effect of weight reduction on ultrasonographic findings of non alcoholic fatty liver

Non-alcoholic fatty liver [NAFL] includes a spectrum of diseases ranging from simple hepatic steatosis to nonalcoholic steatohepatitis [NASH] and cirrhosis. NAFL is typically seen in association with obesity, diabetes and hypertriglyceridaemia. In order to seek the role of diet therapy in treatment of NAFL, we compared the ultrasonographic findings of patients with fatty liver disease before and after standard diet therapy. Twenty-three overweight or obese subjects with incidental fatty liver discovered during ultrasonography were included. Subjects underwent 3 months of diet therapy, and anthropometric data including weight, height, BMI, waist circumference, and hip circumference were measured. Ultrasonographic findings were graded from 0 to 3. Changes in ultrasonographic findings and anthropometric data were studied. After three months of dieting, the ultrasonographic grade of all patients decreased by one or two grades. Fifteen patients decreased one grade while 8 others decreased by 2 grades. We observed a significant correlation between the decrease in ultrasonographic grade and the decrease in weight and BMI. Our study indicates that standard diet therapy could be used as an effective treatment for NAFL patients

Prevalence of fatty liver disease among type 2 diabetes mellitus patients and its relation to insulin resistance

A substantial proportion of the mortality in patients with type 2 diabetes mellitus [T2DM] is related to non-alcoholic fatty liver disease [NAFLD] and its complications. Insulin resistance is a major etiologic factor for the development of fatty liver. We aimed to study the prevalence of NAFLD among T2DM patients and its relation to insulin resistance. Patients with T2DM that were referred to a tertiary referral center in Tehran from February 2003 to August 2005 were evaluated. Patients with characteristic findings on ultrasonography were considered as having fatty Livers. The Homeostasis Model Assistant - Insulin Resistance [HOMA-IR] and Quantitative Insulin Sensitivity Check Index [QUICKI] were calculated as measures of insulin resistance. Of the 172 patients included in the study, 96 [55.8%] had evidence of fatty livers, 6 of which [3.5% of total] presented with elevated liver enzymes. BMI and triglyceride levels in the fatty liver group were significantly higher than patients with normal livers [p=0.002 and 0.036, respectively]. The HOMA-IR and QUICKI indexes were not significantly different between the two groups. Fatty liver is a common finding among T2DM patients. The degree of insulin resistance does not appear to be predictive of fatty liver among this population

Vertebral geometry parameters can predict fractures

The aim of this study was to investigate vertebral geometry changes and determine cutoff value of vertebral height to predict fractures. In a cross-sectional study, 280 postmenopausal women recruited .In all subjects bone mineral density and radiography of the lumbar spine performed. Lateral radiographs were evaluated for identification of vertebral fractures, using a validated semiquantitative method. T-score of vertebral height was calculated based on data extracted from Iranian Multi-center Osteoporosis Study. ROC curve used to determine cut off value of vertebral height T-score to predict fractures. The mean of age and BMI were 55.34 +/- 8.7 years and 27.73 +/- 5 kg/m2, respectively. Among osteoporotic women, 59.8% had one or more vertebral fractures and 23.8% had at least 2 fractures. In fracture group the T-score of spine and femur BMD was lower than the others. The mean of vertebral height in women without fractures was 12.94+0.6 cm, and in the patient with 4 or more fractures was 12.3, thus every fracture accompany with 1.2% decreases in the height of vertebrae. The prevalence of vertebral fracture in osteoporotic patients was 71.4% and in healthy cases 39.5%. Better estimation of vertebral height T score in ROC curve was less than -0.7.The sensitivity and specificity of the cut off value were 81.3% and 52.9%, respectively. Vertebral fractures are common fractures in postmenopausal women. There was a correlation between vertebral height and fractures. Vertebral geometric parameters especially height T score can be used for fracture screening

[High dose intravenous corticosteroid versus placebo in recent traumatic optic neuropathy]

To compare the effect of high dose intravenous corticosteroid therapy with placebo in the treatment of recent traumatic optic neuropathy [TON]. In double masked-placebo controlled clinical trial, 31 eyes of 31 patients were randomly assigned into two groups. Only patients with history of ophthalmic or head trauma within the past 7 days were included. Unconscious patients, with penetrating ocular injury, and candidates for decompression surgery were excluded. The treatment group [16 eyes] received 1 gr methylprednisolone intravenously for 3 days followed by 1 mg/kg prednisolone orally for 11 days. The placebo group [15eyes] received 50 ml normal saline intravenously every 6 hours for 3 days. Visual improvement was defined as increase of at least 0.3 logMAR visual acuity after 3 month. Visual improvement was achieved in 68.8% of the treatment group and 53.3% of the placebo group [P=0.1]. Visual improvement in the first 48 hours was correlated with final visual acuity [P=0.03] but final visual acuity was not significantly correlated with age [P0.06], interval from trauma to treatment [P=0.5], and initial visual acuity [P=0.06]. In patients with recent TON, high-dose intravenous corticosteroids and placebo are comparable in terms of improvement in visual acuity

[Prevalence of lung involvement due to rheumatoid arthritis based on clinical, radiographic and pulmonary functions test]

Background: Pulmonary involvement is a common and serious complication of rheumatoid arthritis. This cross sectional study sought to determine the prevalence of pulmonary disease in patients with rheumatoid arthritis on the basis of history, physical examination, chest X-ray and PFT

Materials and Methods: 103 patients [81 Women, 22 Men] fulfilling the ACR [American College of Rheumatology] criteria for RA [Rheumatoid arthritis] were consecutively included in a cross sectional study. Detailed medical [including respiratory symptoms and the disease activity symptoms] and drug and occupational histories and smoking were obtained. All patients underwent a complete pulmonary and rheumatologic examination and conventional chest radiography. All patients underwent PFT that comprised spirometry and body plethysmography. Results for PFTs were expressed as percentage of predicted values for each individual adjusted for age, sex, and height

Results: On the basis of history: Their mean age was 43.3 +/- 2.6 years [range: 17-74] and the mean duration of the disease was 69.3 +/- 15.6 months. Rheumatoid factor was positive in% 61.2. No patients were 0.5Pack/Year smoker in whole life. Prevalence of pulmonary involvement based on radiographic and pulmonary function test detected in 41 patients [39/7%]. The most frequent respiratory clinical finding was dyspnea [33%], [NYHA grade I in 17.5% and NYHA grade II in 15.5%], Cough [with or without sputum] in 13.6 %, Crackle was the most sign in pulmonary examination [5.8%]. Chest X-ray was abnormal in 13.3 % that the most common finding in this study was reticulonodular pattern in 20 patients [19.4 %], and pleural effusion detected in 7 patients [6.7%]. PFT was abnormal in 30 patients [29.1 %]. A significant decrease of FEF 25%-75% below 1.64 SD. Small airway involvements was the most abnormal finding of PFT. No relation between rheumatoid arthritis disease activity [ESR>30, Morning stiffness>30', Anemia, thrombocytosis] with pulmonary disease was seen

Conclusion: This study suggests a high prevalence of lung involvement in patients with rheumatoid arthritis. Therefore we recommend a complete investigation in patients with RA with any respiratory symptom