Musculoskeletal disorders in hemodialysis patients: prevalence, clinical symptoms, and associated factors

Introduction: One of the major public health problems is end-stage renal disease (ESRD). ESRD is commonly associated with musculoskeletal disorders (MSDs). Objectives: Due to the importance of MSDs in hemodialysis patients and the absence of sufficient studies in Iran, this study aims to investigate MSDs in hemodialysis patients. Patients and Methods: This cross-sectional study was conducted on 75 patients with ESRD, who were under hemodialysis at the special diseases center of Birjand university of medical sciences, south Khorasan, Iran. Inclusion criteria were history of at least 2 years of hemodialysis, and age more than 18 years. All patients with previous neurological disorders, previous rheumatic diseases, previous arthroplasty of the limbs, and severe psychological disorders were excluded from the study. Baseline characteristics and laboratory data collected. MSDs examined based on the Nordic Musculoskeletal Screening Questionnaire (NMQ). Data were described using central tendency, CHI-SQUARE test, and Fisher’s exact test were used. The significance level in this study was P0.05). Dialysis etiology, knee osteoarthritis, shins pain, knee pain and knee range of motion had significantly difference between groups (respectively, P=0.047, P=0.003, P=0.012, P=0.001, P=0.002). Conclusion: The frequency of MSDs in these patients was 84.0%. There was a significant association between MSDs with the cause of hemodialysis, lower limb pain, and knee osteoarthritis

Isolated Internal jugular vein thrombosis as the first presentation of gastric adenocarcinoma

Internal jugular vein (IJV) thrombosis is a very rare vascular disease that is usually the result of trauma, infectious disease, and central vein thrombosis. Malignancy, either known or occult, is an uncommon etiology of IJV thrombosis.The presented patient was a 49-year-old woman who suffered from painful swelling in the right side of her neck. Physical examination revealed a painful and immobile mass in the right side of her neck. Doppler ultrasonography scan showed thrombosis of the right IJV.  Initial workups to find malignancy were unremarkable. She underwent treatment by intravenous heparin and antibiotics and her symptoms resolved after one week. Six months later, the patient presented once more with repeated vomiting and epigastric pain. On gastroesophageal endoscopy, a mass in the lesser curve of the stomach was detected. The pathology report was compatible with gastric adenocarcinoma.Association between IJV thrombosis and some malignancies (e.g., lung and lymphoma) have been reported. IJV thrombosis can be the first presentation of malignancy. IJV thrombosis should be kept in mind in patients with painful swelling in the neck and long- term follow-up to exclude any malignant diseases is recommended

Guessability of U.S. pharmaceutical pictograms in Iranian prospective users

Objective: This study examined the gueassability of US pharmaceutical pictograms as well as associated demographic factors and cognitive design features among Iranian adults. Methods: A total of 400 participants requested to guess the meaning of 53 US pharmaceutical pictograms using the open-ended method. Moreover, the participants were asked to rate the cognitive design features of each pictorial in terms of familiarity, concreteness, simplicity, meaningfulness and semantic closeness on a scale of 0-100. Results: The average guessability score (standard deviation) was 66.30 (SD=24.59). Fifty-five percent of pharmaceutical pictograms understudy met the correctness criteria of 67% specified by ISO3864, while only 30% reached the criterion level of 85% set by ANSIz535.3. Low literate participants with only primary school education had substantial difficulty in the interpretation of pharmaceutical pictograms compared to those completed higher education levels. Younger adults of 31 years old participants. ‘Home patient care’ and ‘daily medication use’ had no effect on guessability performance. Concerning cognitive design features, meaningfulness better predict geussability score compared to the others. Conclusions: Several USP pictograms fail to be correctly interpreted by Iranian users and need to be redesigned respecting cognitive design features. Interface designers are recommended to incorporate more familiar and concrete elements into their graphics in order to create more meaningful pictorial symbols and to avoid any misinterpretation by the user. Much effective medication use is expected to be achieved by means of this approach, through the improvement of the communication property of pharmaceutical pictograms

Comparison of platelet number and function between nonalcoholic fatty liver disease and normal individuals

Background: There is interest about the role of platelet (PLT) number and function in nonalcoholic fatty liver disease (NAFLD). NAFLD patients have abnormalities of PLT number and function, especially mean platelet volume (MPV) which is known as a novel biomarker for atherosclerosis. We decided to compare PLT number and function between NAFLD and healthy participants. Materials and Methods: In this case–control study, two groups of patients (65 cases with NAFLD and 65 cases without NAFLD) were included consecutively. The diagnosis of NAFLD was made using ultrasound examination of the liver. Venous blood samples were taken, and the required laboratory markers including PLT number and function (MPV, platelet distribution width [PDW]), prothrombin time (PT), partial thromboplastin time (PTT), lipid profile, hepatic transaminases, ferritin, and fasting blood sugar were assayed. Results: Mean (± standard deviation [SD]) MPV in NAFLD group (10.29 ± 0.95 fL) was significantly higher than in control group (9.56 ± 1.18 fL); P < 0.001. No significant difference was observed regarding mean (± SD) PLT count between NAFLD (271.20 ± 52.11 × 103/mm3) and healthy participants (262.86 ± 75.81 × 103/mm3) (P = 0.46). Mean (± SD) PDW values were not significantly different between NAFLD and control groups. Logistic regression showed that NAFLD was positively associated with higher MPV (odds ratio [OR] =1.9, 95% confidence interval [CI] =1.20–3.02) and body mass index (OR = 1.5, 95% CI = 1.05–2.15) values. However, PT (OR = 0.14, 95% CI = 0.02–0.82) and PTT (OR = 0.72, 95% CI = 0.58–0.88) had negative association with NAFLD. Conclusion: Higher MPV was found to be significantly associated with NAFLD. However, such significant association was not detected regarding PLT count or PDW. As MPV is a reported risk factor for atherosclerosis, this marker may be useful in follow-up of patients with NAFLD. These findings provide basis for further studies to address this marker in long-term follow-up of NAFLD patients

The Relationship between Serum Uric Acid and Severity of Chronic Obstructive Pulmonary Disease (COPD)

Introduction: Some evidence exists about the possible relationship between the serum uric acid (UA) and exacerbation of the chronic obstructive pulmonary disease (COPD). Present study intended to compare the COPD-related variables and the one-year outcome between the two groups of patients with the high and low UA. Material and Methods: This cohort study consisted of 112 patients with COPD exacerbation. The participants were categorized into low (i.e., Afterwards, the patients were followed up for one year and some other variables such as taking oral antibiotic for respiratory infections, admission to hospital or ICU due to COPD exacerbation, and survival were documented monthly. Results: The mean serum level of creatinine was significantly higher in the high UA group (1.1±0.4 mg/dL) than the low UA group (1.01±0.1 mg/dL) (P=0.02). No significant difference was observed between the two groups regarding the GOLD classification, FEV1, oxygen saturation, pCO2, and echocardiographic indices. In the one-year follow-up, 42 cases (82.4%) of the high UA group and 39 patients (63.9%) of the low UA group reported taking oral antibiotics, which was indicative of a significant difference (P=0.03). Hospital admission was likewise significantly higher in the high UA group (30 patients, 58.8%) than in the low UA group (23 cases, 37.7%) (P= 0.03). Conclusion: Those patients with the UA level of ≥ 6.5 mg/dL experienced more hospital admission and were more likely to take oral antibiotics for respiratory infections during a year. However, UA did not correlate with FEV1 or COPD severity