Serum Sclerostin Levels in Patients with Human Immunodeficiency Virus Infection and Their Association with Bone Turnover Markers and Bone Mineral Densitometry

BACKGROUND: The aim of the study was to compare serum sclerostin levels in human im-munodeficiency virus (HIV)-infected patients and healthy controls, and to evaluate their relationship with bone turnover markers (BTM) and bone mineral density (BMD). METHODS: We prospectively studied 33 HIV treatment-naive patients and 63 healthy individuals; matched for age and sex. Serum sclerostin levels, BTM, BMD were measured. Viral load and cluster of differentiation 4 (CD4) levels were also assessed in HIV-infected patients. RESULTS: The mean+/-standard deviation (SD) age of sample was 37.6+/-10.3 years (range, 19 to 59 years). Of the 96 subjects, 58 (60.4%) were male and 38 (39.6%) were female. Infection with HIV is associated with significant reduction in serum sclerostin levels (HIV-infected: 39.4+/-28.3 vs. non HIV: 76.6+/-15.7 pmol/L; P0.05). CONCLUSIONS: These findings suggest that untreated HIV and the resulting immune deficiency and/or systemic inflammation could be an important regulator of serum sclerostin in this population.

Study on patients with poor control of type II diabetes mellitus at national Ribat university hospital

Diabetes control is elusive so great effort is needed to keep blood glucose normal or near the required level. Various factors are suspected for poor glycemic control. These factors included: aging, sex, duration of diabetes, medication adherence, clinical inertia, physical inactivity, patient knowledge, comorbidity and quality of medications. To assess factors associated with poor glycemic control among patients with type2 diabetes. This was a descriptive cross sectional hospital-based study conducted in the National Ribat University [NRU] Diabetes Clinic, Khartoum state, Sudan. Out of 398 diabetic patients attending NRU Diabetes Clinic 88.2% has type 2 DM, Of whom 31.4% [125 patients] had poor glycemic control and were shifted to insulin therapy. Female constituted 76.8% of the poor glycemic control patients and 88.8% of patients were above 40 years of age. About 64.8% were shifted to insulin within 10 years of diabetes diagnosis. The majority [79.2%] were not having an exercise program, 84% were not having diet program, 70.4% their knowledge about hypoglycemia symptoms was not satisfactory and 61.6% their knowledge about medication usage was not satisfactory. About 66.4% were on mono anti diabetic therapy and need medications intensification, and 54.4% were not adherent to anti diabetic medications. Our findings showed that sedentary life, clinical inertia and longer diabetes duration were behind poor diabetes control

FEV1 and FVC pulmonary function reference values among 6-18-year-old children: a multi-centre study in Saudi Arabia

It is important to establish lung function reference values for each population. This study aimed to determine the spirometric reference values for healthy Saudi Arabian children and adolescents and to derive prediction equations for these. A cross-sectional study was conducted among healthy schoolboys and girls aged 6–18 years old, selected randomly from the 6 administrative regions of Saudi Arabia. Data were collected by questionnaire and physical examinations including spirometry. Forced expiratory volume in 1 second [FEV1] and forced vital capacity [FVC] were significantly higher in males than females. Height was the anthropometric variable most strongly correlated with FEV1 [r = 0. 61], more so for males [r = 0.71] than females [r = 0.50]. In males the multivariate linear regression model explained 53.9% of FEV1 and 35.1% of FVC variations. In females it explained 25.3% of FEV1 and 16.5% of FVC variations. All changes in R2 were statistically significant.

Comparative evaluation of tooth enamel abrasion induced by different toothpastes

Tooth brushing along with a toothpaste is the most frequent and important method in managing a healthy oral hygiene. However, using such products also has its side-effects and shortcomings. Considering the large range of toothpastes available and the insufficiency of proper researches in this area in Iran, this study was designed to evaluate the abrasiveness of a toothpaste for sensitive teeth and a whitening one with two similar Iranian brands. This was an invitro experimental study. Four groups of enamel samples consisting of each 6 specimens were prepared and embedded in acrylic blocks. The initial surface profile for each specimen was calculated using a profilometer. The samples undertook the wear phase in a V8 Cross Brushing machine using toothbrushes and a toothpaste solution. The samples were then dried and the surface profile was again calculated. The variation of the first and second profilometer calculations demonstrate the amount of wear for each specimen. Data was analyzed using the SPSS program by means of One way ANOVA and Repeated Measure ANOVA tests. The amount of wear recorded for the 4 experimental groups was significantly different [p=0.039]. However, the two by two comparision tests showed that the Iranian brands did not appear to have a significant difference with their foreign counterparts [p>0.05]. The only difference was apperant between the two Iranian brand groups. According to the present study, it seems that there is no significant difference in the abrasive properties of the Iranian and foreign made toothpastes. However, similar researches considering different effects of toothpastes and especially in more clinical conditions and by utilizing different measurement methods appears to be necessary in Iran

Is there any difference in rate of acute complications-especially stent thrombosis-between bare metal and drug eluting stents?

Although bare metal stents [BMS] resolved abrupt closure which was the most important complication of percutaneous coronary balloon angioplasty, and then drug-eluting stents [DES] significantly reduced the rate of restenosis that was seen in around 30% to 40% at mid-term of post-percutaneous coronary intervention [PCI], but stent thrombosis is still a major problem which occurs in different phases. This study was conducted to evaluate the rate of acute complications, especially acute stent thrombosis [in the first 24 hours] in patients who received either BMS or DES. This retrospective study was performed on 1674 patients [640 women and 1034 men] who underwent PCI with at least one stent [from 2002 until 2006]. 2404 stents were deployed, 975 BMS [40%] and 1429 DES [60%], [820 Cypher, 570 Taxus and 39 other kinds]. 705 stents [35%] were deployed directly and 1699 stents [65%] followed pre-dilatation. In 35 cases [2%], the procedure was not completed because of several reasons [failure of guiding catheter engagement, failure to cross the lesions by guidewires or balloon catheters]. Fourteen patients [0.8%] suffered acute stent thrombosis [eight in the DES and six in the BMS groups], one of whom was referred for emergency coronary bypass surgery [CABG] and twelve patients treated by re-PCI. One patient was complicated by embolic occlusion of a dominant LCX during manipulation of the guiding catheter that was referred to emergency CABG. Two patients suffered left main [LM] dissection, one of whom was treated by prompt stenting and the other after stabilizing by LM stenting, was referred for urgent CABG. Fifteen cases [0.8%] developed slow or no-reflow phenomenon [six cases in the BMS and nine cases in the DES groups] who were managed by medical and mechanical intervention. Twenty five cases [1.5%] had mild CPK-MB rising [ten patients in the BMS and fifteen patients in the DES groups]. Totally 0.3% of cases were referred for emergency or urgent and [1.7%] for elective CABG. Fortunately there was no in-hospital death. This study showed a low and similar incidence of acute complications, especially acute stent thrombosis, in PCI in both BMS and DES groups

Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension-operative experience in UCSD / 中华胸心血管外科杂志

Objective Background Pulmonary endarterectomy (PEA) is a safe and effective surgical treatment for chronic thromboembolic pulmonary hypertension. University of California at San Diego Medical Center is widely recognized as the world's leading referral center for PEA surgery with extensive surgical experience, which has surgically treated about 2400 patients till 2009, which account for more than 50% of the total cases in the world. Methods During visiting in UCSD, 32 pulmonary endarterectomy operations were performed by Prof. Stuart W Jamieson and Mechel M Madani. In these patients, 17 were males (53%), the average age was (47.56 ± 16.04 ) years, 47% with prior history of pulmonary embolism and/or deep vein thrombosis. Obvious pulmonary hypertension and hypoxemia were observed in all patients. Bilateral pulmonary endarterectomy was performed under cardiopulmonary bypass with profound hypothermic circulatory arrest. Results According to the classification of surgical specimens, 21.8% are type Ⅰ , 28.1% are type Ⅱ and 37.5% are type Ⅲ. The average time of cardiopulmonary bypass (CPB) was (236.32 ± 37.27) mins. The aortic cross clamp time was ( 111.69 ± 28.14) mins. The circulatory arrest time was (38.00±13.58 ) mins [ right side (21.39 ± 9.57 ) mins and left side ( 16.61 ± 6.83) mins]. Postoperatively the average mechanical ventilation time was ( 66.23 ± 99.24) hours, and the ICU stay was (4.62 ± 4.50 ) days.There was no postoperative moorality. All cases had significant decrease in systolic pulmonary artery pressure [(81.03 ± 16.92)mm Hg vs. (51.20±12.16) mm Hg] and pulmonary vascular resistance [(88.91 ±42.32) kPa · s · L-1 vs. (34.38 ±15.68 ) kPa · s · L-1 ], great improvement in cardiac output [(3.65 ±1.08 ) L/min vs. ( 5.85 ± 1.21 ) L/min ] and central venous pressure [(13.07 ± 2.11) cmH2O vs. ( 9.86 ± 3.02 ) cmH2O] postoperatively compared to preoperative data. Shortterm follow-up showed that the cardiac function of all cases returned to NYHA class Ⅰ or Ⅱ, with great improvement in CTPA.Conclusion PEA is definitive treatment of chronic thromboembolic pulmonary hypertension. According the successful experience of UCSD PEA team, first and foremost pulmonary endarterectomy is a bilateral procedure, because chronic thromboembolic pulmonary hypertension is mostly a bilateral disease. Second, cardiopulmonary bypass with the aid of deep hypothermia and circulatory arrest are essential to operator in recognizing the true endarterectomy plane of the media and in following the specimen to its feathered tail end in each branch, using these approaches can effectively reduce pulmonary hypertension and provide good hemodynamic and symptomatic results. Third, PEA remains an uncommon procedure in China. Only a few centers can perform high qualified PEA surgery. In most of inexperienced centers, type Ⅰ and type Ⅱ disease should be choose to operation.Patients with sPAP ≥100 mm Hg, PVR ≥ 100 kPa · s · L-1 or type Ⅲ disease will face more dangers peri-operation.

[Evaluation of bacteremia following percutaneous coronary intervention in Rajaei hospital in 2007]

Cardiovascular disease are the most common chronic disease and the leading cause of disease related disability and fatality around the world. Among the therapeutic strategies of coronary artery disease, [CAO]. Percutaneous coronary intervention [PCI] has achieved an increasing importance. The infectious complication of PCI although uncommon, may lead to hazardous outcome. The study was done on 230 participants, with nopreprocedural infection, fever and antibiotic receipt. The PCI was done via femoral artery access. After PCI, 3 sets of blood culture were taken in eight hours time interval. Our data comprised of demographic, risk factors, procedural information and blood culture results were obtained and analysed consequently. The study demonstrated that, prevalence of bacteremia was 5.7%, although none of the patient did manifest clinical aspects of infection. Hence, the bacteremia was transient in all patients, with positive blood culture result. The most common organism was staphylococcus epidermidis [76.9%]. There was association between bacteremia and duration of procedure, type of procedure, and number of vessels on with PCI was done. Our study demonstrated that, post PCI bacteremia is clinically insignificant. According to the study result, preprocedural prophylactic antibiotic therapy is not recommended

survey on total cost and income of physiotherapy unit in Alzahra Hospital of Esfahan city

Rehabilitation services are among the first response to disability or weakness. Persons who need rehabilitation supports may be calssified on an outpatient and inpatient basis. Physiotherapy unit total cost and income analysis, Was the goal of this study which was conducted in Alzahra hospital in Isfahan university of medical sciences. This survey is analytic and cross sectional. Check list was provided and used for account income and total cost and data was gathered from accounting documents, depot and physiotherapy unit. Average of income for each patient was 34149 Rials [R.]. and average of employee wage was 26801 R. in 1384. Average of consumed material and depreciation expenditure for each patient in this unit were calculated as 171 and 1359 R., respectively. Average of additional costs and energy expenditure in physiotherapy unit for each patient were 5617 R. and 141 R. this results shows that physiotherapy unit was not profitable injurious for hospital during the study time. Time, facilities and equipments are not used completely in physiotherapy unit. We recommend increasing active services time and establishing other services like hydrotherapy

[Investigating the attitudes and performance of dentists in Isfahan in respect to observing health standards to prevent infection transmission in dentistry]

The risk of being affected by infectious diseases in dentistry directly depends upon the degree of contact with body liquids, such as blood and saliva, as well as the working tools. Different micro-organisms including the viruses causing AIDS and Hepatitis B as well as oral thrush are possible to be transferred in dentistry. According to the Dental intervention [FDI], it is suggested that all dental patients, in spite of the healthy look, are considered to be infective. Therefore, the health principles and protective and safety methods must be observed in all the sequences to prevent cross-infection. Thus, the present study seeks to investigate the degree to which the dentists in Isfahan respect and approach to such standards. This is a cross-sectional descriptive study. In order to answer the questions of the study [as found in tables 1 and 2], the data related to the participants' attitudes and performance were collected by having them fill out a questionnaire and a checklist. A total of 140 dentists in Isfahan were selected through a random sampling in 1385 [HS]. The data collected was then evaluated with SPSS. The mean score obtained from the attitude-related questions was 5.36. Also, the mean score of performance-related questions was found to be 8.03. No significant relation was found between the dentists' attitudes and the years of service [P=0.092, r=0.17]. No significant relation was found between the dentists' performance and the years of service [P=0.12, r=0.15]. No significant relation was found between the dentists' attitudes and their performance [p=0.1, r=0.16]