Symptomatic hypercalcemia in a patient with chronic tophaceous gout: a case report

Hypercalcemia has been widely associated with granulomatous processes. This is due to enhanced extra-renal conversion of calcidiol to calcitriol by activated macrophages within the granuloma. Symptomatic hypercalcemia due to granulomatous disorders is not common, with the incidence in sarcoidosis ranging from 10–20%. Large aggregates of monosodium urate crystals in patients with longstanding chronic tophaceous gout can serve as the inciting antigen for the development of granuloma, but hypercalcemia has not been described in this context. We report a case of symptomatic hypercalcemia due to gouty tophi induced granulomatous inflammation. Long term treatment with immunosuppressants, in addition to bisphosphonates and uric acid lowering therapy, has led to stabilization of serum calcium levels and other lab parameters indicative of granulomatous burden

Perceived Severity and Susceptibility of Diabetes Complications and its Relation to Self-care Behaviors among Diabetic Patients

Introduction & Objective: Diabetes is a disease with long cardiovascular, renal, eye and neural complications. It is prevalent all around the world including Iran and especially in Yazd province and its prevalence is increasing. Higher perceived severity and susceptibility of its complications may cause a higher level of self care behaviors in these patients. The aim of this study was to determine the constructs’ status and their related factors in diabetic patients. Materials & Methods: This analytical study was carried out on 120 diabetic patients referred to Yazd Diabetes Research Center which were recruited with a sampling method. A questionnaire was used for data collection which measured the perceived severity and susceptibility and self care behaviors. Subjects’ demographic variables such as age, sex, education level, job, history of diabetes duration and type of diabetes were also recorded. Results: The subjects reported 86.72, 55.72 and 62.79% of receivable scores of perceived severity, perceived susceptibility and self care score, respectively. Deteriorating eyesight was perceived at the highest level of severity and circulatory problems in the feet were at the lowest level. Deteriorating eyesight and aching legs and blurred vision was at the highest level of perceived susceptibility while high and low sugar coma was at the lowest level. Men had a higher level of perceived severity than women. There was a significant correlation between history of diabetes duration and perceived susceptibility and severity × susceptibility. Perceived susceptibility and severity, and severity × susceptibility and self care behaviors had a significant correlation with each other at 0.01 level. Perceived susceptibility and severity predicted 12.1% of variances in self care behaviors while severity × susceptibility predicted 12% of variances in self care behaviors. Conclusion: Despite the fact that perceived severity of diabetes complications among subjects was at favorable level, their perceived susceptibility was low. Diabetic foot complications are more important and in general, increasing perceived susceptibility and severity may induce an increas in self care behaviors among diabetic patients

Study of Continuance Rate and Related Causes of Discontinuance of Pregnancy Prevention Methods among Women in Yazd

Introduction: From maturity to menopause, women are worried about pregnancy. Abstinence from sex or use of pregnancy prevention methods are choices for them. As abstinence is impossible, the only remaining choice is use of pregnancy prevention methods. Effective control of pregnancy is really essential for the health of mother and infant and also control of unplanned increase in population. Regarding the importance of continuance rate of pregnancy prevention methods (OCP, IUD, Condom &DMPA) & the reasons for their disruption, this study was carried out with the aim of determining the continuance rate and reasons for discontinuance of pregnancy prevention methods in Yazd women. Methods: This was a cross-sectional study. Six urban health care centers of Yazd were selected as study clusters and information of 15-49 year old women using the pregnancy prevention methods (OCP, IUD, Condom& injection) was collected via a questionnaire. The data collected was analyzed by Coplan- Mayer statistic method and variance analysis test. Results: Pregnancy prevention methods were most prevalent in the 25-34 years old age group (57%). Mean duration of pregnancy prevention method usage was 27.98 months using Caplan-mayer method with a median of 24 months. 86.3% for 6 months, 72.8% for 12 months, 62.5% for 18 months, 47.9% for 24 months, 39.9% for 30 months and 37% for 37 months had used four certain methods of pregnancy prevention (OCP, IUD, Condom and Injection). The reasons of discontinuance were disease (15.6%) for OCPS, bleeding (27%) for IUD, unwanted pregnancy (21%) for Condoms and also disease (75%) for Injection method. Discussion: According to the results, not only education programs regarding family planning before starting each pregnancy prevention method to women is recommended, but a complete incentive consultation about these methods is essential. This educational & consultation programs should be implemented initially for women using OCP method

Predictors of Self-Care Behaviors among Diabetic Patients Referred to Yazd Diabetes Research Centre Based on Extended Health Belief Model

Introduction: Diabetes is the most common disease related to metabolism disorders with long term complications. It needs lifelong specific self-care, as it causes a promotion in quality of life and decreases disease costs. The Health Belief Model (HBM) is a psychological model that attempts to explain and predict health behaviors. This is done by focusing on the attitudes and beliefs of individuals. The model has been used for studying diabetes self care behaviors. The aim of this study was determination of predictors of self-care behaviors among diabetes patients referred to Yazd diabetes research centre based on extended health belief model. Methods: This cross-sectional study carried out on 120 diabetic patients referred to Yazd diabetes research centre who were entered in the study by convenience sampling. A questionnaire was used for data collection with a private interview which included questions regarding extended health belief model constructs including perceived benefits, barriers, severity, sensitivity, threat, self-efficacy, social support, metabolic control and locus of control and some demographic variables. Results: There was a positive significant correlation between model variable of perceived benefits, severity, sensitivity, threat, self-efficacy, social support, metabolic control and internal locus of control with self-care behaviors, and also a negative significant correlation between perceived barriers (P=0.001),chance locus of control (P=0.037) and self-care behaviors. The above variables explained 45.3 % of variance in diabetes self-care behaviors, with self-efficacy as the strongest predictor. Conclusion: The results of this study approved the effectiveness of extended health belief model in predicting self-care behaviors among diabetic patients, which can therefore be used as a framework for designing and implementing educational intervention programs for control of diabetes

Evaluating Life Quality in Type II Diabetic Patients Compared to Healthy People and Presentating a Structural Model

Introduction: Life quality is regarded as one of the important concepts in diabetic mellitus as a chronic disease, which produces extensive effects on the social and individual performance. Regarding the short-term and long- term complications as well as expensive costs of this disease, the present study aimed to determine the life quality of these patients compared to non-diabetic people and ultimately, a structural model was presented. methods: This analytical study was carried out on 250 diabetic and 250 non-diabetic patients in Yazd. The standard life quality questionnaire (whoqol-bref) was utilized as the data collection tool containing a total of 26 questions and 4 domains of physical health, mental health, social health and environmental health. The study data were analyzed using SPSS software (ver.16) and Amos(21). Results: The study results demonstrated a significant difference between life quality of diabetic patients and healthy subjects (p<0.001), and the mean score of all the different domains of questionnaire proved to be lower in patients than healthy subjects. Path coefficients in the structural equation model proved to be significant (p<0.001). The path coefficient between the environmental and social health with the mental health was 0.62 and 0.76 respectively., and, it was reported 0.96 between the physical health and mental health Eighty-six percent of changes of the physical health variable was explained by the mental health variable and 96% of changes of the mental health variable was explained by the social and environmental health. Conclusion: The study findings revealed diabetes as a chronic disease that can severely affect the patients’ life quality. Every type of attempt in structural models of predicting physical health and life quality plays a meaningful role in alleviating these patients’ problems