MEDICAL JOURNAL OF MASHHAD UNIVERSITY OF MEDICAL SCIENCES
Year:2006 | Volume:49 | Issue:93|Papers Count:22

Introduction: Leishmaniasis is one of the human diseases severity of witch varies from a self limiting cutaneous lesion to a severe visceral form. It is endemic in several parts of the world including our country Iran and especially in the province of Khorasan and the city of Mashhad. The study was intended to evaluate the percentage of monocellular macrophages in 36 patients and to investigate their role in prevention of the disease and its response to the treatment.Material and Methods: The study was a case-control study conducted from August 2001 until October 2002 in Ghaem Hospital and Bu-Ali Research Ins. of Mashhad University of Medical Sciences and fmally 29 patients were carried out the survey as the study group and 23 people of their families as control group.A blood sample of 10 cc was obtained from both groups before and after treatment. Compelet Blood Counting and CD14 marker studies by flow cytometry for evaluating monocyte percentage were used. Personal, laboratory and treatment data were recorded in a question are. Qualitive and descriptive statistics were used for analysis.Results: The percentage of monocytes in the whole population of patients was significantly more than control group (p=0.006).The percentage of monocytes in patients who gave a positive response to the treatment (group 1) and those who did not recovered after the treatment (group 2) was significantly higher, with a p value of 0.013 and 0.015 respectively ,comparing with the control group. In order to get a more delicate evaluation, the study was repeated again by flow cytometry method considering the CD14 marker. The result was similar; percentage of CD14 was increased. significantly in whole patients, first group and second group (p<0.001, p= 0.003 and p=0.015 respectively), comparing with the control group. Meanwhile, comparing the "threestudied groups before and after medical treatment, the percentage of monocytes slightly decreased; the study had a similar result conducted for evaluating CD14 marker.Conclusion: This study suggests the major role of monocytes in revealing the disease and perhaps decreased percentage of monocytes caused by the influence of medical treatment.

Introduction: In the early post-transplantation period, acute rejection is the major cause of graft failure. It is also one of the most important predictors for long-term graft survival following renal transplantation. This study was aimed to compare the rate of acute rejection (AR) between patients receiving and those not receiving IL-2 Receptor Blockers for induction therapy.Materials and Methods: Ninty four patients undergoing renal transplantation from living donor were randomized into a prospective controlled trial. The patients were divided into two groups: D+ including 47 cases (26 men, 21 women with the mean age of 27.8+/-15.2 years) received Prednisolone, Cyclosporine, Mycophenolate Mofetil, plus Daclizumab and D- including 47 cases (28 men, 19women, mean age 28.4+/-12.8 years) received all above drugs except for aclizumab.They were matched considering the age of recipients and donors, recipient-donor relationship, underlying diseases and panel reactivity test status. Individual and laboratory data were recorded in the questionnaire. Data was analyzed using qualitive statistics and frequency distribution tables.Results: All patients completed the 6 month study. The acute tolerability for Daclizumab injection was good without any evidence of cytokine-release syndrome. D+ patients had less AR as compared with D-treated patients (17.02% vs. 8.51%). Graft survival at 6 months was higher with Daclizumab (100%) as compared with no induction (97.4%). Serious infection was seen in five cases (l 0.41%) in D+ group and 4 cases (8.33%) in control group. Patient death or malignancies did not occur in any group. Conclusion: Our study demonstrates that induction with Daclizumab results in reduction of early renal allograft rejection. The therapy with anti-IL-2R antibody is simple and is well tolerated.

Introduction: Infection in the neonate presents a diagnostic dilemma as the clinical presentation is non- specific and final culture results are usually not available until at least 48-72h after sampling. Early confirmation of definitive infection with use of cytokine levels would cause significant reduction in health care costs by shortening the duration of treatment and hospitalization. The objective of the present study was to evaluate interleukin 6 (IL6) level in the early diagnosis of neonatal sepsis. Material and Methods: This single blind clinical trial was done in NICU of Ghaem Hospital in 2003 - 2004. Subject included 60 neonates evaluated for suspected sepsis. All infants had IL6, CBC, B/C, CRP done at evaluation presentation. Infants were categorized into groups according to the likehood of infection on the basis of clinical presentation, blood culture results, i.e., group 1(sepsis), group 2 (clinical sepsis) and group 3 (control). IL6 was compared between two groups by the T-test of mann - whitney; logistic regression was done to establish the best predictors of infection; and sensitivity, specificity, positive and negative predictive values were determined.Results: The IL6 Level was significantly raised in those infants with sepsis (184 pg/ml, p value= 0.000) and clinical sepsis (102 pg/ml p value= 0.001) when compared to those infants without infection (5 pg/ml).Conclusion: An IL6 Value ³11 pg/ml gave a NPV=96/7%, PPV=100%, specify=100%, sensitivity=96/8%. A CRP> 6pg/ml gave a sensitivity and specificity of 75% and 68% respectively. It is concluded that an IL6value done at the time of presentation of sign and symptoms, suggestive of infection, is useful in the early diagnosis of neonatal sepsis. In particular, an IL6 < 11 and CRP < 6 pg/ml may allow antibiotics to be withheld in a number of infants evaluated for sepsis.

Introduction: Acute myocardial infarction (AMI)is an important cause of mortality and morbidity in our country and all over the world. GIK (glucose-insulin-potassium) with some positive effects on myocardial metabolism has been used in order to improve the clinical course in AMI but in spite of some clinical trials, the effect of GIK on outcome is still controversial.Material and Methods: In this clinical trial study, 113 patients with STEMI who referred to Ghaem Hospital (during 1382-83)were divided in 4 groups; 1) GIK+SK (23/9%),2) GIK(13/3%), 3) SK (37/1%), and 4) none (no GIK, no SK) (25/7%) and clinical (CCU and hospital admission days, post MI angina, reinfarction, heart failure, death), electrocardiographic (arrhythmia) and echocardiographic (LV systolic function) parameters were compared. STK was administered to all eligible patients, but GIK patients were selected randomly.Results: From 113 cases with mean age of 59.9 years old, 37.2% received high dose GIK and 61.1% were given STK, there was no difference in age, sex, risk factors (except for smoking), comedication, region of MI and Killips on admission between GIK and no- GIK patients. Door to niddle time was 47.6 minutes for STK and 92.0 minutes for GIK groups. When comparing the 3 groups, GIK with or without SK and also SK itself, CCU (p=0.16) and hospital days (p= 0.39), reinfarction (p= 0.37), pulmonary edema (p= 0.73), in hospital mortality (p= 0.58), and mean LVEF (p=0.80) were not different significantly. The findings were the same in group 4 (no GIK, no SK), surprisingly. Post MI angina (p= 0.07) and arrhythmia (p= 0.06) in group that received GIK alone were slightly less than STK groups. Conclusion: According to the results of this study, apart from slight reduction of post MI angina and arrhythmia, GIK has no significant effect on hospital course of patients with STEMI. 

Introduction: Psoriasis is a chronic inflammatory skin disorder. Several studies have indicated that psoriatic patients have higher risk for coronary heart disease and few studies focused on lipid profiles which are important in the pathogenesis of coronary heart disease.This study was designed to investigate the relationship between psoriasis and hyperlipidemia.Material and methods: In this case control study lipid parameters (cholesterol, Triglycerid, High density lipoprotein, Low density lipoprotein, Very low density lipoprotein) of 40patients with moderate and severe psoriasis (study group) were compared with 40 healthy persons (control group). Study group matched the control group considering age, sex, BMI, hypertension, habit of smoking and alcohol and body activities.Results: In both groups 19 male and 21 female with a mean age of 37±16 were studied. Mean lipid level in case group including: TG, chol, HDL, LDL, VLDL, was respectively 105/4±48/5, 180/52±39/1041, 41/22±11/87, 117/85±35/52, 21/57±10/59 and in control group was 103/8±47/95, 173/92±33/41, 39/25±9/78 114±36/07, 20/62±9/57, which showed no significant difference between the two groups (p>0.05).Conclusion: According to these results it seems that we don't need to investigate lipid profiles in psoriatic patients.

Introduction: Tinea cruris is a relatively common fungal infection. For many years Griseofulvin has been considered as the treatment of choice and now, new oral antifungal agents including Fluconazol are being used widely. The aim of this study was comparison of therapeutic effects of Griseofulvin and Fluconazol for treatment of tinea cruris.Material and Methods: This is a single blind clinical trial study on 64 patients with tinea cruris in Dermatology Department of Ghaem Hospital between August 2004 and February 2005. All patients had clinical exam and a positive KOH test for fungal infection at first, and four and seven weeks later. Patients divided into two groups randomly: 32 patients were treated with 150mg Fluconazol once weekly and 32 were treated with Griseofulvin 500mg daily. Our data were gathered by questionnaires and were analyzed by SPSS statisteca Hysoftware.Results: On the fourth week 60% of Fluconazol group and 79% of Griseofulvin group had clinical improvement (p=0.2), laboratory mycological studies showed that 80% of Flouconazole group and %8404of Griseofulvin group have had improvement (p=0.4).Patients who had positive fungal test in the fourth week were cured clinically and paraclinically in the seventh week. There weren't any statistically significant differences between two groups.Conclusion: Fluconazol as like as Griseofulvin is an effective therapy for tinea cruris and it was also a simple, inexpensive and safe treatment.

Introduction: Primary lung cancer is the most common lethal carcinoma in both male and femal. Unfortunately, signs and symptoms of lung cancer are non-specific. The most common manifestations are coughing, hemoptysis, dyspnea, chest pain, weight loss and hoarseness. Twenty five percent of patients are asymptomatic and are diagnosed with the abnormality of CXR. The aim of this study was evaluation of outcome of chest radiography in patients with lung cancer.Material and Methods: This descriptive study was done in Imam Reza Hospital during the year 1383. As CXR is accessible, easy and low cost, it is suggested as the first step in lung cancer diagnosis. 100 known cases of lung cancer were evaluted. Fiberoptic bronchoscopy and bronchial or parenchymal biopsy plus culture and regular laboratory tests were done for all patients before entering the study. Data was collected in questionnaire and Analyzed by descriptive statistics.Results: The mean age of patients was 62 years. The highest frequency was found in the 6th decade, 77% were smokers. Right lung involvement as revealed by plain and lateral chest radiography was found to be more frequent. The most common abnormal radiographic finding was bronchial obstruction (collapse, atelectasis, obstructive pneumonia).Conclusion: Since lung cancer is so lethal, early diagnosis would have great influence on disease process and treatment result. Chest radiography is a chip, easy available diagnostic method, highly recommended to at-risk patients.

Introduction: Reports of military injuries have advocated early thoracotomy and aggressive management of pulmonary injuries with resection; which opposed to the more conservative and traditional treatment with chest tube thoracostomy in civilian trauma. This study is done in order to study the result of urban lung injury treatment. Material and Methods: A retrospective descriptive study was performed in the General Surgery Department of Imam Reza Hospital during the years 1382- 1383, to determine the incidence of thoracotomy and lung resection in civilian injuries and to evaluate the effective treatment of these injuries in 1168 patients. Indications of thoracotomy were: 1- Air leakage after 2 weeks, 2- drainage of more than 1500 cc blood after tube thoracostomy, 3- Bleeding speed more than 200cc/ hour, 4- Massive air leakage with collapsed lung. All patients with mediastinal or heart trauma were excluded from this study. Personal, laboratory and treatment data were recorded in the quastionare. Data was Analyzed using qualities statistics and frequency distribution tabels.Results: Between 1368-1382 in a series of 1168 patients, there were 384-gunshot wound and 784-stab wound to the thorax. 283 patients with gunshot wound (74%) and 602 with stab wound (77%) were treated with chest tubes alone. 68 patients (9%) of the total required operative thoracotomy. Pulmonary resection was done in 18 patients (9 wedge resection, 6 lobectomy and 3 pneumonectomy). Mortality rate for all injuries was 2/3%, 0.7% for those treated with chest tube alone, 30% for pulmonaryhilar injuries which led to pneumonectomy, 8.6% for sewed parenchymal injuries and 28% for lung resection.Conclusion: Most civilian lung injuries can be treated by tube thoracostomy alone. Only 15-30% will require thoracotomy, among those most injuries can be handled by simple over - sewing of the lung. Some patients may require pulmonary resection because of sever tissue destruction. in these injuries lobectomy may be performed.

Introduction: The Conventional treatment for neonatal immune hemolytic disease is, phototherapy and blood exchange transfusion. The aim of this study was to determine the efficasy of multiple dose of IVIG in reducing the need for exchange transfusion and phototherapy in hemolytic jaundice of newborn.Material and methods: The study was performed at NICU of Ghaem Hospital as a case –control study, over a period of one year (oct 2002-oct 2003). Patients with ABO and RH incompatibility, proven by significant hyperbilirubinemia (Bill>8mg/dl at 12hr of age), positive direct or indirect comb's, and no other Risk factors, like sepsis and G6PD deficiency or early familial icterus, were randomly assigned to receive either conventional intensive phototherapy alone or phototherapy with IVIG 0.5gr/kgevery 12hr for three times. Exchange transfusion was performed if billirubin exceded more than 20mg/dl.Results: A total of 34 newborn infants were included in the study. There was no significant difference between two groups, with respect to birthweight, postnatal age, sex, bilirubin, hematocrit, or reticulocite count. The number of exchange transfusion, duration of phototherapy and hospitalization, were significantly lower in IVIg treatment group than control one. Adverse effects were not observed during MG treatment.Conclusion: IVIG therapy is a safe treatment for newborns with hemolytic jaundice and Reduces exchange transfusion.

Introduction: Patients with ESRD who receive dialysis must confront the burdens of long-term illness and numerous treatment-associated stressors. One of the most important factors in decreasing psychiatric disorders in these patients is using copping methods with physiological and psychosocial stressors. The purpose of the study was to determine the stressors and how the degree of subjective stress depend son sex and age; and to evaluate copping methods in chronic haemodialysis, patients.Material and Methodes: this was a descriptive survey study performed in the Mashhad University of Medical Sciences during the year 1383. 120 patients (49 females and 71 male), regularly treated with hemodialyses were chosen through sensor sampling. Patients filled in the Hemodialysis Stressors Scale (HSS) to determine the prevalance and severity of physicopsychosocial stressors (CES - D). This scale contained29 items and was scored at the basis of four – point ctiteria of Likert's scale (0- 4). Data was Analyzedusing SPSS software and qualitive statistics using Student T-test, X2 and kruskal- wallis statistical tests. Values of pless than 0.05 were considered significant.Results: The mean age of patients was 31.9±3.12 years (between 15 to 64 years).59.4% of patients had duration of dialysis less than 3 years. Results revealed that the average score of physiological stressors was 12.09±4.89 and the average score of psychosocial stressors was 38.51±14.45. Fluid restriction was ranked as the most prevalent psychosocial stressor followed by decrease in social life, and the top physiological stressors were muscle cramps and fatigue. There was a consistent trend for almost all stressors to become more intense over time, with some specific stressors increasing significantly. A positive relationship was demonstrated between emotion oriented copping and psychosocial and physiological stressors, though 67.8% of patients have been using problem- oriented methods.Conclusion: Psychosocial stressors are more common than physiological ones in hemodialytic patients. In attention to copping methods and their benefits for decreasing stress and depression levels, guidance of patients and their families is necessary. Nurses need to be educated about the factors that are stressful to patients, so they can support them appropriately.

Introduction: Vision impairment is an important issue in pediatric ophthalmology. Reports indicate a decrease in educational quality in students with impaired vision especially in primary school age. This study evaluates the prevalence of vision impairment in primary schools of Mashhad in 1383-1384 educational years.Materials and Methods: In this descriptive cross-sectional study, 2130, 7 to 11 year old students (1047 boys, 1083 girls) were examined. Sample size included 2 primary schools (one from each gender) from one of the 7 educational sections of Mashhad city. 150 cases were chosen from each school bearing equal proportions from all primary levels. Visual acuity was measured using Snellen chart regarding 6 meters distance. Students with visual acuity less than 8/10, which was uncorrectable with glasses, were referred to Mashhad Khatam-Al-Anbiya Hospital.Results: In this study 5.2% of cases had different visual impairment in one or both eyes. More than half (3.1%) were referred to Mashhad Khatam-Al-Anbiya Hospital. Prevalence of amblyopic a in one or both eyes was 0.8% and 3.4% of students had refractive error. Strabismus was seen in 0.3% and 0.2% were malingering.Conclusion: This study demonstrates the sufficiency of national program for pre school visual evaluation, especially when compared with similar previous reports.

Introduction: This prospective study attempted to determine the epidemiology, clinical manifestations and prognosis of patients with hospital and community-acquired bacteremia of Klebsiella pneumomae.Material and Methods: From July 1, 2004, to March 31, 2005, we prospectively studied 34 episodes of klebsiella pneumoniae bacteremia in 34 patients, treated in Imam Reza Hospital, Mashad-IRAN.Results: The disease was nosocomially acquired in 58.8% and community acquired in 41.2%. The different types of infection were sepsis (44.1%), burn wounds (26.5%), pneumonia (11.8%) endocarditis (2.9%), urinary tract infection (2.9%), and hepatic abscesses (2.9%). Bum which was found in 9 (45%) patients, was the most common underlying disease, followed by renal failure in 3 (15%), Diabetes mellitus in 2 (10%), leukemia in 2 (10%), and intravenous drug abuse in 1 (5%).The most frequent clinical findings in adult patients were fever (100%), leukocytosis (75%), thrombocytopenia (45%), jaundice (40%), cough (30%), tachycardia (30%), tachypnea (25%), rigors (25%), Hemoptysis (15%) and anemia (11.1%). Carbenicillin and ciprofloxacin were the most active antibiotics.Conclusion: we observed that nosocomial infections are more prevalent than community aquired. Sepsis without focous, burn and neonatal infections were some of the most significant diseases in this study.

Introduction: Hepatitis C is an emerging infection in Iran especially due to unsafe sharing between IVDUs. HCY genotype has an important role in clinical decision- making and drug therapy protocols. Up to now data is restricted and controversial in Iranian patients especially in Mashhad.Material and Methods: This descriptive study was done in the hospitals belonging to Mashhad University of Medical Sciences during the years 1382- 83. We included 63 patients that hepatitis C was confirmed in them by routine HCYRNA PCR method. The test was done in a single lab all by one person by primer-specific method. Genotype of the virus was analyzed against risk factors in patients. Personal and laboratory data collected in a question are were analyzed by qualitive statistics.Results: Relative frequency of different genotypes and subtypes were: 3 (52.3%), 1(30.1%), 2(15.9%) and mixed (1.6%). The relative frequency of genotypes was significantly different in hemophilic patients from others (80% from genotype 1). Relative frequency of Genotype 3 in thalasemics, hemodialysis patients, IVDUs and Blood donors was 66.7%, 66.6%, 55.44% and 46.18% respectively.Conclusion: According to genotyping results about 2/3 of patients are categorized in 'easy - to - treat group, but no discriminative factor could be estimated to differentiate this group of patients that need shorter courses of therapy with lower doses. So genotyping is still necessary for clinical decision making.

A 50 years old woman was admitted to the hospital, because of possible carcinoma of the liver. She has been in a good health until about two months earlier, when symptoms and signs of fatigue, malaise and sensation of heaviness and fullness on the right upperside of abdomen started.She believed that her abdomen was enlarging. Daily temperature was up to 37.5 C° . She lost appetitis and consumed some herbal remedies, but not opium and alcohole. With increasing the symptoms of disease, she consulted a gastroenterologist; who informed that her liver was enlarged C.B.C was normal. But prothromb in time was increased (16 seconds control 12 seconds) Tests for viral hepatitis A, Band C were negative. An esophagogasteroduodenal endoscopic exanimation showed no abnormalities. Utrasonograghy of abdomen revealed diffuse increase in echogenecity of liver as compared with that of kidneys. A computed Tomographic (CT) Scan of the abdomen showed some hepatic lesions that suggested the presence of metastatic disease.!A week before admission in hospital where on further questioning she reported a history of rheumatoid arthritis, from two years earlier, where she has been on methotroxate and non-steroidal anti- inflammatory drugs.Temperature was 3737.5 C°. The pulse was 85 and respirations were 20. The blood pressure was 120/80 mm Hg. On examination, no rash was seen; no cervical and auxiliary lymph nodes were palpated. The lungs on auscultation and chest X. Ray were clear. The heart sound was normal. The spleen was descended below the left costal margin. The liver was no tender and was palpated 3 centimeters below the ribs.There was no edema and ascitis. Lab Tests: Serum level of asparate aminotransferase and alanine transferase were elevated more than two times of maximum normal ranges. Serum alkaline phosphatase and gamma glutamyl transpeptidase were above the normal range. In serum protein ecletrophoresis test; hypoalbuminemia and hypergammaglobulinemia were the significant abnormalities. Total bilirubine was 3.5 with direct bilirubine level of 2 mg per cent. Serum Triglicerid 340 with cholesterol 290mg/dl. Fasting blood sugar 135 mg/dl. In kidney lab tests, a renal dysfunction was seen (creatinin 1.8, mild proteinurea and granulocyte in urine.) CRP +, but ESR and CBC were in normal ranges. Calcium 11.6 mg/dl phosphorus and lipase were normal, uric acid was normal too. The patient admitted in hospital and after some more lab tests a diagnostic proedure was performed on the third hospital day.

Introduction: The absorptive and digestive surface of small intestine in healthy adults is more than that needed to maintain adequate nutrition, so resection of small amounts of small intestine usually causes no clinical symptoms. Resection of up to 40 per cent of total length of the small intestine is usually well tolerated; provided that the duodenum, 100 cm of early jejunum, the distal half of the ileum, and ileocecal sphincter are spared.In contrast, resection of the distal two- third of ileum and ileocecal sphincter alone may induce severe diarrhea and significant malabsorption; even though less than 25 percent of the distal small intestine has been resected.Resection of 50 percent or more of the small intestine usually results in significant malabsorption, and resection of 70 percent or more of the small intestine often produces such catastrophic malabsorption that survival of the patient is threatened. Short bowel syndrome is the clinical and laboratory findings of malabsorption syndrome that result from extensive intestinal resection. Aim of this study is description of small bowel syndrome and various clinical pictures and its complication. In this article 3 patients with short bowel syndrome are introduced. Many problems of these patients that result from resection of large amounts of small intestine, which affect vital organs and cost of its treatment, necessitate more attention to this problem and maintenance of maximal length of small intestine in abdominal operation.

Introduction: Intravesical explosions are a rarely documented complication of transurethral resection of the prostate or bladder tumor. However an intrarenal explosion during ureteroscopic fulguration was documented in 1991. We reported 3 cases of an intravesical explosion resulting in an intrapritoneal bladder rupture during transurethral resection of prostate.

Introduction: The Aorta rupture is a killing complication that could be caused by spontaneous trauma (marfan syndrome), aorta dissection and aneurism tear. Aorta rupture is generally defined as separation of layers of aorta wall in one specific part. Aorta rupture following a coronary bypass operation is a rare complication which is usually caused by dissection of traumatic damage of aorta wall during aorta clamp and tear of suture thread of proximal anastomosis.The purpose of the present study is to investigate the complications that follow aorta rupture in a 43- year- old patient who underwent a coronary bypass operation.

A remarkable aspect of the patient's illness is hepatomegaly, splenomegaly right upper abdominal discomfort and jaundice. In lab tests increasing of SGOT and SGPT with high level of alkaline phosphatase and gammaglutamyltranspeptidase with hypergammaglobulinemia, moderate increasing of bilirubine was seen while all the viral hepatitis markers for hepatitis A, Band C were negative. Liver ultrasonographyrevealed diffuse increase in echogenecity as compared with that of kidneys. C.T scan of liver showed some hepatic lesions that suggested of metastatic lesions. Diffuse increase in echogenecity of the liver of this patient on sonograghy and low density of hepatic parenchyma on C.T scan could be fatty infiltration of the liver. Regardless of the cause, cirrhosis has a similar appearanceon imanging study.This patient as mentioned in her medical history did not consume alcohole, but in lab tests we noted her triglyceride and cholesterol were high and because of rheumatiod arthritis she has been on metothorexate since two years ago. On lab tests all the viral hepatitis markers were negative and esophagogasteroduodenal endoscopic examination showed no ponal hypertention (no dilatation of esophagalveinsin inferior part of esophagus). Steatosisin mostpatients with non- alcoholic fatty liver may have appearance of malignant liver. hypercalcemiamay be co- existence with cancer of liver in this patient. hypercalcemia may have many causes but what are the clues to the cause of hypercalcemia in this case? hyperparathyroidism, hyperthyroidism, thiaside diuretic consumption, chronic renal failure, Addison's disease and ingestion of excess vit A or vit D may cause hypercalcemia, as in this case; because of Rheumatoid arthritis, she has been prescribed excess dosage of vit D Serum protein electrophoresis of this case revealed hypoalbuminemia and hypergammaglobulinemia a phenomena we see too often in chronic liver diseases.In this patient, liver biopsy is the best diagnositic tool and it is usefull to determine kind of treatment and alimentary restrictions. In liver biopsy assay by grading for steatosis and staging for fibrosis you can find the depth of liver lesions. Liver biopsy was done and pathologist data was non-alcoholic steatohepatitis, precirrhotic stage.Conclusion: in non-alcoholic fatty liver with cirrhottic stage, steatos is is diffuse in most patients but, occasionally it is focal in imaging study, both ultrasonography and C.T. Scan may be misinterpreted as showing malignant tumours of liver. In such cases MRI can distinguish space occupying lesions from focal fatty infiltration. But gold standard of diagnosis is liver biopsy. In this patient pathologist data was macro and microvesicularballooning, PMN cells infiltration aroundthe hepatocytes and fibrosis around the hepatocytes. And bridging fibrosis.Scoring: grade II stage IIIThe patient advised for weight loss, avoiding of fatty meals and home Remedies for one year and vitamin E and, B couplex prescribed. Some experts use clofibrate or metformine.