[Frequency of dyslipidemia and its accompanying factors in hemodialysis patients]

Dyslipidemia is a common disorder and one of the major causes of the atherosclerosis development and progression in hemodialysis patients. Timely diagnosis and treatment of dyslipidemia can reduce mortality and morbidity of cardiovascular disease and protect the remaining function of kidneys in patients with chronic renal failure. This study was performed with the objective of evaluating the frequency of dyslipidemia and its accompanying factors in hemodialysis patients. In a descriptive cross-sectional study, 182 patients with chronic renal failure referred to hemodialysis units of Baqiyatallah and Shahid Chamran hospitals, Tehran in 2012 were studied. For data collection, in addition to demographic questionnaire, serum levels of cholesterol, triglyceride, HDL and LDL were measured. Data analysis was done using Chi-square, independent t-test, and one-way ANOVA. The significance level was considered to be p<0.05. In this research, 8.2% of the patients had hypercholesterolemia, 26.4% hypertriglyceridemia, and 6.8% LDL level more than 130. In half of the patients, serum HDL was less than 35. A significant relationship was observed between dyslipidemia and variables of gender [p=0.001], duration of hemodialysis [p=0.004], education level [p=0.005], and weight [p=0.007]. Dyslipidemia has a high prevalence in hemodialysis patients, especially patients with low literacy and obesity. So that, at least one of the components of lipid profiles is abnormal in more than 80% of hemodialysis patients. Therefore, planning to improve life style and provide training on proper nutrition and physical activity is recommended as one of the principles of care in hemodialysis patients

[ effect of vitamin C supplementation on serum levels of hemoglobin, hematocrit and ferritin in hemodialysis patients: a randomized clinical trial]

Anemia is one of the common complications of chronic renal failure and vitamin C can improve anemia through releasing iron from ferritin and its transfer from the reticuloendothelial system to transferrin. This study was performed with the objective of evaluating the effect of vitamin C supplementation on serum levels of hemoglobin, hematocrit, and ferritin in hemodialysis patients. In a double-blind clinical trial, 178 patients with chronic renal failure were randomly divided into three groups of intervention, control, and witness. In the intervention group, 250 mg vitamin C, 250 mg of vitamin C was injected intravenously at the end of each hemodialysis session three times a week for 8 weeks. In the witness group, same amount of placebo saline was injected at the same time, and no intervention was performed in the control group. Laboratory parameters, including serum levels of hemoglobin, hematocrit, and ferritin were measured at the beginning and end of the intervention. Data analysis was performed by Chi-square and one-way ANOVA. The significance level was considered to be p < 0.05. There were significant differences in serum levels of hemoglobin and hematocrit in the intervention group, but, the changes of the serum level of ferritin were not significant in any of the groups. The results of this study showed that vitamin C supplementation in hemodialysis patients can significantly increase the mean serum levels of hemoglobin and hematocrit, however, it cannot significantly change the serum ferritin level

Lumbosacral Sagittal Alignment in Association to Intervertebral Disc Diseases

STUDY DESIGN: A cross-sectional case-control study was designed to compare the sagittal alignment of lumbosacral regions in two groups of patients suffering from low back pain, one with intervertebral disc pathologies and one without. PURPOSE: To evaluate the correlation between lumbosacral sagittal alignment and disc degeneration. OVERVIEW OF LITERATURE: Changes in lumbar lordosis and pelvic parameters in degenerative disc lesions have been assessed in few studies. Overall, patients with discopathy were shown to have lower lumbar lordosis and more vertical sacral profiles. METHODS: From patients with intractable low back pain undergoing lumbosacral magnetic resonance imaging, 50 subjects with disc degeneration and 50 controls with normal scans were consecutively enrolled. A method was defined with anterior tangent-lines going through anterior bodies of L1 and S1 to measure global lumbosacral angle, incorporating both lumbar lordosis and sacral slope. Global lumbosacral angle using the proposed method and lumbar lordosis using Cobb's method were measured in both groups. RESULTS: Lumbar lordosis based on Cobb's method was lower in group with discopathy (20degrees-67degrees; mean, 40.48degrees+/-9.89degrees) than control group (30degrees-62degrees; mean, 44.96degrees+/-7.68degrees), although it was not statistically significant. The proposed global lumbosacral angle in subject group (53degrees-103degrees; mean, 76.5degrees+/-11.018degrees) was less than control group (52degrees-101degrees; mean, 80.18degrees+/-9.95degrees), with the difference being statistically significant (p=0.002). CONCLUSIONS: Patients with intervertebral disc lesions seem to have more straightened lumbosacral profiles, but it has not been proven which comes first: disc degeneration or changes in sagittal alignment. Finding an answer to this dilemma demands more comprehensive long-term prospective studies.

Fungal granuloma of the brain in a case of chronic mucocutaneous candidiasis

Although fungal brain infections are not uncommon, intracranial granulomas due to fungi are rare. Immunodeficiency is considered to be the main predisposing factor. We have presented the case of a 21-year-old lady admitted to the emergency ward with the clinical picture of impending brain herniation. She was a known case of chronic mucocutaneous candidiasis [CMCC] since childhood and had been under oral topical nystatin treatment which she had arbitrarily discontinued for the past ten years. The patient underwent emergent craniotomy and resection of the lesion. Pathologic exam revealed its fungal granulomatous nature. Cultures documented Candida albicans as the offending pathogen. The history of immunodeficiency was a useful clue in this case. To the best of our knowledge, this was the first case of fungal granuloma of the brain in the setting of chronic mucocutaneous candidiasis

Diagnostic accuracy of early computed tomographic angiography for visualizing medium sized inferior and posterior projecting carotid system aneurysms

Conventional angiography, generally referred to as intra-arterial digital subtraction angiography, still remains the gold standard reference method for the diagnosis of intracranial aneurysms, helical computed tomography angiography [CTA] is a new non-invasive volumetric imaging method. This study was conducted to screen patients presenting with subarachnoid-hemorrhage by CTA before conventional digital subtraction angiography [DSA] and subsequently comparing the results for various aneurysm projections. In a prospective study, 99 consecutive patients with an initial diagnosis of subarachnoid hemorrhage were screened for aneurysms with CTA followed by conventional DSA. There were 17 cases with negative angiograms in whom repeat angiograms, three months later were negative for 15 cases, while two cases were found to bear aneurysm on the repeat examination. Eighty two patients had at least one proven aneurysm on initial DSA and two on the repeat angiogram. Out of 84 patients, five underwent endovascular treatment and 79 patients who underwent surgical clipping were considered for projection evaluation. Sensitivity of CTA was 98.78% [95% confidence interval [CI], 93.4-99.7%], while the specificity was 100% [95% CI, 81.57-100%] and the kappa coefficient of agreement between CTA and DSA was 96.5%. The most significant discrepancies with DSA findings were for visualizing the projection of inferior and posterior projecting proximal anterior circulation aneurysms. Helical CTA was in good concordance with DSA for screening of cerebral aneurysms; however, for exact visualization of the aneurysm neck and its projection, especially if it is inferior or posterior, DSA remains the gold standard