Chronic Diseases Journal
Volume:1 Issue: 1, Winter-Spring 2013

Welcome to the first volume of the Chronic Disease Journal (http://cdjournal.muk.ac.ir), a quarterly peer-reviewed scientific journal published by Kurdistan University of Medical Sciences. The journal contains manuscripts on the topic of subacute and chronic medical conditions and diseases.The number of medical articles published in Iran has considerably increased during the past decade. The development of any health care system strongly depends on the production, publication, dissemination, and application of updated biomedical knowledge to prevent and treat diseases and improve health services. The most critical role of medical and health professionals is to provide those in need with adequate related knowledge. The quantity of published articles is a commonly used indicator of the scientific level of a country. It also determines a country''s contribution to the world science and its status in international academic rankings.We promise that the Chronic Disease Journal will be a medium for the release of timely and thoughtful information on control, planning, treatment, patient education, management guides, policymaking, and biopsychosocial-spiritual factors in the field of subacute and chronic diseases.

A variety of drugs can be used for the treatment of acne vulgaris. Every medicine acts against one or some of the mechanisms of the pathogenesis of acne vulgaris. This study was conducted to assess the therapeutic effect of Clinda Soap in the treatment of acne vulgaris. This randomized, double-blind, clinical trial included 82 patients (age: 15-35 years) with mild to moderate acne vulgaris. The study protocol was approved by the ethics committee of Kurdistan University of Medical Sciences (Sanandaj, Iran). The patients were randomized into two groups to receive the standard treatment for acne vulgaris with either Clinda Soap (containing clindamycin hydrochloride 1%, manufactured by Shadakish Company, Iran) or a placebo soap. Both the intervention and control groups were asked to apply soaps twice daily for three months. Monthly examinations were performed by a dermatologist to ensure proper use of the soaps and to assess the rate of recovery and possible complications. Data was analyzed using t-test and repeated measures analysis of variance in SPSS. The mean age of patients was 21.1 ± 4.7 years in the intervention group and 21.5 ± 4.8 years in the control group. The mean duration of the disease was 3.0 ± 1.5 and 3.1 ± 1.8 months in the intervention and control groups, respectively. The mean number of comedones in the two groups had no significant difference at any monthly visit. In contrast, at all visits, significantly fewer papules and pustules were observed in the intervention group than in the control. Significant intra-group and inter-group differences in the number of inflammatory lesions (papules and pustules) were also seen. In general, it can be concluded that Clinda Soap is effective in the treatment of acne vulgaris. The recovery rate of papules and pustules was higher than that of comedones. Easy application of this soap together with its low cost and few adverse effects will increase patients'' compliance.

Differentiating between unstable angina and myocardial infarction (MI) is clinically important as they require different treatments. High sensitivity C-reactive protein (hs-CRP) has recently been recognized as prognostic factor in acute coronary syndrome. Since this biomarker may indicate the prognosis of heart disease, identifying its diagnostic value will be clinically important. This study investigated the diagnostic value of the level of hs-CRP in differentiating MI from unstable angina. Blood samples were obtained from all patients with suspected MI or unstable angina at the time of referral. The patients were put in one of the two groups based on final diagnosis. The exclusion criteria were infectious diseases, immune system diseases, history of a recent surgery or trauma, kidney failure, liver failure, cancers, and use of anti-inflammatory drugs. Data was entered in SPSS16 and analyzed by independent t-test, Mann-Whitney U and chi-square or Fisher’s exact test. ROC curve was used to determine hs-CRP cut-off point. The sensitivity and specificity were calculated at the cut-off point. Overall, 60 patients (30 patients with MI and 30 patients with unstable angina) were studied. Hs-CRP level was 3.68 ± 0.86 mg/L in patients with MI and 2.35 ± 1.30 mg/L in patients with unstable angina (P < 0.001). The best cut-off point for differentiating unstable angina from MI was hs-CRP levels equal to or greater than 3.27 mg/L. At this cutoff point, the sensitivity and specificity were both 77%. Patients with MI had higher levels of hs-CRP than subjects with unstable angina. Hs-CRP levels equal to or higher than 3.27 mg/L are more likely to be associated with MI. It is recommended to test this biomarker in all patients with acute coronary syndrome.

Osteoporosis, the most common pathological cause of skeletal weakening and the most common metabolic bone disease, is caused by loss of bone mass density (BMD). Fractures due to osteoporosis will worsen life, increase pain, and decrease quality of life. The present study aimed to determine the impact of osteoporosis on quality of life among elderly women. In a cross-sectional study, 275 postmenopausal women (age: 50-70 years) who were referred to the Namazi Hospital (Shiraz, Iran) were included. BMD was measured according to the World Health Organization (WHO) standards. Women with BMD < -2.5 standard deviation (SD) of the average value in young adults were defined as osteoporosis cases. Women with BMD > 1 SD of the average value were defined as normal cases. Quality of life was measured by Qualeffo-41 Questionnaire and reported on a scale of 100. Data was analyzed in SPSS and P values less than 0.05 were considered significant. The mean quality of life score was 25.5 ± 11.7. According to the definition by the WHO, 70.2% of the participants were affected with osteoporosis. Only 22.3% of osteoporotic women and 30.5% of normal subjects had good quality of life. A significant statistical difference was observed between osteoporotic and normal postmenopausal women in social activities. Overweight and low education were predictors of poor quality of life in multivariate analysis. The imposed financial burden and complications of osteoporosis can affect the patients’ quality of life. Health education regarding nutritional behaviors and social activities at adolescence are helpful interventions for decreasing the prevalence of the disease. Since osteoporosis has a gradual, outward, and asymptomatic trend, more attention needs to be paid to preventive and screening programs.

Anterior cruciate ligament (ACL) injury is the most common type of ligament injury whose prevalence is higher in athletes. There are different external risk factors for this injury. However, it is important to find its physiological risk factors, as well. This study assessed the relationship between morphometric parameters of intercondylar notch and ACL tears in patients suffering from knee complications. Patients with or without ACL tears who had undergone knee magnetic resonance imaging for any reason were recruited based on inclusion criteria. Intercondylar notch width, femoral bicondylar width, and intercondylar notch index were calculated in both groups. Then, significant variables from univariate analysis were entered in multiple regression analysis with intercondylar notch width, femoral bicondylar width, and intercondylar notch index being assumed as dependent variables. Overall, 199 participants, including 81 patients with ACL tear and 118 without ACL tear, were evaluated. Multiple regression analysis revealed intercondylar notch width and intercondylar notch index to be less common among women and subjects with ACL tears (P < 0.001). Based on the results of this study, there are relationships between ACL tears and being female and intercondylar notch width. Therefore, intercondylar notch index can be used for screening athletes and people at risk of ACL tears.

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the world. While smoking has been identified as the main cause of COPD in many studies, other causes may include environmental pollution and genetic vulnerability in both genders. Considering lifestyle of rural women, and the old structure of Sanandaj (Kurdistan Province, Iran) which is different with other parts of the country, this study compared the risk factors for COPD in men and women. In a descriptive, analytic study 400 subjects of both genders (200 female and 200 male) were evaluated. The files of patients with COPD admitted to Besat Hospital (Sanandaj, Iran) during 2006-11 were randomly selected using a systematic sampling method. The sampling continued until a total of 200 patient files were collected in each group. Eventually, data was analyzed with SPSS16. Smoking was the major risk factor (56.5%) for COPD in both men and women (n = 226). While only 32.5% of women (n = 65) had a history of smoking, the rate was as high as 80.5% in men (n = 161). Most women (60.5%) were more exposed to fossil fuel smoke than men. Fisher’s exact test results showed a significant difference in the risk factors (including Smoking and tobacco use, Exposure to fossil fuel smoke and air pollution) and the type of jobs between the two genders. Based on the results of our study, it is better to obtain an accurate history of exposure to smoke of wood or biomass and a history of residing in rural areas as the main risk factors for developing COPD in patients who have no history of high-risk occupations or other risk factors of the disease (e.g. smoking).

Iodine deficiency disorders (IDD) control program has two important factors: annual monitoring of urine iodine levels and controlling iodized salt consumed in the community. Preserving the iodine indexes in different level is important now too. This survey determined factors affecting median levels of urine iodine levels in students of Kurdistan Province (Iran). This cross-sectional study selected 255 8-10-year-old students using cluster random sampling. Data was obtained by a questionnaire and urine analysis. The collected data was analyzed by Mann-Whitney and Kruskal-Wallis tests, Spearman correlation, and multiple regression. All analyses were performed using SPSS19. The median urine iodine level of the studied school children was 9.7 μg/dl. There was no significant relation between urine iodine level and sex, place of residence (rural/urban areas), and household iodized salt intake (r = 0.188, P = 0.003). Overall, 119 families (46.7%) did not appropriately protect their iodized salt. The amount of iodine in salt and the condition in which salt is kept had relationships with children’s urine iodine levels. Low median level of urine iodine in students, low household iodized salt, and high use of salt with lesser iodine than the standard value showed that the IDD program in Kurdistan Province has not been successful. Therefore, there is a risk for increased prevalence of Goiter in the region. We recommend interventional programs to improve the current status in the province.

One of the causes of low back pain is herniated disc that puts pressure on the nerve roots and cause pain radiating down the legs. Specific body movements tend to aggravate pain. Among treatment approaches, patient education could be considered as an effective way of pain management. We did not find any study showing the effects of educational intervention on pain management in searched medical literature. This study aimed to investigate effects of educational intervention on the level of pain due to herniated disc. In this study, 83 patients with lumbar disc pain were selected and pain intensity and duration were recorded based on a scale from one to ten. The average pain intensity and duration before and after intervention were recorded. Then the data were analyzed using SPSS software. Frequency of L4-L5 herniated disc was 39.7%, L5-S1 was 36.1% and L4-S1 was 24.1%. Mean intensity of pain before intervention was 8.33. After intervention, duration of pain decreased from 8.34 ± 0.73 to 6.76 ± 5.54 (P < 0.001) and mean duration of pain before and after intervention were 65.6 ± 5.21 and 53.5 ± 5.83 minutes, respectively (P < 0.001). Educational intervention for patient with lumbar herniated disc could be used as a practical complementary method beside other therapeutic approaches in the treatment of low back pain.

Behcet’s disease is a systemic disease classified among vasculitides. Major manifestations are mucous membrane lesions (oral aphthae and genital aphthous ulcers), skin manifestations (pseudofolliculitis, erythema nodosum), ocular manifestations (uveitis, retinal vasculitis), joint manifestations, vascular lesions (small to large vessel thrombosis, aneurysm), gastrointestinal manifestations, orchiepididymitis, and some rare manifestations like cardiac, pulmonary, and renal impairment. Diagnosis is mainly clinical. The International Diagnosis Criteria for Behcet’s Disease may be of help.The gold standard of treatment for mucocutaneous lesions is colchicine. In refractory cases, levamisole, thalidomide, and dapson may be of help. For involvements of major organs like the eyes and the brain, immunosuppressive drugs and prednisolone are the gold standard. In refractory cases, biological agents are the last resort. For gastrointestinal manifestations, sulfasalazine and prednisolone are the first-line treatment. Anticoagulation had been the best choice for treating vascular involvements. However, immunosuppressive drugs and prednisolone have been confirmed to cause the best results. In all refractory cases and for all different organs, the last resort is biological agents.