Cocaine, marijuana, hypertension and cardiovascular effects

Cocaine is used by more than 14 million people worldwide; about 0.3 percent of the global population age is 15 to 64 years. After alcohol, cocaine is the most common cause of acute drug-related emergency department visits in the United States. Cocaine consumption is more frequently associated with acute cardiovascular illness. Cocaine stimulates alpha[1], alpha[2], beta[1] and beta[2] adrenergic receptors through increased levels of norepinephrine and a lesser extent epinephrine. The cardiovascular effects of cocaine are thought to be similar and regardless to the route of consumption. An acute coronary syndrome is the most common cardiac problem including myocardial ischemia and infarction even in young persons without atherosclerosis, aortic dissection and rupture, arrhythmias, ventricular tachycardia and fibrillation, asystole and finally sudden death. Other cardiovascular effects that caused by cocaine include coronary artery aneurysm, palpitation, sinus tachycardia, increased systemic vascular resistance and hypertension crisis, left ventricular hypertrophy, myocarditis, cardiomyopathy, myocardial fibrosis, bundle branch block, heart block, supraventricular arrhythmia, accelerated atherosclerosis, hypotension, bradycardia and infective endocarditis among intravenous users. Cocaine by three mechanisms cause ischemia: 1. increased myocardial oxygen demand, 2. decreased coronary blood flow due to coronary artery vasoconstriction and spasm and 3. Coronary artery thrombosis via activation of platelets, stimulation of platelet aggregation and potentiation of thromboxane production

Prevalence of metabolic syndrome in a hemodialysis population

The role of metabolic syndrome [MS] in hemodialysis population has not been thoroughly studied. This study aimed to determine the prevalence of MS and to identify its correlates among hemodialysis patients. This cross-sectional study was conducted on patients in a hemodialysis center. The MS was defined according the Adult Treatment Panel III criteria. Clinical data of the patients were collected and blood samples were studied to measure fasting blood glucose and lipid profile. Eighty hemodialysis patients, including 47 men [58.8%] and 33 women [41.2%] with a mean age of 55.6 +/- 15.6 years, were enrolled in this study. Metabolic syndrome was diagnosed in 23 patients [28.7%]. Hypertension was present in 55 patients [68.8%]. Fifteen patients [18.8%] were diabetic, 24 [30.0%]] had a high serum triglyceride, 22 [27.5%] had a low high-density lipoprotein cholesterol, and 20 [25.0%] had evidence of abdominal obesity. Patients with MS had significantly higher body mass indexes [P < .001], fasting blood glucose levels [P < .001], and triglyceride levels [P = .004]. Metabolic syndrome was not associated with gender, age, and duration of hemodialysis. Men showed significant abnormality in glucose metabolism [P = .008]. Prevalence of low high-density lipoprotein cholesterol was significantly higher in the women than in the men [P = .02]. The prevalence of MS in our hemodialysis patients was relatively high, with the most common element being hypertension. We suggest that there needs to be a new set of criteria defined for MS in hemodialysis patients

Posttransplant lymphoproliferative disorders in kidney transplant recipients. An Iranian multicenter experience

Limited data with adequate sample size exist on the development of posttransplant lymphoproliferative disorder [PTLD] in living donor kidney recipients. We conducted a retrospective cohort study on the data of 10 transplant centers to identify the incidence of PTLD in Iran. Data of 9917 kidney transplant recipients who received their kidneys between 1984 and 2008 were reviewed. Fifty-one recipients [0.5%] who developed PTLD were evaluated with a median follow-up of 47.5 months [range, 1 to 211] months. Patients with PTLD represented 24% of all posttransplant malignancies [51 out of 211 cases]. There was no relationship between PTLD and sex [P = .20]. There were no statistically significance differences considering the age at transplantation between patients with and without PTLD. The late-onset PTLD [70.6%] occurred more frequently compared to the early form. There was no signification relationship between early-onset and late-onset groups in terms of clinical course and outcome. In patients who received azathioprine, PTLD was more frequent when compared to those who received mycophenolate mofetil [P < .001]. The lymph nodes were the predominantly involved site [35.3%], followed by the gastrointestinal tract, brain, kidney allograft, lung, ovary, vertebrae, and palatine. Age at diagnosis and the time from transplantation to diagnosis were comparable for various involvement sites of PTLDs. The overall mortality in this series of patients was 51.0%. Posttransplant lymphoproliferative disorder is a rare but devastating complication and long-term prognosis can be improved with early recognition and appropriate therapy

Epidemiologic study of TB in Iranian prisons during April-September 2004

Despite the advances in medical technology has resulted in decrease of occurrence of infectious disease, tuberculosis is still the most common cause of mortality. Prisoners are at high risk of acquiring TB. The most common reasons are overcrowding, malnutrition, high-risk behaviors, addiction and HIV infection. In current study, the epidemiology and prevalence of TB in prisons in Iran was investigated. Checklists were obtained prisons throughout of iran from and data were then analyzed to determine the prevalence of TB among the prisoners. In this study, 339 patients were diagnosed with TB. All patients were older than 15 years. All except two patients were male. In 83 cases, TB infection is along with HIV. Because of unfavorable environment of prison the level of TB in prisons is higher than that of the civilian population. Additionally high levels of MDR-TB in prisons have been reported from some studies. The results obtained from current study indicated the prevalence of TB also is high in Iranian prisons and in 83 persons it was along with HIV infection which can make difficulty in treatment and increase the risk of MDR. These results show the important role of control and treatment of TB in prisons