Avicenna Journal of Clinical Medicine
Year:2012 | Volume:19 | Issue:2 (SN 64)|Papers Count:13

Introduction & Objective: Acarbose is an intestinal alpha-glucosidase inhibitor that delays absorption of carbohydrates. Findings of some studies show that it has been effective in better control of blood glucose in patients with diabetes type 1. The goal of this study is to investigate the effect of administration of acarbose on glycemic & lipid parameters and daily insulin requirements and tolerability in type 1 diabetic patient.Materials & Methods: This was a clinical trial randomized double blind placebo controlled study. Performed on patients with history of at least 1 year diabetes type 1 and had HbA1c³7.5%. Patients with Cr³2, partial GI obstruction or IBD were excluded from the study. 45 patients were randomized to be administered acarbose or placebo for 12 weeks. Initial dose of acarbose was 25 mg T.D.S for 2 weeks, and then it was increased to 50 mg T.D.S for 10 weeks. BMI, FBS, 2hpp, HbA1c, Total cholesterol, HDL, LDL, TG and Insulin dosage were investigated monthly.Results: The values of BMI, FBS, 2hpp, HbA1c, Total cholesterol, and TG & Insulin requirements decreased significantly in the case group compared to the controls (P=0.003, P=0.005, P<0.001, P=0.001, P=0.003, P<0.001, P<0.001, respectively); but no significant changes were observed in HDL & LDL levels.Conclusion: Administration of acarbose together with insulin to type 1 diabetic patient can be valuable in improving metabolic control (BMI, FBS, 2hpp, HbA1c, Total cholesterol and TG).

Introduction & Objective: Urinary stones are among the most common complaints referred to nephrologist and urologists. Although incidence of urolithiasis is low in children compared to adults and only 7% of all urinary stones are diagnosed before the age of 16 but stones are detected more frequently in pediatric age group in recent years. Metabolic derangements, infection, neurogenic bladder and urinary obstruction are major risk factors of urolithiasis. Common metabolic risk factors of urolithiasis in children are hypercalciuria, uricosuria, hypocitraturia, hyperoxaluria, metabolic acidosis and cystinuria. There are many clinical studies about the frequency of these metabolic risk factors with different results reflecting difference in diet, geographic area and genetics in study populations. In this study we tried to evaluate the frequency of metabolic causes of urinary stones in children referred to Hamadan pediatric nephrology clinic.Materials & Methods: In this cross sectional-descriptive study 156 patients referred due to urinary stones to pediatric nephrology clinic underwent thorough metabolic evaluations including: serum calcium, phosphorus, uric acid, creatinine and non fasting random urine sample for calcium, creatinine, uric acid, oxalate, citrate and cystine. urine solute: creatinine ratios were calculated and compared with normative data.Results: Of 156 patients 136 (87.2%) had metabolic derangements including: hyperuricosuria in 71 (45.5%), hypercalciuria in 41 (26.3%), hypocitraturia in 26 (16.7%), hyperoxaluria in 16 (10.3%), cystinuria in 1 (0.6%) and metabolic acidosis in 39 (25%).Conclusion: High rate of metabolic derangement in pediatric urinary stone patients mandates proper metabolic evaluation in all of them. hyperuricosuria was the most common metabolic finding instead of hypercalciuria in this study. This could be due to differences in diet, geographic area and genetic background in various populations.

Introduction & Objective: Interstitial lung disease is the leading cause of mortality and morbidity in patients with scleroderma. For this reason an early diagnosis of lung involvement is warranted. The best approach to detect pulmonary disease particularly alveolitis (inflammatory NSIP) as a reversible phase is controversial. The aim of this study is estimating the advantage of HRCT as a noninvasive screening test to detect the pattern of ILD related to systemic sclerosis.Materials & Methods: In this cross sectional study, 52 patients with scleroderma who referred to rheumatologic medical center from 2010 to 2011 were evaluated for ILD by the use of history, physical examination, CXR and HRCT. Finally, all the data were analyzed using SPSS13 software.Results: HRCT was normal in 21 patients (40.4%), and NSIP in 19 patients (36.5%) and UIP in 12 patients (23.1%) were reported. CXR was normal in 19 (36.5%) and mild reticular pattern in 15 (28.8%), overt reticular pattern in 14 (26.9%) and honey combing in 4 (7.7%) were seen. HRCT findings were abnormal in 6 (11.5%) patients without dyspnea, 22 (42.3%) without cough, 20 (38.4%) without crackle in lung auscultation and 26 (50%) without clubbing in physical examination. In 2 (3.8%) patients no pulmonary signs and symptoms UIP were reported.Conclusion: HRCT is a noninvasive method to detect lung involvement in early phases independent of presence or absence of pulmonary signs and symptoms.

Introduction & Objective: C-reactive protein plays a special role in systemic inflammation of the body. Its predictive value in cardiac events is highlighted. In this study, the predictive value of CRP was studied in patients with unstable angina and its relation with MI, death, and intervention was assessed on admission and one month later.Materials & Methods: In a cohort study, 180 patients with unstable angina admitted in Hamadan Ekbatan Hospital were evaluated. The patients were divided into a group with high level of hs-CRP and a group with low level of hs-CRP as an exposure and control groups respective and were evaluated on admission and one month later according to MI, death and needs for intervention. The data was extracted with check list and analyzed with a chi square and t-test by SPSS software.Results: We couldn’t find any significant difference according to demographic data in both groups. There was no significant difference in MI, death, and intervention needs between two groups on admission (P>0.05), but in one month follow up we found higher incidence of complications in the group with high level of hs-CRP (P=0.045). The incidence of complication was 19 and 10 patients in the exposure and control group respectively on admission and 29 and 19 patients in the exposure and control group respectively one month later.Conclusion: We can conclude that the high level of hs-CRP can be predictive factor for cardiac complication one month after the admission.

Introduction & Objective: Fever is very common in children and is usually due to self-limiting viral infections. Management of fever is based on culture, community and religion of people all over the world. Parental concerns arise in part because of the belief that fever is a disease rather than a symptom or sign of illness. Misconceptions about childhood fevers heighten parents' concerns leading to inappropriate use of antipyretic drugs or overdosing may cause drug toxicity and frequent use of health care services. This study aimed to identify parental views of fever management in their children aged 0-5 yr.Materials & Methods: In this cross sectional study, 350 parents with children less than 5 years referred to various units of clinics covered by community oriented center of Kermanshah, completed the research questionnaire. Validity and reliability of the questionnaire were determined and the data was analyzed by SPSS Software.Results: Findings showed that the first medical care was sponging (53.1%). Sponging with saltwater was common (47.7%) and Over- the-counter medications were (30%). Acetaminophen was the first drug in 90% of the cases. However, many parents express high levels of anxiety so that they seek for self-medication with antibiotic 34% of the cases. Our study showed that correlation between over concern about fever management and parents who had a positive past medical history in their children with P=0.02, parents education (P=0.018) and in employed mothers (P=0.005) was statistically significant.Conclusion: Considerable efforts will be required to educate parents about fever and its management.

Introduction & Objective: Hodgkin lymphoma accounts for about 1% of all cancers. Cyclooxygenase 2 (COX2) is a cytoplasmic enzyme. Oncogene, and growth factor induce over expression of COX2. COX2 is apoptotic inhibitor. Mutation of the p53 tumor suppressor gene represents the most common genetic alternation in human tumors. This study aimed to evaluate the expression of COX2 and p53 in subtypes of Hodgkin's lymphoma.Materials & Methods: In this cross- sectional study, 62 Hodgkin's lymphomas were studied in admitted samples of pathology departments of Hamadan hospitals before 2005. Age, sex and type of HL were recorded in each case. p53 and COX2 expression was investigated immunohistochemically and expression intensity. The comparison of p53 and COX2 between subtypes of HL was evaluated with SPSS v13 software and chi-square test.Results: The mean age of the patients of HL was 41±16 and 79% if HL immunoreactive for p53. In this study the mean age of the patients of HL who died was more than the mean age of the patients of HL who survived which is statistically considered significant (P<0.003). 24% of the patients of HL were immunoreactive for COX2.Conclusion: Regarding to p53 and COX2 in subtypes of HL and insignificant difference in p53 and COX2 expression between subtypes of HL. We concluded that p53 and COX2 have not an important role in the prognosis of HL, but it is recommended to do more universal studies in the immunohistochemical level of P53 and COX2 to attain perfect results.

Introduction & Objective: The mental foramen is a part of lower jaw which has neurovascular bundles and also is important in biology. 3D imaging of this area by cone beam computed tomography (CBCT) before surgery can prevent some problems. This study aims to evaluate the anatomic position and geometrical shape of the mental foramen by CBCT images.Materials & Methods: In this research, the CBCT images (by NewTom and Planmeca promax 3D set) of 85 patients referred to dentistry school clinic or other clinics in Hamadan city were studied. These patients did not have their first and second premolar teeth extracted in both right and left sides. The geometrical shape of mental foramen, the canal angle connecting to mental foramen compared to the buccal plate of lower jaw, distance from the lower border of mental foramen to the lower border of lower jaw, position of mental foramen relating to the root of adjacent tooth and the incidence of accessory mental foramen were studied.Results: The means of canal angle connecting to mental foramen in the right side in men and women were 123.3 and 130.1 and in the left side were 123.8 and 133.7, respectively. The mean distance from the lower border of mental foramen to the lower border of lower jaw in the right side in men and women were: 12.4 and 13.3 mm and in the left side were: 12.7 and 13.6 mm, respectively. Also, there is a meaningful statistical relation between gender and the angle of canal of mental foramen, regarding to the buccal plate in both sides.Conclusion: Regarding to the variations in the position and shape of mental foramen and the angle connecting to the mental foramen related to the buccal plate and accessory mental foramen, investigation of CBCT images before placement of implants is necessary.

Introduction & Objective: The study of biopsychosocial factors influencing nephropathy as a most serious complication of type II diabetes is important. This study aimed to investigate risk factors accompanied with nephropathy in patients with type II diabetes based on the biopsychosocial model.Materials & Methods: In a cross-sectional descriptive study, 295 patients with type II diabetes were selected by convenience sampling in Tehran Shariati hospital outpatient clinics. The data were collected by demographical information questionnaire along with disease characteristics and depression anxiety stress scales (dass), quality of life scale (who- qol- bref), diabetes self-management scale (dsms), and diabetes knowledge scale (dks), then analyzed by chi-square, independent t-test and logistic regression with pasw software.Results: Hypertension (OR=3.841 & P<0.003), glycated hemoglobin (OR =7.898 & P<0.001), body mass index (OR=5.488 & P<0.001), diabetes self-management (OR=3.102 & P<0.001), depression (OR=2.574 & P<0.007), quality of life (OR=2.836 & P<0.001), and diabetes knowledge (OR=2.941 & P<0.001) can significantly help differentiate diabetic patients with nephropathy from diabetic patients without nephropathy (P<0.001). Sex, age, diabetes duration and stress do not play any significant role in the prediction of nephropathy incidence in this model (P>0.05).Conclusion: It is important to pay attention to hypertension, glycated hemoglobin, body mass index, diabetes self-management, depression, quality of life, and diabetes knowledge for therapeutic intervention programming and diabetes complications control protocols for diabetic patients.

Introduction & Objective: Adiponectin exerts anti-tumor effect through connection to its receptor. Some studies have shown that polymorphism in Adipor1 results in insulin resistance, diabetic type 2 and colorectal cancer (CRC). The purpose of this study is to investigate the incidence mutant allele of adiponectin receptor 1 polymorphism rs2275738 and to examine the association of genetic variant in ADIPOR1 rs2275738 with the risk of colorectal cancer.Materials & Methods: This study was a case-control type. Genotyping of adiponectin receptor 1 gene was determined in series of 106 colorectal cancer patients and 106 controls by the use of polymerase chain reaction and restriction fragment length polymorphism genotyping assay (PCR-RFLP). We calculated odd ratio and confidence interval (CI) of ADIPOR1 genotypes by SPSS 16 and X2 to examine if this polymorphism is associated with colorectal cancer.Results: The frequency of TT, CT, CC genotype for adiponectin receptor polymorphism rs2275738 in the patients was 27.4, 50, 22.6 percent, respectively. Frequency of TT, CT, CC genotype in the controls was 40.6, 22.6, 36.8, respectively. Allele frequency of T, C was 41 and 59 percents in the controls respectively and 52.4 and 47.6 in the patients. Incidence of mutant allele among the patients and the controls shows significant differences (OR=1.57 CI=1.07-2.31 P=0.01).Conclusion: These findings suggest that polymorphism Adipor1 rs2275738 is associated with increased risk of CRC.

Introduction & Objective: Color matching between restoration and natural teeth is a common clinical problem. Despite careful shade selection, color of the restoration may be affected by fabrication procedures such as number of firing. Moreover, color stability is an important factor to ensure the long-term clinical success of ceramic restorations. There is a lack of information about color change of ceramic restoration affected by colored beverages, such as coffee colorants. The purpose of this study was to evaluate the effects of repeated firings and type of ceramic system on the color stability of dental ceramic exposed to a coffee beverage.Materials & Methods: In an experimental in vitro study, ninety disc-shaped specimens (10 mm in diameter with 0.5 mm core thickness and 1.5 mm dentin veneering thickness) from three ceramic system (PFM, IPS Empress 2, Zirconia-based) were made. Each system, based on the number of firings (3, 5, 7) was divided into 3 groups, then after repeated firings, half of each group was immersed in distilled water and another half in coffee (n=5). Color readings were determined with a colorimeter before and after firings and immersion in solutions, and L*, a*, and b* coordinates and total color variation (DE) were analyzed. ΔE was calculated using the formula ΔE*=[(DL*) 2 + (Da*) 2 + (Db*) 2] 1.2. A repeated measure ANOVA was used to analyze the data. The Tukey HSD test were performed for multiple comparisons (a=0.5).Results: The ΔE values of the ceramic system were affected by the number of firings (3, 5, 7) (P<0.005) and the type of porcelain system (P<0.005). Significant interactions were present among the number of firings and the type of porcelain system (P=0.000). An increase in the number of firings produced an increase in the ΔE values but only for IPS system, the number of firings (3-5) was clinically significant (DE>3).The average ΔE values were higher for those with less firings (3-5) than for those with more firings (5-7).The beverages and it’s interaction by the number of firings and type of porcelain system did not cause significant changes statistically (P>0.005).Conclusion: The type of porcelain system and number of firings affected the color of the ceramic material tested. Coffee beverage did not produce any perceptible changes on the final color (DE<3).

Introduction: Medullary thyroid cancer (MTC) is a neuroendocrine tumor which originates from the parafollicular cells. The prognosis of MTC is poor and thyroidectomy can be effective. Castleman's disease or angiofollicular lymph node hyperplasia is an uncommon benign lymphoproliferative disorder. The most common form is hyaline vascular type which is usually asymptomatic and surgical resection often cures it.Case Report: The case was a 38-year-old male with a thyroid mass resected by surgery. The pathology of the mass was MTC. He returned with dyspnea and imaging revealed a mediastinal mass that was Castleman's disease as reported by pathology. MTC lesions can metastasize to regional lymph nodes but the pathology of the mediastinal mass was not metastatic.Conclusion: According to the literature, medullary thyroid cancer and Castleman's disease are not predisposing factors for each other up to now. This is the first case with simultaneous occurrence of these two diseases that might help to find a new etiology for them.

Introduction: Central giant cell granuloma (CGCG) is a relatively rare and non neoplastic tumor with unclear exact etiology that is reported in children. Cone beam computed tomography (CBCT) technique for precise diagnosis and treatment of the jaw lesions is recommended in the recent years. The object of this case-report study is to use CBCT in the diagnosis and treatment of CGCG.Case Report: A 6-year-old boy with a painless swallowing at the right side of the lower face had been arisen 3 months before referring to the pediatric department of Mashhad dental school. The lesion had bony hard consistency and smooth surface. For more accurate examination of the region CBCT radiographs were recommended. According to CBCT radiographic sections, expansion of cortical plates and precise extension of the lesion in buccal-lingual and mesial-distal aspects were distinctly observed.Conclusion: A 12 month follow up after the surgery showed reconstruction and growth of the bone and no sign of recurrence.