Tehran University Medical Journal
Year:2005 | Volume:63 | Issue:3|Papers Count:14

Background: Patients with type 2 diabetes are often obese and require large dose of insulin to achieve glycemic control. Insulin therapy often cause weight gain and results in increasing insulin requirements. This study was conducted to evaluate the efficacy of metformin in combination with insulin in patients with type 2 diabetes poorly controlled with insulin therapy alone.Materials and Methods: In a randomized clinical trial in outpatient diabetes clinic at university medical center, 39 patients with poorly controlled type 2 diabetes who were receiving insulin therapy were randomly assigned to receive metformin in combination with inslin or insulin alone for six months.Results: Hemoglobin A1C levels decreased by 1.56 percentage (95% cl, 0.77 to 2.34 percentage point) in metformin group, a significantly greater change (P=0.008) than the increase of 0.03 percentage points in the insulin alone group. Average final hemoglobin A1C levels were 7.96% in the metformin group and 10.32% in the insulin alone group (difference 17%). For patients who did not received metformin, the insulin dose increased 9.37 units (95% cl 6 to 12 units) or 37% more than did the dose for patients who received metformin. (P<0.0005): for these patients, the insulin dose decreased 6.6 units (95% cl-1.24 to –11.96) Patients in insulin alone group gained an average of 3.08 kg of body weight (95% cl 1.56 to 4.58 kg) patient in the metformin group gained an average of 1.8 kg (95% cl 0.21 to 3.36 kg) Difference (1.9%) was not meaningful. Change of total cholesterol, low density lipoprotein cholestrol and triglyceride levels was not significant.Conclusion: The addition of metformin to insulin therapy resulted in hemoglobin A1C concentrations that were 17.8% lower than those achieved by insulin therapy alone. This improvement occurred with use of 37% less insulin. Metformin is an effective adjunct to insulin therapy in patients with type 2 diabetes.

Background: Medical education is inherently stressful and demanding to deal with various stressors, which may cause impaired judgment, reduced concentration, lack of self-steam, increased anxiety and depression.Materials and Methods: A cross sectional study was conducted on 250 medical students from 6 month period to graduation in medical college of Tehran university of Medical sciences in order to assess their anxiety and practice of health behaviors and also the relation between the two variables and some other related factors..Results: The results of study show that of 6.6% medical students suffer from severe state and 4.9% from trait anxiety. The finding of this study shows that 83.3% of girls and 84.6% of boys have practicing risky health behaviors. No statistical relationships found between, anxiety and practicing health behaviors. The relation between anxiety and health satisfaction was Statistically significant; mental and physical (P<0.001).Conclusion: The information found in this research, can help medical education institute to capitalize an opportunities to help their students in preventing risky behaviors, and different stress management techniques should be taught at medical schools.

Background: Routine Para clinic evaluation of preoperative patients tends to cause unnecessary costs, extra risk to the patients, inefficient operating room schedules and extra medico legal risk.Furthermore, it seldom affects clinician"s preoperative evaluation and decision making process for healthy patients. Numerous studies have shown that about 60% of these will not be performed if they are ordered according to recognizable indications based on history and physical examinations unfortunately the ‘indication based’ method can not replace to “routine” method due to difficulty and complexity to performing.Materials and Methods: We reviewed records of 1700 patients on a retrospective descriptive study in Sina Hospital from September 2000 to the end of September 2001. These patients had undergone general surgical procedures and were categorized as American society of anesthesiologists classification I or II. Results of complete blood count, fasting blood sugar, blood urea nitrogen, serum creatinin, sodium, potassium, chest X-ray, electrocardiogram and urinalysis were compared between patients under 40 years of age (n= 894) and patients aged 40 and over (n= 806).Results: Among 4935 tests performed in patients under 40 years of age, only 1004 (20.3%) were indicated, and treatment plan was not altered due to the results of routine tests in any case. In the other group, patients aged 40 and over, 6300 tests were performed, from which 3361 (53.3%) were indicated and treatment plans of 5 patients were influenced by the results of routine tests.Conclusion: Routine preoperative Para clinical tests is not cost effective method, otherwise the “indication based” also is difficult and complex method. We offer routine preoperative Para clinical tests only in patients over 40 years to combine ease of “routine” with a great reduction in medical costs and no adverse affect to patient care.

Background: Pre-eclampsia is characterized by hypertension development and proteinuria during pregnancy. Hypertension disorder is a leading cause of maternal and fetal morbidity and death in worldwide. Although the pathophysiology of hypertension during pregnancy is unclear, but there is consensus that early diagnosis and aggressive treatment is warranted to prevent complicated to both fetus and mother. The changes of serum trace elements during pregnancy are paramount important to predict and good understanding the situation of patients. The aim of this study was about this issue.Materials and Methods: In a case-control study we investigated the possible differences in the level of serum calcium, phosphorus and total protein in 55 healthy pregnant and 52 pregnant with hypertensive disease at 32-40 weeks of gestational age during the recent two years in Loghman hospital of Tehran. Some information such as age, blood group, parity number and blood pressure was taken from patients by a questionnaire. Results: The case population consisted of 22 sever preeclampsia, 15 mild preeclampsia, 8 eclampsia, and 7 chronic hypertensive. The mean serum calcium concentration (mg/dl) was 9.18±0.74 in control group, 8.81±0.9 in mild preeclampsia, 7.85±0.38 in sever preeclampsia, 7.83± 0.47 in eclampsia, 8.91± 0.3 in chronic blood pressure. The mean serum phosphorus (mg/dl) level observed, 4.27 in sever preeclampsia, 3.74 in eclampsia, 3.59 in mild eclampsia, 4.09 in chronic blood pressure, and 3.43 in control pregnant women. The mean serum total protein concentration level in sever preeclampsia and eclampsia was 5.46 and 5.04 mg/dl respectively. Conclusion: In conclusion, sever preeclampsia and eclampsia are associated with decreased level of calcium, total protein, and increased concentration of phosphorus.

Background: The purpose of this study is to determine the incidence of electrolyte and ABG abnormalities in infants with HPS and also we evaluate other parameters of the study.‎Materials and Methods: This descriptive study covers 161 infants with HPS hospitalized in children Medical center of Tehran university underwent surgical repair from march 1996 to march 2002 . ‎Results & Conclusion: The results indicated that Hypokalemic metabolic alkalosis had occurred in 40% of patients. ‎The sex ratio was 3/1 =M/F and the most time of presentation was between 15t and 5st week and the most presenting sign was vomiting. Clinical icter happened to be found in 15% of patients. The incidence of accompanying anomalies was 9% and olive sign was palpable in 40%. ‎The best way for evaluating and diagnosis was sonography. ‎The mean period to begin postoperative feeding was 30 hours" no complication related to option was reported after operation.

Background: Low back pain (LBP) is a one of the most common symptoms of vertebral column diseases. Spinal muscles have a outstanding role in maintaining vertebral column function in daily life. But proper function and motion of hip and knee joints also has an important role in performing smooth, fine and nonstressed movements of lumbar spin. Where as accurate and fine motions of hip and knee joints in cooperate with lumbar spin can improve translation and summation of forces and increase performance of movements. The aim of this research is to indicate the amount of interventions of lower limb joints on lumbar spin function in patients with LBP, and attention to physical treatment (PT) of them. Materials and Methods: Fifty females with LBP due to osteoarthritis (OA) of lumbar spin participated in this study and divided in two groups randomly with similar number of cases: a) ordinary treatment or control group and b) complementary treatment group. Patients in control group treated by routine PT approach ( superficial heat, ultrasound, TENS, forward flexion and back extension exercises ) and patients in complementary or test group received routine treatment similar to control group and also strength and stretching exercises of hip and knee joint muscles (latisimous dorsi, gluteous maximus, iliopsoas, quadriceps and hamstring ) bilaterally. Range of motion (ROM) of lumbar, hip and keen joints by valid goniametere and pain of lumbar in motions at all of axis by visual analog scale measured before, after five and ten sessions of treatments in both groups.Results: In control group with non parametric tests there was not significant difference of MMT of muscles and ROMs of hip and knee joints. Lumbar pain in motion after ten sessions of PT in this group reduced significantly (P<0.05). Increase of lumbar motion in all of axis after PT was significant at this patients (P<0.05). In second group that received complementary treatments; ROM of joints, lumbar pain had significant differences between onset of treatments and five and ten sessions later (P<0.05), but there was not significant findings in MMT of muscles. There were significant differences between percentages of reduce of pain and increase of ROM in comparison of two groups (P<0.05).Where as patients that received ordinary PT and strength and stretching of muscles around of hip and knee indicated better recovery signs.Conclusion: Reduce of lumbar pain with improve of motion and flexibility of muscles such as quadriceps, hamstring, gluteus maximus, iliopsoas and latisimous dorsi in a complete physical therapy approach indicate there are a great correlation between lumbar pain and functionality of lower limb joints. Therefore concentration to flexibility and extensibility of muscles of lower limbs is a basis aim in treatment of patients with lumbar OA.

Background: The aim of this study was to provide data, on the distribution or intraocular pressure (IOP) in Tehran population. Materials and Methods: Through a population-based, cross-sectional study, a total of 4565 Tehran citizens were studied in the Tehran Eye Study. The findings of the participants (n=3834) 10 years and older free of glaucoma diagnosis or suspicion who had undergone applanation tonometry examination are presented. All participants received a standardized protocol included applanation tonometry, and some other ocular measurements, fundus examination, demographic data and an interview. IOP measurement was used to evaluate its distribution by age, sex, and some eye parameters. ‎ Results: Mean ± SO IOP was 14.5±2.6 in the total population, 14.4±2.7 in men, and 14.5±2.5 in women. Normal range (mean±2SD) of IOP was determined to be 9.3 - 19.7 mmHg. IOP increased significantly with age and cup-disc ratio except for a fall in old ages. This relationship was also observed when we analyzed individuals without diabetes or hypertension history. IOP increased with darker eye pigmentation except for blue/gray eyes. There was a non-linear ‎increase of IOP from emmetropic to high myopic eyes. ‎ Conclusion: Mean and/or normal range of IOP and their associations have been reported with wide differences in various studies. It is wise that studies evaluate IOP distribution or associations in healthy people and glaucoma people separately and also report the prevalence of IOP risk factors in their population to allow for a logical comparison of studies.

Background: Despite several years of intensive investigation, relatively few studies have been made of children with lupus nephritis. The prognosis of children with lupus nephritis is poor for those with diffuse proliferative glomerulonephritis and active interstitial inflammation. As newer treatment modalities become available for patients with severe lupus nephritis, it become increasingly important to identify patients at risk for renal failure. The aim of this study was to evaluate the clinical course, histopathology, serologic features and prognostic significance of some parameters, to identify the risk factors for renal failure and mortality in children with lupus nephritis. Materials and Methods: Retrospectively 30 children under 16 years of age with lupus nephritis from 1989 to 1999 were studied. All patients received renal biopsy and follow-up biopsies were performed in 3 children. Lupus nephritis was classified by the World Health Organization (WHO) criteria. The clinical and serologic parameters at the time of renal biopsy were recorded.Results: All children underwent renal biopsy within 1 year of disease onset. There were 1 (3.3%) patients with class II, 5 (16.7%) with class III, 21 (%70) with class IV, and 3 (%10) with class V nephritis based on initial biopsy according to the WHO classification. The mean follow-up time was 60 months. Follow-up biopsies were histologically stationary in 2 patients and progressive in one. The overall renal and patient 5- year survival rates were 46.66% (14/30) and 93.33 %( 2/30) respectively. They were 47.61% (10/21) and 95.21 %( 20/21), respectively, of patients with class IV proliferative glomerulonephritis. Children with renal pathology (class V in the WHO classification system) at initial biopsy, were at high risk for renal failure 66.66% (2/3) or morality %33.33 (1/3) despite aggressive treatment. The results revealed that those with persistent hypertension, anemia, and decreased creatinine clearance rate, nephrotic proteinuria, at initial biopsy were more prone to develop renal failure (P<0.01).Conclusion: The prognosis of children with class IV nephritis in our study was better than reported in other series in recent years. However, those with class V disease, persistent hypertension, anemia, low creatinine clearance and nephrotic proteinuria at the time of diagnosis are at increased risk for renal failure. The improved results may be due to initial histological classification, better supportive care and selective use of aggressive therapy such as methylprednisolone pulse therapy and intravenous cyclophosphamide for those with high risk factors.

Background: Sub clinical hyperthyroidism is a state of subnormal serum TSH and T3,T4 within normal range, although usually without overt clinical manifestation but many disastrous complications especially in senile patient. In Iranian people, serum TSH is generally assayed by IRMA method. This study is aimed to determine the value of low serum TSH in these patients, better management and decision when encountered.Materials and Methods: The populations under study are guys with serum TSH lower than 0.5mu/l and normal thyroid hormones without known thyroidal and non-thyroidal illness. A basal serum TSH and TSH 30 minutes after TRH injection intra venous were sampled and correlation of clinical signs and symptoms and basal TSH with sub clinical hyperthyroidism was considered.Results: The population under study was categorized into five groups and prevalence of sub clinical hyperthyroidism was noted. In patients with b.TSH equal or lower than 0.1mu/l, 100%, 0.1-0.2mu/l, 75%, 0.2-0.3mu/l, 38.5%, 0.3-0.4mu/l, 14.3% and TSH levels greater than 0.4mu/l, were all normal. After analyzing of these data and determination of sensitivity and specificity of IRMA, it was concluded that IRMA is not sufficient to distinguish sub clinical hyperthyroidism, although there is a good linear (r=0.68; P<0.001) and cubic (r=0.79; P<0.001) relationship between b.TSH and d.TSH.Conclusion: Since TRH test is not cost effective for all cases, TSH levels lower than 0.25mu/l, can be considered as sub clinical hyperthyroidism and levels more than 0.4mu/l, as normal. In cases with TSH level between 0.25 and 0.4mu/l, TRH test is needed in high-risk patients.

Background: Bacterial meningitis is a fatal disease with high mortality and morbidity that needs emergency management. But due to nonspecific signs and symptoms it"s diagnosis in children is difficult. Recently procalcitonin has been used for diagnosis of serious bacterial infections like bacterial meningitis. We conducted a prospective study in children for evaluation of procalcitonin in differential diagnosis of acute bacterial and viral meningitis.Materials and Methods: In a prospective process research, we measured CSF procalcitonin levels in 43 children older than two months referred to Markaz Tebbi hospital. According to the results of universal PCR the patients were divided into two groups: bacterial meningitis (n=11) and nonbacterial meningitis (n=32). To analysis the results, Mann-Whitney test was used.Results: CSF procalcitonin level in bacterial meningitis was significantly higher than viral meningitis (1.72±0.9 ng/ml and 0.71±0.04 ng/ml respectively, Pvalue= 0.00). A serum procalcitonin level >0.5 ng/ml had high sensitivity and specificity (90.1% and 97.1% respectively) in the diagnosis of bacterial meningitis.Conclusion: CSF procalcitonin level seems to be a valuable marker in differentiating between bacterial and viral meningitis.