Chronic Diseases Journal
Volume:2 Issue: 1, Winter-Spring 2014

Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance that is detected for the first time during the most recent pregnancy. It can lead to serious complications for mother and infant. The current study aimed to determine the important risk factors for GDM in Sanandaj, Iran during 2010-2011. This was a case-control study in which 220 people were chosen for each group from referees to the healthcare centers and diabetes center in Sanandaj. Data were collected through interviews and review of medical records. Data analysis conducted using chi-square test and logistic regression. In the present study, diabetic mothers were older and more obese than non-diabetic mothers. In the logistic regression, variables such as familial history of diabetes in first-degree relatives, history of gestational diabetes, age ≥ 30 years, history of stillbirth, history of macrosomia, and body mass index above 30 were considered as the most important independent risk factors for gestational diabetes respectively. However variables such as smoking, blood pressure, and history of infant death showed no statistical significant difference between the two groups. The most important risk factors for developing GDM included history of diabetes among relatives (family history), mothers with a history of gestational diabetes, and history of macrosomia. Therefore, controlling these factors can reduce the incidence of diabetes during pregnancy.

lumbosacral radiculopathy is one of the most common disorders that can be examined by neurologists. Electromyography (EMG) and magnetic resonance imaging (MRI) are used to inspect this disease; however, the application of MRI and EMG in patients with back pain is still under study. This study was designed and implemented to compare the diagnostic values of MRI and EMG in the diagnosis of lumbar radiculopathy. This was cross-sectional study which included 62 patients with suspected lumbosacral radiculopathy in a referral neurology clinic in Sanandaj, Iran, in 2009-2010. EMG was considered as the gold standard test. Inclusion criteria were being older than 20 years of age, and suffering from back pain or radicular pain in the lower limbs for more than four weeks. Data were entered into SPSS software and the diagnostic indices and agreement were calculated. The percentage of agreement between MRI and EMG results were calculated as 80.6%. The sensitivity of MRI compared with EMG at different levels was calculated between 44.4% and 79.6% and its specificity was calculated between 46.1% and 94.3%. In total, sensitivity and specificity of MRI were 68.9% and 86.3%, respectively. The Lasègue''s sign, used for detection of disc herniation, had the sensitivity, specificity, and positive and negative predictive value of 28.8%, 50%, 75%, and 11.9%, respectively. MRI and EMG tests have no superiority over one another for the evaluation of lumbar radiculopathy and it is necessary to do both. The Lasègue''s sign is also not an appropriate test for detection of lumbar spine disc herniation, and it is not helpful in diagnosing or ruling out the disease.

Prematurity is the most common cause of neonatal death and according to Millennium Development Goal (MDG), two-thirds of all under-five deaths should be reduced by 2015. Therefore, this study examined factors related to preterm birth in Sanandaj, Iran in 2012. This case-control study has been conducted on 600 pregnant women; cases were 200 women with preterm labor and controls were 400 women with term labor, in Be’sat Hospital, Sanandaj, Iran, in 2012. Results were analyzed by Chi-square, Mann-Whitney U and logistic regression tests. In univariate analysis, overt diabetes (P = 0.030), chronic hypertension (P < 0.001), preeclampsia and eclampsia (P < 0.001), had significant correlations with preterm labor. However, multivariate analysis results showed that factors like preeclampsia and eclampsia (P < 0.001) and chronic hypertension (P = 0.030) had significant correlation with the incidence of premature birth. In univariate and multivariate analysis, anemia (P = 0.340) had not any association with the preterm labor. The results of this study showed some chronic maternal conditions such as chronic hypertension and diabetes mellitus, which are important pre-existing medical disorder complicating pregnancy and control of blood pressure and blood sugar before pregnancy, and have an important effect in decreased of preterm labor and complications. But others such as mother’s anemia were not responsible for the prematurity.

The present study aimed to track adolescents’ attitudes towards changes in their health behavior considering perceived benefit and barrier in different stages of physical activity during a three-year transitional period from junior high school to high school. Data were collected amongst female adolescents in 2010 (n = 558) using random cluster sampling method, of whom 400 were provided by follow-up data in 2013. The stages of change and health beliefs regarding physical activity were measured using self-reported questionnaires. The research data were, then, analyzed in SAS, using inferential statistics. The baseline participants had a mean age of 14. 28 ± 1. 54 and at follow-up were 17. 52 ± 1. 82. At the baseline and follow-up, proportions of participants in pre-adaption and adaption stages were 26. 7%-73. 3% and 72. 3%-27. 7%, respectively. At baseline, pre-contemplators showed significantly lower positive attitude and greater agreement for most of the barrier items than those on other stages. In the baseline, female in action and maintenance stages endorsed greatest agreement for the barrier item i. e. having too much homework. In comparison to females, in the maintenance stage pre-contemplators were more likely to agree that a «not knowing how to do a certain type of exercise» (OR = 10. 30, CI = 4. 42-23. 99). At the follow-up, in the pre-contemplators and maintenance stages, the greatest amount of agreement for the barrier item was «not enough time». This study revealed transition from junior high school to high school and showed lower physical activity in females. Consequently, perceived barriers increased and perceived benefits decreased in the transition from junior high school to high school.

A varying background in situations of chronic diseases affects the selection of strategies in clinical judgments. This study explained the strategies used to enhance the clinical judgment in chronic diseases situations. This article was the part of a grounded theory study. Obtained data from open and semi-structured interviews were analyzed simultaneously with data collection and according to the Corbin and Strauss approach. The first experienced nurse was selected with purposive sampling and 25 other participants were selected on the basis of the theoretical sampling from different wards of the clinical and educational care centers of Sanandaj, Iran from 2011 to 2013. As shown in results, the core variable “situation-based efforts for enhancing clinical judgment” represented the main process used by participants in the promotion of clinical judgment in situations of chronic disease. The main categories included a «comprehensive collaboration», «inclusive education», «matching of clinical judgment skills», «maintaining patient''s and nurses'' autonomy» in a clinical judgment. Participants were trying to use strategies appropriate to different situations for clinical judgment in terms of chronic diseases conditions. Applying these processes with regard to the present context, can enhance the clinical judgment in chronic diseases situations.

Renal osteodystrophy is a major complication among dialysis patients that can lead to muscle weakness, and bone pain and fractures by minor trauma. In the present study, the frequency of these symptoms and status of blood markers among dialysis patients are discussed. In a crass-sectional study, blood sample was obtained from 82 hemodialysis patients for calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), and parathyroid hormone (PTH) level measurement. Radiography of the right hand was performed for 57 patients. Data analysis was performed via SPSS by using chi-square test, Fisher’s exact test, and Pearson correlation coefficient. The prevalence of osteodystrophy among dialysis patients was 72% (59 patients), including 29 patients with high bone turnover and 30 patients with adynamic bone disease. Moreover, 24 patients (29.3%) were hypocalcaemic and 25 patients (30.5%) were hypercalcemic. In addition, 25 (30.5%) patients had hyperphosphatemia. In the present study, 82 patients, 40 male (48.8%) and 42 female (51.2%), were recruited. Patients’ mean age ± standard deviation was 55.77 ± 14.99. There was a relation between increase in age and adynamic bone disease (P = 0.004). Calcium level had a significant association with radiologic manifestation of renal osteodystrophy (P = 0.007). PTH levels had moderate correlation with ALP level (r = 0.55). In the present study, there was a relation between age and adynamic bone disease; meaning that by increasing of age, the prevalence of adynamic bone disease also increased. There was a strong positive correlation between PTH and ALP.

Uterine leiomyoma is a prevalent benign tumor. Several studies have shown the positive effects of raloxifene in the treatment of leiomyomas. Since raloxifene has fewer side effects than the gonadotropin-releasing hormone (GnRH) agonist, if proven effective, it can be applied easily. This study aimed to compare the medical effects of raloxifene and GnRH on uterine leiomyoma size. This clinical trial included 53 women with uterine leiomyoma. Participants were randomly divided into 2 groups of raloxifene and GnRH. The GnRH group received 1 dose per month (intramuscular injection) and the raloxifene group received 60 mg raloxifene orally/day for 3 months. The size of the leiomyoma, prior and during the intervention, was determined by a sonographist. During the study, repeated measurement was used for comparing the trend of alterations in the tumor size. Analysis of changes in leiomyoma tumor size (log of tumor size) by repeated measurement showed that decrease in tumor size in the raloxifene group was significantly higher than GnRH group (P = 0.042). The trends of changes in endometrial thickness were different in the 2 groups and the reduction of thickness was more significant in the GnRH group (P = 0.026). This study showed that raloxifene is an appropriate medicine to reduce the size of uterine leiomyoma and is more effective than GnRH.

Human Brucellosis still challenges many physicians, especially in developing countries where it is still a very common, but sometimes ignored disease. Its reemergence in developed countries and its status as a class B bioterrorist agent has recently attracted much interest. Having over 500,000 new cases annually, Brucellosis is known as one of the most common zoonotic infections in the world and “the great imitator” because of many clinical and hematological manifestations. Brucellosis is still endemic in many developing countries and remains under-diagnosed and sometimes missed reported. Although this province (Kurdistan, Iran) is a Brucella endemic area with a very high prevalence and incidence rate, except for very few and negligible case reports, we did not find any reports or epidemiological study regarding this zoonotic infection. This is the first reported case of Brucellosis with pancytopenia from this western province of Iran which has been neglected. Our case was a 16-year-old girl referred with protracted fever during the last month and undetermined diagnosis. She also suffered from generalized pain, pale skin, sweating, anorexia, and weight loss. After clinical surveying, taking history, and physical examination, Brucella infection was suspected. Diagnosis confirmed by standard tube agglutination test (STA), 1/640. The patient was successfully treated with doxycycline, rifampicin, and ceftriaxone.

Fibrosing mediastinitis is a rare benign disorder caused by the proliferation of acellular collagen and fibrous tissue within the mediastinum. Although many cases are idiopathic, many (and perhaps most) cases are thought to be caused by an abnormal immunologic response to Mycobacterium tuberculosis and Histoplasma capsulatum infections. Collagen formation leads to compression of vital structures, resulting in cough, chest pain, and dyspnea. The following case is a former healthy middle-age man who presented with an 8-year history of cough, chest pain, facial swelling, and trouble breathing, and was subsequently found to have fibrosing mediastinitis. Fibrosing mediastinitis should be considered in the differential diagnosis of cough, chest pain, and dyspnea, primarily when findings such as increased venous pressure are present on physical exam, and hilar abnormalities are seen on chest radiograph.