relation between serum vitamin D levels and blood pressure: a population-based study

Vitamin D deficiency has been proposed as an associating factor with increased blood pressure. We studied the relationship between serum vitamin D and blood pressure in a large representative sample of Iranian population. In this cross-sectional study, based on the data of 2508 adults [aged between 20 and 70 years] from the Iran Multicenter Osteoporosis Study [IMOS], the association between serum vitamin D and blood pressure was investigated. There was a significant difference between mean [ +/- SD] vitamin D levels of the individuals with stage I hypertension and that of the three other groups [Normal: 32.9 [ +/- 27.5]; Prehypertension: 34.4 [ +/- 27.2]; Stage-I: 38.7 [ +/- 29.2]; Stage-II: 34.7 [ +/- 24.0] ng/ml; P<0.05. In multivariate regression models, the weak positive association of vitamin D and systolic blood pressure values disappeared after age and Body Mass Index [BMI] adjustment. We found a statistically positive but weak association between vitamin D serum concentration and systolic blood pressure. Considering the difference noted between our results and previous studies, further research is needed to assess the potential effect of ethnicity and genetic factors on these findings

impact of alendronate on bone mineral density of osteoporotic patients

The present study assessed the real life therapeutic effects of weekly doses of alendronate in treating a group of osteoporotic patients in Iran. The present historical cohort was conducted on patients who had undergone two or more bone mineral densitometry within an interval of 1.5-2 years in Shariati Hospital bone mineral density department between 2002 and 2010. Patients were asked by phone about consumption of alendronate. The mean increase in the BMD values at different sites was calculated. There was a significant increase in the body mass index [BMI] values of both the individuals taking alendronate and the control group [P<0.001]. Taking the weekly dosage of the drug was associated with a 7.67% increase in the BMD values at the femoral neck, 8.68% at the total hip, and 3.17% at the lumbar spine. Moreover, our results showed a significant difference between the height decline in the two groups [alendronate taking: 0.7 +/- 2.4 vs. control: -0.7 +/- 2.6, P<0.001]. Comparing the results of the present study with that of previous ones revealed the drug is beneficial in improving bone mineral density in Iranians; as well alendronate is more effective in Iranian postmenopausal women when compared with the Americans

Cysclosporine-A versus prednisolone for induction of remission in auto-immune hepatitis: interim analysis report of a randomized controlled trial

Corticosteroids are used to induce remission in auto-immune hepatitis. They are not universally effective; therefore, alternative treatments are needed. In this study Cysclosporine-A has been compared with prednisolone as an alternative treatment in a randomized controlled trial. This paper is an interim analysis of an ongoing clinical trial. Sixteen years and older consenting patients were enrolled. Group-A received prednisolone and group-B cyclosporine-A according to a preset protocol and followed at regular intervals for 48 weeks. Final assessment was done at week 48. Primary outcome was response rate as defined below. [Complete response] was defined as achieving AST and ALT in the normal range and absence of any clinical signs of deterioration, and partial response was defined as a decrease in AST and ALT by less than half of their original values but not to within normal limit. Non-responding ones at week eight were switched to the other arm. Thirty-nine patients were enrolled [24 group-A, 9 male]. Mean AST and ALT at baseline were higher in group-B, but other variables were comparable. At week 12, 34.8% and 64.3% of group-A and B had achieved AST and ALT in the normal range less than 40 IU/L]respectively [P=0.081]. Corresponding figures at week 48 were 50.0% and 47.6% 0=0.62 and48 respectively]. At week 12, 86.9% and 85.7% of patients had AST and ALT levels less than twice upper normal limit in groups-A and B respectively [p=0.54 and 0.42]. Corresponding figures at week 48 were 90.0% for both groups. There was one treatment failure in group-B which did not respond to prednisolone either. Serious adverse events [death and liver transplantation] occurred in group-A only. Serum creatinine did not change during the study period in either group. According to our data, Cyclosporine-A is as effective as prednisolone for induction of remission in AIH. Adverse event and serious adverse were more common with prednisolone

Diagnostic accuracy of CT scan in abdominal blunt trauma / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the sensitivity and specificity of CT scan findings in patients with blunt abdominal trauma admitted to the university hospital.</p><p><b>METHODS</b>All the patients with blunt abdominal trauma admitted at a tertiary teaching trauma center in Iran between 2005 and 2007 were enrolled in this study. In the absence of any clinical manifestations, the patients underwent a diagnostic CT scan. Laparatomy was performed in those with positive CT results. Others were observed for 48 hours and discharged in case no problem was reported; otherwise they underwent laparatomy. Information on patients?demographic data, mechanism of trauma, indication for CT scan, CT scan findings, results of laparotomy were gathered. The sensitivity, specificity and accuracy of the CT-scan images in regard with the organ injured were calculated. The sensitivity, specificity and accuracy of the CT scan were calculated in each case.</p><p><b>RESULTS</b>CT scan had the highest sensitivity for detecting the injuries to liver (100%) and spleen (86.6%). The specificity of the method for detecting retroperitoneal hematoma (100%) and injuries to kidney (93.5%) was higher than other organs. The accuracy of CT images to detect the injuries to spleen, liver, kidney and retroperitoneal hematoma was reported to be 96.1%, 94.4%, 91.6% and 91.6% respectively.</p><p><b>CONCLUSION</b>The findings of the present study reveal that CT scan could be considered as a good choice, especially for patients with blunt abdominal trauma in teaching hospitals where the radiologic academic staff is not present in the hospital in the night shifts.</p>

effect of intravenous nitroglycerine on blood pressure during intubation

Hypertension is one of the most frequent complication during laryngoscopy and intubation; thus in the premedication or induction stages, many drugs have been used to control this hypertension. Nitroglycerine is one of the drugs thought to be effective and the purpose of this study is to appraise this deliberation. 150 patients of 20-50 years of age were enrolled in this randomized double blind clinical trial. They were randomly divided into two group, one received 2 micro g/kg nitroglycerine while the other group did not received any drug. Blood pressure was checked in 3 different stages and compared. In both groups, pre and post intubation systolic pressure had a significant difference; whereas this relation could not be found for the diastolic pressure. These variables did not have a statistically significant relation prior to intubation; whilst after intubation, a significant relation was elicited. Injection of 2 micro g/kg nitroglycerine immediately after anesthetic induction is effective in preventing the unwanted increase in the blood pressure, and as a result, complications following this response in patients with ischemic heart disease would be reduced

Hypertonic saline 5% vs. lactated ringer for resuscitating patients in hemorrhagic shock

Through hypertonic and isotonic crystalloids are used nowadays in resuscitating patients in hemorrhagic shock, yet there is no sufficient data in support of either. The aim of this study was to compare the hemodynamic effects of hypertonic saline 5% and lactated ringer solutions when used for the resuscitation of patients in hemorrhagic shock. In a double-blinded randomized clinical trial, sixty adult patients in hemorrhagic shock admitted to the Emergency Department of a teaching Hospital between September 2005 and September 2006, were enrolled in this study. Patients were divided into two groups, The first group received lactated ringer 20 ml/kg, and the second group received 4 ml/kg of 5% hypertonic saline infused intravenously within 10 to 15 minutes followed by lactated ringer 10 ml/kg/hr. Hemodynamic parameters were measured at hospital admission as well as every 15 minutes for an hour and the results were compared between the two groups. Gastrointestinal bleeding was the most common cause of shock. There was a significant difference between the baseline and final hemodynamic parameters [MAP, HR, CVP] in each group; however, data of the two groups did not differ significantly. The PaO[2] was higher in the lactated ringer group and there was no difference in PaCO[2] neither in each group nor between the two groups. Both hyper and isotonic crystalloid solutions can improve hemodynamic status and the blood gas measurements, similarly; however, lactated ringer is a more potent solution in improving tissue oxygenation

Olfactory groove schwannoma masquerading as an orbital mass

Olfactory groove schwannoma is a very rare tumor breaking through the skull base and orbit. The tumor may also extend to the subfrontal region intradurally. A case of olfactory groove schwannoma in a 35-year-old female, originating from the left olfactory groove with left proptosis, diplopia, supra-orbital mass, and gross intracranial extension is reported. The presence of bony scalloping on CT and absence of meningeal tail on contrast enhanced MRI are in favor of the diagnosis. Histological examination and immuno-histochemical evaluation for S-100 protein, showed the tumor as a schwannoma. Total excision through a frontal craniotomy and skull base reconstruction are the main therapeutic steps