[Age- and gender-specific prevalences of refractive errors in an elderly population in Mashhad]

To determine the prevalence of refractive errors among elderly residents of Mashhad during 2006 based on age and gender. Through proportionate cluster random sampling, urban residents of Mashhad aged 55 years or more were invited to attend the Vision Clinic of Mashhad Medical University for an eye examination including autorefraction and subjective refraction. Of 1,540 invited persons, 1,440 persons [response rate= 92.5%] participated in the study of whom 1,367 individuals including 883 [64.6%] male and 484 [35.4%] female subjects with mean age of 63.7 +/- 7.1 [range 55-92] years were examined. The prevalence of myopia was 27.2% [95% confidence interval [CI], 24.8-29.5%] overall, 29.6% in men and 22.5% in women [P<0.001]. The rate of myopia showed an increase with age [P<0.001]. The prevalence of hyperopia was 51.6% [95%CI, 48.9%-54.3%] overall, 48.3% in men and 57.6 in women [P<0.001]. The rate of hyperopia showed a significant decrease with age [P=0.009]. The overall prevalence of astigmatism was 37.5% [95% CI, 34.9-40.0%]. Refractive errors are a major issue among the elderly and their prevalence rates varies greatly depending on age and gender

[Visual acuity and contrast sensitivity in pseudophakic patients after cataract surgery]

This study was designed to determine the role of intraocular lens implantation in visual acuity and contrast sensitivity in pseudophakic patients. This case control study was done in the year 2004 in Mashhad Ophthalmology Center of Khatam- al- Anbia. with convenience sampling method based on object visual acuity and contrast sensitivity in 85 pseudophakic patients [110 eyes] with a mean age of 63.83, and 20 age - matched phakic subjects [40 eyes] were compared. The visual acuity and contrast sensitivity at distance after correction of refractive disorders were measured by Snellen chart and Cambridge Low Contrast grating chart at 6 meter. Individual data, surgery date, visual acuity, and contrast sensitivity were gathered in a questionnaire and analyzed by descriptive statistics and frequency distribution tables. Statistical test showed that the best corrected visual acuity in IOL group had no significant difference from that in the phakic group [p=0.36]. But the contrast sensitivity reduces in the pseudophakic group comparing with the phakic group [p=0.004]. These patients often complain of blur vision, despite of good visual acuity. Contrast sensitivity reduced significantly with increase of age in both groups of normal and pseudophakic patients. No improvement in contrast sensitivity and visual acuity was found over the time [P[va]=0.174, P[cs]=0.257]. This study showed that intraocular lenses could provide good visual acuity for distance but there was slight reduction in contrast sensitivity. Contrast sensitivity test is an important tool for evaluation of visual function; especially age related changes or intraocular differences, which may not have been detected by visual acuity tests

comparison between the levels of cyclosporine CO and C2 in children undergoing renal transplantation

Cyclosporine A [CSA] with intra- and inter-individual variability in absorptive property needs individualized dose adjustment in patients receiving the drug. This study was performed to compare cyclosporine C0 [before morning dose] and C2 [two hours after morning dose] levels in order to adjust the maintenance dose of CSA in stable renal transplant patients in Shiraz, southern Iran. From October 2004 to June 2005, 64 kidney transplants of Nemazee Hospital entered our study. All patients underwent renal transplantation for the first time except one subject who received the second transplant. All patients received three immunosuppressive drugs of which CSA was administered in two divided doses in the form of microemulsion. The height, weight, blood pressure, periodical tests and C0 and C2 levels were determined at the time of referral, as well as one and 5 months later. The amount of CSA was adjusted based on C0 levels of 100-250 ng/mL. The patients were divided into two C0 subgroups with C0 levels of <100 and >/= 100 ng/mL. In regard to C2, the two subgroups were <800 and >/= 800 ng/mL. In addition to CSA, cellcept and prednisolone were administered to 47, immuran with prednisolone to 15, and only prednisolone to 2 patients. Comparing the two subgroups of C0 and C2, no differences were observed between serum creatinine level, CSA doage and the drug complications. A significant correlation was found between C0 and C2 levels, and also between C2 level and CSA dosage. A negative correlation was seen between C0 level and serum creatinine. The coefficient of variation of the three samples of each patient was 10.89% for C0, and 8.94% for C2 with constant drug regimen. As there was no significant difference between mean C0 and C2 levels, and renal function at the start and the end of study, there seemed to be no need to recommend C2 level for follow up of renal transplantation

Abnormal Cambridge low-contrast grating sensitivity results associated with diabetic retinopathy as a potential screening tool

Contrast sensitivity is proposed as a potential screening tool for the early detection of diabetic retinopathy. A cross-sectional study was performed in a tertiary referral university eye centre. A total of 80 diabetes patients were recruited and tests were performed on 154 eyes. Contrast sensitivity was checked using Cambridge low-contrast grating. Abnormal contrast sensitivity was observed in 27.1% of eyes with diabetic retinopathy, compared with 9.0% in unaffected eyes, a statistically significant difference. Cambridge low-contrast grating is a potential screening tool for early detection of diabetic retinopathy by non-ophthalmologistsp

[Effect of oral-carnitine supplementation on hyperlipidemia in hemodialysis children]

Hyperlipidemia [HL], especially when started during early childhood will increase the risk of atherosclerosis. It is also a major risk factor for allograft nephropathy and post-transplant HL, so its treatment is highly suggested. In this study, the effect of oral L-carnitine on the lipid profile of children with end stage renal disease [ESRD] on maintenance hemodialysis [HD] after a 3-month period was evaluated. Twelve out of 15 children [80%] had abnormal lipid profiles at the beginning of the study. HDL-C level increased in all of them following the treatment [P<0.001]. No significant change occurred in the level of Triglyceride, Cholesterol, LDL-C, VLDL-C, but the ratio of TG/HDL-C as a major risk factor for cardiovascular disease decreased significantly [P=0.004]. Dyslipidemia is common in hemodialysis children. In this study, short term L-carnitine administration [3 months] had major effect on HDL-C level increment; a longer administration may affect other components too

[ study of the severity of keratoconus in optometric clinic's patients of Mashhad University of medical sciences]

Keratoconus is characterized by thinning and steepening of the central cornea. This study was undertaken to determine the severity of this disease and its relation with age and gender. In a cross sectional study, the data are reviewed from 1485 keratoconic eyes examined at the optometric's clinic of Mashhad University of Medical sciences from 1991 to 2005. The criteria for diagnosis of keratoconus were: Irregular corneal astigmatism, scissors retinoscopy reflex, Vogt's striae, Fleischer's ring or central corneal power higher than 47.2 D. The disease severity based on the central keratometry reading classified into mild, moderate, advanced and severe. SPSS software was used for data analyzes. The patient's mean age in this study was 25.33 +/- 8.39 years. From 1485 eyes, 73.1, 20.7, 5.9 and 0.3 percent had mild, moderate, advanced and severe keratoconus respectively. The highest prevalence of this disease was in 20-29 years [49.02 percent] and the lowest was related to over 40 years of age [6.4 percent]. The prevalence of keratoconus in females was higher than males [P< 0.001]. The majority of patients in this study had mild keratoconus and were in 20-29 years and it's prevalence in females were higher than males

Bone mineral density in children with relapsing nephrotic syndrome

Given the high relapse rate of disease in children with steroid dependent nephrotic syndrome and the osteoporotic effect of long periods of steroid therapy, this survey was performed to find the bone mineral status of these patients. Bone mineral density and content [BMD and BMC] were measured using Dual energy X-ray absorptiometry in 37 nephrotic children, six girls and 31 boys aged from four to 21- yrs, as patient group and 37 age and sex-matched healthy individuals as control group. Historical data were collected by chart review. As compared to the control group, the patients were shorter in stature. The percentage of BMC of lumbar and BMD of femoral bones of the patients was significantly lower than control group. According to the Warner method, 12% of the patients were osteoporotic and the BMD of their femoral and lumbar bones was inversely correlated with cumulative steroid dose. Bone loss can occur in some steroid-dependent nephrotic patients, especially those with low age of onset and those with longer duration of the disease and higher cumulative dose of steroid. Therefore, measurements of BMD and BMC could be recommended, at least, for the selected patients

Nephrotic syndrome in a girl with vesicoureteral reflux and situs inversus

In this case report a five year old girl is presented with steroid-responsive nephritic syndrome who had bilateral Vesicoureteral Reflux [VUR] and situs inversus. A combination of situs inversus, nephritic syndrome and VUR has been reported previously

Educational needs assessment of Mashad university of medical sciences' managers in management and leadership

Background: The first step in human resource development is educational need assessment. A sound knowledge of managerial roles and skills is vital for a successful management in the educational system

Purpose: To determine the educational needs of managers and directors of Mashad Medical University in filed of educational management and leadership

Method: A survey of a 40-person sample of the university managers including deans and vice deans for education of the faculties and the heads of educational groups the data were analyzed with SPSS

Results: The mean age of the sample was 47.2[+/- 7.5] and the mean duration of serving in managerial positions were 5.4[+/-3.6].The most needed items to be taught were identified as strategic planning in management, setting educational goals, deciding whether the ability to be a manager is inborn or must be acquired, main problems in educational planning and surveillance techniques, educational guidance, system analysis and educational evaluation. Characteristics of educational advisors were also of great importance

Conclusion: Our study showed that educational managers were aware of their need for further development of a sound basis of managerial knowledge

Assessment of general practitioners' knowledge of clinical applications of nuclear medicine

Background: the demand for nuclear medicine procedures is growing in recent years but training of medical students in this subject is not appropriately developed. There is no well defined program for training medical students in the field of nuclear medicine

Purpose: to evaluate the knowledge of the general practitioners from clinical applications of nuclear medicine

Methods: one hundred and six general practitioners [58 male and 48 female] participated in an exam with 14 multiple questions [Four question on general nuclear medicine and 10 questions on clinical applications of nuclear medicine]. Also their idea was asked regarding training in nuclear medicine. Validity of questions was confirmed by nuclear medicine specialists and consensus of four reference text books[3-5]. Minimum score was 0 and maximum score was 14. Correct answering of less than 50% of questions were considered as poor, 50 70% were intermediate and >70% as good

Results: of all participants, 95% were under 40 years old , 92% graduated in the last 10 years and 52% were trained in Mashad universities. The study showed that 32% of participants have poor results and only 12% of participants had good results. About 62% of participants correctly answered to less than 58% of questions. Overall mean score was 7.53+/-2.72. Doctors graduated from Tabriz universities had significantly higher scores than graduates from other universities. Sixty nine percent of participants had no training in nuclear medicine at all and the rest had a variety of 3-15 hours of training. About 90% of participants needed more information in nuclear medicine as they checked in the questionnaire

Conclusion: our study showed that knowledge of general practitioners in the field of nuclear medicine is poor and they need to improve their knowledge

Visual outcome of extracapsular cataract extraction and intraocular lens replacement in leprosy patients

The study was carried out in Meshed, Islamic Republic of Iran, from 1998 to 2000 to explore the visual outcome of eye surgery with extracapsular cataract extraction and intraocular lens replacement on 18 leprosy patients [20 eyes]. The most common complications of leprosy were madarosis [90%] and partial or total corneal opacity [90%]. Visual acuity before surgery ranged from 'light perception' to 1/10, and this improved after surgery to 5/10-8/10 for 55% of patients. Postoperative infection leading to endophthalmitis occurred in only 1 patient and was treated with drugs; this patient's visual acuity remained at 10 cm finger count. Posterior synechia due to chronic uveitis in leprosy was diagnosed in 70% of eyes, obstructed iris in 25%, keratic precipitates in 25% and moderate iris atrophia in 10%

Pain tracker diagnostic instrument: effect on patients' satisfaction with their interactions with the primary care physician

In a r and omized trial, the pain tracker instrument was evaluated as a diagnostic screening tool and for its effect on patients' satisfaction with their interactions with the primary care physician. The instrument form was filled in by the physician after asking the study patients about symptoms. Control [n = 53] and study patients [n = 49] were interviewed and the instrument's effect was analysed from responses to 15 statements. The pain tracker group were significantly more satisfied with the physician relationship than were controls [mean satisfaction score 85 +/- 8 versus 61 +/- 9]. A direct linear correlation was found between patients' assessment of the visit and overall satisfaction [r = 0.86]. The pain tracker can be an important component in history taking and a useful diagnostic screening tool in pain presentations

Prolonged paralysis as an unusual presentation of renal tubular acidosis

A case of renal tubular acidosis [RTA] who had gradual onset of paralysis of lower extremities and persisted for a long time is presented. His primary workups were mistaken for muscular dystrophy. Eventually, an abdominal ultrasonography revealed small stones in both of the kidneys and his workup for the stones were in favour of distal renal tubular acidosis and advanced rickets with hypokalemia. He had a dramatic response to alkaline therapy. There are many reports of periodic paralysis in RTA but no report of prolonged paralysis is found in the literature

Primary vesicoureteral reflux in children in southern Iran

Experience with vesicoureteral reflux [VUR] differs in different centers and there is plenty of controversies. To evaluate the outcome of primary VUR complications and the rate of recurrence of UTI. In a retrospective study, the medical charts of all infants and children with primary VUR who were followed up by one nephrologist were reviewed. During 16 years, 271 patients [226 females, 45 males] with 401 refluxing ureters were followed up as primary VUR. The patients' age at diagnosis was 4 days to 16 years [Mean: 4.4 years] and the mean duration of follow-up was 4.2 years. Urinary tract infection [UTI] was the presenting symptom in 97% and fever was recorded in 30% of cases. Frequencies of different grades of VUR at initial investigation were 6.5%, 52%, 23.4% and 18.1% for grades I to IV, respectively. The responsible microorganism in 90% of the first episodes of UTI was E. coli. Scarring or small size kidney was present in 63 patients. Recurrence of UTI in VUR of grades I to IV, were 68.7%, 51%, 60.1% and 46.8%, respectively. Follow-up voiding cystourethrogram revealed resolution of VUR in 52%, improvement in 31%, no change in 11%, and deterioration in 6%. Complications such as chronic renal failure, hypertension and renal tubular acidosis were observed in 11, 10 and 9 patients, respectively. Symptomatic primary VUR is more common and has better prognosis in girls. Recurrence of UTI is not related to the grade of VUR