Razi Journal of Medical Sciences
Year:2003 | Volume:10 | Issue:34|Papers Count:26

Urge incontinence (UI) is the most common clinical types of urinary incontinence in elderly women. In neurolohically normal patients, detrusor instability (DI) is a common cause of UI. Treatment of this condition is primarily pharmacologic (Anticholinergics, Calcium antagonists), with surgical options being reserved for selected patients. In an experimental double- blined placebo- controlled study the symptoms, micturation variables and cystometry results were compared before and after of treatment. Twelve of 30 (40%) in drug group (D) considered themselves improved and 60% unchanged. Of the 30 women in the placebo group(P) only 16.7% considered themselves improved, a statistically significant response in favor of the drug group(p=0.001). Micturation variables were statistically changed in favor of magnesium hydroxide. In drug group, number of nocturnal episodes changed from 1.8 to 1.3 times per daytime, frequency changed from 12.4 to 10.4 and daytime incontinence changed from 3.2 to 2.3 times. In placebo group these changes is not significant (P=0.096). Among drug and placebo groups changes in detrusor pressure rise and first sensation volume before and after treatment is statistically significant but other parameters showed no statistically significant differences in any category. In conclusion magnesium hydroxide was more effective than placebo but note that this improvement was much more apparent on subjective assessment than on objective evaluation of cystometric and micturation data.

This study was done to compare the efficacy and side effects of methotrexate (MTX) and azathioprine (AZA) in treatment of patients with Rheumatoid arthritis (RA). 45 patients who diagnosed as RA according to 1987 revised criteria of ARA (American Rheumatism Association) envolled and randomly assigned in a double blind study, to recived AZA (100mg/dialy)or oral MTX (7.5mglweekly), clinical parameters; [morning stiffness, grip test, Number of tender and swollenjoints, ritchi index, pain degree based on visual analoge scale (VAS)] and paraclinical parameters; (ESR at first hours, Rhematoid factors, hemoglobin, platletes, WBC count) were analysed and compared in two groups as well as side effects.Paired t-test, t-test used in analysis of continous parameters and chi squared for non-parametric data.Comparison of clinical value at week 24 and 48 with baseline revealed significant improvement in two groups. Overall clinical improvement based on disease activity score was found in 14, 19patients in AZA group and 14, 13 patients in MTX group after 24, 48 weeks respectively comparing the reference show no significance P>0.05. The nuM.D.er of withdrawals to side effects was the same, 2 patient in each group.Clinical improvement with azathioprine and methotrexate and side effect were the same in two groups of RA patients.

The precise mechanism of ischemia reperfustion (IR) injury is not fully understood. Recent studies on Rat myocardium revealed that activation f the K ATP channels inhibits this process. The goal of this study is coding the same effect of K ATP channels on IR injury, in rat kidney. In his study the effects of K ATP agonist (Diazoxide) and K ATP antagonist (Glibenclamide) plus a K ATP indepennt vasodilator (Hydralazin) on ischemia reperfusion injury examined. Female rats of 200-250g were anesthesized and used for study. Different doses of Diazoxide (1, 5, 15 mg/kg) and Glibenclamid (1, 510 mg/kg) and Hydralazin (1, 3, 15 mg/kg) were used (SC) 120 munutes prior to the initiation of IR. Kidneys were removed and checked histologically for the grading of inury. Diazoxide (5 mg/kg) prevented these lesions. Different doses of Glibenclamide and Hydralazine failed to prevent IR injury. Diazoxide is also a vasodilator agent but failure of Hydralazine to prevent the injury revealed that vasodilation was not the exact mechanism of action of Diazoxide.

Respiratory distress syndrome is the most common cause of hospitalization in newborn that is mainly appears in the preterm infants and had reveres ratio with gestational age and weight. The main cause of this disease is the surfactant deficiency that is lead to increase the alveolar surface tentionand it causes atelectasis. The cause of extent incidence of pulmonay hemorrhage and infection in pathological speciamen maybe release of chemical mediators from polymorphonucloar leukocytes (PMNS) and platelets and this can cause decreased of these circulating cells. Thus, there is relationship between severity of respiratory distress syndrome (RDS) and circulating leucocytes and plateletes. The goal, of this cross-sectional study was determine of association between severity of RDS and circulation leukocyte and platelets in the first 5 day of life. For this reason, newborn that hospitalized with respiratory distress syndrome in NICU in akbarabadi hospital in 1998, have been chosen. Newborn with premature rupture of membrane, sepsis, intrauterine growth retardation, meconium aspiration or neonates that their mothers who received dexamethazone were omitted for effects of this agent on the circulating PMN and platlets. Thus, 66 preterm infants have been chosen and according to need to mechanical ventilation were divided to sever and mild to moderate groups. 29 infants were in sever group (43.93%) and 37 infants in mild to moderate group (56.06%). The average of the circulating platelets in first 5 days of life, in sever group was 108051.7 and in mild to moderate group was 223527, that according to statistic test. T=0.7222 and Pvalue<0.00001 that is revealed meanfull difference between two groups. The average of the leucocytes (PMNs) in first 5 days of life in sever group was between 2695.21 and 1130.13and in mild to moderate group was between 5324.59 and 1507.72. The result of the statistic test was T=7.84289 and Pvalue<0.000001 that revealed meanful difference in two groups. There is association between severity of respiratory distress syndrome in infants and circulatory PMN and platelets.

One of the common G.I.T neoplasms is gastric cancer. Because of its invasion, and nonspecific symptoms and signs, the disease often diagnosed at advanced stage with short survival. Since epidemiological consideration, location of gastric involvement and clinical finding are different in each setting, to assess this purpose and survival rate with regard the stage of disease. This investigation was perform. A descriptive study on exiting data on 141 patients with gastric cancer was done during 7 years carried out patient's characteristics such as age, gender, signs and symptoms pathological finding, staging and survival rates were considered. Male to female ratio was 2.8:1. The peak incidence (34%) was occurred in 8 th decades of life most clinical finding were: epigastric pain (69.5%), weight 10ss (52%) Anorexia (42%) and anemia (77%). The most common blood groups were A+ and then O+ (40.4 and 29%) respectively. Antric involvement incidence was more than anywhere, but from 2 years ago it changed to cardia and proximal of stomach. Most patient were at late stage and curative procedure was performed in only 33.6% and in remainder(66.4%) the palliative options (simple bypass) was done and in some of this group we could not carry any procedure. From the beginning of this investigation (1994-2001) and 6 month later 20 patients (14.2%) were alive with considering TNM analysis: 4 patient were at TINO, 7 PT anT2NI, and 6 PT at T3NI which involvement was in prepyloric region 3 PT in antrum. Adenocarcinoma was the most type (97%). The most location of the cancer was in Antrum but it changed to proximal of stomach, subsequently it caused to decrease survival. A+ blood group must be considered as a relative risk. Epigastric pain, Weight loss, Anorexia and the age>50 years old recommended as screening test, with high suspicious to gastric cancer and gastroscopy promptly should be performed. Detected cancer in early stage had excellent survival but in late stage had short survival exception in prepyloric which had better survival in this investigation.

Infertility is one of the social problems all over the world included our country. One of the treatable causes of infertility is an ovarian diseases like polycstic ovary syndrom (PCOS). The first line of treatment of women with polycystic ovary syndrom (PCOS) and women who are resistant to clomid and gonadotropin is to use the standardized techniqe of Laparoscopic ovariain drilling with unipolar forceps cautery. The purpose of this research was to evaluate the reproductivity outcome of infertile women with PCOS in jahrom city. In this retrospective study, e evaluated a consecutive series of 40 - cases of PCO related unovulatory infertility treated with Laparoscopic ovarian drilling between march 1999 and September 2001. In all of these cases PCOS was demonstrated by using sonography, hormaonal profile and menstural history. All of them were resistand to maximum dose of clomid (200 mg/day) and some of them did not response to HMG. Ovulatory rate, pregnancy rate and miscarriage rate were obtained. Evaluation of menstural history and basal body temperature after surgical operation showed the ovulation with regular cycle in 35 women (87.5%), 17 women conceived after 1-2 years of surgery (42.5%) and two cases had abortion (11.7%). In general the results of this research showed that Laparoscopic ovarian drilling is an effective alternative treatment in clomid resistant infertile women with PCOS.

The extent of Cephalosporin C (CPC) production in producing strains is elated with the expression or inhibition of the relevent genes. The goal of this study was manipulate of the producing strain in order to increase its CPC production. Acremonium chrysogenum DSM 2399 is used as parent strain. Mutagenesis is performed on solid form of optimized production media. UV ray and NTG (with their optimum doses) were used as mutagens. Random and directed (in presence of Hg ++ or nystatin elections were applied. Biological (Bioassay) and HPLC assay were performed for CPC measurement. The identity of CPC is confirmed by mass spectrometery in final resulting best strain. The optimum mutagenic doses of UV and NTG were 200 sec. And 5-7 min respectively. Also the inhibioty does of Hg++ and Nystatin were 0.006 g/dl and 0.3 g/dl respectively. Raised titer mutants wee obtained with both mutagens and both selection methods, although UV mutagen and the presence of Hg++ were more effective. CPC titer was rised 2.3 old in final resulting mutant. CPC identity in its production media were shown by observing, the unique 415 ion in mass spectrometery. By mutagenesis protocols, it is available to change the CPC- biosynthetic genes in producing strains and increase CPC titer.

Unfavorable cervix is a major problem in termination of prolonged pregnancies. It is one cauese of increased cesarean section rate in these pregnancies. Prosta glandines are used for cevical ripening. In this randomized controlled trial, two groups with post term pregnancy and unfavorable cervix each included 50 patients underwent induction of labor with oxytocin. In the case group, prostaglandin suppository was used intravaginally 8 hours before induction. In this group Bishop score increased (0.75±0.69 vs 2.39±0.84) (P<0.005) and the time from beginning of induction to delivery was shorter than control group 574.8±280.1 vs 843.04±412.8min) (P<0.005). C/S rate was the same in two groups. The only side effect of PGE2 was nausea. It can be concluded that PGE2 vaginal suppoditory is useful for ripening of cervix and decreasing the duration of induction without serious side effects.

A report of two cases of tuberculosis Arthritis of shoulder joint with different clinical manifestations.The first case a young worker man with pain and pseudo paralysis of shoulder. The second case was an eldery afghani immigrant with a huge cold abcess on the proximal humerus along the long head of biceps tendon.

Several polymorphisms within the apo AI-CIII-AIV gene cluster have been detected there is ample evidence about variations at the adjucent apo AI and apo CIII gene loci influence the risk for hypertriglyceridemia and coronary artery disease (CAD). This study was conducted to elucidate the association between two restriction fragment length polymorphisms (RFLPs) of the adjacent apo AI and cm genes and CAD in Iranian patients. The polymorphisms sites were MspI site in the promoter region of the apo AI gene (G-78A substitution) and SstI site in the apo CIII 3' untranslated region (G 3175C substitution). Total genomic DNA was prepared from the whole blood of 46 hypertiglyceridemic patients with CAD and 36 normolipidemic Iranian subjects. Amplification of a 355 bp fragment of the promoter region of the apo AI gene and a 280 bp fragment of apo CIII 3' untranslated region were achieved by I. polymerase chain reaction(PCR) with specific primers. Genotype distribution and the allele frequencies for the apo AI MspI and apo CIII Sstl polymorphi sms were determined and compared in patients and I normolipidemic healthy subjects. Dispite the significant differences in plasma lipids concentration between patients and healthy subjects; no association between any of two investigated polymorphisms and cornary artery disease was found. This lack of association was held for both allele frequencies and genotype distribution in different sexes.

Patellar taping is one of the method of treatment of patellofemoral pain but effect of patellar taping on VMO and VL reflex as a one of mechanism of pain relieve is questionable. The purpose of this study were to investigate the effect of patellar taping on the timing of the onset of VMO and VL reflex in patients wit patellofemoral pain and to compare the obtained of VMO and VL reflex with normal subject. Onset times of VMO & VL reflex to a special mechanical stimulus (tapping the quadriceps tendon) were measured in 21 healthy subjects and 15 patients suffering from patellofemoral (20-30 years old). Each subject's quadriceps tendon was tap armed reflex hammer and EMG signals were recorded. Following this recording, the patellar taping was performed on the patients using leucoplast tapes, so that their pain score dropped to less than 50% of their original pain according to VAS, when one leg provocation maneuver was used to provoke the pain in the patellofemoral joints. Latency of the onset of the reflex response of VMO and VL was different in normal subject's compare to the patients. Taping of patellofemoral joint, as performed in this study, change the timing of the activity of the VMO in the patients suffering from patellofemoral pain. Reduced latency of VMO activation as the result of taping as observed in this study may have a positive effect on the patellar tracking. Further studies are recommended in order to substantiate the clinical effects of such that change caused by patellar taping.

Musculoskeletal disorders which are introduced with back pain are now the most common cause of chronic incapacity in industrialized countries. One of the important causes of low back pain is, spinal instability. A recent focus in the physiotherapy management of patients with back pain has been the active spinalstabilization exercises of muscles surrounding the spine considered to provide dynamic stability and fine control to the lumbar spine with increasing endurance and coordination of spinal stabilizer muscles.On the other hand many studies have found that inadequate strength and endurance of the back muscles are significant risk factors and symptoms for low back pain. The aim of the current study was to evaluate the effectiveness of specific stabilizing exercises on the lumbar muscle performance in saggital plane in normal subjects with Isostation B200 and clinical endurance tests. In a randomized clinical trial (RCT) 30 young healthy females were assigned randomly to case and control groups. The case group underwent a 4 week specific exercise program. After intervention the case group showed a statistically significant increase in strength and endurance variables in all tests, but after 4 weeks follow up, strength decreased significantly. Improvement in trunk muscle strength and endurance after spinal stabilization training suggests that these exercises can be the best choice for low back pain.

VPI, which is inability of velopharyngeal sphincter closure, has many etiologies that one of the most common of them is cleft palate. In spite of palatal closure some of them will lead to VPI. Therefore we decided to evaluate which patients are more prone to this problem. A retrospective study with studying of patients who had been operated between 1996-2001was planned and 91 patients was selected as control.From case group, 3 patients had unilat CL/P, 8 had bilat, CL/P, 2 had unilat C/P and 3 had bilat, C/P but in control group, 34 unilat CL/P, 16 bilat, CP, 36 unilat CP and 5 bilat CP. Comparison between two group (unilat or bilat) showed that prevalence of VPI in bilatal Types were significantly more than unilateral types (P<0.05). This can be attributed to greater size of defect in bilaterals cases, but the nature of muscle in sphincter can be an ethiology too, that must be evaluated in other studies.

Pseudomonas aeroginosa plays a Prominant role as an etiological agent involved in serious infection in burned Patients. This study analayzed Pseudomonas aeroginosa infections in the "Motahari Burn Center" during four months(from 22Dec.1998 to Apr.1999) in order to estimate their frequency, antibiotic susceptibility and stereotyping. 184 positive cultures with 205 bacterial strains were isolated among surface swabs or tissue biopsies that were collected in this study period. Pseudomonas was the most common strain (57.07%, n=117) followed by Acinetobacter (16.6%) Ecoli (11.7%), staphylococus aureus (7.8%) and other organisms (6.83%). The frequency of P.aeruginosa resistance to Gentamicin, ceftizoxime, carbenicillin, cephalothin, ceftazidime was over 90%. The most sensitive antibiotics were Amikacin and Tetracyc1in.The serotypes isolated from 117 pseudomonas aeruginosa were O:2, O:5, O:6, O:8, O:11, O:12 and O:16.most common serotypes was O:6 (20.3%) followed by 0:11 (18.6%) and O:5 (14.4%). Most resistant serotypes were O:16 (7.6%) and most sensitive was O:8 (4.2%).The results show the difficulty of treatment of this infection with available antibiotics. Therefore prevention is an appropriate means of conquering infection in burned patients. Vaccination with Polyvalent Antiserum against to.0:6. O: 11, O:5, O: 8 and O:16 may produce immunity in approximately more than 60% of Burn Patients.

Carpal tunnel syndrome which is median nerve entrapment neuropathy is the most frequent occupational disease. Diagnosis is mainly made by electrodiagnostic study but there is no specific exam for screening of patients. In study of 101 hands (55 patients) with CTS (confirmed by electrodiagnostic study), wrist-squareness. Ratio (thickness/width=T/W) were measured. Correlation between T/W³0.7 & DL³4.2 (distal latency=DL) were assessed In order to find whether or not T/W³0.7 would indicate a median nerve sensory latency greater than 4.2ms, as a predictor of CTS. Results of this study indicate that: There is a positive correlation with T/W & DL. The sensitivity of TIW was 59.8%, so this ratio in screening of suspicious patients with CTS has limited value.

Infection may be caused by transfer of bacteria from the hands of the surgical team during operative procedures. Therefore careful surgical scrubbing is performed to reduce the number of bacteria on the skin. The duration of scrubbing and the antiseptic solution are two variables in this purpose. One hundred samples were removed from the index pulp of Right hand of the surgeons. At the time of zero, 2, 4, 6 and eight minutes after hand scrubbing with betadyn and brush. After incubation of the samples, culture results were reported. This study showed that 2 minutes scrubbing the hand by povidine iodine %7.5, would probably be enough to reduce the number of the bacteria of the skin.

Aorto-left ventricular tunnel (ALVT) is a rare congenital anomaly in which an abnormal communication connects the ascending aorta with the left ventricle that results volume overloads on left ventricle. It is clinically undistinguishable from aortic insufficiency. Its prompt and precise diagnosis is crucial since early surgical treatment is definitely indicated. In this report clinical, roentgenographic and electrocardiographic features as well as echocardiographic and cardiac catheterization data of three patients with this cardiac anomaly are reviewed. All of our three patients were male. Two cases referred because of heart murmer and another case because of dyspnea. All of cases had dilation of left ventricle, ascending aorta and aortic arch. Open heart surgery and repair of tunnel was done for all patients and in one case because of abnormal aortic valve leaflets, aortic valve replacement also was done.

Loudness of verbal commands affects the Voluntary motor response. It seems the more intensity of verbal command, the more muscle contraction force. The purpose of this study was to investigate the hypothesized effect of verbal command loundness onmagnitude of a resulting voluntary isometric contraction of triceps brachi muscle. Thirty five female subjects between ages of 18-30 performed four isometric contractions of the right triceps branchi muscle in response to fluctuations of verbal command in four stages with one-minute rest between stages. The muscle contraction force was measured at each stage by digital dynamometer. The intensity of verbal commands in four stages was 66, 88, 66, 88 decibels, respectively. Statistical analysis showed that increasing voice volume between first and second stage increased the muscle isometric force significantly (P<0.05) and decreasing voice volume approximately 22 db between second and third stage had significant effect on muscle force. But increasing voice volume between third stages did not have any significant effect on muscle force. Therefore the verbal command repetitions caused decrease of the primary effect.

Diseases control is based on surveillance system of disease in national health system. On time reporting of diseases and appropriate action for reported cases are required in the national health system. Therefore making physicians familiar with accurate definitions of diseases, what diseases are internationally valuable to be reported and how to report them are priorities of the surveillance system of diseases. This study assessed general practitioners' knowledge who works in Tehran of this requirement of the surveillance system. The study was conducted along both private and governmental sectors. This study was a comparative descriptive study. 200 physicians in governmental and private sectors in Tehran were contributed in this study and filled a questioner. For analyzing of the data, SPSS software was used.Calculated mean total score among governmental sector and private sector physicians was 22.7 (±7.4) and 18.9 (±8.3) respectively. These scores were significantly different (p=0.001).There was no significant relation between sex and total score. An age differences in these two studied group was considered by defining age sub groups and total score was calculated in this sub groups accordingly. The highest calculated score was achieved by younger subgroup in government physicians, which was significantly different with the same age sub group in private sector. The lowest calculated score was in + 35 years old physicians working in private sector and there was no significant difference between this subgroup and the similar age subgroup in government sector. Two age subgroups of government sector had significant difference in mean total score (p=0.003) but this difference was not significant in private sector age sub groups. To predict the total score with having age, job sub group (private-governmental) and years after graduation parameters a multiple linear regression model was used. We found that these variables participate in determining the total score. Mean total score in governmental physicians who have management activities was significantly higher than clinicians. Physician knowledge of reportable diseases was lower than 50% of score: Governmental sector physicians showed a better understanding of surveillance system reporting requirements.

Extramedullary hematopoiesis is an extension of marrow beyond its bony casement. It is associated with a number of diseses when the normal function of marrow is disturbed. A large accumulation of extramedullary hematopoiesis may occur at the paravertebral area, mediastinum, spleen and liver.Intrarenal extramedullary hematopoiesis is rare. Only a few cases have been reported of myelofibrosis and idiopathic thrombocytopenic purpura. We report cases of intrarenal extramedullary hematopoiesis that mimicked a renal tumor. A 23 year-old man which is known case of osteopetrosis presented with pancytopenia and abdominal mass.