Effect of vitamin D supplementation on chronic liver disease: systematic literature review

Introduction: It is long known that vitamin D deficiency was common in patients with liver disease, but little is known on the therapeutic effects of vitamin D, especially in patients with chronic liver disease. In this study, we aimed to systematically review the literatures and study the evidences in which the effects of vitamin D supplementation had been investigated on the severity of chronic liver disease or liver cirrhosis

Methods: A systematic literature search was performed by using the following key terms "vitamin D supplementation" and "chronic liver disease" in the PubMed, Scopus and Google scholar to find relevant articles. After collecting the eligible documents, data were extracted and described based on the purpose of this review

Result: Of total 196 articles found, only 7 relevant documents with 518 studied patients were included. The results of this study showed that the levels of 25[OH] D were considerably lower in patients with chronic liver disease. Findings showed that vitamin D supplementation can rise up the mean serum level of 25[OH] D in patients with severe vitamin D deficiency, especially patients with liver cirrhosis

Conclusion: The results of this review showed that vitamin D deficiency is associated with the severity of liver disease and may have prognostic value in the assessment of liver disease. Also, it was shown that vitamin D supplementation may be helpful for the treatment of liver disease at least in certain groups of patients

interesting anomalous coronary artery: right coronary artery arising from the mid part of the left anterior descending artery

A 48-year-old woman was admitted to the emergency department with complaints of typical chest pain, cold sweat, and dyspnea of 24 hours' duration. She had a history of hypertension, hyperlipidemia, and diabetes mellitus for many years. On admission, her electrocardiogram [ECG] revealed normal sinus rhythm and dynamic T inversion in the precordial leads. Her enzyme levels were normal. Transthoracic echocardiography showed a left ventricular ejection fraction of 60%, with mild mitral regurgitation. Because of ST depression during the peak exercise test, cardiac catheterization was suggested and then performed. Coronary angiography demonstrated normal left main coronary artery courses with normal dominant left circumflex artery and left anterior descending artery [LAD]. An anomalous right coronary artery [RCA] was seen, with a nondominant separate branch arising from the mid part of the LAD. It then coursed anteriorly down on the right atrioventricular groove [Figure 1]. Attempts for the cannulation of the RCA were unsuccessful. Aortic root angiography did not show the presence of an independent-origin RCA from the ascending aorta [Figure 2 and Figure 3]. We selected medical management of X syndrome [microvascular disease] and followed up the patient because of the nondominancy of the RCA. There was no need for revascularization or surgery. She was discharged in good condition. The prevalence of the anomalous origin of the RCA from the left system varies from 0.1% to 0.9%.[1] The risk of sudden death and the anomalous origin of the RCA from the left side has yet to be fully elucidated. Some studies have shown that the anomalous origin of the RCA is generally asymptomatic.[2] The management of patients is different, depending on their clinical presentations, anatomical details, and additional findings.[3]

Association between Vitamin D deficiency and the severity of chronic liver disease and liver cirrhosis: systematic literature review

Background: Vitamin D deficiency is believed to cause variety of abnormalities such as liver stifihess and fibrosis. It is also shown that vitamin D deficiency may result in chronic liver disease or liver cirrhosis. In this study, we aimed to systematically review the literature wherein the relationship between vitamin D deficiency and the severity of chronic liver disease or liver cirrhosis had been investigated

Materials and Methods: PubMed, Scopus, and Google scholar were searched using the following search method [vitamin D deficiency OR vitamin D insufficiency OR insufficient vitamin D] AND [chronic liver disease OR chronic hepatitis OR cirrhosis OR liver cirrhosis] AND [severity OR intensity] to evaluate the role of vitamin D deficiency or vitamin D inadequacy in the occurrence and severity of chronic liver disease. Articles were collected and the data were extracted

Results: Totally, 641 articles were found through searching the databases and reference list scanning. Of the collected documents, only 19 articles with 4895 studied patients were included and analyzed. The results of this study showed that almost 80% of patients with chronic liver disease had severe vitamin D deficiency

Conclusion: Vitamin D deficiency is associated with the occurrence of chronic liver disease. The severity of liver cirrhosis is also associated with the level of 25 [OH] in progressive liver disease

Types of traumatic lens dislocations at Larkana

The objective of this study was to determine the pattern of traumatic lens dislocations presenting at our institute. This may help develop the preventive strategies. The number of cases of traumatic lens dislocations, presented at the Department of Ophthalmology, Chandka Medical College, Larkana, Pakistan, from January 2002 to June 2015, were 59 including 61.02% [n=36] males and 38.98% [n=23] females. Cause of trauma was wood or plant impalement in 35.6% [n=21] cases, cracker blast in 13.55% [n=8] cases, fall on ground in 11.86% [n=7] cases, penetrating injuries with needle, scissors or knife in 10.16% [n=6] cases, road traffic accidents in 10.16% [n=6] cases, sports injuries [cricket ball and gulle danda] in 8.47% [n=5] cases, firearm injuries in 5.1% [n=3] cases, and fist hitting in 5.1% [n=3] cases. Lens was dislocated posteriorly in 33.90% [n=20] cases, anteriorly in 25.42% [n=15] cases, inferiorly in 11.86% [n=7] cases, medially in 10.17% [n=6] cases, laterally in 10.17% [n=6] cases, superiorly in 6.78% [n=4] cases, and a single [1.69%] case of lenticele was seen

Non-hodgkin's lymphoma presenting as constrictive pericarditis: a rare case report

Constrictive pericarditis [CP] is an uncommon post inflammatory disorder. It is described as pericardial thickening, myocardial constriction, and impaired diastolic filling. The most common etiologies are idiopathy, mediastinal radiotherapy, and prior cardiac surgery. Less common etiologies include viral infections, collagen vascular disorders, renal failure, sarcoidosis, tuberculosis, and blunt chest trauma. CP can less commonly be caused by malignancy. We report a very rare case of non-Hodgkin's lymphoma [NHL] presenting twice with attacks of decompensated heart failure. Echocardiography revealed that CP was responsible for the patient's symptoms as the first manifestation of NHL. Chest computed tomography scan and biopsy findings were compatible with the diagnosis of NHL. The patient received R-CHOP [cyclophosphamide, hydroxydaunorubicin, Oncovin®, and prednisone or prednisolone, combined with the monoclonal antibody rituximab] chemotherapy. Three months later, there was significant improvement in the patient's symptoms and considerable decrease in pericardial thickness

Tamoxifen Induces Apoptosis of Leishmania major Promastigotes in Vitro

Tamoxifen is an antagonist of the estrogen receptor and currently used for the treatment of breast cancer. The current treatment of cutaneous leishmaniasis with pentavalent antimony compounds is not satisfactory. Therefore, in this study, due to its antileishmanial activity, effects of tamoxifen on the growth of promastigotes and amastigotes of Leishmania major Iranian strain were evaluated in vitro. Promastigotes and amastigotes were treated with different concentrations (1, 5, 10, 20, and 50 µg/ml) and time periods (24, 48, and 72 hr) of tamoxifen. After tamoxifen treatment, MTT assay (3-[4,5-dimethylthiazol-2-yl]-2,5 biphenyl tetrazolium bromide assay) was used to determine the percentage of live parasites and Graph Pad Prism software to calculate IC50. Flow cytometry was applied to investigate the induction of tamoxifen-induced apoptosis in promastigotes. The half maximal inhibitory concentration (IC50) of tamoxifen on promastigotes was 2.6 µg/ml after 24 hr treatment. Flow cytometry analysis showed that tamoxifen induced early and late apoptosis in Leishmania promastigotes. While after 48 hr in control group the apoptosis was 2.0%, the 50 µg/L concentration of tamoxifen increased it to 59.7%. Based on the in vitro antileishmanial effect, tamoxifen might be used for leishmaniasis treatment; however, further researches on in vivo effects of tamoxifen in animal models are needed.

Expression Levels of Vascular Endothelial Growth Factors A and C in Patients with Peptic Ulcers and Gastric Cancer

PURPOSE: Vascular endothelial growth factor (VEGF) is one of the most important growth factors for metastatic tumors. To clarify the role of VEGF-A and C in patients with peptic ulcer disease (PUD) or gastric cancer (GC), we evaluated the expression levels of these two molecules. We also analyzed the effect of Helicobacter pylori infection on VEGF-A and C expression levels. MATERIALS AND METHODS: Patients with dyspepsia who needed diagnostic endoscopy were selected and divided into three groups: non-ulcer dyspepsia (NUD), PUD, and GC, according to their endoscopic and histopathological results. Fifty-two patients with NUD, 50 with PUD, and 38 with GC were enrolled in this study. H. pylori infection was diagnosed by the rapid urease test. After RNA extraction and synthesis of cDNA, the expression levels of VEGF-A and C were determined by quantitative reverse transcriptase polymerase chain reaction. RESULTS: The VEGF-C expression level in the PUD and GC groups was significantly higher than that in the NUD group. Moreover, the VEGF-A expression level in the PUD and GC groups was higher than in the NUD group, although the differences were not statistically significant. Significant positive correlations were also observed between the expression levels of these two molecules in the PUD and GC groups. In addition, the expression levels of these two molecules were higher in H. pylori positive patients with PUD or GC than in H. pylori negative patients of the same groups; however, these differences did not reach statistical significance. CONCLUSIONS: Up-regulation of VEGF-C expression during gastric mucosal inflammation may play a role in the development of peptic ulcers or GC.

Pathological findings of chronic supparative otitis media in tertiary care hospital

Objectives: To see the clinico-pathological pattern of findings in the chronic supparative otitis media [CSOM] during surgery

Study Design: A prospective observational study

Place And Duration: This study was conducted in Karachi Medical and Dental College and Abbasi Shaheed Hospital during the period of October 2006 to October 2010

Methodology: For this study, 288 patients were selected. After complete history, examination and relevant investigations surgery was performed and intra-operative findings of middle ear cleft were noted

Results: Total number of patients selected were 288, in which female were dominating slightly with 54.1%. Maximum incidence was noted between the ages of 16-30 years of age in 180 patients [62.5%]. 140 cases [48.61%] had no ossicles damage while 148 cases[51.38%] had one or more ossicles damage. Granulation tissue found in 99 patients [34.37%], while cholesteatoma found in 77 patients [26.73%]

Conclusion: Pathological changes varies from simple mucosal edema to extensive destruction of the middle ear cleft

[Effects of aquatic balance training and detraining on neuromuscular performance and balance in healthy middle aged male]

Since disorders in neuromuscular performance and imbalance are the main cause of falling among the middle aged, their aspects including rehabilitation of balance are the main concern the researchers attend to them. The aim of this study was to determine the effects of eight weeks aquatic balance training [ABT] and detraining on neuromuscular performance and balance in healthy middle aged male. Thirty adult male subjects were randomized into two groups of ABT and control [n=15 per group]. Berg balance scale, Timed Up and Go and 5-Chair stand tests, as they are indicators of balance and neuromuscular performance in older subjects, were taken as pretest and post-test and after four, six, and eight weeks of detraining as well. The ABT consisted of the sessions that lasted one hour, three times a week, for eight weeks. Results showed that neuromuscular performance and balance improved significantly in ABT group [P<0.05], and there were not any significant differences in these parameters between post-test and four, six, and eight weeks of detraining periods in this group [P > 0.05]. ABT can affect neuromuscular performance and balance in healthy middle aged male, and reduce the probability of falling among them. Moreover, the effects of these training are persistent after detraining periods. Hence, ABT can be recommended as an effective neuromuscular and balance training in healthy middle aged male

Demographics and angiographic findings in patients under 35 years of age with acute ST elevation myocardial infarction

ST-elevation myocardial infarction [STEMI] is a major cause of cardiovascular mortality worldwide. There are differences between very young patients with STEMI and their older counterparts. This study investigates the demographics and clinical findings in very young patients with STEMI. Through a review of the angiography registry, 108 patients aged 35 years [Group II] who underwent coronary angiography after STEMI. Group I patients were more likely to be male [92.6%], smokers, and have a family history of cardiovascular diseases [34.6%]. The prevalence of diabetes, dyslipidemia, and hypertension was higher in the old patients. Triglyceride and hemoglobin were significantly higher in Group I. Normal coronary angiogram was reported in 18.5% of the young patients, and in 2.1% of the older patients. The prevalence of single-vessel and multi-vessel coronary artery disease was similar in the two groups [34.3% vs. 35.2%]. The younger subjects were more commonly candidates for medical treatment and percutaneous coronary intervention [PCI] [84.2%], while coronary artery bypass grafting [CABG] was considered for the 39.5% of their older counterparts. In the young adults with STEMI, male gender, smoking, family history, and high triglyceride level were more often observed. A considerable proportion of the young patients presented with multi-vessel coronary disease. PCI or medical treatment was the preferred treatment in the younger patients; in contrast to their older counterparts, in whom CABG was more commonly chosen for revascularization

Epidemiological survey of animal bites in east of Iran

Animal bite is an important public health problem. In Iran, surveillance system carries out primary prevention for total animal bite cases in order to prevention of rabies. This study is carried out to investigate animal bite epidemiology in Birjand from 2002 to 2009. Standardized investigation form is used to record data from Birjand health center regarding demographic data of individuals, exposure status, treatment and biting animals between 2002 and 2009. The mostly affected individuals were in age group of 20-29 [23.9%], males [78.3%] and in rural residents [64.2%]. Moreover, 86.3% were bitten by domestic animals and most cases were bitten by dog [80.3%]. Incidence rate of animal bites in Birjand was increased from 54.36 to 86.74 in 100 000 from 2002 to 2009. This study indicated that rabies surveillance in Birjand should focus on education to individuals, domestic animal vaccination and eradication of stray dogs

Role of fibrocytes [CD34+] derived from peripheral blood in the pathology of dermal fibrosis in a model of scleroderma

Peripheral blood fibrocytes are a newly identified circulating leukocyte subpopulation that migrates into injured tissue where it may display fibroblast-like properties and participate in wound healing and fibrosis of skin and other organs. In this study, fibrocyte recruitment to skin in a bleomycin-induced dermal fibrosis model of human scleroderma in vivo was studied. Sections of skin from normal mice [control group] and bleomycin-treated C57BL/6 mice [Experimental group] were stained for Procollagen a2 Type I and CD34 and the double stained cells, and also fibrocytes were counted in the tissue sections. There were more fibrocytes in the dermis of experimental group than control group. There was no significant difference in fibrocyte number between skin samples with 1 week bleomycin treated and 3 weeks treated samples. We also found that fibrocytes [CD34+ and procollagen+] were mainly localized in clusters around blood vessels in the dermis and also individually close to epithelium. Our data suggest an important role of fibrocytes in the pathology of dermal fibrosis

Frequency of the uremic pruritis and its associated factors in hemodialysis patients in the Golestan Province dialysis centers in 2009

Pruritus is one of the most disabling complications in patients with chronic renal failure that have negative effect on patients' quality of life. The aim of this study was to determine the frequency of the uremic pruritus and its associated factors in hemodialysis patients referred to the dialysis centers in Golestan Province. In this cross-sectional study, all 375 patients referred to eight dialysis centers in Golestan Province were selected via census sampling method. Data were gathered by using demogeraphic and Yosipovitch pruritus questionnaires. Data analysis was performed using SPSS software through conducting t and chi square tests. The mean +/- standard deviation of patients' age was 48.36 +/- 13.27 years and 51.2% of patients were male. One hundred and eighty one [48.3%] patients had uremic pruritus. The lowest and highest frequency of pruritus among surveyed centers were 37.9% and 57.1%, respectively. 60.2% of patients had localized pruritus and the most common location was back [68.8%]. There was a statistically significant correlation between uremic pruritus with number of dialysis session [P<0.001] and serum level of phosphorus [P<0.001]. The results indicated that uremic pruritus is still one of the most common problems in hemodialysis patients. Therefore it seems necessary providing ways to eliminating or reducing the problem

Comparison of three different ceruminolytic agents [soda-bicarbonate, almond oil and normal saline] with respect to their efficacy

To compare the efficacy of three ceruminolytic agents for cerumen impaction with respect to its ease of complete removal via suctioning or probe. A comparative prospective study. This study was conducted carried out at the outpatient department of ENT, Abbasi Shaheed hospital, Karachi from November 2010 to March 2011. A comparative prospective study of 75 adult patients with cerumen impaction in either or both of the ears carried out at the outpatient department of ENT, Abbasi Shaheed hospital, Karachi. The study was done after taking the consent of the patients. All the adult patients of age 18 years or greater, of either sex with the symptoms in the ear[s] because of cerumen which was hard/dry and difficult to remove were included in the study. Those of age less than 18 years and not having any symptomatology because of the cerumen or with soft wax which was easy to clear were not included in the study. The study was carried out from November 2010 till March 2011. the patients with problematic, difficult to remove cerumen or cerumen impaction with symptoms were divided in to three groups: Groups A, Group B and Group c; all having equal number of cases that is 25 each. In group A they were given soda-bicarbonate in glycerin based ear drops; in group B almond oil and group C the normal saline for instillation in ear. The doses and timings for drops were equal in all the group and it was 3 drops in the affected ear every 6-hourly for 1-week. They were councilled that the dose should not be missed and they have to lay down for 5 minutes so that drops are absorbed and does not come out of the ear. After one week they were called in the OPD, was compared with completeness of removal of impacted cerumen for the three groups. Ease and completeness of cerumen removal was 80% in group A, followed by 60% for group C and 20% for group B. We found soda-glycerin to be superior to almond oil and normal saline as ceruminolytic agent

Cerebral tuberculoma in pregnancy: overview of the literature and report of a case

Tubercle bacilli infect about one third of the world's population and over the past decade resurgence of tuberculosis has been a major health threat mainly due to increasing frequencies of immunosuppressive states and drug-resistant organisms. Although tuberculosis is essentially a lung disease, intracranial elements become involved in 5-10% of cases either as meningitis or tumour-like masses [tuberculoma]. Tuberculoma is common in endemic areas but its occurrence during pregnancy is occasional and of particular interest is its intriguing clinical picture mimicking toxemia of pregnancy and brain tumor. In addition, the effects of pregnancy on tuberculosis or vice versa have been controversial. We present here a review of the recent literature and discuss a case coming to medical attention with manifestations of intracranial hypertension during 2 consecutive pregnancies; 4 years apart. On operation a dura-attached mass was detected that proved to be a tuberculoma. After 18 months of close observation and under drug therapy she obviously improved with no ensuing complication. Immunodeficiency state associated with pregnancy is likely to play a role in activation of infection. Tuberculoma should be considered in differential diagnosis of eclampsia and brain mass particularly in women coming from endemic areas for this infection even in the absence of pulmonary involvement

[Job satisfaction and organizational commitment among nursing staff: a study from Golestan, Iran]

To study the relationship between Job satisfaction and organizational commitment in nursing staff in medical university hospitals. In a cross-sectional study, all 750 nursing staff working in hospitals affiliated to Golestan university of medical sciences were entered into the study. Job Satisfaction Questionnaire and Meyer Organizational Commitment Scale used as research instruments. Data were analyzed using descriptive statistical tests and Pearson correlation coefficient. The mean age of participant was 32.6 +/- 7.4 years and 72.7% were female and married [74%]. Job satisfaction in 37.7% of nurses was low and only 2.2% of them had very high level of job satisfaction. Organizational commitment in 49.6% of subjects was low and just 4% of nurses had high level of organizational commitment. There was a statistically significant relationship between job satisfaction and organizational commitment [P<0.05]. There is a significant relationship between job satisfaction and organizational commitment

Efficacy of two streptokinase formulations in acute myocardial infarction: a double-blind randomized clinical trial

We sought to evaluate the efficacy and safety of the different trade forms of streptokinase available in our country, namely Heberkinasa [Heberbiotec, Havana, Cuba] and Streptase [Aventis Behring GmbH, Marburg, Germany]. We conducted a double-blind randomized clinical trial to compare the two streptokinase formulations, i.e. Heberkinasa [HBK] or Streptase [STP], in patients with acute myocardial infarction who needed thrombolysis. Thrombolysis success was evaluated angiographically and/or clinically. Clinical follow-up was done 30 days after thrombolysis. We randomly allocated 221 patients with a mean age of 56.9 +/- 10.8 years [males: 88.2%] to HBK [n = 119] and STP [n=102] groups. Baseline clinical and demographic characteristics were similar between the two groups, and the two groups were not significantly different in terms of door-to-needle and pain-to-needle intervals. The rate of complications was not significantly different between the groups [44.1% [HBK] vs. 42% [STP]]. Angiography was done for 158 [71.5%] patients in the first 24 hours [9%] and in the first 72 hours [38.8%] after thrombolysis. Lesion morphology and lesion/patient ratio were not significantly different between the two groups [1.87[HBK] vs. 1.67[STP]]. The two groups were similar with respect to angiographic patency rate [67.5% [HBK] vs. 67.6% [STP]]. The study groups were also similar as regards clinical outcome and complications of both streptokinase formulations. The present study demonstrated that Heberkinasa is as effective and as safe as a standard streptokinase, namely Streptase, in a clinical setting

Effect of cardiac rehabilitation program on heart rate recovery after percutaneous coronary intervention and coronary artery bypass grafting

The objective of this study was to evaluate the effect of a hospital-based cardiac rehabilitation program on heart rate recovery [HRR] in patients who received percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]. Two hundred forty patients, who completed 24 sessions of a cardiac rehabilitation program [phase 2] after PCI [n=62] or CABG [n=178] at the rehabilitation department of Tehran Heart Center were included in the present study. Demographic and clinical characteristics and exercise capacity at baseline and at follow-up were compared between the two groups. The main outcome measurements were: Resting heart rate, peak heart rate, and HRR. All the patients showed significant improvements in heart rate parameters from the baseline to the last sessions. The profile of atherosclerotic risk factors [except for diabetes mellitus] was similar between the PCI and CABG subjects. After eight weeks of cardiac rehabilitation, HRR increased averagely about 17 and 21 bpm among the CABG and PCI patients, respectively [p=0.019]. The results of the present study were indicative of an increase in HRR over 1 minute in patients irrespective of their initial revascularization modality [i.e. PCI or CABG] after the completion of cardiac rehabilitation. Be that as it may, the PCI patients achieved greater improvement in HRR by comparison with the CABG patients

Dermatophytes causing tinea cruris in our population

To find out etiology and species identification of dermatophytes causing tinea cruris. Prospective study.This study was conducted in the Department of Microbiology, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi from September 2000 to August, 2001. Ninety-five patients having skin infections [clinically suspected cases of tinea cruris] were examined. The skin scraping were taken from active border of the lesions and subjected to direct microscopy and culture on mycobiotic agar [Difco] for isolation of dermatophytes. Various special media were used for species identification. Tinea cruris was predominantly seen in adult [85.2%] than in adolescent [9.5%] and children [5.3%]. Out of 95 cases studied 83 [87.4%] were males and 12 [12.6%] were females. Tinea cruris was significantly found more in males [87.4%] than females [12.6%] [P < 0.001]. Regarding various species of dermatophytes, 38 [67.9%] cases were caused by Trichophyton rubrum, 14 [25%] by Epidermophyton floccosum and Trichophyton mentagrophytes 02 [3.5%]. Trichophyton violaceum and Trichophyton tonsurans accounted for the remaining 01 [1.8%] case respectively. Tinea cruris is a common problem of our population affecting predominantly male population. Different species like Trichophyton rubrum, Epidermophyton floccosum, Trichophyton mentagrophytes and Trichophyton violaceum and Trichophyton tonsurans is most commonly isolated from study group. It is proposed that a large sample size study with antifungal drugs sensitivity should be designed to get a more clear picture of dermatophytes involved in Tinea cruris

audit of laparoscopic cholecysstectomies performed at PNS Shifa

Open cholecystectomy used to be the gold standard for more than 100 years, now this has been taken over by laparoscopic cholecystectomy. The operation has proved its worth because of little post operative pain, minimal scar, reduced hospital stay [1-2 days] and convalescence 1 to 2 weeks as compared to open cholecystectomy. The only problem seems to be the proper training of surgeons for safety of the patient to avoid common bile duct [CBD] and other injuries