Internal Medicine Today
Year:2008 | Volume:14 | Issue:3|Papers Count:15

Background and Aim: Freiberg’s disease is osteochondrosis or a vascular necrosis of metatarsal head. In many cases treatment is no operative. In patients who fail no operative treatment, surgical treatment may be offered. In this article, we studied surgical treatment with resection arthroplasty of metatarsophalyngeal joint in patients with unsuccessful no operative treatment.Materials and Methods: Resection arthroplasties of metatarsophalyngeal joint were performed in 16 patients with Freiberg’s disease and unsuccessful no operative treatment between 2001 and 2007. In all patients, second metatarsophalyngeal joint involved. The average of follow up was 34 months (12-56).Results: There were 12 female (75%) and 4 male (25%) patients with an average age of 25 years (range 18-40). There were excellent outcome in 12 (75%), good in 2 (12.5%) and moderate in 2 (12.5%) cases.Conclusion: Surgical treatment with metatarsophalyngeal joint resection arthroplasty has very good result in patients with Freiberg’s disease that conservative treatments have failed.

Background and Aim: Urtica dioica has been consumed as antihypertensive, antilipidemic and antidiabetic herbal medicine. Since consumption of fructose-enriched diet causes insulin resistance, the objective of this study was to evaluate the boiling solution effect of Urtica dioica on serum glucose, insulin and lipids in fructose-fed male rats.Materials and Methods: The experiment was performed on 28 Wistar-Albino male rats that randomly divided in control and two test groups. Control group intake tap water, but test groups consumed fructose-enriched diet (66%) for 4 weeks. The first test group received 40-60 ml boiling of Urtica dioica on experiment period, but the second test group received the same volume of distilled water during study. At the end, animals were anesthetized and sacrificed and blood samples were collected. Serum glucose, lipids insulin were measured. Obtained data were analyzed by SPSS V.11, via ANOVA and Scheffe tests. Results were expressed as mean±SD and p<0.05 were recognized significant.Results: Results showed that serum glucose, insulin, water and food intake were significantly decreased on fructose-fed male rats who received Urtica dioica boiling, compared with those of other test group but other parameters did not show any difference between test groups.Conclusion: These results indicated that Urtica dioica boiling induced decreased insulin resistance in fructose-fed male rats. Further studies are needed to explore the exact mechanism.

Background and Aim: Nosocomical infections are of the problems of all societies and the most common way for its transference is contaminated hands. According to the recommendations of W.H.O. on using alcohol-base formulation for hand hygiene and it got used to some hospital sections for some time, this study was done with the aim of comparing skin complications of alcohol-based hand rub with antiseptic and plain soap on hands of nursing personnel.Materials and Methods: This study is a randomized, three-group, clinical trial. 128 nursing personnel including nurses and nurse assistances selected randomly by classified sampling, has been studied.Three hand hygiene products were tested: alcohol-based hand rub, antiseptic soap and plain soap. Each product was used for a week after teaching hand hygiene based on W.H.O. standards. Finally self assessment tool was completed by nurses and during the week skin condition was monitored by researcher assistance. Kruskal Wallis, Man-Whitney and Chi- Square, were used for analyzing data by SPSS software, version 14.5.Results: Kruskal Wallis test was used for assessment of skin complications in groups with four dimensions: appearance, intactness, moisture content and sensation. Among three groups, the alcoholbased hand rub in comparison with plain soap showed less skin complications in intactness (p=0.04).Conclusion: Regarding this fact that one of the most important ways of transferring nosocomical infections is personnel's hands, as the alcohol-based hand rub has less skin complications in intactness and less cost in comparison with soap and regarding its easy application even without water, it is recommended to use it instead of soap for hands as an antiseptic.

Background and Aim: 39 cases of retinal vein occlusion that sequentially attended to eye clinic in 3 years enrolled in this study. The hypertension, cigarette smoking, mean plasma homocystein and agerange in retinal vein occlusion category were compared with 49 controls.Materials and Methods: 19 cases had Branch retinal vein occlusion and 20 have Central retinal vein occlusion, 15 of them were female and the remainder (24) was male 17 cases had left eye involvement and one has bilateral involvement.Results: Except 5 cases, most of the patients had at least one of 3 systemic diseases (Hypertension, Diabetes, and hyperlipidemia). The mean plasma homocystein level in cases was 15, 39 mmol/l and in controls it was 15.95 which was not statistically significant. (p=0.42). The mean plasma homocystein level was above the normal in 21 cases (13.0 mmol/l) and in 28 control subjects.Conclusion: This study showed that retinal vein occlusion is mostly associated with one of the systemic diseases. We could not find also statistically significant relation between homocysteine level and retinal vein occlusion in this study.

Background and Aim: Early diagnose and management of GDM can decrease perinatal, neonatal and long-time infant problems. There is now accumulated evidence in the literature that high maternal Hemoglobin is associated with increased incidence of adverse pregnancy outcomes which include low birth weight and preterm labor. In the no pregnant population, an association between hemoglobin concentrations with Diabetes Mellitus has been reported before. We decided that we study relationship between maternal Hemoglobin concentration at the first trimester and occurrence of GDM.Materials and Methods: In a retrospective study sample comprised 100 women. Age, weight, parity, Hemoglobin concentration and FBS at the initial antenatal visit and GCT during 24-28 weeks are recorded.Results: In this study 36 women had GDM and the rest were health. Age, parity and Hemoglobin concentration emerged to be significant factors in incidence of GDM.Conclusion: High maternal Hemoglobin (more than 13 g/dl) at the initial pregnant visit (the first 14 week) is an independent risk factor for GDM.

Background and Aim: Acute renal failure is a common complication of cardiac surgery and oxidants and diabetes play an important role in renal injury in this condition. In this study, we aimed to assess whether vitamin E as a supplemental antioxidant and allopurinol as an oxygen radical antagonist could prevent renal dysfunction after coronary artery bypass graft (CABG) surgery.Materials and Methods: eighty diabetic patients with GFR less than 60 ml/min undergoing CABG surgery were randomized into two groups: treated with vitamin E and allopurinol (group A: n=40) and without treated (group B: n=40). Diabetic patients were detected. Group A, drugs 3 to 5 days before surgery. Serum creatinine, potassium, creatinine clearance and urine output were measured preoperatively and daily until day 5 after surgery.Results: The patients consisted of 41 males and 39 females with a mean age of 63±9 years. The mean serum creatinine and creatinine clearance were 1.3±0.5 mg/dl (0.8±3 mg/dl) and 48±10 ml/min (22-68 ml/min), respectively. There were no differences in baseline variables such as age, body mass index, sex, hypertension, diabetes, duration of operation and aorta cross clump, serum creatinine and potassium, and creatinine clearance between the groups.When comparing two groups, there were no significant differences in mean of variables before and after operation such as serum creatinine (1.2±0.4 vs. 1.2±0.3 mg/dl, p=0.4), serum potassium (4.3±0.3 vs. 4.4 ±0.3 meq/l, p=0.7). Length of intensive care unit stay in control group was more than treated group (3.8±1.2 vs. 2.8±0.5 day, p=0.00).Conclusion: Prophylactic treatment with vitamin E and allopurinol have no Reno protective effect in these patients but these two drugs can decrease hospitalization in ICU with intervention by two drugs.

Background and Aim: Hepatitis B is a major problem occurred in patients with thalassemia major due to repeated blood transfusion. Regarding its acute and chronic complications (Fulminant hepatitis, Cirrhosis, Hepatic neoplasm), vaccination could be helpful in thalassemia patients. Immune suppression due to frequent blood transfusion iron blood persistent hemolytic, decreased anti-HBS-Ab level after HBV vaccination.Materials and Method: This descriptive study was performed in South Khorasan in 2007 on 38 patients with major thalassemia. All patients have received Hepatitis B vaccine. A questionnaire containing some questions about demographic characteristics was filed for all patients including: age, sex, frequency of blood transfusion in year. The blood samples of patients were tested to detect serum markers including HBS Ag, anti-HBS with ELISA method. The results were analyzed by using SPSS.Results: Of 38 patients with major thalassemia, 20 (52.6%) were male and 18 (47.4%) were female.Average age of patients was 9.2±4.6.37 patients (97.4%) have transfusion >12 time in year. All of patients were negative for HBS Ag and anti-HBC. 16 patients (42.1%) was anti-HBS Ab positive and 22 patients (57.9%) was anti-HBS-Ab negative. Based on the Serum levels of anti HBS-Ab, subjects were categorized as: Good responder (anti HBS> 100 IU/lit) (34.2%) Low responder (anti-HBS 10-100 IU/lit) (23.7%) Non responder (anti-HBS < 10 IU/lit) (42.1%). 34.2% of patients that over 5 years lapsed since last vaccine injection were responders. Statistical analysis has not shown significant relationship between age, sex and anti-HBS-Ab (p>0.05) and time lapsed since last vaccination in two groups (p>0.05).Conclusion: Immune response in children with thalassemia major lower than normal children and we recommended determining the antibody level after the last vaccination and if necessary, booster dose gives them.

Background and Aim: Manufacturing substandard and low quality pharmaceutical products will lead to waste of resources with added health risks to public health.Materials and Method: The research was a descriptive and comparative study. USA, EU, Australia and Iran, and WHO, ICH and PIC/S were selected for the comparative study. Internet sites and scientific journals were used for data collection. The comparative study determined the primary proposed model. Then, based on Delphi technique, the primary model was evaluated by experts and eventually the final model was designed.Results: Pharmaceutical quality assurance model of USA had two parts without annexes. The first part described the general concepts. The second part was much larger and had eleven subparts. Each subpart included some GMP requirements. The model of EU was based on two parts. The first part, with nine chapters, presented the basic GMP requirements, and the second part, consisted of nineteen annexes, and illustrated the method of GMP implementation on specific areas of production. The model of Australia was very similar to EU model, structurally and contextually. The model of WHO had written the GMP principles in seventeen chapters without annexes. The model of ICH consisted of nineteen chapters and had no annexes. The model of PIC/S was designed as EU model completely.Iran had no pharmaceutical quality assurance model. The comparative study and feedbacks of experts determined the final proposed model for pharmaceutical quality assurance (GMP) of Iran, which consisted of two parts. The first part, chapters, included thirteen chapters and each chapter described isolated parts of GMP principles. Each chapter was divided to some major titles. Overall, the first part (chapters) consisted of sixty-two major titles. The second part of model consisted of sixteen annexes, which illustrated the method of GMP implementation on specific areas of production.Conclusion: Establishment of standards of the final model of GMP in the drug industry could lead to the improvement of quality of national manufactured drugs, hence, promoting the population health levels.

Background and Aim: Diabetic complications have been related to hyperlipidemia and hyperglycemia. Alpha - tochoferol has antioxidant effects and can improve lipid profiles. We evaluated the effect of vitamin E supplementation on glucose, insulin and lipid profiles in type 2 diabetic patients.Materials and Methods: In a randomized clinical trial, 31 patients included 14 men and 17 women (51.9±5.9 year) with type 2 diabetes were randomly divided into treatment with vitamin E (800 mg/day) and placebo groups for 2 months. Plasma glucose, Insulin and lipid profiles were measured at the beginning and at the end of 3 months supplementation. The Paired and independent-t -test was used for analyzing of data.Results: Anthropometric indexes were stable throughout the study. Vitamin E administration lowered fasting plasma insulin concentrations (28.25± 2.37 and 27.8±2.56, p<0.016) plasma triglyceride concentration (279.41±194.99 and 212.48±85.18, p<0.03). The plasma glucose and the other lipid profiles did not change after vitamin E consumption for 2 months.Conclusion: We need more research to establish beneficial effect of vitamin E intake in type 2 diabetic patients.

We present a rare case of intramuscular Haemangioma of the forearm with periosteal reaction of radius and ulna. A 38-year-old female presented with a tumefaction in distal and dorsoulnar side of the right forearm. She had 1.5 years history of tumor which was painful during resent 2 months. Plain xray and MRI was done and the diagnosis of Haemangioma was proved by open biopsy. The tumor plus periosteal reaction and enlarged bone was respected. After 4 years follow-up no recurrence was seen.