BACKGROUND: The objective of this study was to evaluate the association of some factors such as serum levels of homocysteine, folate and B12 vitamin with stroke in acute ischemic stroke patients.METHODS: In this case control study, serum levels of homocysteine, folate and B12 vitamin in 93 patients with acute ischemic stroke admitted to Imam Khomeini Hospital between September 2008 and January 2010, and 93 healthy controls were measured. Cerebrovascular risk factors including age, sex, hypertension, hyperlipidemia, smoking, diabetes mellitus, alcohol consumption, coronary artery disease and obesity were recorded. The results were compared between the case and control groups.RESULTS: The mean ± standard deviation (SD) of fasting total homocysteine (tHcy) level in acute ischemic stroke patients was 20.58±19.6 mmol/l, which was significantly higher than that of control group being 14.11±9.5 mmol/l (P=0.002). 39 (41.9%) stroke cases and 25 (26.8%) controls had hyperhomocysteinemia. There were no significant relationships between tHcy, folate and B12 vitamin levels with the above mentioned cerebrovascular risk factors except for smoking (p>0.05). No significant difference in B12 vitamin and folate levels between patients and healthy controls were detected (P>0.05).CONCLUSION: Hyperhomocysteinemia is common in Iranian patients with acute ischemic stroke and might play a role as an independent risk factor in stroke.

Cerebrovascular accidents rank first in the frequency and importance among all neurological disease. Although a number of studies had shown increased level of the high sensitive C-reactive protein (hs- CRP) in patients with ischemic stroke, the association of increased hs-CRP with various type of stroke especially the assessment hs-CRP level in ischemic and hemorrhagic stroke have not been investigated. In the present study, we assessed the concentration of hs-CRP in patients with documented ischemic and hemorrhagic stroke in the first 24 hours of the onset of symptoms. Thirty-two patients with Ischemic and hemorrhagic stroke were evaluated at neurology department of Poursina Hospital. The presence of baseline vascular risk factors, including hypertension, diabetes mellitus, hypercholesterolemia, obesity, and smoking, was determined. The blood samples were then collected and routine hematology and biochemistry tests were done. hs-CRP levels were determined using a highly sensitive immunonephelometric method. In this cross sectional study, the age of patient varied from 45–85 years (Mean 70.9±9.4). Serum level of hs-CRP in Ischemic patients were 18.92±11.28 and in hemorrhagic group was 2.65±1.7. This relationship was statistically significant (P<0.0001). It might be concluded that hs-CRP might be considered as a usefully adjunct method for the initial diagnosis of the type of stroke.

Introduction: EAT is an independent factor in coronary artery disease (CAD). The objectiveof the current study was to define an echocardiographic cut-off point for EAT and to determine its diagnostic value in predicting the increase in CAD risk.Methods: Two hundred patients underwent coronary artery angiography for diagnosis of CAD and transthoracic echocardiography for measurement of EAT on the right ventricle (RV), RV apex and RV outlet tract. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the EAT cut-off points in the three above-mentioned areas for predicting the severity of CAD were measured. The relation between the EAT and CAD risk factors was evaluated as well.Results: EAT was independent from gender, height, hypertension, diabetes, HDL, total cholesterol, ejection fraction, acute coronary syndrome, and the location of the coronary artery stenosis in the coronary artery in all three anatomical areas. EAT on RV and RV apex had a significant relation with CAD (P£0.05). Overall, RV EAT³10 mm and RV apex EAT³8 mm had sensitivity and PPV of more than 70% in predicting coronary stenosis ³50% and acute coronary syndrome (ACS) and RVOT EAT ³13 mm is of PPV=83.5% for predicting coronary stenosis ³50%.Conclusion: EAT thickness has an acceptable diagnostic value for predicting severe coronary artery stenosis and ACS. Therefore, non-invasive EAT thickness measurement could be of great assistance to clinicians for detecting the patients at risk and helping them to undergo supplementary evaluations with invasive approaches.

Introduction. Focal segmental glomerulosclerosis is one of the causes of ESRD that can recur in the transplant kidney (TX). Proteinuria may recur within hours after the graft is received whereas overt sclerosis is not evident until weeks or months later. Extensive foot process effacement is sometimes the earliest sign of recurrence of FSGS. However, segmentally sclerotic glomeruli in transplant kidney could also be seen secondarily due to other causes like hypertension, chronic allograft nephropathy, chronic transplant glomerulopathy, and calcineurin inhibitor toxicity. Otherwise, it could also be considered as de novo FSGS. In this study, regarding the importance of differential diagnosis of recurrent primary FSGS (Rec FSGS) from secondary FSGS (Sec FSGS) due to the possible recurrence of FSGS in next transplant, we tried to find out the diagnostic criteria of Rec vs Sec FSGS based on clinical findings at presentation, time of diagnosis after transplant, and light microscopic and EM findings. We also studied the spectrum of different morphologic variants of FSGS in transplant kidney based on new Columbia classification. Methods. All Tx biopsies with segmental sclerosis and/ or extensive foot process effacement (FPE) and negative IF between 1995 and 2006 were reviewed excluding cases diagnosed as Tx glomerulopathy. All slides, reports, EM phothomirograph, clinical history, and follow-up reports were reviewed. Light microscopic findings were classified by the Colombia schema. Findings of Sec FSGS such as CNI toxicity, expanded lamina rara interna of GBM, and limited FPE were assessed and cases were classified as primary vs Sec FSGS. Results. Forty-two patients (29 males, 13 females) met entry criteria. Average age was 37±13.8 years (range, 11 to 56 years). Four patients were children (< 18 years old). Twenty cases (48%) were African American and 13 (31%) were Caucasian. Twenty-three (55%) had nephritic proteinuria at the time of biopsy. Biopsy interval ranged from 4 days to 8 years after Tx. Twenty-three (54%) cases were classified as Rec FSGS, 15 (35%) as Sec FSGS, and 4 (10%) as likely de novo FSGS. Ten (54%) cases showed only extensive FPE, 4 (17%) cellular (CELL), 4 (17%) collapsing (COLL), and 4 (17%) not otherwise specified (NOS) lesions. In cases classified as likely Sec FSGS, NOS lesion was the most common morphologic variant, in 6 (40%), followed by 3 (20%) COLL, 2 (13%) CELL, and 3 (20%) with only FPE. Rec FSGS was the most common in early biopsies (85% of all FSGS cases in first 6 months). In contrast, 13 (65%) biopsies at >2years showed Sec FSGS. Nearly all patients, whether Rec or Sec FSGS, lost their kidney during the following months to years. Conclusion. Early time of recurrence and extensive FPE were characteristic of Rec FSGS. NOS variant is more common in Sec, whereas extensive FPE alone is the most common finding in Rec FSGS. COLL, related to CNI toxicity, and CELL lesion can be seen in both Rec and Sec FSGS. We conclude that integrated analysis of LM, EM, and clinical data help to differentiate varying etiologies of sclerotic lesions in the Tx.

Background: CKMB elevation after percutaneous coronary intervention (PCI) correlates with major adverse cardiac and cerebrovascular events (MACCE). There is, however, some controversy over this issue, with some studies having reported different conclusions. We assessed the correlation between the CKMB level after PCI and one-year MACCE incidence in these patients.Methods: We measured the CKMB level before and after PCI in 221 patients with normal baseline CKMB who underwent PCI at Ekbatan University Hospital, Hamedan, Iran, between April 2013 and October 2013, and divided them into 4 groups based on the post-PCI CKMB level. Then, we evaluated one-year MACCE incidence.Results: CKMB elevation was detected in 81 (37.6%) patients and MACCE occurred in 11 (5%) patients. CKMB elevation after PCI was correlated to MACCE. The predictors of CKMB elevation were hyperlipidemia, number of deployed stents, stent diameter ³4 mm, and complicated PCI.Conclusions: CKMB elevation after PCI was detected in 37.6% of the study population and was common in the setting of hyperlipidemia, more than 1 stent deployment, stent diameter³4 mm, and complicated PCI. MACCE at 1 year occurred in 5% of the patients and was correlated with the post-PCI CKMB level³3 times of normal, history of diabetes mellitus, history of hypertension, and inappropriate use of clopidogrel.

Introduction. Vesicoureteral reflux (VUR) has been known to be a risk factor for urinary system of infants and children with urinary tract infection. It can induce permanent adverse effect such as scar, hypertension, and ongoing declining renal function. DMSA renal scan is still a main pointer of acute and chronic damages of kidneys due to VUR. Other unsuccessful attempts including measuring interleukin-6 (IL-6), tumor necrosis factor (TNF)-alpha, and soluble TNF receptor-1 have been done to eliminate its invasive and expensive undesirable effect. The aim of this study was to determine and compare urine mean microalbumin and creatinie and their ratio between 3 groups of 2 to 10- year-old children affected by and recovered from reflux in comparion with normal matched age group. Methods. In this cross-sectional study, thirty-three 2- to 10-year children without UTI during the last 3 months, whose reflux or recovery had been diagnosed by VCUG or DRNC, were divided into 2 groups of 16 children affected by reflux, 17 recovered from reflux, and 18 matched normal children groups. Then, the point urine specimens were collected with permission of their parents in a single laboratory, and urine microalbumin (MA) and creatinine (Cr) for each specimen were measured. Alb/Cr ratio was calculated for each child to evaluate Alb excretion from urine possible without collecting 24-hours urine. MA/Cr ratio mean and MA were compared between the groups. To analyze our data, one way ANOVA test was used.Results. A total of 51 children, included 16 children affected by reflux, 17 recovered from reflux, and 18 normal children were entered to our study. The mean of MA/Crea and MA were 5.039±4.737 and 19.68±13.42 in affected group, respectively, 0.118 ± 0.187 in recovered group and 20.66 ± 12.5 in normal group. There was not a significant statistical difference between the 3 groups for MA and MA/Cr. Conclusion. Urine mean micro-albumin and its ratio with creatinine did not have any difference in children with reflux, with improved urinary reflux, and normal age matched group.

Background and Aim: Urinary tract infection (UTI) causes significant illness in children. The diagnosis in most developing countries is often overlooked due to difficulties in obtaining urine from children especially those who would not void voluntarily. Misdiagnosis often leads to renal damage and hypertension, which could be avoidable with early diagnosis and proper management. Empirical antibiotic treatment in UTI, especially if based on the epidemiology and resistance patterns of common uropathogens, plays an important role in prevention of renal damage. The aim of this study was to evaluate the prevalence of clinical symptoms, laboratory findings, renal ultrasonography, Dimercaptosuccinic acid (DMSA) renal scanning and antimicrobial sensitivity of uropathogens.Materials and Methods: This retrospective study was conducted on 136 patients hospitalized in Qods hospital of Qazvin with positive urine culture during 2006 (from March through October).Results: One hundred and thirty five children were included in the study. Of the total, 108 (80%) were females and 27 (20%) were males with a female to male ratio of 5.4:1. The median age of the patients was 24.4 months. Ninety eight (72.6%) patients were from cities and 37 (27.4%) were from rural areas. Of 135 patients, 17 (11.1%) had past history of hospitalization with UTI. Fever was the most common clinical presentation (68.1%) followed by dysuria (37%) and vomiting (29.6%) Normal white blood cell count was found in 113 cases (83.7%) and 22 patients (16.3%) had leukocytosis. Increase erythrocyte sedimentation rate (ESR) was found in 64 cases (55.6%) and positive C-reactive protein (CRP) in 54.8% of patients. Escherichia coli (E.coli) caused 67.4% of the infections followed by Klebsiella species (14.1%). The majority of the E.coli isolates (90.1%) were from females, while the remaining were from males. Among the gram negative enteric bacilli high prevalence of resistance was observed against ampicillin (86.9%) and co-trimoxazole (78.3%). E. coli isolates had the most sensitivity to amikacin (90.1%), ciprofloxacin (83%), nitrofurantoin (81.2%), ceftriaxon (78.5%), gentamycin (77.8%) and ceftizoxime (74%). Sonography of the kidney and bladder showed abnormality in 15.3% of patients, while the DMSA renal scan was abnormal in 46.5%.Conclusion: UTI is one of the most common infections diagnosed in hospitalized children, particularly in females. Since in the young children specific clinical signs and symptoms of UTI are uncommon, the presence of other potential signs and symptoms are not reliable in excluding UTI. This study revealed that enterobacteriaceae were the predominant bacterial pathogen of hospitalized children with UTI. It also represents high level resistant of E.coli isolates to ampicillin and cotrimoxazole. Thus, continued local surveillance studies are urged to monitor emerging antimicrobial resistance and to guide interventions to minimize its occurrence. This study is useful to improve the empiric treatment.

INTRODUCTION: Central obesity is one of the coronary artery diseases (CAD) risk factors that has been regarded, recently. There are several methods for measuring abdominal obesity. We used abdominal diameter index (ADI) as an index of abdominal obesity and studied its relation to CAD.METHODS: 180 patients [90 male and 90 female] with CAD were studied in Shahid Chamran Hospital affiliated to Isfahan University of Medical Sciences. Patients were stratified as normal group (without significant occlusion of CAD) and group with coronary artery diseases (over than 75% occlusion in at least one of the coronary arteries: LMA, LAD, RCA, LCX). People with diabetes, hypertension, hyperlipidemia, foot paralysis, edema, hypertriglyceridemia and ascitis were excluded. ADI was compared between groups. The relationship between ADI and coronary artery occlusion was tested in patients with CAD.RESULTS: The mean of ADI in patients with CAD was significantly higher than normal group (0.52±0.85 versus 0.41 ± 0.082 in men and 0.51 ± 0.15 versus 0.42 ± 0.07 in women, respectively) (P < 0.05). Significant correlation was seen between ADI and coronary artery occlusion only in women (P < 0.05). ADI had not any significant correlation with hyperlipidemia, diabetes, high blood pressure, sex, and smoking.CONCLUSION: It seems that ADI, as an index of central obesity might be included as an independent predictor of CAD. This hypothesis needs large follow up studies to be tested in future.

Despite the many studies about timing for surgery in subarachnoid hemorrhage (SAH), the optimum time is still unclear. The aim of this study was to determine the results of early and late surgery for aneurysmal subarachnoid hemorrhage. In this cross-sectional study we evaluated the results of 70 consecutive surgery for aneurysmal subarachnoid hemorrhage in in Firuzgar hospital from 2005 to 2008. Surgery was performed in 50 cases (71.4%) in early period after SAH (first 4 days) and in 20 cases (28.6%) in at least 7 days after SAH. Statitical analysis was done by SPSS software, using Chi-square and t-test. Mean age of patients was 48.54±13.4 years. 41.4% of patients were male and 58.6% were female. Most (77.2%) of patients had clinical grade I or II. 92.9% of aneurysms were single. hypertension was the most common associated disease (34.3%). The most common site of aneurysms was anterior communicating artery (41.4%), followed by middle cerebral artery (35.7%). The outcome of surgery was favorable in 70% and unfavorable in 30%. Mortality rate was 24.3%. Outcome was favorable in 66% of early surgeries and 80% of late surgeries. There was no statistically significant difference between early and late surgery in terms of complications and outcome. Mean hospital stay of patients in the early surgery group was significantly lower than late group (16.46±9.36 vs.22.5±7.97 days; P=0.01). The results of early and late surgery for aneurysmal subarachnoid hemorrhage is similar and decision making for timing of surgery should be based on each patient individual clinical conditions, age, size and site of aneurysm.