Asymptomatic gallstones and related risk factors in Iran.

BACKGROUND/AIMS: Gallstone is a common disease worldwide. Ultrasound is known to be highly reliable in the diagnosis of gallbladder disease. Asymptomatic cholelithiasis is increasingly diagnosed today, mainly as a result of the widespread use of abdominal sonography for the evaluation of patients for unrelated or vague abdominal complaints. The goal of this study was to determine the prevalence of asymptomatic gallstones and some of its risk factors in this population by ultrasound profile. METHODOLOGY: The patient population consisted of those (outpatients and inpatients) referred to Imam Reza Hospital of Birjand for diagnostic ultrasonography and without any gallbladder symptoms. Patients were considered asymptomatic if gallstones had been diagnosed after ultrasonography and there was no history of biliary origin pain, or if there was a documented unrelated explanation for the pain. RESULTS: A total number of 599 patients were included and prevalence of asymptomatic gallstone was 2.5%. Gallstone disease was detected in 4.4% (8/182) of patients older than 40 years vs. 1.7% (7/417) of patients under 40 years old (OR=2.69). Also BMI ³25 (OR=4.42), diabetes mellitus (OR=26.18), and parity ³3 (OR=4.92) were significantly higher in gallstone disease (p<0.05). CONCLUSIONS: The prevalence of gallstone disease in Iran is low. There was a positive correlation between prevalence of gallstone with age, BMI, diabetes mellitus and number of parity.

Ceftriaxone-associated nephrolithiasis in children.

OBJECTIVE: Ceftriaxone is a third-generation cephalosporin which is widely used for treatment of infection in children accompanied by complications like urinary tract lithiasis and gallbladder psudolithiasis or sludge. The aim of this study was to investigate the incidence and predisposing factors that contribute to these complications in children. METHODS: This quasi-experimental and before- and after-study was conducted in 96 children who were hospitalized for treatment of different bacterial infections and received 50-100 mg/kg/day ceftriaxone divided into two equal doses intravenously under conditions of adequate hydration. Sonographic examinations of urinary tract and gallbladder were carried out before and after treatment for that purpose. Patients with positive sonographic findings after treatment were followed with serial sonographic examinations. FINDINGS: Post-treatment sonography demonstrated nephrolithiasis in 6 (6.3%) and gallbladder stone in one (1%), all were asymptomatic. Comparison of the groups with and without nephrolithiasis demonstrated no significant differences with respect to age, body weight, diagnosis, season of hospitalization, dosage of drug and the duration of treatment. Nephrolithiasis had a significant relation with male gender (P=0.02). CONCLUSION: Our results showed that pediatric patients may develop small sized, asymptomatic renal stones during a 2-6 day course of normal or moderate dose of ceftriaxone therapy. Close monitoring of ceftriaxone treated patients especially on high dose long term therapy for nephrolithiasis and gallbladder psudolithiasis or sludge is recommended.

The Prevalence of Undetected Vertebral Fracture in Patients with Back Pain by Dual-Energy X-ray Absorptiometry (DXA) of the Lateral Thoracic and Lumbar Spine.

STUDY DESIGN: This is a prospective study. PURPOSE: This study is conducted to determine the prevalence of unrecognized vertebral fracture (VF) in patients who present with back pain. OVERVIEW OF LITERATURE: VF is often unrecognized, and significantly increases the risk of further fractures. Unfortunately, the patients at a high risk for VF usually do not receive adequate therapy to reduce the fracture risk. METHODS: This is a prospective study of 344 patients who presented with back pain from April 2008 to May 2009. The patients underwent dual-energy X-ray absorptiometry (DXA) evaluation and vertebral fracture assessment from T4 to L4 using a hologic densitometer. RESULTS: Three hundred forty four of 386 patients who presented with back pain were included. Forty two patients were excluded because of a prior history of VF or the lack of written consent. Most of the patients were female (95.3%). The mean age of the patients was 58.21 ± 11.74 years. According to the World Health Organization definition (based on the T-score), 13.4% of the patients had normal lumbar spine bone mineral density (BMD). 27.9% of them were osteopenic and 58.7% were osteoporotic. The overall prevalence of VF, as established by lateral vertebral assessment, was 39% (n = 134). Moreover, 62.6% (n = 84) of the patients with VF had more than one fracture and 64.1% (n = 86) of them had Grade 2 or 3 fracture. CONCLUSIONS: We recommend performing not only DXA scanning for BMD evaluation, but also VFA by DXA in old patients with back pain.