Internal Medicine Today
Year:2008 | Volume:14 | Issue:1|Papers Count:12

Background and Aim: Hypogonadism is the most common endocrinologic complication among major beta thalassemia patients. Absence or irregular chelation therapy in these patients leads to various complications such as hypogonadism. This complication in addition to organic dysfunction, results in behavioral and psychological effects on the patients and their families. The purpose of this study was to evaluate the prevalence and determination of effective factors on occurrence and cumulative risk of this complication.Materials and Methods: 641 one thalassemic (316 males and 325 females) patients referring to Cooley’s ward of Dastgheib hospital in Shiraz were studied using a structured questionnaire through enumeration method in 2005-2006. The age of occurrence, demographic information, the age of onset and type of transfusion, and the age of onset and method of chelation therapy were specified. Specialist physicians diagnosed the complication. The data were analyzed using descriptive and analytical (OR confidence interval, chi square test, student T- test and Log Rank test) statistics.Results: Mean ± SD of age in these patients were 17.32±5.3 years. The prevalence of hypogonadism was 18.3%. This complication was seen in 24.9% of girls and 11.4% of boys. Risk of this complication in girls was 2.6 times more than boys (P<0.05), and in patients that their mothers had not academic education this ratio was 2.2 times as compared to patients that their mothers had academic education (P<0.05). The age of onset of this complication in girls and boys was 17.13±7.08 and 19.31±2.57 years respectively (P>0.05).There was no significant association between prevalence of hypogonadism and type of transfused blood and chelating method. In survival analysis model using Log Rank test, age at onset of chelating and sex were related with cumulative risk of this complication (P<0.05). The median of survival without hypogonadism was 26.5 years.Conclusions: Early onset of blood transfusion with late onset of chelating increases the occurrence probability and early onset of this complication. For prevention of this complication, we recommended that onset of blood transfusion must be according to onset of chelating. Educational level of parents and education to parents and patients is very important. Progression of this complication will be prevented by regular survey and early diagnosis and this complication leads to high ability of the patients.

Background and Aim: Depression is the most common and important psychological disorder among End- Stage Renal Failure especially those who are undergoing hemodialysis, that can have a negative impact on quality of life and treatment acceptance. Since the patient participation in self-care activities, lead to more independence and patient adjustment with his/her illness, the aim of this research is to determine the relationship between self-care and depression in hemodialysis patients.Materials and Methods: This is an analytical-descriptive (cross-sectional) study from correlation type that was done on 60 patients under hemodialysis treatment that were selected in randomized cluster sampling in Imam Reza and 17 Shahrivar hospitals of Mashhad in 2006. Data were collected through three questionnaires including demographic information, self-care and depression of CES-D. The data were analyzed by SPSS 11.5 soft ware and with Pearson correlation test, linear regression, Kendal b Tao and kruskal-wallis test. (p<0.05)Results: The mean age of the patients was 42.6±12.3 years and the most frequencies were 63.3% males, 78.3% unemployed, 76.6% married, and 33.9% with elementary education. The findings showed that there is a strong negative relationship between self-care and depression. It means that with self-care increase, depression rate is decreasing in the patients. (p<0.001, r=-0.59). There was a significant relationship between depression and self-care levels. (p= 0.016)Conclusion: There is a negative relationship between depression and self-care in hemodialysis patients. It is better and recommended to improve and prepare any way and methods (teaching and …) for improving selfcare in hemodialysis patients behavior to decrease physical and mental complications resulted from hemodialysis treatment.

Background and Aim: Cadmium element is found in all of tobacco products such as cigarette. There is some evidence that indicate cadmium may interfere with morphine tolerance development. The effect of cadmium on morphine tolerance development and its possible cross tolerance were investigated in this study.Materials and Methods: To induce tolerance to analgesic effect of morphine or cadmium, morphine (15 mg/rat) or cadmium (20 nmol/rat) were injected intrathecally to male rats twice a day for five days. To investigate the effect of cadmium on morphine tolerance, another group of rats were injected intrathecally with cadmium and morphine. Cadmium was applied 15 minutes prior to morphine administration. The analgesic effect of different treatments was measured using tail flick test.Results: The results indicated a long lasting analgesic effect of cadmium which was obvious after 12 hours.Repetitive administration of cadmium caused tolerance development to its analgesic effect. In animals which received cadmium during first 5 days, morphine could not induce a significant analgesia on day 6 (cross tolerance). The comparison of the tail flick latencies in morphine and cadmium+morphine treated groups, did not show a significant difference, indicated that cadmium did not have any inhibitory effect on development of morphine tolerance.Conclusion: Our results showed that intrathecal administration of cadmium causes cross-tolerance to analgesic effect of morphine. It seems that, cadmium of cigarettes which induces analgesia by itself causes morphine tolerance and develops some aspect of morphine addiction.

Background and Aim: The advent of brain CT revolutionized the diagnostic evaluation of neurologic patients. The aim of this study was to evaluate brain CT results and it's relationship with requesting clinical complaints.Materials and Methods: In this descriptive cross-sectional study, brain CT scan of 100 children referred to the center of Shaheed Sadoughi Hospital radiology ward, was evaluated.Results: The mean age of the patients was 42.17±49.17 months and 40% of the cases were girls. The result of CT was normal in 61%. The risk for abnormal CT report in patients with less than one year increased significantly. The most frequent abnormal results of CT were brain atrophy (21%) and hemorrhage (5%). The most cause of CT requests was recurrent seizure (35%) and developmental delay (25%). CT scan in all of focal seizures and in 61% of developmental delays reported abnormal .The most frequent final diagnosis were CNS structural disorders and epilepsy. CT scan in 29.4% of CNS infections, 17.2% of epilepsy and in 42% of CNS structural disorders, reported abnormal.Conclusion: CT in meningitis without loss of consciousness, in first generalized seizure with normal physical exam and in headache without worrisome signs, is not so helping and MRI is more useful in neurodevelopmental delay due to structural CNS dysgenesia.

Background and Aim: In this study drug susceptibility of shigella strains was detected in diarrheal patients in Gonabad's 22-Bahman hospital, 2005-2006.Materials and Methods: For this purpose, Kirby-Bauer method of susceptibility testing was used for drug susceptibility of shigella strains.Results: In total, 134 samples belong to the patients referred to Gonabad's 22-Bahman hospital, were collected. From 134 cases, 32 cases were identified as shigellosis. All of the isolates were sensitive to Cefotaxime, Ceftizoxime and Ciprofloxacin, 81.3% and 53.1% of the isolates were resistant to Tetracycline and Sulfametoxazole - Trimetoprime respectively.Conclusion: The dramatic rise in resistance has a major implication for the appropriate selection of antibiotics and brought empiric use of Tetracycline and Sulfametoxazole - Trimetoprime in to question.

Background and Aim: Treatment of thoracic outlet syndrome is a challenging problem for the physiotherapists and the conservative approach preferred for treatment. The purpose of this study was to determine and to compare the effects of stretching and nerve mobilization exercises on pain intensity and upper extremity functions in patients with thoracic outlet syndrome.Materials and Methods: For this double-blind, randomized controlled trail, 20 patients with thoracic outlet syndrome aging 34.95±12.9 years were recruited from zahedan physiotherapy clinics. The patients were randomly assigned to either a stretching (n=10) or a nerve mobilization groups (n=10). Before and after three weeks treatment, shoulder range of motion (degree), pain intensity (ordinal), two point discrimination (mm) and shoulder function (ordinal) were measured using goniometer, visual pain scale, caliper and shoulder pain and disability index, respectively. Independent and paired T-tests were used for comparisons between and within groups, respectively.Results: The mean of shoulder pain and disability index decreased from 92.3±9.6 to 40.5±13.9 in the stretching exercises group and from 81.0±16.3 to 25.0±12.6 in the nerve mobilization group (P<0.05). After treatment, the mean of shoulder pain and disability index decrement was greater in the nerve mobilization group than the stretching one (P<0.05). The mean range of motion of shoulder increased in both groups (P<0.05). However, no significant difference was seen between two groups in measures of shoulder joint range of motion, pain intensity and two point discrimination (P>0.05).Conclusion: Both the stretching and nerve mobilization exercises decrease pain intensity and improve hand two point discrimination, shoulder function and joint ranges of motion. However, in order to improve shoulder function, the nerve mobilization exercises are more effective than other one.

Background and Aim: Cardiac autonomic neuropathy (CAN) is one of diabetes micro-vascular complications associated with increased cardiovascular mortality. CAN is more frequent in patients with other diabetes micro-vascular complications. In this research we evaluated the relation between CAN and other diabetes micro-vascular complications.Materials and Methods: This research includes 41diabetic patients (25 female and 16 male with mean age of 44.9 yr and 8.6 yr of history of diabetes) who had regular evaluation in Kashan Diabetes center. All of them assessed for diabetes micro-vascular complications and CAN.Results: There wasn’t any meaningful statistical relationship between CAN and diabetic sensory neuropathy, retinopathy and nephropathy. Sensory neuropathy was the most frequent diabetic micro-vascular complications associated with CAN (71%). There wasn’t any evidence of CAN in 31% of the patients with sensory neuropathy while CAN had founded without sensory neuropathy in 21% of these patients.Conclusion: There wasn’t strong statistical correlation between CAN and other diabetic microvascular complications. Diabetic patients should be evaluated for CAN because it can’t be rule out in the absence of other microvascular complications.

Background and Aims: Driving is one of the occupations that afflict a person to get the musculoskeletal disorders because of the awkward working postures and imposition of stretch and strain in the driver’s body musculoskeletal system. We used the cushion for correcting driver’s body posture and their body conditions.Our goal in this study was the survey of cushion usefulness to posture correcting.Materials and Methods: 95 persons of bus drivers for this descriptive, analytic, interactive and cohort study were selected. In this research driver's postures while driving were assessed with RULA method (Rapid Upper Limb Assessment) in two stages, before and after the cushion usage. Then the data were analyzed by Spearman, Wilcoxon and Paired Sample tests with the aid of SPSS software program.Results: The statistic tests results show that RULA Grand Score for these drivers is between 2-6. Wilcoxon test results for comparing of RULA indices before and after using the cushion show that using this cushion decrease neck score (P<0.001), trunk score (P<0.001) and Grand Score (P<0.001).Conclusion: This cushion affects correcting drivers posture but this correction isn’t so idealistic. Therefore our recommendation to designers is that further study and redesign of cushion is necessary to cushion optimizeation.

Background and Aim: The certain personality characteristics including hardiness and locus of Control are mediating and facilitatively a stressful life events and psychology problems such as burnout due to work.Nursing has always been a stressful profession and nurses are therefore prone to high degree of burnout, but the majority of studies in this field have emphasis on other factors on preventing of burnout and we can rarely find a study which addressed personality factors as a mediator / moderator for burnout.Materials and Methods: In this descriptive - correlative study the relationship between hardiness / locus of control and burnout among 300 full time nurses were examined. 300 nurses were selected randomly.instruments: sample selection form, demographic inventory, Ahvaz hardiness scale, Rotter's locus of control scale, Tedium burnout scale have been used to measure the variables.Results: In this study 300 nurses was cooperated with an average age 25-53 years that was 214 (%71.3) female and 86 (%28.7) male data analysis indicated that no differences in burnout were found to sex (p=0.1) and Pearson correlation indicated that burnout scores were not significantly associated with age. A significant negative correlation was found between hardiness and burnout (r=-0.52, p=0.000) and a significant positive correlation was found between external locus of control and burnout (r=0.44, p=0.000) and a significant correlation was found between internal locus of control and burnout. (r=-0.42, p= 0.000)Conclusion: As it was found that hardiness as personality characteristics plays an important role in burnout and predicts the majority of variances in burnout it is suggested that using the formal-informal training method which hardiness components will be addressed is the best Preventing strategy for burnout in nurses.

Homozygous Familial Hypercholesterolemia (HFH) is a rare lipoprotein Disorder. Transmission is autosomal codominant. The prevalence of (HFH) is estimated at approximately 1:1000,000. Aortic root and valve leaflets become atherosclerotic and thick due to cholesterol deposition and then aortic insufficiency and stenosis appears which sometimes may be severe.We report a10 year-old boy with multiple Cutaneous and tendinous xanthomata, exertional angina from age 8 and severe atherosclerotic involvement of aortic valve and aortic root who was referred from one of villages of Birjand. Considering that 70% of the reported cases with aortic involvement have relatively mild aortic stenosis, our case is one of less frequent ones. His plasma total cholesterol was 766, LDL cholesterol was 658 mg/dl, Triglyceride 150 and HDL was 46 mg/dl.Diagnosis was confirmed by typical skin and tendon lesions, including typial yellowish orange skin xanthomas, achili xanthomas, corneal arcus and the typical type IIa Fredrickson dyslipoproteinemia, and echocardiographic changes of aortic valve and root.Considering very few reports in this regard in our country, and a relatively high prevalence of the disorder in nearby countries, such case reports may improve our knowledge and also help to find and treat many families of such patients with heterozygous FH who have not got pathognomonic skin or tendon lesions.