Shiraz Emedical Journal
Volume:13 Issue: 2, Apr 2012

Balneotherapy is known to alleviate pain in bone and joint diseases, and many blood parameters were shown to be modified upon thermal water therapy. In our study, we sought to investigate the effect of sulphur thermal water on blood lipids and total anti-oxidant capacity in patients suffering from knee osteoarthritis. Interventions: Patients were selected according to the American College of Rheumatology criteria. Volunteers (13 women, aged 30 to 60 years old) underwent a thermal water cure session of 20 min daily during two weeks in a sulphur water pool of Moulay Yacoub spring. Outcome measures: Patients have ha lipid laboratory tests and total anti-oxidant capacity measured before and after two weeks of thermal water treatment. In this study, we found that sulphur thermal water treatment reduced cholesterol, triglyceride and LDL in patients’ blood; instead, no change was found in their plasma total anti-oxidant capacity. Balneotherapy sessions lead to lowering of blood lipid of patients suffering from knee osteoarthritis. The latter effect could be part of the mechanism of action of thermal water in decreasing disease activity in knee osteoarthritis. On the other hand, blood total anti-oxidant capacity, as measured by our method, does not seem to be of relevance in the pathology of our patients.

Systemic inflammation is a common complication in patients with chronic renal dysfunction including hemodialysis patients. The aim of this study is evaluating association of inflammatory factors on β2-microglobulin (β2-m) in hemodialysis patients This is a single-center prospective study conducted on 39 hemodialysis patients in Sina hospital in 2009. All cases had well-functioning arteriovenous (AV) access or permanent venous catheter and were dialyzed thrice weekly. All patients were hemodialyzed using low flux membranes and Ferzinuce system. Blood samples were taken from the arterial line for the following assessments: Hct, hemoglobin, WBC, platelets, erythrocyte sedimentation rate (ESR), blood urea and serum creatinine, HDL cholesterol (HDL-C), total protein, albumin, CRP, and β2- microglobulin. The statistical analyses were performed using Chi-square test for relationships. All tests were two-tailed and with P<0.05 were considered significant. The cases included 28 females (71.8%) and 11 males (28.2%) with the mean age of 60.61±15.25 yrs. There was no significant relationship between CRP, HDL-C, Albumin and β2-microglobulin (P ≥ 0.05). Although the rise of inflammatory factors may increase β2-microglobulin levels, we found no significant relationship between inflammatory factors and β2-microglobulin when low-flux biocompatible membranes are used.

End stage renal disease (ESRD) is one of the most common life-threatening diseases. In the past two decades, there have been significant changes in the cause of ESRD around the world, and aim of the study was to determine its causes in Khouzestan province, Iran. We retrospectively reviewed the medical records of our ESRD patients from January 1999 to March 2010. ESRD was defined as chronic and irreversible loss of kidney function requiring dialysis. We included only adult ESRD patients on maintenance hemodialysis, more than 2 months before entering the study. SPSS (version 15) software was used for data analysis. In our study, a total of 1000 adult ESRD patients, with mean age of 51.54 ± 16.39 years were included. The male to female ratio was 1.3: 1 which had no significant changes during the period of study. The mean age of our patients at starting of hemodialysis was 41.23 years in 1999, but it increased to 56.91 years in 2010, which is up 15.68 years during this period.In overall, the most common causes of ESRD were Diabetes Mellitus (n=282, 28.2%), Hypertension (n=265, 26.5%), unknown (n=242, 24.2%), Glomerulonephritis (n=79, 7.9%), Obstructive Uropathy (n=70, 7%), Cystic Kidney Disease (n=51, 5.1%) and unirenal (n=1, 0.1%). Although, two main causes of ESRD in patients aged 40 years and older (n=761) were also Diabetes Mellitus (n=255, 33.5%) and Hypertension, however, in patients with less than 40 years of age (n=239), the most common causes were unknown and Glomerulonephritis. There were no significant difference in the main causes of ESRD (Diabetes Mellitus and Hypertension) between men and women (P= 0.26 and P= 0.48). But there was a significant association between mean age of diabetic (56.71± 13.35) versus non diabetic (49.51 ± 17.03) hemodialysis patients (p< 0.001). Based on our findings, the most common causes of ESRD in Khuzestan province, Iran were Diabetes Mellitus and Hypertension similar to developing countries. But, its causes are unknown in the significant percent of patients in contrast to these countries.

one of the most important neonatal morbidity during labor is Perinatal asphyxia. Hypoxia causes release troponin from cardiac muscles. Fetal distress during labor may be detected by monitoring the fetal heart rate. Elevated levels of troponin T in cord blood may be associated with intrauterine hypoxia Relations between umbilical troponin T levels and fetal distress Cord blood samples were collected from 80 neonates and analyzed. Data on birth weight, sex, APGAR scores, and mode of delivery were recorded a total of 80 samples were collected, 40 samples from infants with fetal distress and 40 samples from infants without fetal distress. The gestational age of these infants ranged from 38 to 40 weeks and birth weight ranged from 2.5 to 4 kg. There was no relation between umbilical troponin T levels and mode of delivery. Fetuses with distress had significantly higher cord troponin T levels than control group (26/42 versus 50/46 μg /ml respectively; p < 0.01) Troponin T levels in the cord blood are unaffected by mode of delivery. Infants with distress had significantly higher cord cardiac troponin T levels, suggesting that troponin T may be a useful marker for early detection of hypoxia in neonates

Medical residents are a population who are at great risk to develop sleep disruption due to demanding clinical and academic duties..Knowing how much change in sleep wake pattern is associated with subsequent psychological distress could be useful to establish a systematic mental health program for medical residents. a cross sectional study was conducted to explore the association between shift works and general health status of 128 medical residents. A self report sleep-wake questionnaire and general health questionnaire (GHQ) were used to test the pattern of sleep-wake and general health status respectively. There was a significant correlation between sleep disruption and general health status of study sample (p=0.001).number of night shift was a predictor for general health among medical residents. sleep disruption due to shift work could be a predictor for mental morbidity. Reduce in night time shift among medical residents might prevent both physical and mental morbidity among them.

Tuberculosis is an important infectious disease which can involve respiratory system and other organs. Lymph nodes are common site for tuberculosis involvement.Clinical Presentation and Intervention: We report a 30 year old male patient with a draining sinus on neck and lymphadenopathies in the inguinal region. He was improved by a standard medical therapy after being documented with a suggestive pattern for tuberculosis by lymph node biopsy. cervical Lymph adenopathy is a presentation of tuberculosis. Extra pulmonary tuberculosis should be ruled out via Para clinic studies. Lymph-node biopsy is helpful in this era.

Hydatid cyst disease is a significant clinical problem in endemic regions.(1) Cystic echinococcosis is a zoonosis caused by the larval stage of Echinococcus granulosus.(1) it has an indirect life cycle, with canines (mainly dogs) as definitive hosts, and herbivores and human as intermediary hosts.(2) Hydatid cyst disease in human commonly affecting the liver and lungs.(3) The bone involvement is rare in hydatid disease and represents less than 2 % of all cases. The most common bone localization is vertebral hydatidosis which is seen in 44 %of the patients.(4) The disease occurs by direct extension from a pulmonary or liver infestation (5) or, less common, begins primarily in the vertebral body.(6) Hydatid disease of the spine is rare and has poor prognosis, (7) in such condition; the severity of disease is related to the neurological complications.(4) Paraplegia is the most serious complication which is caused by compression of the spinal cord by the cysts.(7) The treatment relies on the actual surgical removal of cysts although the bone involvement is quite challenging. The poor outcome of posterior decompression and laminectomy for intraosseous spinal hydatid disease were reported by several authors.(8) In endemic countries, prevention and health education are the best measures.(4) Herein we report a 55-year-old man who referred to our outpatient clinic due to back pain and progressive numbness and weakness of both lower extremities and disability in walking. The condition was per diagnosed as disc herniation. In physical examination, the patient had low back pain, weakness and paresthesia of both lower extremities. In imaging work ups Magnetic resonance imaging (MRI)revealed an epidural cystic lesion extending from T6 to T7. Laboratory analyses were performed. Total blood cell counts, erythrocyte sedimentation Rate (ESR), complete biochemical serum and urine parameters, coagulation tests were within normal ranges. ELISA for Echinococcus granulosus was positive. Daily doses of albendazole 400 mg (twice per day) were used for 2 weeks and then the patient underwent surgical intervention. The cyst had been totally removed. Bilateral laminectomy, medial facetectomy and extra Dural cord decompression were done. Cystic lesion was shown to be hydatid cyst by histopathologic confirmation after the surgical removal. No neurological bladder, or bowel symptoms was seen in the postoperative period. The patient received antibiotic (cephalexin 500mg four times per day) in addition to daily albendazole (400 mg twice daily for 3 months). Following 3 months of rehabilitation program his neurological status revealed. He was symptom-free after operation in three years follow up.Hydatid disease is a health problem in the endemic areas such as Iran.(9) The condition can easily be confused with tuberculous spondylitis where tuberculosis is endemic too. Misdiagnosis could result in serious consequences. Spinal hydatid disease is usually situated in the dorsal region and generates medullary or radicular symptoms according to its location.(10) The symptoms present due to compression effect of the cysts.(11) The most important clinical manifestations of the condition are paresthesia, paraparesis, paraplegia and sometimes sphincteric dysfunction.(12) Neurological signs are usually very slow, but will result in paraplegia in 25-50% of patients.(13) There are 5 major groups of spinal hydatid disease which may causes paraplegia in the patients.:(1) Primary intramedullary cysts, (2) intradural extramedullary cysts, (3) extradural intraspinal cysts, (4) hydatid disease of the vertebra, and the last (5) paravertebral hydatid disease. This classification was done in 1981 by Braithwaite and Lees.(14)MRI is the most beneficial method in the diagnosis of spinal hydatidosis.(15) It reveals precise anatomic localization and extension of the spinal hydatid disease. Overall MRI is the superior method in the diagnosis than computed tomography scan (CT).(16)On the other hand CT scanning may be more convenient and advantageous in follow up of bone lesions progression which is associated with this disease.(14)Cystic lesions require urgent surgery. Although, medical antihelmintic treatment (mebendazole or albendazole) could be an alternative for uncomplicated uninfected hydatidosis. The major factor influencing the surgical approach is the degree of spinal canal involvement.(17)In the report of Golematis et al (18) it was shown that albendazole decreased the size of the large cysts and in some cases cured the smaller ones. The effectiveness of medical treatment can be evaluated with follow-up CT scan and MRI which may show the gradual shrinkage or calcification of the cysts in one hand or maintenance of the cyst size for 1 year follow up in the other hand.(19)Recurrence (30% to 100%) remains as a major problem in spinal hydatid disease.(12) It can cause persistent pain and significant neurologic deficits. in such cases a high morbidity and mortality and poor prognosis is predictable. Albendazole treatment which can prevent the late recurrence should be started in the postoperative stage and continues for two years.(17)

Myasthenia gravis (MG) is associated with diabetes mellitus (DM) type 1 and other autoimmune disorders. Some cases of MG may progress to DM type 2 following corticosteroid therapies. We reported a 53-year-old woman with DM type 2 who subsequently developed MG. She did not take any corticosteroids prior to MG occurrence. MG may be associated with DM type 2 disease even in the absence of corticosteroid therapy.