[ prevalence of antithyroid antibodies in women with polycystic ovary syndrome in Shahrekord, Iran]

Polycystic ovarian syndrome [PCOS] accompanied with obesity and insulin resistance. Many findings have shown that fat tissue has an important role in creating and resisting of various disorders in PCOS. On the other hand, thyroid has an obvious and dominant role in metabolism [specially in the metabolism of lipids and carbohydrates]. Both PCOS and thyroid diseases are accompanied with disruption in function of hypothalamus - pituitary -gonad axis. This study aimed at finding the relationship between antithyroid antibodies and polycystic ovary syndrome. In this descriptive analytical study two groups of 54 women with the age ranges of 15 to 45 years from Shahrekord, Iran were selected and consecutively were entered the study. The first group [control group], did not have any thyroid disease, systemic disorders or PCOS based on the history, physical examinations and blood tests and they did not use any medicine. The second group [patients groups], did not have any thyroid diseases and systemic disorders based on the history, physical examinations and blood tests but they had PCOS. Antithyroid antibodies in both groups were measured and compared using K[2], t test and ANOVA. There was no significant difference in the prevalence and levels of antithyroid antibodies between PCOS group and control subjects [P>0.05]. The level of [T3] and [T4] was significantly higher in polycystic ovary syndrome than in control group [P<0.05]. It does not seem that to be more prevalent than in the healthy women and it is unlikely that they have an important role in pathophysiology of the disease

[Results of descemet`s stripping with endothelial keratoplasty [dsek] in patients with bullous keratopathy after cataract surgery]

To evaluate the anatomical and visual outcomes of Descemet`s stripping with endothelial keratoplasty [DSEK] in patients with bullous keratopathy after cataract surgery. The study was performed on 20 eyes of 20 patients [13 male, 7 female] with bullous keratopathy [pseudophakic=15, aphakic=5]. Donor lenticule was prepared using a micro keratome [n=12] or manual dissection [n=8]. Patients were excluded in case of extensive corneal scarring and/or vascularization. DSEK surgery was performed by removal of recipient endothelium and Descemet`s membrane, and replacement by the donor lenticule. Patients were followed at least for 6 months. Mean age at surgery was 64.6 +/- 6.7 years and mean follow up was 7.3 +/- 2.1 months. At final follow up 15 grafts were clear. Failure was seen in 5 cases. Visual acuity LogMAR was 1.96 +/- 0.38 before and 0.52 +/- 0.09 after the procedure [P<0.0001]. Mean topographic keratometry was 46.0 +/- 2.9 D before surgery which reached 44.4 +/- 1.7 D postoperatively [P=0.219]. Preoperative astigmatism was 2.5 +/- 1.7 D which decreased to 1.1 +/- 2.3 D at final follow up [P=0.229]. Mean pre- and postoperative surface regularity index [SRI] were 1.47 +/- 0.60 and 0.43 +/- 0.17, respectively [P=0.006]. No case of endothelial rejection was observed. DSEK surgery is an effective treatment modality in cases of bullous keratopathy after cataract surgery with acceptable anatomical and visual outcomes

[Usage of autologous serum eye drops]

Tears have antimicrobial, nourishing, mechanical, and optical properties and contain components such as growth factors, fibronectin and vitamins to support proliferation, migration and differentiation of corneal and conjunctival epithelial cells. Lack of these epitheliotrophic factors, as in dry eye, can result in severe ocular surface disorders such as persistent epithelial defects. Recently, the use of autologous serum in the form of eye drops has been reported as a new treatment for severe ocular surface disorders. Serum eye drops may be produced as an unpreserved blood preparation. They are by nature non-allergenic and their biomechanical and biochemical properties are similar to normal tears. In vitro cell culture experiments showed that corneal epithelial cell morphology and function are better maintained by serum than by pharmaceutical tear substitutes. Clinical cohort studies have reported its successful use for severe dry eyes and persistent epithelial defects. However, the protocols to prepare and use autologous serum eye drops varied considerably between the studies. In addition to different biochemical properties, protocol variations may also influence the epitheliotrophic effect of the product. Before establishing the definitive role of serum eye drops in the management of severe ocular surface diseases in a large randomized controlled trial, this has to be evaluated in more detail. Based upon the literature reviewed here, two preliminary standard operating procedures for the preparation of serum eye drops are proposed

[Hypotonous maculopathy following ocular blunt trauma]

To report a case of hypotonous maculopathy after blunt trauma and its treatment. A 34-year-old woman presented with decreased visual acuity in her left eye following blunt trauma. Right eye examination was unremarkable, but visual acuity of left eye was counting fingers. Slit lamp biomicroscopy of the left eye was within normal limits, but on funduscopy, papillomacular chorioretinal wrinkling was present. Intraocular pressure [IOP] of left eye was 4 mmHg. On gonioscopy, a cyclodialysis cleft was seen from 11 to 1 o'clock. Argon laser therapy to cyclodialysis cleft was performed. Two months later, best spectacle corrected visual acuity of left eye was 20/20 and chorioretinal wrinklings disappeared and IOP was 15 mmHg with timolol 0.5% twice daily. Blunt ocular trauma may result in cyclodialysis cleft which can lead to hypotony and maculopathy, consequently. Argon laser photocoagulation to the cyclodialysis cleft might be an effective way to relieve hypotony and improve vision

Secondary hyperparathyroidism in association with malnutrition - inflammation complex syndrome in chronic hemodialysis

To found the association of high PTH levels with some indexes of malnutrition-inflammation complex syndrome [MICS], a study was carried out a group of maintenance hemodialysis patients[MHPs] consisting of nondiabetic and diabetic patients. Intact serum PTH [iPTH] and serum C-reactive protein[CRP], serum calcium [Ca], phosphorus [P], alkaline phosphatase [ALP], serum cholesterol [chol]and serum triglyceride [Tg] were measured .Body mass index [BMI] was also calculated. Total patients were 36[f=15 m=21], consisting of 25 non-diabetic HD patients and 11 diabetic HD patients. The mean patient's age was 44[ +/- 17] years. The value of serum iPTH of total HD patients was 434 +/- 455 [median:309]pg/nd, the value of serum iPTH of diabetic and nondiabetic-dialysis patients were 201 +/- 277[median:41] and 537 +/- 483[median:340]pg/ml respectively. In this study we found a near significant positive correlation of serum iPTH with serum CRP, a significant inverse correlation of serum iPTH with BMI and a near significant positive correlation of serum ALP with Logarithm of CRP, a significant positive correlation of serum phosphorus with serum CRP and also a significant inverse correlation of serum phosphorus with BMI were found. A near significant inverse correlation of serum cholestrol with serum phosphorus as well as a near significant inverse correlation of serum cholestrol with serum CRP were existed too. When patients with iPTH below than 200 pg/ml were deleted, the correlation of iPTH with CRP was positive [r =0.42, p =0.085] and when patients with iPTH more than 500pg/ml were deleted, this correlation was found to be negative[r = -0.42, p =0.047], means that a low iPTH values is an index of malnutrition while higher values is associated with inflammation, Further attention needs to better control of hyperphosphatemia and maintaining the iPTH levels 1.5 times of normal to avoid the sides effects of secondary hyperparathyroidism

Relationship of serum lipoprotein - [a] with carotid intimae media thickness

To evaluate the correlation of lipoprotein[a] as a risk factor for accelerated atherosclerosis with intimae-media thickness of carotid artery as a sign of atherosclerosis in chronic renal failure patients, not yet on dialysis, hemodialysed and kidney transplanted patients. One hundred-thirty subjects consist of [group 1] 29 normal healthy persons, [group 2] 33 chronic renal failure not yet on dialysis, [groups 3] 43 hemodialysed patients and [group 4] 25 kidney transplanted patients were evaluated for carotid-intimae-media [IMT] sonography and some laboratory analysis. IMT more than 0.8 mm and Lp[a] more than 39 mg/dl were considered abnormal. There was significant difference of Lp[a] between control group and group 2 and 3. Scheffe test showed a significant difference of IMT between normal subjects and CRF group, HD group and kidney transplanted group. Moreover the study showed significant difference between IMT of CRF patients with HD group. There was a significant correlation between IMT and age in group 1, group 2 and group 3, no significant correlation between IMT and age in group 4 was found, no significant correlation between constant variables [LDL-c, HDL-c, Lp[a], Tg, chol, sex] with IMT [dependent variable] in group 1 and 2 were found. No association between IMT with other lipids [chol, Tg, LDL-c, HDL-c], sex and duration of disease in group 2 and 3 were found. In group 4 only the positive correlation, was between IMT and LDL-c. This study showed positive correlation of lipoprotein [a] with IMT only in hemodialysed patients, which showed effects of dialysis on acceleration of atherosclerosis, and the most important factor in association with thickening of intimae-media complex in normal, CRF as well as hemodialysed and kidney transplanted groups

Close relationship of carotid intimae-media thickness with left ventricular hypertrophy and ejection fraction in end-stage renal disease patients undergoing hemodialysis treatment

Background: Two principle findings of cardiovascular disease in end-stage renal disease patients undergoing regular hemodialysis is left ventricular hypertrophy [LVH] and arterial disease due to rapidly progressive atherosclerotic vascular disease that can be characterized by an enlargement and hypertrophy of arteries [Intimae-media complex thickening [IMT]]. In this study we sought to study the relationship of left ventricular hypertrophy with Intimae-media complex thickening in end-stage renal disease patients undergoing regular hemodialysis

Patients and Methods: This cross-sectional study was done on Sixty-one patients with end-stage renal disease [ESRD] undergoing regular hemodialysis treatment [F=23 M=38] consisting of 50 non diabetic hemodialysis patients [F=20 M=30] and 11 diabetic hemodialysis patients [F=3 M=8]. For all patients echocardiography was done and carotid-Intimae-media thickness by B-mode Ultra-sonography was measured

Results: There was positive correlation between stages of LVH with duration of hemodialysis treatment. Positive correlation between stages of LVH with stages of hypertension was seen. More over significant correlation between stages of LVH with carotid-IMT and also positive correlation between stages of LVH with presence of chest pain was found. More thickening of Intimae-media complex in diabetic group, and association of diabetes mellitus with the presence of chest pain as well as positive correlation between stages of HTN with IMT was also demonstrated. More over linear inverse correlation between IMT with percent of LV ejection fraction were observed

Conclusion: Thickening of intimae-media complex is more evident in hemodialysis subjects with LVH, when there is an LVH; the IMT is similar in severity to the LVH

[Evaluation of the anticoagulant efficacy of Low molecular weight heparin [Fragmin] during hemodialysis in dialysis patients]

Low-molecular- weight heparin [LMWH] is a derivative of conventional heparin [standard unfractionated heparin [SUFH]]. Its beneficial effects during hemodialysis anticoagulation has caused this drug to open a new horizon for itself as an appropriate anticoagulant drug during hemodialysis. We decided to evaluate the anticoagulant efficacy of Fragmin as a low-molecular-weight heparin during hemodialysis. This experimental study was done on 35 hemodialysis patients. First blood sample was obtained for partial thromboplastin time [PTT] and predialysis BUN. Then 5000U single dose of Fragmin was injected into the arterial line of hemodialysis apparatus. After half an hour and at the end of hemodialysis session blood samples were drawn for PTT measurements. At the end of dialysis, blood samples for BUN were also drawn. For dialysis adequacy, we used Urea Reduction Rate [URR] method, and we compared the URR of LMW heparin with URR of SUF heparin by using pair T statistical analytic test. Half an hour after starting the dialysis 94% of patients had PTT equal and more than 1/8 base PIT, and at the end of four hour hemodialysis 51% had PTT equal or less than 1/4 base PTT. 49% of patients at this time had PTT more than 1/4 base PTT. Among of 49% patients there was not any need for more compression on venous sites after needle extraction at the end of session and any episode of hemorrhage was noted. We conclude that low-molecular-weight heparin can induce an appropriate anticoagulation and with single dose usage can induce an appropriate hemodialysis adequacy

Relationship of conjunctival and corneal calcification with secondary hyperparathyroidism in hemodialysis patients

Hyperphosphatemia is the consequence of end stage renal failure. Inadequate control of serum phosphorus results in elevated Ca'P product with subsequent soft tissue deposition in the form of conjunctival and corneal calcification. In this study, we evaluated the relationship of conjunctival and corneal calcification with secondary hyperparathyroidism in hemodialysis patients. Patients and methods: This is a descriptive-analytic study performed on 24 hemodialysis patients. We measured serum calcium, phosphorus, alkaline phosphatase, iPTH and conjunctival and corneal calcification using slit-lamp microscope according to a modification of Porter's criteria. The duration of hemodialysis was 30.7 21.7 months. 24 patients participated in this study. The biochemical values were: Ca: 9.1 0.8 mg/dl, P: 6.5 2.2 mg/dl, ipTH: 488 326 pg/ml, Ca'P: 51.5 16.6 The mean of conjunctival and corneal calcification score was 7.1 4. There was a positive correlation between conjunctival and corneal calcification with a duration of hemodialysis [p=0.033, r=0.436], Ca'P product [p=0.007, r=0.538]. P [p=0.006, r=548] and iPTH [p= 0.028, r=0.449]. There was no correlation between conjunctival and corneal calcification with the age of the patients, serum calcium and alkaline phosphatase. There is a positive correlation of serum phosphorus, Ca'P product and iPTH with conjunctival and corneal calcification and no significant correlation with serum calcium implying that there is a central role for phosphorus in calcium-phosphorus deposition in soft tissues like cornea and conjunctiva, underscoring further attention to phosphorus control in hemodialysis patients