Shiraz E-Medical Journal
Year:2010 | Volume:11 | Issue:3|Papers Count:8

Background: Patients with rheumatoid arthritis (RA) are at increased risk of developing low bone mineral density. The aim of the present study was to compare the bone mineral density of Iranian female RA patients with healthy controls.Materials and methods: In this case-control study, bone mineral density of 391 rheumatoid arthritis patients and 391 healthy controls referred during a 4-year period (2003-2007) to Imam Khomeini Hospital in Tehran, were studied. Patients were assigned in two subgroups; group 1 (n=184) with a history of current oral corticosteroid use and group 2 (n=207) with-out corticosteroid use. Dual-energy x-ray absorptiometry technique was used to measure bone density. Differences between groups were analyzed using Fisher's exact test. Duncan test and Schaffer test were used to compare mean difference between each two groups.Results: Among £45 and >60 years females, bone density did not show a significant differ-ence at lumbar region between the 3 groups, however, the differences at femoral neck were statistically significant (p<0.04 for £45 years and p<0.0003 for >60 years). Among subjects aged 46-60 years, bone mineral density showed significant differences at both lumbar and femoral neck regions (p<0.001, p<0.001, respectively).Conclusion: Low bone density in Iranian female patients with RA is in accordance with west-ern societies. Among RA female patients the risk of BMD reduction is increased by age and partly by oral glucocorticoids. Therefore, routine BMD evaluation is strongly suggested for RA patients.

Background: Salmonellosis is a major health problem, especially in developing countries like Rwanda. Salmonella typhi infects only human and human transmission occur through feacooral route. Moreover, species are becoming resistant to the commonly used antibiotics.Objective: The aim of the present study is to know antimicrobial susceptibility patterns with special reference to multidrug resistance Salmonella enterica serovar Typhi and reduced susceptibility to nalidixic acid.Materials: A total 69 S.typhi isolated of King Faisal hospital, Kigali, Rwanda from stool and blood specimens were included in the study. Antimicrobial susceptibility was done by using Kirby Bauer disc diffusion method.Results: There was decreased susceptibility was observed in Chloramphenicol, Ampicillin, Amoxycillin/Calvvlanic acid, Tetracycline, Cotrimoxazole and Nalidixic acid. These were significant increase in the multidrug resistant salmonella typhi (MRST) from 9.1% to 25% respectively between 2007 and 2008. All the isolates were 100% sensitive to Ceftriaxone, Levofloxacin and Ciprofloxacin.Conclusion: Typhoid fever has been endemic in Kigali. Decreased susceptibility towards nalidixic is obsevered which gives us alarm for treatment failure towards fluoroquinolones. The antibiotic sensitivity pattern is changing and resistant cases are emerging due to inappropriate use of antibiotics.

Background: Concerns about infection with Human Immune Deficiency Virus (HIV) among adolescents has renewed interest in developing countries, where they represent a large proportion of population and are at high risk. Little is known about sexual knowledge of university students in Malaysia. University students’ pattern of risky behavior and the extent of their knowledge regarding HIV can determine the type of interventional programs that can be developed for the sensitive issue of HIV in a country where Islam is the national religion.Methodology: A cross-sectional study on sexual and drug use behavior, knowledge and attitude of HIV risk was undertaken amongst 530 university students using simple random sampling.The study was conducted using a self-administered questionnaire.Result: Knowledge of university students about HIV was high but there are still some remaining misconceptions. Contribution of parents and medical personnel in informing students about HIV was negligible while audiovisuals including internet were found to be the main source of knowledge. Students’ risk taking behavior was low as only 2.3% of students reported sexual activity during last 12 month, 58.3% of whom were using condoms. Frequency of intravenous drug use was 1.7% only. Two percent self-reported as HIV positive. However frequencies of tobacco use and alcohol intake was 21.2% and 9.7% respectively. Peer pressure (63.9%) and lack of guidance (23.9%) was reported to be the main reasons for students’drug use. Females had a better attitude than males (p=0.02). There was a correlation between score of knowledge with attitude (p=0.01) and behavior (p=0.05).Discussion and conclusion: Parents’ guidance about risk taking behavior should be encouraged.Peer education intervention programs are needed for university students to clarify theirmisconceptions, improve their attitude and prevent risky behavior. Further studies to investigate the role of tobacco and alcohol use on the students’ risk taking behavior are recommended.

Background and Objectives: The objective of this study was to find out the prevalence of anxiety and depression in adult hospitalized patients in internal and surgical wards of Shiraz University Hospitals in year 2008.Materials and Methods: The study was designed as a cross sectional study. A validated measurement tool was used in this study was the Hospital Anxiety and Depression Scale (HADS) (the questionnaire of case ness). Data collection was carried out in two major university hospitals and two private hospitals in Shiraz. Statistical analysis included the Student’s t test, and chisquare test and logistic regression analysis.Results: Thirty (4.3%) patients were normal within anxiety and depression, 216 (30.9%) were borderline cases of anxiety, 454 (64.9%) were probable cases of anxiety, 373 (53.4%) were borderline cases of depression and 296 (42.3%) were probable cases of depression. There was significant association between normal, borderline and probable groups of depression according to times of admissions and also between normal, borderline and probable groups of anxiety and depression according to duration of hospitalization and ward of admission. Most of borderline and probable cases of anxiety were admitted in internal ward. Most of normal and probable cases of depression were admitted in internal ward too.Discussion and conclusion: Prevalence of anxiety and depression in hospitalized medical patients is grate. The high levels of anxiety and depression detected in this sample suggests that screening for psychological comorbidity is important in rehabilitation settings and should be included in the clinical interview carried out by the nurse at the duration of admission to the ward. Accurate diagnosis of comorbid depressive and anxiety disorders in patients who admitted in medical care services is essential in understanding the cause and in optimizing the management of somatic symptom burden.

Introduction: suitable information of different cancers in special geographic areas can help define medical programs for treatment and screening of high-risk groups.Aims and Methods: The aim of this study is to present the frequency of cancers in Hospitals of the Zahedan. A comprehensive search was undertaken to survey and register all cases of cancer r during a 4-year (2003-2006) period among the indigenous population of Zahedan. Diagnosis of cancer was based on histopathology, clinical or radiological findings, and death certificates. From these analyses, the general and specific frequencies by age and by sex were obtained for the different group of neoplasms. Also, the frequency of the stage of the disease that had been diagnosed in cases with solid tumors was obtained.Results: A total of 1452 patients with cancers (mean age 51‡19 years) were found during the study. Of these, 841 (58%) were in males. Gastrointestinal cancers were the most common tumors with a frequency 30%. In upper gastrointestinal cancers, Esophagus cancer was the most common (26 %), followed by stomach malignancies (22%), colorectal (20 %), liver (15 %). Hematological malignancies were second common malignancies in Zahedan with a frequency of 20%. In Hematological Malignancies ALL was the most common (28.44%). The top 5 cancers in males (excluding skin cancer) according to the calculated ASR (age standard rate) were esophagus, stomach, leukemia, colon and rectum and bladder; in females, these were stomach, esophagus, breast, colon and rectum and lung and bronchus. In the child population the most common tumors were Acute lymphocytic leukemia, lymphoma and bone.Conclusion: Hematological malignancies alone constitutes onefifth of all cancers in Zahedan, with the highest ASR incidence rate reported from Iran up to now, and one of the highest in the world. The principals cancers in the patients treated in Hospitals of Zahedan were esophagus cancer, gastric cancer, Leukemia, and breast cancer consistent with those reported by other place. In this population Leukemia had a very high incidence. This fact will need to be confirmed by a longer period of observation, but even now the total number of cases (particularly Leukemia) is high when compared with the data of other Leukemia registries which give rates for longer period and for similar or larger population.

Atrial fibrillation (AF) is the most com-mon sustained cardiac arrhythmia, af-fecting an estimated 2.3 million people in North America. The estimated prevalence is 0.4% to 1% in the general population and up to 8% in the population>80-years-of-age. AF is associated with an increased risk of stroke and all-cause mortality, although it is unclear whether this is a marker of severity of underlying heart disease6 or whether there is a causative relationship.

Metastasis to small bowel may occur in patients with cutaneous malignant melanoma. Intestinal metastases may present with pain, constipation, obstruction, perforation, bleeding, and anemia. A 40-year-old man, a known case of malignant melanoma diagnosed 5 years back, was brought to the emergency department with intestinal obstruction. He had widespread metastatic disease with involvement of brain, lung, liver and small bowels. One metastasis in the ileocecal region caused obstruction. Proximal ileostomy was created as an emergent palliative procedure. In conclusion, palliative operations are successful in reliving some intestinal complications of metastatic malignant melanoma.

Medical education in India has come a long way since independence. Various medical institutions and regulatory bodies have made considerable changes in the systems and procedures required for opening medical colleges and postgradu-ate institutes.Today growth has taken place both in Government and private sectors. Many new medical institutes and universities are being started to cater to the growing needs of our country.