Journal of Medical Council of Iran
Year:2011 | Volume:29 | Issue:1|Papers Count:16

Background: Non alcoholic fatty liver disease probably is the most common liver disorder in the world. The causes of NAFLD may be divided into two broad categories: drugs and metabolic abnormalities. Because previous studies reported relatimship between celiac and NAFLD/ we have studied this association in this article.Methods: This study was performed between September 2007 and Desember 2008. We measured human anti-tissue transglutaminase IgA antibody titratage by ELISA technique in 95 NAFLD inflicted patients, with out any risk factors for NAFLD, then patients with positive ATTG underwent upper endoscopy with duodenal biopsy.Results: Positive ATTG was found in 6 out of 80 patients (7.5%). Endoscopy was performed in 6 patients. Duodenal biopsy was normal in 2 patients (33.3%) and 4 patients (66.7%) had abnormal duodenal biopsy. Two patients were in Marsh stage 1 and one in Marsh stage 2 and a nother one in Marsh stage 3. None of them had symptoms suggestive of celiac disease.Conclusion: This present study shows that positive ATTG is not rar in patients with NAFLD. we recommend serum ATTG  should be check in patients with NAFLD without any obvious etiology, also upper endoscopy with duodenal biopsy should be taken for all patients with positive ATTG.

Background: Preoperative consumption of some drugs can control intra operative and post operative pain. Gabapentin and Tizanidine analgesic effects have been studied but a comparison between analgesic effects of these two drugs has not been studied before.Methods: we studied 60 patients with tibial fractures between 15 to 80 years. They were divided into two groups: 30 patients were given 300 mg Gabapentin orally 1 hour before operation (Group G), and 30 patients were given 8 mg Tizanidine by oral route 1 hour before operation (Group T). pain was assessed 1 hour before untill 12 hours post operation using Visual Analogue Scale (VAS). All patients had general anesthesia. Vital Signs and fentanyl consumption during Surgery, the first time morphine was needed and the total dose of Morphine after operation were assessed.Results: Systolic, diastolic blood pressure and heart rates during operation between two groups were not statistically significant. Intra operative fentanyl dose in group G was significantly less than group T (P=0.001). The first time morphine was needed in group G was significantly longer than group T (P=0.001) and total dose of Morphine Consumption during 12 hours after operation in group G was significantly less than group t (P=0.003). VAS was only different between two group 12th hours. After operation.Conclusion: preoperative oral consumption of Gabapentin compared to Tizanidine might facilitate better analgesia and more opioid saving during and after operation.

Background: Heart rate recovery (HRR) after exercise test and resting heart rate are shown to be important predictive risk factors for cardiovascular and all-cause mortality in individuals with CVD. Therefore the purpose of this study is comparison of the effects of selected aerobic continues and interval exercise training on resting heart rate and heart rate recovery after 1, 2 and 3 minutes in POST CABG patients.Methods: Twenty four POST CABG patients (22 men, 2 women with mean age: 57.04±8.42 and mean BMI: 27.17±2.98 kg/m2) were divided to a selected aerobic continues training, 30-60 min and intensity of 70–85% of HR maximum (n=12)  and  an aerobic interval training with three interval (9-15 min), 27-45 min and intensity of 75-90% of HR maximum (n=12). They perform the exercise protocols three times per week for 8 weeks.Results: Result of pair T test showed, there are significant differences between pre and post resting heart rate after continues and interval training (respectively, p=0.034, p=0.013). Continues and interval exercise training have significant effects on heart rate recovery in 1, 2 and three minutes after exercise (continues; t1: p=0.049, t2: p=0.033, t3: p=0.005. interval; t1: p=0.033, t2: p=0.038, t3: p=0.018). Also there are not any significant differences between the effect of continues and interval exercise training on resting heart rate (p=0.311) HRR (t1: 0.181, t2: 0.885, t3:953) after program.Conclusion: Both continuous and interval exercise training program improves resting heart rate and HRR minute’s 1,2 and 3 in Post CABG patients and there are not any significant differences between two methods. This indicates the positive effects of exercise training on vageus tone and autonomic nervous system.

Background: There are a few articles about effects of anaesthesia methods in different labor phases so the aim of this study is to compare effects of different anesthetic methods (Epidural, spinal, general) on duration of different labor phases in pregnant women.Methods: In a descriptive cross-sectional study on 80 pregnant women that refered to Najmieh’s labor block in summer of 2007 duration of active phase and second stage of labor were compared based on anesthesia method.Results: Mean time from anesthesia until full cervix dilatation (Active phase) in pregnant women with epidural, spinal, and general method of anaesthesia were 124.83±96.42, 118.25±83.10 and 102.51±76.02 (minutes) respectively. The difference between 3 methods was not statistically significant (P=0.55). Also mean time of Cervix dilatation till full delivery (stage 2) with epidural, spinal, and general anesthesia was 71.33±39.21, 61.72±43.23 and 57.19±20.1 (minutes) respectively, but the difference was not statistically significant, (P=0.60).Conclusion: Labor phases in 3 methods of epidural, spinal, and general anesthesia does not differ statistically. So in addition to improving quantity and quality of painless Laber for decreasing cesarean rate, improvement of regional anesthesia techniques is a must.

Background: Abnormal uterine bleeding (AUB) is a common disease which can lead to several somatic and psychiatric problems. In the other hand, the causes of AUB seems to be different in virgin patients under 40 years old comparing to married women. So we decided to study the findings of transabdominal sonography in virgin patients under 40 years old with AUB.Methods: Two hundred virgin patients under 40 y/old with AUB were studied. At first, the type of AUB, the duration of disease and previous history were registered and then transabdominal ultrasound was done by two separated radiologist with a Gynecologist, logic 500 ultrasound system with 3.5 MHZ convex probe and sonographic findings were recorded.Results: Ultrasound was normal in 49.5% and abnormal in 50.5% of patients. Ovarian findings were more common than uterine findings and were seen in 46% of patients but uterine abnormal findings were seen in only 12.5% of patients. (In some patients, ovarian and uterine abnormal findings were seen together).The most common sonographic findings including: absence of dominant follicle in ovaries (25%) and then ovarian cyst (19.5%) and polycystic ovary syndrome (13.5%) and endometrial hyperplasia (8.5%). By the way, the most common types of AUB were oligomenorrhea (56%) and hyper menorrhea (25%). In patients with oligomenorrhea the most common abnormal findings were absence of dominant follicle (35%) and PCO (21%) and in patients with hypermenorrhea were ovarian cyst (22%) and absence of dominant follicle (10%).Conclusion: In our study, ultrasound was normal without any detectable sonographic abnormality in about half of the patients. The cause of AUB in these patients, seems to be dysfunction, may be due to Psychiatric problems and stresses.Among the pathologic findings, absence of dominant follicle due to an ovulation (dysfunction) is the most common finding and uterine pathology is less common.According to all findings, it seems that in virgin patients under 40 old with AUB, dysfunction due to stress and Psychiatric problems is the main reason and therapeutic management should be relay on it.

Background: Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinsl disorders characterized by abdominal pain/discomfort in association with altered bowel habits in the absence of any organic cause. The pathophysiology of IBS remains uncertain but hereditary and environmental factors are likely to have a role. The diagnosis of IBS is currently based on the ROME III symptom-based criteria. IBS is subtyped based on predominant bowel habit and pharmacologic treatment is according to this classification, too. In addition to pharmacologic agents, effective patient-physician relationship, diet and psychological treatment are important in management.Nowadays, with improvement in understanding the pathophysiology of IBS, many therapeutic modalities have introduced and new drugs with novel mechanism of action will hopefully be developed.

Free living amoebas are abiquitous in environmental sources. Some species of these organisms are causative agent of fetal diseases in both immunocompetent and immunocompromised individuals. Member of four genera including: Acanthamoeba spp., Balamuthia mandrillaris, Naegleria fowleri and Sappinia diploidea causes infections of the central nervous system, lungs, sinuses, eyes and skin in human being. Due to progresses of human knowledge about these protozoa, it is possible that other free living amoeba may be found as potential agents of human and animals infections and death. Because of prevalence of Acanthamoeba keratitis in Iran, Familiarity with these species is important.

Introduction: HELLP syndrome is a multisystem disease and a pregnancy complication consisting of Hemolysis, Elevated Liver enzyme level and Low Platelet count. (1) We report on a patient with postpartum presentation.Case Report: The patient was a 28 years old female at 30th week of her third pregnancy referred to bank melli hospital complaining of fevere, chills, dysuria and frequency and admitted with diagnosis of urinary tract infection. After few days disease was progressed and abnormal laboratory tests ensued. Due to worsening general condition the pregnancy was terminated .After delivery platelet count decreased and she met all criteria of HELLP syndrome and received corticosteroid and the disease improved.Discussion: Pathogenesis of HELLP syndrome is vague and there are different hypotheses all common in endothelial damage, vasospasm and coagulation system activation. This syndrome can present in the third trimester of pregnancy (%69) or after delivery (%31). In most patient with post partum presentation, the disease is manifested during the first 48 hours after delivery.Corticosteroid therapy in all patient with complete HELLP syndrome (hemolysis, elevated liver enzyme level and low platelet count) is recommended. We reported on patient with complete HELLP syndrome presented post partum and good response to corticosteroid therapy.