Evaluation of osteoporosis in patients with non-alcoholic liver cirrhosis

The liver is a vital organ that plays an important role in the metabolism of nutritional agents, drugs and hormones,synthesis of various proteins, coagulation factors and maintenance of hemostasis between calcium,and phosphorous. Biochemical changes in the skeletal system such as osteopenia and pathologic fractures may follow hepatic failure. This researchevaluates metabolic bone changes in non-alcoholic cirrhotic patients. We evaluated 50 known cases of nonalcoholic cirrhosis in the Internal Medicine Clinic and Ward of GhaemHospital during the second half of 2004. Inclusion criteria were: age >14 years anda Child-Pugh score of A or B. Exclusion criteria were: history of previous bone metabolic disorders; endocrine disease; hepatocellular carcinoma; liver metastasis;previous use of calcium, vitamin D, calcitonin, bisphosphonates, hormone replacement therapy, and prednisolone; and alcoholics. Patients underwent clinical and laboratory studies in addition to bone densitometry analyses of the femoral neck and second to fourth lumbar spine area. Patients' mean age was 41.18 +/- 15.94 years and the male to female ratio was 1.5 to 1. Cases presented with the following types of non-alcoholic cirrhosis: post-hepatitis B [58%], cryptogenic [26%], autoimmune hepatitis [10%], post-hepatitis C [4%] and primary biliary cirrhosis [2%]. There were 68% of our cases classified as Child-Pugh score A; 32% were Child-Pugh score B. Osteoporosis and osteopenia were more common in the Child-Pugh B group. T-score of the femoral neck was normal in 39 [78%] cases. The lumbar spine Z-score was normal in 46 [92%] and the femoral neck Z-score was normal in 48 [98%] cases. There were more post-hepatitis B and cryptogenic cirrhosis cases that had decreased bone density.The Child-Pugh A group had more increased calcium, phosphorous, and PTH levels and decreased ALP levels compared to the Child-Pugh B group. Progression of liver failure [according to Child-Pugh] in patients with non-alcoholic cirrhosis to some extent causes increased osteoporosis and osteopenia. It is necessary to place increased emphasis on the importance of mineral supplementation in cirrhotic patients

Investigation of periodontal conditions in patients with rheumatoid arthritis

Periodontal disease with alveolar bone resorption and tooth loss is common in rheumatoid arthritis [RA]. RA subjects show inadequate plaque control due to physical disability as well as compromised immune response, both of which might result in a greater predisposition to periodontal disease in these subjects than in the normal population. The aim of this study was to evaluate the prevalence of periodontal disease among rheumatoid arthritis patients. Periodontal status [plaque index, papillary bleeding index, and missing teeth] was examined in 70 individuals including 35 patients with active rheumatoid arthritis and 35 healthy individuals as control group. The results were analyzed using SPSS software and student /-test Patients with rheumatoid arthritis included 31 females [88.6%] and 4 males [11.4%] with a mean age of 45 years. Healthy control group included 26 females [74.3%] and 9 males [25.7%] with a mean age of 37 years. Patients with rheumatoid arthritis showed significant increases in Plaque index [P=0.0001], papillary bleeding index [P=0.002], and number of missing teeth [P=0.03] compared to the healthy control group. Three patients also had secondary Sjogren's syndrome. Patients with rheumatoid arthritis had a greater level of periodontal disorders compared to control group. In addition to the effects of this chronic inflammatory disease and immune host deficiened, this could be attributed to physical disability in maintaining oral health and gingival effects of and rheumatic medications

Assessment of bone density in patients before and after kidney transplantation

Accentuation of bone loss is one of the most important skeletal complications after transplantation. Early diagnosis and treatment of osteopenia and osteoporosis reduce risk of fractures and prevent the aggravation of it by using corticosteroid after kidney transplantation. A total of 50 patients that received graft during the research time, 31 of them completed it. They were screened for decreased bone mineral density at baseline, 6 and 12 months after transplantation with dual-energy x-ray absorptiometry [DEX A] of lumbar spine and hip. A total of 31 patients [17 [55.8%] female and 14 [45.2%] male] with end stage renal disease entered the study. The mean age of patients in both genders were 39.67 +/- 14.5 years [range: 20-67years]. Replacement therapy in 24 patients [77.4%] was hemodialysis and in 7 patients [22.6%] was peritoneal dialysis. Before transplantation, the mean of T-score in femoral neck and lumbar vertebra were -0.88 +/- 1.19 and-0.37 +/- 1.12 respectively, osteopenia was found in 41.9% and 29% of each region. On 6 months after transplantation, the mean of T-score in femoral neck and lumbar vertebra -1.42 +/- 0.95 and -1.41 +/- 1.36 respectively. Incidence of osteopenia in each region was 83.9% and 64.5% in turn. We tried to examine them in the first year after transplantation, the mean of T-score in femoral neck was-1.13 +/- 1.11 and in lumbar vertebra was -1.29 +/- 1.33. After 6 months, bone mass reduction was significant [p<0.05], but there was not any significant difference between 6 and 12 months following transplantation [p>0.05]. Bone loss was highest in the first 6 months after transplantation. Then, treatment was necessary during this period of time

Triage of war-injured troops in the Iran-Iraq War

This study compared the triage of Iran-Iraq war-injured troops within the first two years of the war with that after the first two years. This was a retrospective study, which compared the triage of the admissions for abdominal injuries during the first two years of the Iran-Iraq War with that in the next 6 years. Out of nearly 50, 000 cases, 1, 176 ones were randomly selected and their triage information was recorded and analyzed. About 12.5% of patients were operated on within less than 8 hours during the first two years. From 1982 towards the end of the conflict [1988], the patients were treated within progressively shorter periods of sustaining injury; 68.8% were operated on within less than 4 hours of injury. The mean delay between injury and treatment in the first two years of war was 12 hours while it was 5 hours between 1982 and 1988. The difference was significant [P<0.05] but the mortality rate was not significantly different. Patient triage was conducted differently at various stages of conflict. Better patient triage after 1982, may have been due to improved care and more specialized triage of injured troops

role of performing life support courses in rural areas in improving pre-hospital physiologic conditions of patients with penetrating injuries

To evaluate the impact of animal model based medical training courses for village healthcare workers on prehospital physiologic condition and prognosis of patients with penetrating injuries. Experimental study. This study was carried out in Mehran city and its neighbouring rural districts in western part of Iran from 2002 to 2004. Seventy-six village healthcare workers were trained and equipped to deliver in-field medical first cares. First group [226 patients] consisted of those who received this cares by the trained group and second group [245 patients] were those who received no in-field cares and were transported directly to the trauma center in provincial capital, Ilam. Physiologic Severity Score [PSS] was calculated to determine the physiologic condition of patients in both groups. The most prevalent cause of trauma in both groups was car accidents [61.6%]. Controlling of hemorrhage was the most frequent provided initial medical care [40.6%]. A significant improvement regarding the PSS score was observed in the first group of patients compared to the second group [7.505 vs. 6.799, 95% CI for difference: 0.3 to 0.9]. The mortality rates of the first and second group of patients were 3% and 7.3%, respectively [p=0.051]. Performing life support courses in rural areas of low-income countries where there is no pre-hospital triage and emergency medical system and provision of classic resuscitative measures are limited, has a significant impact on improvement of pre-hospital physiologic condition and prognosis of patients with penetrating injuries

Inhaled corticosteroids and bone density in chemical warfare patients with pulmonary complications

The most effective treatment in chemical warfare victims [CWV] suffering from severe long-term obstructive pulmonary disease is inhaled corticosteroids [ICS] and long acting beta-2 agonists. Study results on adverse effects of ICS on bone were conflicting. In the present study, we evaluated the effect of ICS on bone mineral density [BMD] of CWV and possible effects of chemical warfare agents on BMD. Thirty-five CWVs entered this study. Demographic and spirometric data [including staging of severity of lung disease] and BMD results as shown by z-score and t- score measured in lumbar and femoral regions were evaluated in this group of patients. In comparison, 75 normal subjects as controls were included in this study and their BMD results were compared with those of the case group. The mean age in CWVs was 41.40 +/- 7.74 years, which showed no significant difference with that of the control group. According to spirometric data, CWVs had obstructive lung disease. BMD in lumbar and femoral regions in the case group was 1.14 +/- 0.14 and 0.93 +/- 0.13 g/cm[2] respectively, which showed no significant difference with that of the control group. Regression analysis showed that BMD in the femoral region was correlated with forced expiratory volume in 1 second [FEV1] and forced vital capacity [FVC] and t-score in lumbar region was correlated with FEV1. BMD in the femoral region decreased as the severity of bronchial obstruction increased [0.99 +/- 1.07 g/cm[2] in mild form to 0.75 +/- 0.27 in severe form; F=3.91, P=0.03] but in the lumbar region BMD had no significant correlation with severity of bronchial obstruction. BMD did not decrease during long-term therapy with ICS in CWVs. Severity of bronchial obstruction can be an important risk factor

Basal cell nevus syndrome presenting as a tender mass of the jaw: a case report

Basal cell nevus syndrome [Gorlin's syndrome] is a rare autosomal dominant tumor-predisposing syndrome which is classically consisted of multiple cutancous basal cell carcinomas, odontogenic keratocysts of the jaw, pits of the palms and soles, ectopic calcification of cranial membranes and various skeletal abnormalities. We report a typical case of Gorlin's syndrome in a 50-year-old man who presented with a tender mass of jaw