[Examination with two types of semmes Weinstein monofilaments as screening tools for diabetic peripheral neuropathy]

Diabetic neuropathy is one of the more common complications plaguing individuals with type 2 diabetes. The development and progression of such complications are responsible for much of the morbidity and mortality related to this disease. This investigation evaluated accuracy of lily and Semmes-Weinstein monofilaments examination for diabetic peripheral neuropathy screening. Our study population consisted of 150 patients treated for diabetes mellitus at the Diabetes Clinic of the Ahvaz Jundishapur University of Medical Sciences. The samples were chosen on the basis of a non-randomized sampling. All patients were tested for sensory neuropathy using two types of monofilament [Semmes Weinstein monofilament examination 8, and 10-grams]. In the next phase EMG-NCV were examined. Sensitivity and specificity two types of monofilaments were analyzed. The 10-g monofilaments had a sensitivity ranging from 38.5% to 51.3% at sites 1-4, and specificity between 73 to 87.4 the sensitivity and specificity of the 8-g monofilament were 41 to 51.3% and 72.1 to 86.5% respectively. Two types of monofilaments at with 51.3 and 74.8% sensitivity and specificity respectively sites 1 and 4 was the most useful diagnostic test for DPN. These data suggest that the monofilaments may be the optimum methodology for identifying individuals at risk of diabetic peripheral neuropathy. Hence, we recommend screening of patients for neuropathy as soon as they are diagnosed with diabetes

Prevalence of gastrointestinal symptoms in type 2 diabetic patients and its association with glycemic control and duration of diabetes

Long-standing uncontrolled type 2 DM may affect the motility and function of the gastrointestinal [GI] system, throughout the GI tract, from the esophagus to the anorectal region. This study was designed to evaluate the prevalence of GI symptoms in type 2 DM patients and its association to age, sex, glycemic control and duration of diabetes. This was a cross-sectional study conducted on 350 adult type 2 DM patients, selected with sequential sampling from the Ahvaz Diabetes Research Center Clinic in 2010. Data were collected by a questionnaires and analyzed using independent t-test and Chi-score with SPSS version18. Patient mean age was 56 +/- 11 years, and the prevalence of GI symptoms was 67%. The most prevalent GI symptoms were constipation [43%], bloating [35%] and regurgitation [31%]. Prevalence of GI symptoms was related to duration of diabetes [P<0.001]. Higher levels of fasting plasma glucose increased the prevalence of GI symptoms [P=0.003], which were significantly higher in females than in males [P<0.001], and also in older patients [P=0.003]. There was no association between prevalence of GI symptoms and levels of HbA1C or BMI. Prevalence of GI symptoms in type 2 DM was 67%, the most prevalent being constipation, bloating and regurgitation. There was significant association between prevalence of GI symptoms and acute glycemic control [FBS], duration of type 2 diabetes, female gender and age

Determination of the attenuation coefficient for megavoltage photons in the water phantom

Attenuation coefficient [micro] plays an important role in calculations of treatment planning systems, as well as determination of dose distributions in external beam therapy, dosimetry, protection, phantom materials and industry. So, its exact measurement or calculation is very important. The aim of this study was to evaluate the micro in different points in the water phantom analytically as a formula, in addition to derive and parameterize it with dosimetry measurements data results. To find the attenuation coefficients at each point along the central axis of the beam in the phantom for every size of the fields, the first mathematical approach was performed for derivation of micro s from percentage depth dose [PDD] formula. Then by dosimetry for different fields in different depths of water phantom, one can parameterize the obtained formula for micro in any field and depth. By comparing the mathematical and dosimetry results, the parameters of the micro-expression were derived in terms of the dimension of square field in different depths. From this formula one can find the micro for any field in different depths for two energies of the Varian 2100CD linear accelerator, 6, 18MV with the statistical coefficient of determination of R2>0.98. The measurement of the micro in each field size and depth has some technical problems, but one can easily measure the micro for every point of central axis of the beams in any field size

effect of energy and field size on determination of virtual source of the linear accelerator varian 2100 CD

In dosimetric calculation, it is desirable to represent the actual electron beam as originating from a virtual point source in vacuum so that the inverse square law can be applied. Therefore in this research with dosimetry of different treatment fields for different energy of electron beams the position of virtual source for electron beams is determined and one can use the inverse square rule for this electrons as the photons. In this work, the source position of electron beams [s[vir]] from a Varian clinac 2100 CD for different field sizes at different energies was determined by use of elastic scattering theory and dosimetry data. With a parallel plate chamber PPC40 in a 50x50x50cm[3], phantom and Omini-pro accept software the depth dose profiles of 6x6, 10x10, 15x15, 20x20 and 25x25 cm[2] applicators in different energies [6,9,12 and 15 Mev] for treatment electron beams determined. From the dose profile of maximum depth and multiple scattering rules of electrons from the target the position of virtual source of electron beams for each applicator in different energy were obtained. The obtained results from this method showed a dependence on energy and field size for S[vir]. The position of S[vir] is a function of dimension of treatment field and energy. In larger treatment fields and higher energies this distance is longer

Half-saline versus combined normal saline and 1/3-2/3 intravenous fluid therapy in kidney transplantation

Sufficient intravascular volume should be established for optimal graft function after renal transplantation. However, there is no recommendation for the type of fluid therapy post-operatively. We compared half-saline vs. normal saline and 1/3-2/3 intravenous fluid replacement after renal transplantation. We enrolled all patients who underwent kidney transplantation between June 2008 and March 2010 in Golestan Hospital, Ahwaz, southwestern Iran. Patients were randomly divided into two groups using a blinded allocation technique. Group A patients [Case] received half saline, and group B patients [Control] received normal saline and 1/3-2/3 intravenous fluid. According to our protocol, we replaced as much as 100% of hourly urine output in the first day, followed by 90% and 70% of every 2-hour urine output in the 2nd and 3rd days, respectively. Blood pressure and pulse rate were recorded hourly. Serum sodium, potassium, creatinine and pH were assessed twice a day. There were 34 and 36 eligible patients in the case and control groups, respectively. The mean +/- SD 6-hour urine output in the first 5 days after surgery was 2586 +/- 725 mL in the control group and 2764 +/- 758 mL in the case group [p=0.31]. The mean +/- SD serum creatinine level at the end of the 5th post-operative day was 1.3 +/- 0.5 and 1.4 +/- 0.7 mg/dL in the case and control groups, respectively [p=0.56]. Serum creatinine level did not reduce to 1.5 mg/dL or lower in 6 of 36 control subjects and in 4 of 34 cases at the end of the 5th day [p=0.558]. The mean +/- SD time to creatinine level<1.5 mg/dL was 1.3 +/- 1 days in the control group and 1.7 +/- 0.8 days in the case group [p=0.635]. Hyperkalemia occurred in 3 of 36 patients in the control group and in 2 of 34 patients in the case group [p=0.318]. The incidence of hyponatremia in the control group was 11% [4 of 36 patients] vs no patients in the case group [p=0.115]. Either half-saline or normal saline and 1/3-2/3 intravenous solution can be safely used as fluid replacement therapy after kidney transplantation

[Occurence of permanent hypothyroidism in patients with postpartum thyroiditis]

Postpartum thyroiditis is often a syndrome of transient thyroid dysfunction, but can develop to permanent hypothyroidism in some patients. The incidence of postpartum thyroiditis is variably reported, ranging from 1.1% to 16.7% with an incidence ranging between 11% to 63% for permanent hypothyroidism. This study was conducted to assess the prevalence of permanent hypothyroidism after postpartum thyroiditis in Ahwaz. All cases of postpartum thyroiditis referred to the endocrinology clinic between 1999 March and 2007 March were followed for 2 to 10 years. Levothyroxin was administered for 6 to 24 months after diagnosis, and then discontinued to evaluate the patients. Based on laboratory hormonal tests, patients were divided into 3 groups: 1] Normal thyroid function test, 2] Sub clinical hypothyroidism, and 3] clinical hypothyroidism. Fifty-eight women, were followed 6 months after discontining levothyroxin, twenty five [43.1%] of group 1, 13 [22.45%] of group 2 and 20 [34.55%] in group 3. The average T4 level was significantly higher in group 1 compared to groups 2 and 3 [p=.003]. Permanent hypothyroidism was more frequent in patients who initially [during postpartum thyroiditis] had TSH levels >10 mg/dL. Occurrence of permanent hypothyroidism was less frequent in patient who were initially hyperthyroid. [p=.006] It is concluded that a high percentage of patients with postpartum thyroiditis proceed to permanent thyroid failure. The timely recognition of mild to severe cases of postpartum thyroiditis is important for the improvement of life for mothers and infants

[Epidemiology of chronic kidney disease in Iran and worldwide]

Chronic kidney disease [CKD] is a worldwide public health problem. Increasing evidence indicates that earlier stages of CKD can be detected through laboratory testing, and that therapeutic interventions implemented early in the course of CKD are effective in slowing or preventing the progression toward end stage renal failure and its associated complications. Each physician should consider how he/she can contribute to an increase in the local screening, identification, and treatment efforts for CKD. Multidisciplinary collaboration between physicians, health care workers, and the government is necessary to halt the progression of CKD. Unfortunately, there is paucity of data concerning epidemiologic characteristics of CKD in Iran, resulting in lost opportunities for prevention. The present article summarizes recent observations about CKD epidemiology, both in Iran and worldwide

[Determination of the equivalent field size of asymmetric fields in photon beam therapy analytically based on physical theories]

The aim of this study was to obtain relatively theoretical methods based on physical rules in interaction of radiation with matters which can be sensitively, rapidly and easily used in different radiotherapy centers. In this study with the aid of the exponential attenuation rules of photon beams and inverse square distance rule, in 6MV and 18MV energy of 2100C Varian accelerator X-ray and 1.25MeV energy of Cobalt-60 gamma-ray in Ahvaz Golestan Hospital and considering the scatter radiation of therapeutic field and irregular field to be equal, the side of equivalent square field were calculated. In this method, since the calculation was done taking into account the situation of the field, energy and position of the shield, a very good agreement with dose measurements showed [with error, less than 2%]. Not all of these considerations are taken into account in previous methods. In addition, the calculations can be done on a computer for each therapeutic irregular field.

[Androgen- secreting adrenal tumors, 3 case reports]

Adrenal tumors that secrete androgens are rare; the tumor may be an adenoma or a carcinoma. This paper discusses the signs and symptoms, diagnostic methods, treatment and prognosis of these tumors, witnessed in 3 cases of androgen producing adrenal tumors. The first case was a 14 year old girl presented with hirsutism and virilism and primary amenorrhea. Testosterone and DHEAS showed very high levels while other adrenal hormones were within in normal limits. A pure androgen producing adrenal adenoma was diagnosed in this patient. The second case was a 7 year old girl with hirsutism, virilism and cushingoid facial features, acne and weight gain and a large abdominal mass. An adrenal carcinoma producing cortisol, testosterone, and DHEAS was diagnosed in this patient. The third case was a 10 month old baby with weight gain cushingoid facial features, acne and growth of pubic hair. High level of DHEAS, testosterone and cortisol due to an adrenocortical carcinoma, detected in this patient

[ diagnostic accuracy of fine needle aspiration [FNA] in thyroid nodules]

Thyroid nodules are a common clinical problem and Fine Needle Aspiration [FNA] is the principal method used for preoperative diagnosis. This study was designed to evaluate the diagnostic accuracy of FNA for detection of malignancy in thyroid nodules. In this retrospective study, 1016 patients with thyroid nodule were evaluated over a six year period [1999-2005]. FNA was done for all of these patients by two expert pathologists. Thyroidectomy was performed on 104 patients and the cytologic and pathologic diagnoses were compared. For evaluation of diagnostic value of FNA, malignant and suspicious diagnoses of FNA were considered as positive cytologic results and the final malignant cases [excluding microscopic carcinoma] as positive pathologic results. In addition, risk of malignancy in thyroid nodules was calcuated based on the cytologic results documented in our patients. There were 884 females and 132 males [f/m: 7:1], with an age range of 9-81 years. The cytological results of 1016 specimens were as follows: 85% benign, 7% suspicious, 0.9% malignant and 7% inadequate. One hundred and four patients underwent surgery, [85 females and 19 males, f/m: 4.5:1], with an age range of 13-56 years. Preoperative cytologic results in this group were as follows: 62.5% benign, 35.5% suspicious and 2% malignant. Final pathologic results were 83.6% benign and 16.3% malignant. FNA sensitivity was 93.8%, specificity 72.7%, diagnostic accuracy 75.9%, positive predictive value 38.4% and negative predictive value 98.4%. False positive rate was 27%, and false negative rate 6%. Among patients with a suspicious cytology who were operated, malignancy in pathologic results was 35% [13 cases of 37 cases]. While the incidence of malignancy in thyroid nodules was 3.8% in all patients, this rate was 6% in solitary thyroid nodules and 2% in multinodular goiters. Because of its high sensitivity and low false negative results, FNA seems a reliable method for the diagnosis of cancer in thyroid nodules, a method however that is useful only as an adjunct to clinical judgment and not as a replacement

[ impact of intraluminal vancomycin adminstration on prevention of hemodialysis catheter-related infections]

Percutaneously inserted double-lumen central venous hemodialysis catheters provide the nephrologist with an excellent temporary access for an immediate hemodialysis treatment and preserve the peripheral veins for the future creation of a permanent arteriovenous vascular access. Unfortunately catheter-related infections are usually common. In this study, the impact of intra luminal vancomycin administration on catheter-related infections in a group of hemodialyzed patients has been investigated. A total of 100 patients with renal failure requiring hemodialysis by way of double-lumen central venous catheters inserted into the internal jugular or subclavian vein in 6 months period, were randomly divided into two groups of receiving a single intravenous dose of 1000 mg of vancomycin during catheter insertion and no antibiotics. The rate of infection, in situ duration of the initial catheter, number of dialysis sessions per week, site of catheter, length of the catheter which was outside of the skin, catheter tip cultures and the presence of systemic infections related to the catheter, were recorded for every patient. The study period was terminated when the initial catheter was changed or removed for any reason. Catheter-related infection was observed in 6 patients: 2 patients [4%] in the first group who received vancomycin and 4 patients [8%] in the second group who received no antibiotic [P= 0.05]. In regard to infection, 33.3% of the infections occurred in the first week after catheter insertion, 16.7% in the second week and 50% in the third week and there was no association between the duration of catheter fixation and infection [P= 0.7]. The type of the catheter [jugular or subclavian] and the length of the catheter which was outside of the skin had not any effect on the catheter infection [P= 0.5 and P= 0.6 respectively]. In all cases infection was due to staphylococcus. It can be concluded that in uremic patients, a single intravenous dose of vancomycin during the insertion of a double-lumen hemodialysis catheter into the internal jugular or subclavian vein has no effect on prevention of catheter-related infections

[ prevalence of hypoparathyroidism among patients with major thalassemia aged above 10 years]

Major Thalassemia is a chronic hemolytic anemia. It is the most common hemoglobinophathy disorder in Khuzestan province. Hypoparathyroidism is one of its endocrinologic complications due to Iron deposition especially in the second decade of life. Early diagnosis of this complication could prevent other sever disorders such as seizures, osteopenia, and osteoporsis. In a cross sectional study, 96 patients with major thalassemia at the age above ten years referred to Shafa Thalassemia Center, Ahwaz, in addition information about age, sex, weight, height, duration and route of desferral injection, duration of transfusion therapy, vitamin D and calcium consumption, social and educational level of parents, history of splenectomy, any history of seizures, tingling, chvostek, trousseau, carpopedal signs, plasma level of calcium, phosphorus, alkaline phpsphatase, PTH, BUN, Cr, ferritin, and total protein were obtained using questionnaires. In ninety'six patients with major thalassemia the prevalence of hypoparathyroidism was%27/1 in 11-39 yearolds[average 19.3 years]. All patients had low serum calcium, PTH, high serum phosphorus and low to normal alkaline phosphatase. In 26 patients with hypoparathyraidism, 46% had tingling, 38.4% positive chvostek, 30.7% positive trousseau and 11.5% carpopedal spasm. 69.2% of the patients had only sign, whereas 30.8% showed clinically no signs. The average level of serum ferritin in thalassemia patients without hypoparathyroidism was 2770 ng/ml, in hypoparathyroid patients 5020 ng/ml. From 10 patients with irregular desferral consumption 7 patients had overt hypoparthyroidism. Significant correlation was seen between irregular desferral consumption, high ferritin level and hypoparathyroidism. Screening for hypoparathyroidism is recommended in children with major thalassemia aged above 15 years once every 6 months or yearly with measurement of plasma level of PTH, Ca and alkaline phosphatase

Kaposi sarcoma in kidney trasnplanted patients

Newly developed malignancies in kidney transplanted patients are one of the complications attributed to immunosuppression. Kaposi sarcoma is an unusual malignancy in general population, but may develop in kidney transplanted patients with highly varying prevalence. Our aim is to evaluate the prevalence, clinical manifestations, and outcome of Kaposi sarcoma in kidney transplanted patients. Five hundred and eighty cases [330 male, 250 female] with a mean age of 38.2 were followed for 36 months [range 9 months to 10 years], visiting every two months. History taking and physical examination with emphasis on skin and mucosa were taken. Biopsy of suspicious skin, mucosal, and visceral lesions assigned by other paraclinical methods was performed. Except 7 cases which were HLA identical to donors, all patients were managed with cyclosporine, Azathioprine and Prednisolone. Fourteen patients [2.2%] developed Kaposi sarcoma [biopsy documented] which constituted 60% of all post-transplantation malignancies. They were 11 males and 3 females with a mean age of 41 years. Sarcoma developed 8 to 31 months after transplantation with an average of 18 months. Of these patients, 13 had skin involvement that one of them had pulmonary involvement too. Another patient had only abdominal involvement. Azathioprine was discontinued in all patients, and cyclosporine was reduced in skin affected patients. In patients with visceral involvement cyclosporine was discontinued and then chemotherapy was initiated. All 3 patients with visceral involvement didn't respond to chemotherapy and expired after 6 months. Of 11 patients with skin involvement, one had complete and 2 had incomplete remission of whom, one expired due to acute rejection. Renal function in 8 patients was acceptable, but 2 had impaired renal function, yet didn't need dialysis. Prevalence of Kaposi sarcoma in our patients is more than western countries. Visceral involvement is uncommon, but has poor prognosis. Reducing immunosuppression with discontinuation of Azathioprine and significant reducing cyclosporine dosage can cease skin evolvement, with preserving renal function in most of the patients

Regression of left ventricular hypertrophy after successful renal transplantation among uremic patients

Recognition of the natural history and responsible leading factors for regression of left ventricular hypertrophy after successful renal transplantation are very important. The aim of this study was to assess the regression of left ventricular hypertrophy after successful renal transplantation among uremic patients. In this study 27 uremic patients [18 males and 9 females] with an average age of 38.5 years were randomly selected. Left ventricular mass index [LVMI] was calculated before and after renal transplantation at the beginning, and at 4, 6 and 8 months. The means of LVMI before and after transplantation were 180 +/- 19.3 g/m[2] and 133.8 +/- 16.8 g/m [2] respectively [p<0.001]. The means of regression after transplantation at 0, 4, 6 and 8 months of follow up were 191g/m[2], 157.3 g/m[2], 147.8 g/m[2] and 138.8 g/m[2] respectively. There was a significant difference between the means of hemoglobin concentration and blood pressure before and after transplantation [p<0.001]. For instance the means of hemoglobin concentration and blood pressure was 7.2 +/- 0.4 and 13.1 +/- 0.7 g/dL, 154 +/- 6 / 97 +/- 4.4, and 135 +/- 6.3/ 89 +/- 3.8 mmHg respectively. This study showed that maximum left ventricular hypertrophy regression occurred 4 months after transplantation, then decreased to a minimum level of 147.8 and 135.8 g/m[2] at 6 and 8 months after transplantation respectively. Restoration of hemoglobin concentration and blood pressure to normal levels may be recognized as a main cause of left ventricular hypertrophy regression