. The most paraclinical finding was para-hilar lymphadenopathy. Elevated ESR was also significant.

In this research we studied esophageal strictures in children comparing endoscopic. Results with Barium study. The aim of the study is to assess and compare the diagnostic accurucy of both methids. 126 children with symptoms of esophageal stricture have been investigated with barium study and modified barium swallow technique and endoscopy. Their results described in terms of location and type of stenosis and age frequency distribution. After that, the result has been compared with endoscopy method result as the gold standard method. The relationship between the two diagnostic methods was assessed using chi-square test. The odds ratio and 95% confidence intervals were estimated for each of the methods. Diagnostic sensitivity and specificity of the test was calculated. All analysis was performed using SPSS version 12 and the significance level was set at 0.05. The results showed that barium swallow and modified barium study are the best and safe and available modalities in all radiology centers with simple equipment and cost effective in comparison with endoscopy in diagnosis of esophageal stenosis in pediatrics. Modified Barium study did not show a significant difference compared with the endoscopic technique, is also easier in smaller centers with less radiation compared to standard methods can be done.

Epithelial myoepithelial carcinoma (EMC) is a rare cancer of the parotid glands. The probability of distant recurrence is rare and less than 5%. This case is reported, regarding to the rare occurrence. A 66-year-old woman presented with diagnosis of parotid gland tumor that has been operated for8 years ago. No adjuvant therapy was perscribed. In follow-up evaluations 8 years later, CT scan showed numerous pulmonary masses. According to, few respiratory signs, age and performance of the patient did not receive any treatment and just has evaluated in every follow up visit. According to slow-growing nature of metastasis form EMC of parotid to lung lobes may follow up of asymptomatic patients may be considered, unless any sings may be re.