Cardiometabolic risk factors in Iranians with spinal cord injury: analysis by injury-related variables.

Persons with spinal cord injury (SCI) have a high prevalence of abnormalities in carbohydrate and lipid metabolism. These abnormalities cause adverse coronary heart disease (CHD) in patients with SCI. In this study, we performed a detailed analysis of the level-specific cardiometabolic risk factors in individuals with SCI and analyzed the association of injury level on these risk factors. This was a cross-sectional study of 162 patients with SCI, assessing the prevalence of diabetes mellitus, dyslipidemia, hypertension, obesity, and smoking. Fasting blood sugar (>100) was diagnosed in 27 patients (16.7%). Of the total patients, 36 (22.2%) had a total cholesterol (TC) level of >200. A triglyceride level of >150 was present in 56 patients (34.6%). Hypertension was present in 2.5% of the entire patient group. Body mass index (BMI), TC, and low-density lipoprotein cholesterol (LDL-C) were significantly higher in the paraplegia group than the tetraplegia group (24.44 +/- 4.23 vs 22.65 +/- 4.27, p = 0.01; 185.71 +/- 40.69 vs 163.28 +/- 37.92, p < 0.001; and 102.51 +/- 28.20 vs 89.15 +/- 22.35, p = 0.01, respectively). Patients with paraplegia may have increased hypertension, higher BMI, and increasing levels of serum LDL-C and TC than those with tetraplegia. Conventional risk factors for CHD should be identified and treated in individuals with SCI.

Relationship between serum leptin levels and bone mineral density and bone metabolic markers in patients on hemodialysis.

Leptin is the protein product of the obesity gene, which is produced in fat tissue. It was originally thought to be involved only in the regulation of food intake and energy balance. We aimed to investigate the relationship of serum leptin levels with bone mineral density (BMD) and biochemical markers of bone turnover in patients on hemodialysis (HD). This study included 72 patients (43 males and 29 females), whose mean age was 55.1 ± 11.4 years, mean body mass index was 23.13 ± 2.75 kg/m 2 and mean duration on HD was 5 ± 3.4 years. The BMD values were calculated using dual-energy X-ray absorptiometry (DEXA) at the femoral neck and lumbar spine. Blood samples were taken for leptin, intact parathyroid hormone (I-PTH), bone alkaline phosphatase (BAP), calcium (Ca), phosphate (P) and albumin. The leptin levels were higher in females than in males (22.3 ± 19.6 vs 20.8 ± 23), but this difference was not significant. The serum leptin level had a strong positive correlation with Ca levels in the female patients (r = 0.659 and P = 0.01) and a negative correlation with albumin levels (r = -0.461 and P = 0.01). No correlation was found with age, BMI, duration on dialysis, BMD and serum levels of PTH, BAP and P for the entire patient group or either gender separately. The serum leptin level was significantly lower in females with PTH >300 pg/mL when compared with patients with PTH = 100-300 pg/mL (86 ± 85 vs 47 ± 48) (P = 0.011).Women with BAP <300 IU/L had significantly higher serum leptin than those with BAP 300-600 IU/L (P = 0.024). Women with Ca <8.5 mg/dL had significantly lower serum leptin levels compared with those with Ca levels of 8.5-10.5 mg/dL (P = 0.011). There was no significant difference between the two genders among variables such as age, BMI, duration on dialysis, serum leptin, I-PTH, Ca, P, BAP, albumin and BMD of the femoral neck and lumbar spine.

Relationship between serum parathyroid hormone levels and lipid profile in non-diabetic hemodialysis patients.

Elevated levels of intact parathyroid hormone (iPTH) may play an important role in the pathogenesis of the dyslipidemia in hemodialysis (HD) patients, but the underlying mechanisms are not clearly defined. In this cross-sectional study, we examined the effects of iPTH on dyslipidemia among HD patients by analyzing the data of 51 patients (18 males and 33 females) with combined mean age 51.7 ± 18.3 years (range 22-85 years) who were on HD between April 2009 and April 2010, in the dialysis center of Imam Khomeini Hospital Complex in Iran. On enrollment, we measured lipid profile, apoprotein (apo) A, apo B, alkaline phosphatase, calcium and phosphorus and also recorded the duration that they were on HD, and evaluated the correlation of these with iPTH level using Spearman's rank analysis. The mean duration on HD was 7.07 ± 6.53 years. Except for high-density lipoprotein, there were no changes in the lipid parameters in our HD patients. We also compared lipid profile among subjects, classifying them according to their iPTH levels. There was no correlation between serum lipids and iPTH levels in these groups. A significant positive correlation was found between iPTH and alkaline phosphatase( ALP) (r = 0.333, P = 0.017) between iPTH and HD duration (r = 0.408, P = 0.003), whereas there was a significant negative correlation between iPTH and Ca (r = -0.294, P = 0.037) between iPTH and apo B (r = -0.431, P = 0.002) and between iPTH and Body Mass Index (r = -0.362, P = 0.009). In conclusion, no significant relationship between iPTH and lipids was found in the studied HD patients. These findings suggest that iPTH most probably does not play a significant role in the dyslipidemia of renal failure.

A randomized controlled trial of two schedules of hepatitis B vaccination in predialysed chronic renal failure patients.

BACKGROUND: Patients with chronic renal disease should be vaccinated as soon as dialysis is forestalled, and this could improve the seroconversion of hepatitis B vaccination. OBJECTIVES: In this study, we aimed to compare seroconversion and immune response rates using 4 doses of 40 µg and 3 doses of 20 µg Euvax B recombinant Hepatitis B surface Antigen (HBs Ag) vaccine administered to predialysis patients with chronic kidney disease (CKD). PATIENTS AND METHODS: In an open, randomized clinical trial, we compared seroconversion rates in 51 predialysis patients with mild and moderate chronic renal failure who received either 4 doses of 40 µg or 3 doses of 20 µg of Euvax B recombinant hepatitis B vaccine administered at 0, 1, 2, 6 and 0, 1, 6 months, respectively. RESULTS: Differences in seroconversion rates after 4 doses of 40 µg (80.88%) compared to 3 doses of 20 µg (92%) were not significant (P = 0.4124). The mean HBs antibody level after 4 doses of 40 µg at 0, 1, 2, and 6 months (182.2 ± 286.7) was significantly higher than that after 3 doses of 40 µg at 0,1, and 6 months (96.9 ± 192.1) (P = 0.004). Seroconversion after 4 doses of 40 µg (80.8%) was also significantly higher than that after 3 doses of 40 µg (77%) (P = 0.004). Multivariable analysis showed that none of the variables contributed to seroconversion. CONCLUSIONS: We found that 4 doses of 40 µg did not lead to significantly more seroconversion than 3 doses of 20 µg.

Ultrasonic predictors of improved seminal parameters after bilateral laparoscopic varicocelectomy.

OBJECTIVE: The effect of varicocelectomy on semen parameters of varicocele with low-grade reflux and low testicular vein diameter is poorly documented. Our study aimed at determining whether preoperative venous diameter and grade of reflux predict semen parameters improvement after varicocelectomy. PATIENTS AND METHODS: We studied 85 patients undergoing bilateral laparoscopic varicocelectomy (BLV). Follow-up was performed at 3 and 6 months after surgery. We surveyed the correlation between semen parameters improvement and testicular vein diameter at the inferior pole of the testis, and the degree of reflux measured by color Doppler ultrasound (CDU). RESULTS: BLV resulted in a statistically significant increase in semen analysis parameters (p = 0.00). There was a correlation between testicular vein diameter and the improvement index in sperm motility (r = 0.31, p = 0.006). There was a significant correlation between the degree of reflux detected by CDU and improvement index in sperm concentration (r = 0.37, p = 0.001). CONCLUSION: Patients with testicular vein diameter >2.5 mm and higher grades of reflux detected at the veins at the lower pole of the testis had higher improvement index after BLV. Therefore, we can select the patients with these criteria for BLV.

Influenza immunization rates, knowledge, attitudes and practices of health care workers in Iran.

INTRODUCTION: This study aimed to determine influenza vaccine coverage and evaluate the knowledge, attitudes and practice about influenza and vaccine of health care workers in Tehran, Iran. METHODOLOGY: This cross-sectional survey involved 144 health care workers (HCWs) at the Tehran University of Medical Science between October 2008 and February 2009. Participants received a self-administered questionnaire directed at 35 items of knowledge and every correct response was scored one point. RESULTS: Influenza vaccination coverage for the 2008-2009 season was 66.9 % (range, 45% to 62%). Most HCWs (80.6%) had received an influenza vaccination in the past, and 65.4% intended to receive vaccination in the coming year.  The main reason given for being immunized was the effectiveness of the influenza vaccine (51.4%). The main reason given for not being immunized was concern about adverse effects (23.1%). The knowledge score for the 35 items ranged from 0 to 34 (mean 17.37). Mean knowledge scores differed between educational levels. There was no significant difference in mean knowledge scores between females and males (P > 0.05). Independent variables (age, sex, marital status, having children aged ≤ 16 years, educational level) were not significant predictors of taking influenza immunization. CONCLUSION: Despite the high coverage rate of influenza vaccination in our study, we would expect a higher rate because of free vaccine availability. The results indicate the need for on-going education of influenza disease among HCWs to increase vaccination rates.

Postmastectomy locoregional recurrence and recurrence-free survival in breast cancer patients.

BACKGROUND: One essential outcome after breast cancer treatment is recurrence of the disease. Treatment decision is based on assessment of prognostic factors of breast cancer recurrence. This study was to investigate the prognostic factors for postmastectomy locoregional recurrence (LRR) and survival in those patients. METHODS: 114 patients undergoing mastectomy and adjuvant radiotherapy in Cancer Institute of Tehran University of Medical Sciences were retrospectively reviewed between 1996 and 2008. All cases were followed up after initial treatment of patients with breast cancer via regular visit (annually) for discovering the LRR. Cumulative recurrence free survival (RFS) was determined using the Kaplan-Meier method, with univariate comparisons between groups through the log-rank test. The Cox proportional hazards model was used for multivariate analysis. RESULT: The median follow up time was 84 months (range 2-140). Twenty-three (20.2%) patients developed LRR. Cumulative RFS rate at 2.5 years and 5 years were 86% (95%CI, 81-91) and 82.5% (95%CI, 77-87) respectively. Mean RFS was 116.50 +/- 4.43 months (range, 107.82 - 125.12 months, 95%CI). At univariate and multivariate analysis, factors had not any influence on the LRR. CONCLUSION: Despite use of adjuvant therapies during the study, we found a LRR rate after mastectomy of 20.2%. Therefore, for patients with LRR without evidence of distant disease, aggressive multimodality therapy is warranted.