[Association of serum cortisol with critical illness scoring and prognosis in intensive care unit]

Background: The prevalence of adrenal insufficiency and association of serum cortisol with prognosis in intensive care unit patients is controversial. Some studies have shown a direct association between serum cortisol and bad prognosis while in other studies no such association has been made

Objective: This study was designed to evaluate the association between serum cortisol and prognosis of patients in intensive care unit

Methods: This was a cross-sectional study performed on intensive care unit patients of Bou-Ali teaching hospital in Qazvin [Iran] in 2009. Serum cortisol levels were measured before and after injection of cosyntropin. Basal cortisol level below 441 nmol/l was interpreted as adrenal insufficiency. In patients with serum cortisol between 441 and 938 nmol/l following injection of cosyntropin the level of serum cortisol was re-measured after 60 min. Patients with serum cortisol response less than 255 nmol/l were interpreted as having partial adrenal insufficiency. Later, patients were divided into 4 groups based on APACHE scoring system. Association of serum cortisol with APACHE score, hypotension, intubation, and mortality was evaluated

Findings: Of 60 patients under study, none found to have adrenal insufficiency. Serum cortisol was independently associated with mortality, hypotension, and intubation

Conclusion: Based on results found through this study, Adrenal insufficiency was not common in ICU patients and serum cortisol could be used as a predictor of prognosis

[Effect of education and social support on quality of life among elderly living in nursing homes [2010]]

Background: Aging is an inevitable phenomenon that the human societies are facing with. Health and life style of elderly in nursing homes are challenging thus, achieving appropriate measures to improve the quality of life seems to be necessary

Objective: The purpose of this study was to assess the effect of education and social support on quality of life among elderly living in nursing homes in Qazvin, Iran

Methods: This was an interventional study performed on all old people [37] who were living in nursing homes in Qazvin, Iran. Quality of life was assessed before and 1 month after intervention using SF36 questionnaire. Intervention included education, monthly physical exam, city tours, visiting places of public worship, field trip to recreation sites, and weekly visits. Data were analyzed using paired t-test

Findings: Of total 37 participants [female=17 [45.9%]; male=20 [54.1%]] with an average age of 66 years, 86% and 62.2% were illiterate and married, respectively. The average score for quality of life were increased in all areas following intervention [P<0.005]

Conclusion: Based on the results, it seems necessary to plan and arrange suitable programs to improve the quality of life in elderly living in nursing homes

[Effect of different dosage of intramuscular vitamin D3 on serum 25[OH]D]

Pareneteral vitamin D3 administration, a common practice in Iran, is usually used based mainly on clinical symptoms or serum mineral disturbances. Since studies about the effects and side effects of parenteral vit D3 preparations are limited, this study was designed to evaluate the effect of different intramuscular vitamin D3 dosage on serum 25[OH]D levels. In this study, 54 health volunteers were selected, and randomly assigned to 4 groups, based on their serum vitamin D3. Mean body mass index, age and sex frequency were not significantly different between groups. Mean serum 25[OH]D levels before injections were 27.24 +/- 21.30, 25.21 +/- 17.09, 24.70 +/- 16.8 and 25.10 +/- 14.48 ng/mL in groups I to IV respectively. Vitamin D3 was injected in dosages of 300/000, 600/000, 900/000 units and placebo in groups I-IV respectively. 25[OH]D levels were determined before, and at 2 weeks, 2 months and 4 months after injection. Serum 25[OH]D levels before injection were significantly higher compared to levels assessed 2 and 4 months after injection. At the end of study, in groups I to III, mean serum 25[OH]D levels in group I to IV were 48.20 +/- 28.32 ng/mL, 65.46 +/- 33.52 ng/mL, 72.90 +/- 37.68 ng/mL, and 14.38 +/- 11.14 ng/mL respectively. Frequency of vitamin D hypervitaminosis in groups I, II and III was 9%, 38% and 40% respectively. Usage of parenteral vit D3, especially dosages higher than 300/000 III, is associated with a high risk of vitamin D hypervitaminosis

[Non-alcoholic steatohepatitis presenting as metastatic liver masses]

Non-alcoholic steatohepatitis is a form of chronic hepatitis. Fatty degeneration may involve liver focally or as a whole. The patient was a 41-year-old woman who was diabetic and admitted in Buali hospital in Ghazvin because of right flank pain, fever, vomiting and diarrhea. The patient was treated as pyelonephriris. Liver function tests were as below: ALT: 62 [40] AST: 54 [40], Alkaline Phosohatase: 378 [306]. Imaging study of liver and kidney showed multiple masses in liver that documented again in CT scan of abdomen. Liver biopsy was performed ultrasonography guided. Macrovesicular fatty changes were seen histologically and documented again by review of liver specimens. No any malignant structure was identified. The patient was treated as diabetic patients. Focal fatty infiltration can be misdiagnosed as liver metastasis; it is seen as nonspherical lesion in CT scan, without mass effect, with density similar to water. Guided biopsy of the liver can help to have the correct diagnosis