Iron status and metabolic syndrome in patients with non-alcoholic fatty liver disease

Background: A hypothesis has been presented about the role of serum iron, ferritin and transferrin saturation among patients with non-alcoholic fatty liver disease [NAFLD] and resistance to insulin [metabolic syndrome [MetS]], but there is much controversy. This study aimed at investigating the level of serum iron and demographic characteristics in patients with NAFLD with or without MetS

Methods: A case-control study was conducted on patients with elevated liver enzymes referring to Baqiyatallah clinic, Tehran, Iran during 2010-2011. After ruling out other causes of increased aminotransferases and approving the diagnosis of NAFLD, the patients were divided into two groups of with or without MetS. Then, the individuals' demographic, sonographic, and laboratory characteristics were recorded

Results: This research included 299 patients suffering from NAFLD who were divided into MetS [n=143; 47.8%] and non-MetS [n=156; 52.2%] groups. The age, systolic and diastolic blood pressure, body mass index, waist/hip ratio, glucose tolerance test, serum insulin, C. peptide, triglyceride, and HB A1c were different between MetS and non-MetS groups [p<0.05]. There was no significant difference in serum iron and ferritin levels between the two groups, however, a significant correlation was found between serum ferritin and alanine transaminase [p=0.005] and also aspartate aminotransferase [p=0.032]

Conclusion: Our findings did not show a significant relationship between iron, in free or storage form, and the presence of MetS among patients with NAFLD, but serum ferritin can correlate with hepatocytes injuries indicated by raised aminotransferases. Nevertheless, to clarify this relationship further molecular, genomic, and histopathological studies are required

Comparison between traction-countertraction and modified scapular manipulation for reduction of shoulder dislocation / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>One of the most common joint dislocations presented to the emergency department (ED) is anterior shoulder dislocation (ASD). Various techniques for the treatment of this abnormality have been suggested. In this study, we evaluated the efficacy and success rate of modified scapular manipulation (MSM) as a painless procedure compared to traction-countertraction (TCT) for reduction of ASD.</p><p><b>METHODS</b>Patients with ASD who were presented to ED of Baqiyatallah Hospital, Tehran during 2011 were included. They were randomly divided into MSM group or TCT group and then pain at reduction, time of reduction, duration of hospitalization, and success rate were compared. In TCT group, reduction was performed using sedative and antipain medications.</p><p><b>RESULTS</b>Ninety seven patients (81.6% male) with a mean age of 34.15 years±13.48 years were studied. The reduction time between both groups showed a significant difference (470.88 seconds±227.59 seconds for TCT group, 79.35 seconds±82.49 seconds for MSM group, P<0.001). The success rate in MSM group in the first and second effort were 89% and 97% whereas 73% and 100% in the TCT group respectively (P<0.001).</p><p><b>CONCLUSION</b>It seems that the manipulation technique can be more successful than the TCT method at the first effort whilst the second effort has the opposite results. Also MSM can be safer, cheaper and more acceptable for patients than TCT as a standard traditional method.</p>

Cardiovascular disorders in the context of non-alcoholic fatty liver disease: a literature review

Non-alcoholic fatty liver disease [NAFLD] is the leading cause of chronic liver disease in the United States and other industrialized countries, and the reported prevalence in the developing countries is also rather high. This disease is associated with a high rate of morbidity and mortality and damage to the other organs. The cardiovascular system is, perhaps, the most vulnerable organ to NAFLD adverse effects to the extent that most mortality associated with this disease is reportedly from the cardiovascular system rather than from the liver itself. In this article, we review the significant aspects of cardiovascular disorders associated with NAFLD, including the epidemiology of cardiovascular diseases in NAFLD patients, factors that interfere in this relationship like hypertension, severity of NAFLD, and age of the patients, and finally preventive strategies whose employment could significantly improve the outcome

role of serum level of interleukin-6 in severity of pulmonary complications of sulfur mustard injuries

Diverse studies suggest that interleukin-6 [IL6], as a member of cytokines family, has a major role in inflammatory processes of airways and lungs. In this study, an attempt was made to determine the serum level of IL6 in sulfur mustard [SM] injured patients and its comparison with controls. The measured IL6 mean level in patients with chemical injuries [0.76 +/- 0.3 ng/ml] was significantly higher than the control group's mean level [0.34 +/- 0.12 ng/ml]. Furthermore, patients with moderate to severe symptoms had a serum level of [0.95 +/- 0.92 ng/ml] which was significantly higher than mild [0.47 +/- 0.54] and control [0.34 +/- 0.12] groups. The outcome of this research program demonstrates that an increase in serum level of IL6 can have a role in pulmonary complications of SM, similar to other well defined pulmonary diseases. However, further studies are required to clarify the role and mechanism of IL6 in such patients

Occupational risk of bladder cancer among Iranian male workers

Approximately 5-10% of human cancers are thought to be caused by occupational exposure to carcinogens. Compare to other cancers, bladder cancer is most strongly linked to occupational exposure to chemical toxins. This study has been performed to understand which occupations and exposures are related to bladder cancer in Iran. This study is a case-control study which is conducted on cases with bladder cancer [160 cases] diagnosed in Baharlou hospital in 2007-2009. One hundred sixty cases without any occupational exposure were considered as controls matched for demographic characteristics. Demographic data and characteristics of occupation were compared. Mean age of cases and controls were 63.7 and 64 years, respectively [P = 0.841]. History of urinary tract stone had significantly difference in two groups [P = 0.039]. Occupations such as bus and truck driving, road and asphalt making, mechanics, working in refinery and Petrochemical, plastic, metal manufactory, welding, and pipeline founded a higher risk for bladder cancer rather than controls. Our findings on Iranian workers are concurrent and compatible with findings of previous reports about occupational and environmental risk factors of bladder cancer. Although our study population was not little, further studies are needed to declare the risk of working in some occupations such as drivers and metal factories for bladder cancer

[ effect of renal arteries sympathectomy on refractory hypertension]

Sympathetic complex of over-activation kidneys is one of the main causes of primary hypertension [HTN]. We aimed to assess the efficacy and safety of sympathectomy using 5Fr mariner catheter ablation on patients with refractory hypertension. In this prospective cohort study, patients who received three or more antihypertensive medications with 160mmHg systolic blood pressure [BP] or more were randomly included and divided into 2 groups. Cases in the first group were undergone to renal denervation and the second group was treated by previous antihypertensive medications. Both groups were followed for six month by assessing BP and adverse effects. One hundred and seventeenth patients [54%] out of 212 screened patients were included in the first group [renal denervation] and 95 patients as the second group. The mean of BP changes in the first group was 35.15 mmHg with standard deviation of 22.11mmHg. [P<0.001] in the second group, the mean changes of BP was not statistically significant. [5.0mmHg +/- 22.11, P=0.79 for systolic BP and P=0.96 for diastolic BP].92% of 117 patients in the first group had a favorable BP decrease, which was defined as a 20mmHg or more decrease in BP, in comparison with 15% of 95 patients as controls [P=0.001]. There was no observed complication after denervation in the first group. It seems that the sympathetic renal denervation can be an effective and safe method for treatment of refractory hypertensive patients indeed of routine medications although further studies with longer follow up duration and more cases are suggested for confirming this issue.

Thyroid function test in pre-term neonates during the first five weeks of life

Congenital hypothyroidism [CHT] is one of the most common congenital endocrinal disorders. The prevalence of CHT is estimated about 1 in 3,000 newborns. The prevalence, etiology and associated disorders of abnormal thyroid screening tests are reported in different ranges. In this study, we assessed the pre-term newborns for CHT and associated factors that influence thyroid function. One hundred newborns with the gestational age fewer than 35 weeks were investigated. Baseline serum thyroid stimulating hormone [TSH] and free thyroxin [FT4] levels were measured during the first 5 days of life and were repeated during the first 5 weeks. We analyzed the effects of demographic factors and the presence of respiratory distress syndrome on the alteration of thyroid function tests during the first 5 weeks of life. The mean gestational age [GA] at delivery was 32.35 +/- 1.97 [range 28 to 35] weeks. CHT was observed in 13[13%] preterm infants. GA was the only factor which affect the FT4 changes over the two weeks follow-up [P < 0.001, b: -2.783, Power: 70.2%] although the differences between baseline and follow-up amount of TSH were not significantly influenced by GA [P = 0.062, power: 46%]. However, the adjusted TSH and FT4 serum level changes during follow-up were significantly different between two groups [between CHT and normal, P = 0.006, 0.000, respectively]. It seems that thyroid function tests should be repeated in preterm infants, especially for patients with lower gestational age, to confirm the diagnosis of CHT. Also, CHT should be considered among the newborns that are affected by RDS.

[Comparison of impacts of friction massage, stretching exercises and analgesics on pain relief in primary fibromyalgia syndrome: a randomized clinical trial]

Stretching exercises and massage therapy are both suggested for pain relief in fibromyalgia syndrome. Previous studies have not proved their superiority over each other. This study compared the therapeutic effects of friction massage, stretching exercises, and analgesics on pain relief in patients with fibromyalgia syndrome. We evaluated 129 female patients with the diagnosis of primary fibromyalgia visited at the physical medicine clinics of Baqiyatallah Hospital in Tehran, Iran during 2010- 2011. Patients were randomly divided into three groups: the first group received 400 mg ibuprofen P.O. [3 times per day] and 25 mg nortriptyline [daily] P.O. as analgesic, the second group was treated by friction massage and the third group performed stretching exercises. Patients were assessed three times [initially, after one and four weeks] by visual analogue scale [VAS]. The mean age of participants was 60.46 years. The mean age in each treatment group was 46.66 years in medication group, 46.73 years in stretching group and 46.65 years in friction massage group. Changes in VAS score over 4 weeks were 2.4, 3.1 and 1.9, in the first, second, and third groups, respectively. The changes in VAS were significantly different in the first and second groups rather than the controls [P<0.05]. The effect of stretch exercise on pain relief was similar to analgesics, but it was more effective than friction massage. Moreover, the therapeutic effect of stretching exercise on pain relief upon four weeks was more permanent than friction massage but it was similar to analgesics

Pepsin and bile acid concentrations in sputum of mustard gas exposed patients

Gastro-esophageal reflux has been suggested to be associated with several pulmonary complications such as asthma, and post-transplant bronchiolitis obliterans [BO]. Pepsin or bile salts in the sputum is shown to be an optimal molecular marker of gastric contents macro/micro aspiration. In this study, we investigated sputum pepsin as a marker of micro-aspiration in sulfur mustard [SM] exposed cases compared to healthy controls. In a case controlled study, 26 cases with BO and 12 matched healthy controls were recruited and all cases were symptomatic and their exposure to SM was previously documented during Iran-Iraq conflict. Pepsin levels in sputum and total bile acids were measured using enzymatic assay. The severity of respiratory disorder was categorized based upon the spirometric values. The average concentration of pepsin in sputum was higher in the case group [0.29 +/- 0.23] compared with healthy subjects [0.13 +/- 0.07; P +/- 0.003]. Moreover, the average concentration of bile acids in the sputum cases was not significantly different in comparison to the controls [P = 0.5]. Higher pepsin concentrations in sputum of SM exposed patients compared with healthy control subjects indicate the occurrence of significantly more gastric micro-aspiration in SM exposed patients

Magnetic resonance imaging findings in epileptic children and its relation to clinical and demographic findings

Epilepsy is an important disease with a cumulative incidence of 3% all over the life and more than half of them are started from childhood. In this study we surveyed magnetic resonance imaging [MRI] findings in epileptic children and its relation with clinical and demographic findings in order to find better diagnostic and treatment modalities for these children in the future. In this cross sectional study, we investigated consecutively all 1 to 15-year-old epileptic children who referred to the pediatric neurology outpatient clinic from 2004 to 2010. Two hundred children were enrolled for investigation. There were 85 [42.5%] girls and 115 [57.7%] boys, aged 1 to 15-year-old [7.7 +/- 4]. 196 [98%] of the children had abnormal electroencephalography [EEG]. Abnormal MRI was seen in 57 [28.5%] patients and consisted of brain atrophy [10%], increasing white matter signal intensity in T2-weighted images [8%], benign cysts [5%], brain tumors [4%] and vascular abnormalities [1.5%]. Abnormal MRI findings had significant relation with abnormal EEG, age, positive family history for epilepsy, dysmorphic appearance, and abnormal physical exam. Considering 98% EEG abnormalities in these epileptic children, benign nature of MRI findings in most of our cases, the high price of MRI and the small minority of patients who benefit from active intervention as a result of MRI, we suggest to use EEG for confirmation of epilepsy and perform MRI for patient with abnormal physical exams, focal neurologic deficits or focal EEG abnormalities

[Diagnostic accuracy of general physician versus emergency medicine specialist in interpretation of chest X-ray suspected for iatrogenic pneumothorax: a brief report]

Pneumothorax is a potential life-threatening condition especially in patients with underlying disorders. In this study we compared the diagnostic accuracy of general practitioners and emergency medicine specialists in interpreting chest x-rays [CXR] suspected of having iatrogenic pneumothorax in emergency departments. This cross-sectional study was conducted in Shahid Chamran Hospital in Tehran, Iran during 2008- 2010. The study was designed to compare the ability of general practitioners and emergency medicine specialists in diagnosing iatrogenic pneumothorax regarding 500 CXRs of one-hundred patients admitted for upper central venous catheterization. General practitioners and emergency medicine specialists could accurately [P<0.001] diagnose pneumothorax in 484 [96.8%] and 497 [99.4%] CXRs, respectively. None of the underlying causes of the condition affected the diagnostic accuracy of both physician groups [P>0.05]. These findings indicate that the diagnostic accuracy of emergency medicine specialists is significantly higher than those of general physicians. The diagnostic accuracy of both physician groups was higher than the values in similar studies that signifies the role of relevant training given in the emergency departments of the Hospital

[Effects of simvastatin with or without fenofibrate on echocardiographic findings of patients with coronary artery disease and dyslipidemia: a brief report]

Various therapeutic protocols have been recommended for treating dyslipidemia, particularly in patients with coronary artery disease. The purpose of this study was to assess the efficacy of statin use with or without fenofibrate on echocardiographic findings of patients with coronary artery disease and dyslipidemia. This clinical trial was conducted on 124 patients with coronary artery disease and dyslipidemia in Baqiyatallah Hospital in Tehran, Iran during 2008 to 2010. The first group of patients [64] received simvastatin [20 mg] and fenofibrate [200 mg] with low lipid diet and exercise while the second group [60] only received simvastatin with low lipid diet and exercise for one year. The mean age of the participants was 54.3 +/- 6.5 years. The first group showed significant changes in lipid profile and left ventricular ejection fraction [LVEF], [P<0.05]. Left ventricular diastolic function parameters showed no significant changes in both groups upon 12 months of treatment. The results of this study show, one-year treatment by simvastatin and fenofibrate can be effective on lipid profiles, and improve LVEF with resultant positive effect on heart function

[Short- and long-term outcomes of angioplasty and stenting for high-risk extracranial carotid stenosis in carotid endarterectomy]

Carotid endarterectomy [CEA] is a standard method for patient with significant carotid stenosis but direct surgical repair via carotid endarterectomy may not be a good option in some patients because of the overall health status that may make the surgery too risky. Carotid angioplasty and stenting [CAS], is a relatively new procedure for the treatment of carotid artery disease in patients who may not be fit enough to undergo surgery. In this investigation, we determined short- and long-term outcomes of stent angioplasty in high-risk patients for whom the risk of perioperative morbidity and mortality is high. We have followed 82 consecutive symptomatic patients with a >/= 50% and asymptomatic patients with a >/= 70%- 80% carotid stenosis within 15.9 months of angioplasty and stenting in Baqiyatallah and Jamaran hospitals from 2008-2010. All the patients were considered poor surgical candidates by experienced surgeons and anesthesiologists upon pre-surgical consultation. This descriptive cross-sectional study was performed on 28 women and 54 men with a mean age of 69.7_9.2 years. The procedure was technically successful in 79 [96.3%] cases. There were 6 [7.3%] deaths, 5 [6.1%] strokes, 4 [4.9%] MIs and 4 [4.9%] TIAs during the follow-up period. The clinical results during the short available follow-up period suggested stent angioplasty to be useful, effective, reliable and safe in the treatment of significant cervical carotid stenosis in high-risk patients. Further analytical investigations with longer follow-up periods for predicting risk factors are recommended

[Effects of calcitonin nasal spray on serum bone resorptive marker CTX and other laboratory findings in osteopenic menopausal women: a clinical trial]

Various therapeutic options such as calcitonin have been suggested for patients with low bone density, despite uncertain efficacy in most patients. C-telopeptide of type I collagen [CTX] is a new bone marker used for the assessment of bone resorption. The aim of this study was to evaluate the therapeutic effects of nasal spray calcitonin in women with osteopenia via serum CTX and other laboratory tests. We conducted a self controlled clinical trial in 2009 on 105 women of menopausal age diagnosed in Baqiyatallah Hospital Clinic with osteopenia based on a bone mineral density score of 1.5 SD lower than peak bone mass. The patients were assigned to receive nasal spray calcitonin [200 IU/day], calcium [1000 mg/day] and Vit-D [400 IU/day] for 6 months. Serum CTX and other laboratory parameters were measured before and after the treatment. The data were analyzed by SPSS, version 17, using t-tests and a P<0.05 was considered statistically significant. Fifty-two patients completed the study and the mean CTX level decreased significantly from 3.10 +/- 2.03 to 2.61 +/- 1.82 pmol/lit [P<0.001], but total serum levels of PTH, Ca, AST, ALT and Alkaline Ph decreased insignificantly. It seems that nasal spray of calcitonin is significantly effective in preventing disease progression and treatment of low bone density by inhibiting bone tissue resorption indicated by CTX although further studies with larger samples sizes and inclusion of control groups are warranted

Intramuscular midazolam for pediatric sedation in the emergency department: a short communication on clinical safety and effectiveness

Procedural sedation in children continues to be a problem in the emergency department [ED]. Midazolam is the first water-soluble benzodiazepine and it has been widely used for procedural sedation in pediatric patients. The aim of this study was evaluation of clinical safety and effectiveness of intramuscular Midazolam for pediatric sedation in the ED setting. We performed a self-controlled clinical trial on 30 children who referred to the Baqiyatallah Hospital ED between 2009 and 2010. They received intramuscular Midazolam 0.3 mg/kg for procedural sedation and then they were folio wed for sedative effectiveness and safety. Vital signs and O2 saturation were also observed. The findings were I compared using SPSS ver. 16 software. I The mean age was 5.50 +/- 2.70 years, the mean weight was 19.50 +/- 6.63 kilograms and 16 patients [53.3%] were females. The most common adverse effect was euphoria [66.66%] and vertigo [6.7%]; 27.7% did not show any side effects. There was an overall complication rate of 72.3%. The vital signs including heart rate, respiratory rate, systolic and diastolic blood pressure and O2 saturation decreased significantly during sedation [P value < 0.05]. Midazolam is an effective and relatively safe sedative for pediatric patients in the ED. The patient should be observed closely and monitored for psychological and hemo-dynamic side effects

Echocardiographic and exercise test findings in patients with dyslipidemia and coronary artery disease before and after treatment with simvastatin with or without fenofibrate

Various treatment protocols for dyslipidemia and coronary artery disease have been suggested. In spite of lipid-lowering effects, various effects of statins and fi-brates have been reported in the literature. The aim of this study was to assess the cardiac efficacy of Simvastatin with or without fenofibrate on cardiac function. A cohort study was conducted on 124 patients with dyslipidemia and coronary artery disease. Patients were randomly divided into two groups: the first group [n = 64] received Simvastatin [60 - 20 mg/day] and fenofibrate [200 mg/day], and the second group [n = 60] received Simvastatin [20 - 60 mg/day] alone. Treatment lasted l year, and the patients were evaluated after treatment. The mean age was 54.3 + 6.5 years, and 53.2% of patients were male. Compared to baseline, after 12 months of treatment the lipid profiles of both groups decreased significantly [P< 0.05]. The change in left-ventricular ejection fraction in the first group was statistically significant [P = 0.01]. The exercise test time and metabolic equivalent of tasks index significantly increased in the first group [P = 0.014, P = 0.006], but these changes were not significant in the second group [P = 0.289, P = 0.744]. Lipid-regulating therapies including Simvastatin and fenofibrate improved myocardial function and reduced myocardial ischemia, so combined therapy is recommended for treating dyslipidemia in high-risk patients for cardiovascular problems