Nephroprotective effects of L-carnitine against contrast-induced nephropathy in patients undergoing percutaneous coronary intervention: a randomized open-labeled clinical trial

Background: L-carnitine may prevent the incidence of AKI by its antioxidant effects and improving circulation in ischemic conditions. The goal of this trial was to evaluate the impact of L-carnitine on contrast-induced nephropathy in patients undergoing elective PCI

Methods: totally, the patients were randomly allocated to 2 groups. The treatment group received 1 g of L-carnitine orally 3 times a day, 24 hours before the procedure [3 g before PCI] and 2 g after PCI, whereas the control group did not receive L-carnitine. In both groups, the plasma level of neutrophil gelatinase-associated lipocalin [NGAL] was measured at baseline and 12 hours after PCI

Results: our study was conducted on 202 patients [including 91 vs. 111 patients in the treatment and the control group; 31 [34.1%] vs 33 [29.7%] female in carnitine and control group; and ages include 62.0 +/- 9.0 vs 57.0 +/- 11.2 years]. The median plasma levels of NGAL were not different between the carnitine and control groups at baseline [57 [IQR: 22 - 255] vs. 54 [IQR: 29 - 324]; p value = 0.155] and 12 hours after PCI [71 [IQR: 52 - 129] vs. 70 [IQR: 46 - 153]; p value = 0.925], but the changes in the plasma NGAL from baseline to 12 hours after PCI were different between the 2 groups [5 [IQR:-147 - 30] vs. 17 [IQR: -21 - 41]; p value = 0.010]

Conclusion: our results showed that oral L-carnitine was able to prevent an increase in NGAL following contrast medium administration in patients undergoing PCI. More studies should be performed to fully elucidate the nephroprotective effects of L-carnitine

Occurrence of Budd-Chiari syndrome as adverse effect of long term DMPA injections: a case report and review the literatures

Budd-Chiari syndrome [BCS] refers to thrombosis of hepatic veins as well as intrahepatic or suprahepatic inferior vena cava. We present for the first time a case of possible occurrence of Budd-Chiari syndrome with the history of depot medroxy progesterone acetate [DMPA] injections in a 33-year-old Iranian woman. An underlying disorder can be identified in most of patients with BCS. Many of these disorders are characterized by a hypercoagulable state, but it may occur due to other unknown pathophysiologic factors. Also, medical evaluation was performed for inflammatory, immunologic, and thrombotic disorders as well as hepatic imaging. Considering different case reports like this study may help to decrease the percentage of idiopathic cases

Screening for retinopathy of prematurity in South of Iran

The purpose of this study is to report the screening data for retinopathy of prematurity [ROP] at a screening center in Southern Iran. A chart review was performed of all screened neonates who were referred to Poostchi screening center affiliated to Shiraz University of Medical Sciences from February 2006 to January 2010. Statistical analysis of data was performed with the Chi-square and independent t-test where appropriate. A P < 0.05 was considered statistically significant. Of 787 infants referred, 293 [37.2%] had some form of ROP and 77 cases [9.8%] had plus disease, only 6 [2%] patients progressed to advanced ROP stages 4 and 5. The mean gestational age [GA] of patients with ROP [ROP group] was statistically significantly lower at 29.46 +/- 2.31 weeks compared to patients without ROP [non-ROP group] [31.56 +/- 2.03 weeks] [P < 0.05]. The mean GA of patients with plus disease was statistically significantly lower at 28.92 +/- 2.18 weeks compared to patients without plus disease [30.98 +/- 2.30 weeks] [P < 0.05]. The mean birth weight in the ROP group was statistically significantly lower at 1248.46 +/- 301.75 g compared to the non-ROP group [1485.79 +/- 268.66 g] [P < 0.05]. The mean birth weight of patients with plus disease was statistically significantly lower at 1207.92 +/- 334.79 g compared to patients without plus disease [417.99 +/- 293.19 g] [P < 0.05]. There was no difference in the occurrence of ROP or plus disease between single or multiple births, normal vaginal delivery, and caesarian section and between clomiphene users and nonusers [P > 0.05, all cases]. Greater cooperation between ophthalmologists, neonatologists, gynecologists, and health policy makers is necessary to optimize ROP screening programs. Data from this study can be used by health policy makers for implementation of health programs. These programs must include screening guidelines and effective coordination among the screening centers, antenatal, obstetric, and neonatal care services

Clinical and epidemiologic characteristics of severe childhood ocular injuries in southern Iran

To evaluate the clinical and epidemiological characteristics of children with ocular trauma. We retrospectively reviewed the medical records of 278 children [aged 15 years or less] hospitalized with ocular injuries and treated as inpatients at a tertiary referral center in Shiraz, Iran, from 2005 to 2008. Nominal variables were evaluated with a Chi-square test. A P-value less than 0.05 indicated statistical significance. The cohort was comprised of 205 [74%] males, outnumbering females by a ratio of 2.81/1. The mean age was 7.6 +/- 3.96 years. Rural residents comprised 125 [45%] of the cohort. Sharp objects caused ocular injury in 211 [76%] cases, and 207 [74%] cases had open-globe injuries. The lens was injured in 62 [30%] cases at initial examination and 89 [43%] patients according to ultrasound examination [P = 0.006]. Twenty-eight cases [10%] developed post-traumatic endophthalmitis. Endophthalmitis was associated with needle injury [odd ratio [OR] = 19.25] and presence of intraocular foreign body [OR = 3.48]. Visual acuity of patients with closed-globe injuries was 20/200 or better on both initial and final examinations. Visual acuity of patients with open-globe injuries were in the range of light perception to 20/200. Trauma is an important cause of childhood ocular morbidity in southern Iran. Playing with sharp objects is an important cause of ocular trauma in children, and most injuries can be prevented by careful supervision

Incidence and risk factors of retinopathy of prematurity among preterm infants in Shiraz/Iran

Retinopathy of prematurity [ROP] is a serious complication in preterm infants. To avoid this complication the risk factors leading to the disabling This is a descriptive study. All preterm infants with birth weight under 1500 g and preterm infants with birth weight between 1500-2000 g who had unstable clinical condition and admitted in neonatal intensive care unit from February 2006-March 2007 at tertiary hospitals of Shiraz University, Iran, were introduced into the study. All infants are examined by indirect ophthalmoscopy. Risk factors analysis was performed in two groups. Group 1 consisted of infants with no ROP or ROP that regressed spontaneously, and Group 2 of those with severe ROP that needed laser therapy. Of 199 preterms, ROP that needed laser therapy was detected in 19 [9.5%]; 65 [32.6%] had ROP that regressed spontaneously and 115[57.8%] had no ROP. Risk factor analysis showed significant P-values for gestational age, birth weight, Apgar score of first minute, mean duration of mechanical ventilation, mean duration of oxygen therapy, eclampsia-preeclampsia, hypoxia, hyperoxia, Pa CO2 >60 mmHg, pH>7.45 and frequent blood transfusions. Using stepwise logistic forward regression showed the three factors mean duration of oxygen therapy, birth weight and mechanical ventilation to be independently significant variables for increasing the rate of ROP. The main risk factors for development of threshold ROP are low birth weight, mechanical ventilation and duration of oxygen therapy. So it seems that prevention of premature delivery and judicious oxygen therapy is the main step for prophylaxis of ROP

accuracy of ocular sonography in detection and measurement of intraocular foreign bodies

To evaluate the accuracy of ocular sonography in measurement of size of intraocular foreign bodies [IOFB]. In a case series study, 58 consecutive patients with intraocular foreign body were included. Ocular sonography was performed to detect intraocular foreign body and the results were compared with the same intraoperative findings. Metallic material was found to be the most prevalent one [71%] followed by glasses [12%], stone [8%] and wood [6%]. Ultrasound localized the foreign body lodged in the lens in 10.3%, in the angle in 3.4% and in the vitreous or vitreoretinal region in the rest of them [86.3%]. The mean size measured by ocular sonography was 3.5x4.5 mm and that was reported by the surgeon was 2.9x4 mm. While the reports of sonography in detection and localization of IOFB was completely comparable with surgical findings, size measurements were considerably different from true measurements after intraocular surgery. Ocular sonography showed mostly overestimation in measuring intraocular foreign bodies. Although ocular sonography was one of the best methods for assessment of IOFB, it doesn't have high accuracy in estimation of size of IOFB