Juvenile hemochromatosis in iran: a case report with 5-year follow-up after treatment

Juvenile hemochromatosis is a rare autosomal recessive disorder that typically occurs in the first to third decades of life. Its symptoms are more acute and severe than classic hemochromatosis. We describe a 27-year-old man who was referred to the gastrointestinal clinic with a probable diagnosis of fatty liver and was finally diagnosed as having juvenile hemochromatosis. A review of the scientific literature reveals that recently only three siblings suffering from the disease have been reported in Iran

Association of Helicobacter pylori Infection with Hashimoto's Thyroiditis

Autoimmune thyroid diseases [ATD] are multifactorial conditions that result from genetic predisposition in combination with environmental risk factors. Helicobacter pylori infection as an environmental risk factor has been proposed to imitate the antigenic components of the thyroid cell membrane and may play a leading role in the onset of the autoimmune diseases, such as Hashimoto thyroiditis. The aim of this study was to investigate the association between Helicobacter pylori [HP] infection and Hashimoto's thyroiditis [HT]. The participants in this case-control study included 43 patients affected by Hashimoto's thyroiditis, and 40 healthy individuals without history of autoimmune disease as the control group. Anti HP IgG and anti-TPO antibodies were determined using ELISA method. Results were considered positive when the IgG anti-HP value was higher than 30 lU/ml and the anti-TPO autoantibody value was higher than 75 lU/ml. The mean TSH level was 18.3 +/- 16.8 lU/ml for patients and 2.8 +/- 1.2 lU/ml for the control group [P<0.001]. 46.5% of the patient group and 10.8% of the control group were infected with HP. The association between HP and Hashimoto's thyroiditis was statistically significant [Odds Ratio=7.2, 95%, Confidence Interval: 2.0- 28.8, P<0.001]. The findings show that, there is an association between HP and Hashimoto's thyroiditis. To establish a definite correlation between them, more detailed studies with a more specialized examination and precise consideration regarding species of HP, genetic polymorphism of the host and investigation of environmental factors are needed

[Effect of royal jelly intake on serum glucose, HbA1c, and total antioxidant capacity [TAC] in type 2 diabetic patients: a randomized, double blind clinical trial study]

Type 2 diabetes melitus [DM] is highly prevalent worldwide. Evidence supports a role for royal jelly in reduction of serum glucose and lipids. The purpose of this study was to determine the effects of royal jelly intake on serum glucose, HbA1c, and Total Antioxidant Capacity [TAC] in type 2 diabetic patients. Fifty patients with type 2 DM participated in a double-blind, placebo-controlled, 8-weeks study. The patients with type 2 DM were divided randomly into placebo and royal jelly groups of 25 each. Both groups received the treatment for 8 weeks. In royal jelly group participants received three 1000 mg royal jelly capsules daily and placebo group received three 1000 mg placebo capsules daily. Blood samples were taken after 12 hours of fasting at the beginning and the end of the study. Serum glucose, HbA1c, and TAC were evaluated. Forty six participants completed the study. Royal jelly intake reduced FBS levels [p=0.006] and increased TAC [p=0.016] significantly after 8 weeks compared with placebo. Royal jelly did not affect serum HbA1c levels. This study shows that royal jelly has some benefits in type 2 diabetic patients

Medical management of diabetic retinopathy: an overview

Diabetes mellitus is a global health problem affecting 366 million people worldwide and its prevalence is growing rapidly. Diabetic eye disease is present in up to 25% of diabetic subjects. Diabetic retinopathy is a chronic complication of diabetes that can result in blindness. Generally, there are two stages of diabetic retinopathy, non-proliferative and proliferative. The longer a person has diabetes and the poorer metabolic control, the higher the chance of developing diabetic retinopathy. The majority of people with type 2 diabetes will ultimately develop diabetic retinopathy. Multifactorial therapy targeted to lifestyle modification and optional glycemic control reduces the risk. However, diabetic retinopathy develops or progresses with time. Primary [preventive] strategies include glycemic, lipid, and blood pressure control. Glycemic control effectively reduces the incidence of diabetic retinopathy. In additional, its effect on progression of diabetic retinopathy has been demonstrated in randomized clinical trials. Furthermore, tight control of blood pressure significantly reduces the progression of retinopathy and visual loss. However, the Action to Control Cardiovascular Risk in Diabetes [ACCORD] Eye Study Group has shown that intensive blood pressure control has no beneficial effect on reducing the rate of diabetic retinopathy in subjects with type 2 diabetes. Elevated serum lipids and dyslipidemias are associated with a higher risk of diabetic retinopathy. The beneficial effects of lipid-lowering agents on the progression of retinopathy have been reported. Intensive combination therapy for dyslipidemia has been shown to effectively reduce the rate of progression of diabetic retinopathy in type 2 diabetes. Secondary strategies are focused on various pathophysiologic approaches such as blockade of the renin angiotensin system [RAS], anti-vascular endothelial growth factor agents, somatostatin analogues, protein kinase inhibitors, and anti-inflammatory agents. The purpose of the current overview is to look into the medical management of diabetic retinopathy, and to explore the primary [preventive] measures as well as secondary strategies proposed to be effective in its medical management

[Serum lipids status and its disorders among 30-70 years old population in Semnan province, Iran]

Cardiovascular diseases are the most common cause of mortality and morbidity in new societies. Dyslipidemia is one of the main causes of coronary artery disease. Since there is not comprehensive information about this subject, we aimed to survey dyslipidemia in urban and rural communities/areas in Semnan province. An epidemiologic cross-sectional study was conducted among 3799 persons who were 30-70 years old in Semnan Province, Iran. Multistage cluster sampling was performed, and subjects were selected from urban and rural populations of Semnan, Shahroud, Garmsar and Damqan. Data were collected through questionnaires, then a blood sample was collected from selected patients with 12 hours fasting for evaluation of triglyceride [TG], cholesterol, high density lipoproteins [HDL] and low density lipoproteins [LDL] levels in urban and rural communities. Totally, 3799 persons enrolled in this study with mean age 41 +/- 10.2 years that 44.6% of them were male. High TG was seen in 29.1%, high LDL in 11.8% and low HDL in 30.7%. Prevalence of all kinds of dyslipidemia was higher in Shahroud. In conclusion, prevalence of dyslipidemia among 30-70 years old was higher than expected. So that, comprehensive preventive and educational programmes on lipid disorders and related diseases are necessary

[Epidemiology of smoking in an Iranian population [Semnan province]: a population-based study]

Cigarette smoking is a known cause of systemic disorders such as bronchogenic carcinoma and cardiovascular diseases. The aim of this cross-sectional study was to estimate prevalence of smoking in 30-70 year old men in Semnan province in Iran. This survey was conducted in a sample population of 1695 men 30-70 years old, in October 2005 to February 2006 in both rural and urban areas of Semnan province. A multistage clustered sampling was performed with, first, 760 clusters [households] selected randomly using a systematic sampling technique. Then one or two more households in the neighborhood of each of the former households were also selected. Finally, in each household a 30-70 year old person was randomly selected and asked to complete a questionnaire. The overall prevalence of current cigarette smoking in men 30-70 years old was 24.1% [95% confidence interval: 22.1-26.1%].18.3% of them were daily and 5.8% occasional smokers. 26.8% of rural and 23.0% city resistant adults were cigarette smokers [P=0.053]. Prevalence of cigarette smoking in under 40, 40-49, 50-59 and >/= 60 years were 21.1%, 32.6%, 25.1% and 11.9%, respectively [all, P<0.001]. 19.7% of illiterates, 24.9% of primary, 30.8% of intermediate, 25.4% of high school and 11.8% of university level education were cigarette smokers[P<0.001]. 46.6% of them before, and 39.2% between 21-30 years have started cigarette smoking. Mean [ +/- SD] age for starting cigarette smoking was 24.1 +/- 8.0 years. Prevalence of cigarette smoking in Semnan, Damghan, Garmsar and Shahrood were 22.5, 23.2, 27.6 and 23.4% [P=0.554], respectively. Only 0.1% and 1.6% of them were pipe and tobacco smokers, respectively. 0.4% tobacco smoking was simultaneously with cigarette smoking. 15.2% non-cigarette smokers were passive smokers. Overall, 39.3% of Semnan province adults, aged 30-70 years, were active or passive cigarette smokers. Findings showed that prevalence of cigarette smoking in Semnan province in adults aged 30-70 years is high. Therefore, a community-based multiple strategies are required to combat with increasing rate of cigarette smoking and its complications

Effect of different doses of folic acid on serum homocysteine level in patients on hemodialysis

Hyperhomocysteinemia is common in patients with end-stage renal disease. It is one of the risk factors for cardiovascular disease. We evaluated the effect of different doses of folic acid on serum homocysteine level in patients on hemodialysis. Patients on maintenance hemodialysis were randomized into 4 groups to receive oral folic acid at doses of 2, 5, 10, and 15 mg/d, each for a period of 4 weeks. Serum homocysteine level was measured in all of the patients before and at the end of each week of therapy. Folic acid supplementation was discontinued during a washout period of 1 week between each of the four phases of the trial. Thirty-one hemodialysis patients completed the four phases of treatment with each dose of folic acid [17 women and 14 men]. The mean age of patients was 57.6 +/- 14.6 years. Serum homocysteine level was reduced significantly compared to its basal level after treatment with folic acid at different doses [P < .001]. Different doses of folic acid were not significantly different in lowering serum homocysteine levels. Our study failed to show any difference between high-dose and low-dose folic acid therapy regarding their effect on serum homocysteine level. It seems folic acid, 2 mg/d, is an adequate dose, and there is no need to administer a higher dose of it

Relationship between patients' perception of the importance of diabetes and metabolic control and pursuing chronic complications of disease

Type II diabetes is a metabolic disorder. Environmental factors and patient awareness have major roles on chronic complications. The purpose of this study was to determine the association of patients' perception of t the importance of diabetes and metabolic- control and pursuing of chronic complications. 194 patients with diabetes enrolled from diabetes clinic of Institute Endocrinology and Metabolism in a cross-sectional study, from February to March 2010. Data were collected using a questionnaire to assess the personal demographics, individual approach in pursuit of complications, and glycemic control, as well as patient perception and attitude toward the importance of disease process and follow-up. Level of perceptions was determined as well, moderate and weak. Out of 194 patients, 77 [39.7%] were male and 117 [60.3%] female. Mean age was 52.18 +/- 10.17 years. 69.2% did not know what the glycosylated hemoglobin was. In 71.4%, willing to participate in decisions making on medical treatment was good and they knew that with initiation of insulin therapy, they would have better metabolic control. 68.9% of patients had regular follow-up for eye complications, and 51% for cardiac complications. Follow-up for diabetic foot complication was poor. Patients with good perception had regular follow-up regarding cardiac, eye and renal complications. These results indicate that better perception of diabetic patients might improve their compliance for regular follow- up regarding the pursuit of chronic complications, especially cardiac, eye and renal problems. Although, the metabolic- control of patients had not the association with patient perception about the importance of diabetes

[Comparing the effects of iontophoresis and phonophoresis of dexamethasone on the treatment of carpal tunnel syndrome]

Using anti-inflammatory medicine injection such as dexamethasone acetate [DXA] is a common treatment for carpal tunnel syndrome [CTS]. Iontophoresis and phonophoresis of DXA are two other ways which may help to introduce DXA locally to inflammated tissues. This study has been deigned to compare the effect of iontophoresis and phonophoresis of DXA on the CTS treatment. 35 mild or moderate CTS patients [51 affected hands] were randomly assigned in one of the two experimental: iontophoresis [25 affected hands] and phonophoresis [26 affected hands] groups. Subjects in iontophoresis group received 10 sessions of iontophoresis of%0.4 DXA solution [DC, 0.2 mA/cm2, 20 min] over the wrist of the affected hands while the other group received 10 sessions of phonophoresis of%0.4 DXA jell with pulsed ultrasound [1 MHz, 1 W.cm-2, 5 min]. The strength of hand and thumb grips, paresthesia, pain, motor and sensory distal latency and evoked potential of median nerve were measured before and after intervention and after 4 weeks follow-up. Comparisons of the mean changes showed more increase in hand grip [P=0.006] and thumb grip [P=0.0002], less pain perception [P=0.001], shorter sensory [P=0.0001] and motor [P=0.0008] distal latency and higher sensory and motor [P=0.0001] action potential in the phonophoresis in compared with the iontophoresis group. Our results show that using phonophoresis of DXA is more effective for CTS treatment, than the iontophoresis method. More studies are needed to investigate the role of different parameters used during phonophoresis of DXA in the CTS treatment

[Survey of the relationship between of thrombophilic factors and the rate and severity of bleeding in patients with severe hemophilia A]

Hemophilia is the most common disorder of deficiencies in thrombotic factors. In most patients, severities of symptoms are in proportion of the seriousness of deficiency in the thrombotic factors. But in some patients with severe hemophilia, having less than 1% in factor level; the clinical symptoms are lower and slighter than the other hemophilic patients. Even in some cases, thrombotic events in the severe hemophilic patients have been accrued. The underlying causes of these findings are unknown. The aims of this study were to determine the role of some factors and also the type of genetic mutation of these factors in the rate and severity of bleeding and also the symptoms of the severe hemophilic patients. Sixty hemophilia A patients [FVIII<1%] with having records in Hemophilic Patients Center were divided on the basis of the received factor rate items per year, bleeding score, orthopedic score and radiologic score, in three groups with mild, moderate and sever clinical presentations [each group with 20 patients]. And then the mutation tests in the gene of Leiden V factor, PG20210A, MTHFR, level of thrombotic factors [II, V, VII, VIII, IX, X, XI, XII, XIII, and Fibrinogen], Protein C, S, Antithrombine III, Phospholipid Ab and Hemosisteine and number of platelets were performed. Data using the x2, Fischer, ANOVA and Tukey test and SPSS-14 were analyzed. Of the studied factors, the differences among 3 groups from view point of daily activity [P<0.002], antithrombine III [P<0.013], number of platelets [P<0.007], protein C [P<0.013] and level of factor XII [P<0.01] was significant. No significant differences were found in three groups in other tested factors. In this study, there were significant differences only in the daily activity, antithrombine III, number of platelets, protein C and level of factor XII. Thus, further studies are required to determine the role of other factors that may contribute to differences in the clinical presentations of the severe hemophilic patients

Leukocyturia and coronary artery disease: further evidence to the presence of inflammatory processes in acute coronary syndrome

Cardiovascular disease is the main cause of mortality in developing countries. Because the major classic risk factors fail to explain the disease's epidemiologic diversity, other risk factors such as inflammation and systemic infections are being investigated, although no cause and effect relation between these infections and acute coronary syndrome [ACS] has yet been decisively proven. In view of the possible role of local and systemic infections in the occurrence of ACS, as well as leukocyturia and hematuria, the present study was designed and carried out. This was a prospective case-control study of all patients diagnosed as having ACS and hospitalized at the CCU of Fatemiyeh Hospital in Semnan. Urine analysis and culture were performed in all patients and the control group in the early stage of admission to the CCU. After collecting data, we examined the associations and the differences between the two groups by using t-test and chi-square test. The case and control groups did not show any significant difference based on age and sex [age 60.03 +/- 19.32 years in cases and 59.9 +/- 17.2 years in controls, female prevalence was 40.5% in both groups]. Hematuria was seen in 18.5% of cases and 5% of controls [P<0.0001]. Leukocyturia was seen in 28.5% of cases and 12% of controls [P<0.0001]. Albuminuria was seen in 6% of cases and 7% of controls [P>0.05]. These findings indicated the presence of sub-clinical underlying infection process due to uncommon pathogens or leukocyturia and hematuria in a systemic inflammatory process that can predispose to ACS by systemic inflammation