Shiraz Emedical Journal
Volume:13 Issue: 3, Jul 2012

Diabetes mellitus refers to a group of common metabolic disorders that share phenotype of hyperglycemia. Fatigue is one of complains of diabetic patients. Due to lack of available documents in the prevalence of fatigue in Iran, we decided to study prevalence of this problem in our diabetic patients and compare with normal population. This is a cross-sectional study that was done in Shiraz city (in south of Iran).Sample included 400 patients diagnosed with diabetes referred to Naderkazemi diabetes health center and 400 healthy controls among patient’s attendance and health center staff, were matched in age and gender with patient group. Data was collected by using Iowa Fatigue Scale (IFS) questionnaire. This questionnaire consisted of 2 parts. Second part included 11 questions that evaluated level of fatigue. Its validity and reliability was confirmed. Data was analyzed by SPSS 15 by chi-square test and p< 0.05 was considered as significant level. 223 (55.75%) patients reported fatigue and 96 (24%) had sever fatigue. Also in control group 94 (23.5%) persons had fatigue and 23 (5.75%) had sever fatigue and difference between two groups was statistically significant. Some demographic factors such as age, duration of disease and education had a significant linear relationship with fatigue. Considering the severity of fatigue among diabetic patients and its relation with older age, higher educational level and duration of disease further recommended interventions specially in this group of patients with serious matters such as the use of better therapies, social work and rehabilitation, providing more facilities for assistance and treatment, mental health and … comes to action.

Ovarian cysts occur in 30% of females with regular menses, 50% of females with irregular menses and 6% of postmenopausal females. In the present study we aimed to compare the actual practice with optimal practice in management of F.O.C. The aim of this study is to find out how many functional ovarian cysts are removed in studied gynecologic departments with the current practice. Methods and Material: In a multi-centric study histopathology of benign ovarian involvements of patients coming to 20 hospitals were reviewed from 1998 to 2005. Age, sonographic findings and histopathology were recorded. Statistical analysis used: Analysis was done using SPSS software (Version 13, SPSS Inc., Chicago, Illinois, USA). Statistical analysis of the results were recorded as frequency, (mean + SD) and median (range). In 2981 patients with benign ovarian histopathology undergoing surgery, 1732 (58.5%) had functional ovarian cysts. Among patients with functional ovarian cyst, 1005 (58%) were uncomplicated, followed by 686 patients (39.6%) having hemorrhagic and 41 patients (2.3%) having torsed ovarian cyst. Our finding suggests more functional ovarian cysts might have avoided surgery, if more strict criteria for surgery were followed in gynecological departments.

Respiratory dysfunction is one of the most common problems among patients with end stage renal disease (ESRD). The aim of the present study is to evaluate the effects of hemodialysis (HD) with and without ultra filtration on various parameters of pulmonary function test among these patients.Methods and Materials: one hundred sixty ESRD patients undergoing maintenance HD more than 3 months and without acute lung disease were included in the study. HD was done using Fresenius 4008B dialysis machines, synthetic dialyzer membranes, bicarbonate base dialysate and with zero to 1-4 lit ultra filtration rate during each session. Spirometry test was performed before and immediately after a 4-hour HD session and alterations in spirometry parameters including forced expiratory volume in first second (FEV1), forced vital capacity (FVC) and maximal mid expiratory flow rate (MMEF) were determined and their relations with ultra filtration rate were analyzed. The most common causes of ESRD were hypertension in 65 (40.6 %) and diabetes mellitus in 46 (27.7%). Three patterns in spirometry were found among our patients; obstructive, restrictive and normal pattern in 20%, 35.6% and 44.4% respectively. There was a significant increase in FEV1, FVC and FEF 25-75% after dialysis (P < 0.001). But, the average rate of increment in FEV1 and FVC was higher in patients undergoing hemodialysis without ultra filtration versus ultra filtration and the difference was statistically significant (FEV1, P = 0.04 and FVC, P = 0.001). According to the results of our study, spirometry parameters increase significantly after a session of HD but these increments were much more in patients undergoing HD without ultra filtration.

This study aims at evaluating the medical faculty Interns'' skills in ambulatory area both from their own perspectives and researchers’ observations, in order to diagnose the causes of the problems and to recommend the right solution. In this study (2010), 4 researchers and 45 Interns of the Imam Reza Academic Medical Center (IRAMC), Tabriz- Iran measured the Interns'' abilities in ambulatory care setting from 9 disciplines based on 1335 patients visited and using a well-structured questionnaire covered those abilities based on the MD2000 curriculum of the Brown University. Ambulatory teaching process in each clinic was described according to various items and based on researchers’ direct observations of 45 sessions. forty six faculties visited 10293 patients during two-hour sessions in an extremely varied range -two to five times- per week for a period of five months (439 sessions) in 9 visit rooms with about 160 square feet area. The teaching model in all clinics was Grand Stand model, and some important reasons of the Interns'' imperfect ambulatory education were distinguished: attending in a resident-centered venue just to observe those mostly follow-up, complex and referral cases; lack of engagement in the patients'' visit process and not receiving any feedback. The level of the Interns'' abilities was mostly low both from their points of view and researchers'' observations. Significant differences upon 4 items were found. We found «frenetic and chaotic pace “of patient visit in IRAMC as the key constraint on ambulatory teaching, and in order to augment the Interns'' unsatisfactory skill level, several customized recommendations would be presented.

In spite of the certainty of reality of death, people seem unable to escape anxiety at the prospect of them. Death anxiety contributes to important emotional and behavioral consequences. The aim of this study is to investigate relation of death anxiety with variable such as severity of illness, depression and religious belief The study is a cross-sectional, descriptive study. Data were collected using demographic questionnaire, templar death anxiety scale, beck depression questionnaire, cumulative illness rating scale and religious attitude questionnaire. The co relational and regression analysis were conducted to identify the factors that correlate and predict the level of death anxiety respectively. A group of hundred and fifty persons including 50 severely ill patients, 50 relative caregivers and 50 normal healthy controls completed the questionnaires. Death anxiety score was 7.2 relatives, 5.3 in patients and 4.4 in control group. Depression and severity of illness had positive correlation with death anxiety in medical patients (P < 0.05).in addition to that religious belief had negative correlation with death anxiety (P < 0.05) and was the strongest protective factor for death anxiety in patients group. In relatives and controls depression predicted more death anxiety. individuals suffering from Sever medical illnesses do not inevitably experience more death anxiety. Discussing to the relative the fact, the low death anxiety in their relative patients, will preserve the right of patients to make rational decision about their treatment and life. In presence of death anxiety early detection and management of depression could reduce death anxiety.

Addiction to opioids poses serious problems for communities, families, and individuals. Solutions sometimes seem uncertain, difficult, and controversial. Most of patients can not tolerate drug abstinence permanently and they continue to live through preparing and using drugs permanently if there is no method of maintenance treatment. Methadone Maintenance treatment (MMT) has become a major intervention in the care and treatment of drug dependence in many countries. Now MMT is used as a maintenance method in Sari and we decided to evaluate this method in addicted patients in private MMT clinic.Method and Materials: This cross-sectional descriptive study was performed from April 2009 to April 2010 in all patients who have been referred for treatment to the private MMT clinic during this year. The tools for searching were epidemiologic questionnaire, patients file and interview. Collected data was analyzed using the descriptive statistics. Data collected from 200 patients were analyzed. Most patients (142 patients) were urban. 44 patients (22%) had finished high school and 36 (18%) had higher educations. 155 patients use opium. 85 patients have treatment history of their addiction in recent years. 38 (19%) subjects had suspicious sexual relations. 67 (33.5%) cases had depression and 68 (34%) ones had aggressive behavior on the basis of DSM-IV criterion. 66 patients (33%) had full-time jobs. This study shows the most common substance that use in Iran is still opium. And it uses in all range of ages. A large number of our patients had finished high school and higher education degrees. So it shows the importance of preventive strategies in society.

Liver disease caused by hepatitis C virus (HCV) in patients with end-stage renal disease (ESRD) causes significant morbidity and mortality. The aim of this study was to determine the prevalence of HCV infection and its relationship in ESRD patients living in the province of Khuzestan, Iran. In a cross sectional study from December 2010 to March 2011, entire of ESRD patients treated with hemodialysis (HD) or peritoneal dialysis (PD) in the Khuzestan province enrolled for the study. A standardized questionnaire was used to collect Social and demographic data including cause of ESRD and date of onset of PD or HD. Blood samples were tested for hepatitis C antibody (anti-HCV) by enzyme-linked immunosorbent assays (ELISA). The Research Center of Ahvaz Joundishapur University of Medical Sciences approved the study. In overall, 1117 ESRD patients were enrolled for the study. The prevalence of anti-HCV was 3.4 % (38 patients, 20 males with Mean age of 45.29 years and 18 females with Mean age of 45.6 years). The most common Cause of ESRD in anti-HCV positive patients was high blood pressure in 45.4%, followed by, DM in 28.7%, and unknown in 13.9%. We din not find any association between both sexes (P = 0.06) and also between mean age of anti-HCV positive and negative patients (P = 0.59). There was a significant association between high blood pressure as cause of ESRD with anti-HCV positivity (0.033). Although, the prevalence of HCV infection among ESRD patients has decreased in recent years, however it remains as a significant cause of viral hepatitis among these patients in Khuzestan province.

Subarachnoid hemorrhage is a rare complication after snake bite. Herein, we report A 63 year old lady with generalized tonic colonic convulsion due to Subarachnoid hemorrhage after Echis Carinatus bite.