Annals of Military and Health Sciences Research
Year:2003 | Volume:1 | Issue:2 (Serial Number 2)|Papers Count:13

Background: Pericarditis & Pericardial effusion are one of the complications of end stage renal disease and despite using dialysis form 1960s, the incidence of them reduced from 50% to 10%, they cause significant mortality and morbidity. Many of these patients are asymptomatic that can be found according indirect witnesses in chest reontograms, electerocardiographies and echocardiographies.Materials and Methods: In this cross sectional study in order to assess the relation between pericardial effusion and serum blood urea nitrogen and creatinine in patients with end stage renal disease in two university hospital of Dr. Shariati and Ashrafy-esfahani in March 2001 until March 2002, 132 patients on regular dialysis were studied with Echocardiography and some demographic & lab data like blood urea nitrogen, creatinine, hemoglobin, calcium, total cholesterol, phosphorous, Ca*P, triglyceride and uric acid.Results: Pericardial effusion was present in 13%, of whom 6.1%, 6.1%, and 0.8% had mild, moderate, and mild PE, respectively. In one patient there were typical signs of pericarditis like chest pain and others were symptomatic. Presence of pericardial effusion related conversely with serum BUN & Creatinine (P<0.05). Patients with mild PE in comparison with moderate PE had higher serum Albumin & Phosphorus (p<0.05).Conclusion: With respect to statistically significant negative correlation between pericardial effusion and serum BUN and Cr proved in this study, it seems that in patients with more severe dialysis; incidence & intensity of pericarditis and pericardial effusion are lesser. However more studies is needed to demonstrate it and it can be concluded that if quantitative skills were utilized for detection of pericardial effusion volume (for example Simpson echocardiography), more accurate results will be obtained.

Background: Peptic ulcer disease and esophagitis are the most common cause of dyspepsia that have high coincidence. Also, 1/3 cases of recurrent dyspepsia after anti-H. Pylori treatment in D. U are caused by esophagi is. The purpose of this study was to determine the rate of coincidence between D.U and Esophagitis.Materials and Methods: Endoscopic finding of 806 patients who had been referred to endoscopic ward of Golestan hospital has been evaluated from 1999 to 2001.Results: D.U with R.E was detected in 104 cases (21%). The most common endoscopic finding was diffuse gastritis of antrum (91.4%).Conclusion: This rate of coincidence between D.U and R.E indicates that esophageal investigation is needed during the endoscopic study of patients with D.U.

Background: Over the past decade, cardiac transplantation has evolved into an acceptable therapy for patients with end stage heart failure not amenable to conventional therapy. The purpose of this study was to determination of prognosis in Iranian patients receiving heart transplantation and assessing the improvement alternatives.Materials and Methods: This retrospective study reviews 32 patients who underwent orthotopic (30 patients) or heterotopic (2 patients) heart transplantation over a period of 10 years (between January 1992 and since December 2002) in Or. Shariati Hospital (Tehran Univ. of Medical Sciences). Indications of heart transplantation, outcome and mortality rate and their causes, one, three and five-year survival in cardiac transplant recipients were assessed.Results: The mean age was 32±11 years (range 12 to 45 years). There were 22 male and 11 female. 71.8 percent of patients have a NYHA class lll cardiac status and 28.2 percent with a NYHA class IV. The indications for transplantation included: dilated cardiomyopathy in 81 percent, and ischemic cardiomyopathy in 19 percent. The median follow-up period was 24 months (ranging 2 to 110). 19 patients (59.4 percent) have 36 serious postoperative complications (including acute rejection, infection, hepatic and renal failure, heart failure and pericardial effusion). Of the 32 patients who had heart transplants, 15 patients (47 percent) died during the study period, 1 day to 2 year after transplantation. Overall survival at one year, three year and five year was 39.1 percent (95% Cl, 17.5 percent to 60.7 percent), was 34.8 percent (95% Cl, 13.7 percent to 55.8 percent) and 30.4 percent (95% Cl, 10.1 percent to 50.8 percent) respectively. Main causes of death were respectively including rejection, infection and sepsis and heart failure.Conclusion: Finally the authors recommended that however there are numerous factors affecting survival rates, and there is a long way to come aggress developed countries results, in future studies the role of follow up system and postoperative cares and the position of the primary care physicians in improving the survival rates, could be assessed.

Background: Our aim was to determine whether semen volume "per se" is indicative of semen quality or not.Materials and Methods: A total of 1160 samples obtained from 1160 men and semen characteristics were analyzed.Results: The study showed that 58% of the samples showed normal volume, 18% showed high volume, and 24% showed low volume. In 42% of men who attended IVF programs, the semen volumes were abnormal. Sixteen percent with high volume and 12% with low volume had semen with characteristics of fertile group.Conclusion: High and low volumes of semen were associated with altered motility and morphology and with high incidence of spermatozoa exhibiting subfertile characteristics. Normal volume "per se" did not indicate the quality of semen.

Background: Tuberculosis is a considerable life threat to global health in developing countries. Smoking, as a social habit, is also an important risk factor for TB and its development.The aim of this study is to find the role of smoking in pulmonary tuberculosis mortality.Materials and Methods: The patients with documented history of tuberculosis in Dr. Masih Daneshvari Hospital were enrolled into this study. Case group included all deceased patients due to pulmonary tuberculosis and Control group was chosen randomly from alive TB patients (same in number). The necessary information was gathered and the data were analyzed using Chi-square and Fisher's Exact. Odd's Ratio was also calculated using Mantel- Haenszel Method. Results: During two years, 53 cases of died TB patients were enrolled into this study.Mean age in Case group was 53±18 years and in 57 patients in Control group, mean was 50 20 years. In case group, 26 (49%) and in control group, 22 (39%) were male. Among Case group 47% has positive smoking habit while 17% in Control group. According to the statistical study, it wasn't any significant difference regarding age and sex between two groups. There was greater percent of smoking habit in case group (P = 0.001). Odd's ratio of smoking habit in case-control was 4.19 (Cl 95%: 1.75, 10.01).Conclusion: This study appears that smoking is an important risk factor on mortality due to pulmonary tuberculosis. According to the results, mortality risk in smoker with pulmonary TB is more than 4 time in non-smokers.Although it needs cohort studies considering other mortality risk factors.

Background: Rheumatic heart disease (RHD) continues to be a common health problem in the developing world, causing morbidity and mortality among both children and adults. There are only a few population surveys available in Iran to determine the prevalence of RHD. In order to estimate its prevalence among schoolchildren in urban areas of Hamadan province, this survey was undertaken.Materials and Methods: The study was a cross-sectional survey, carried out by a specially trained medical team headed by a cardiologist. The study involved all of the schoolchildren (7-18 years of age) from 7 cities of Hamadan province, situated in the west of Iran during 1993.Diagnosis of rheumatic heart disease was confirmed only after Doppler echocardiography in suspected cases.Results: A total of 167,786 children on the school register (104, 242 boys and 63,544 girls) were examined generally and specifically for evidence of RHD. Out of the 167,786 children screened, 714 were suspected cases and 23 were confirmed cases of RHD (14 boys and 9 girls), giving an overall prevalence rate of 1.37 per 10000 children with no significant difference among the age groups of 7-11, 12-14 and 15-18 years. Only sixteen of the 23 patients were aware of their disease (69.6%). The mitral valve was affected in all of the cases. Out of 23 cases of RHD, isolated mitral regurgitation (MR) was present in six (26%), combined MR and mitral stenosis (MS) in nine (39.1%), combined MS and aortic insufficiency (Al) in one, and combined MR and MS and AI in four patients (17.3%). Also one patient had acute rheumatic carditis. The tricuspid valve and pulmonary valve involvement were not seen in any cases.Conclusion: This study revealed a lower prevalence of RHD than that reported in earlier studies from developing countries. The lack of patient's awareness about their disease, noted among the patients revealed that public health education is necessary. Also, regular studies are needed to identify new cases and to ensure secondary prophylaxis; thereby preventing the progression and the severity of the valvular lesion.

 Background: Cancer is one of the great problems of world population. No body is immune against this disease. The aim of this study was registration of epidemiologic data of patients with cancer who where referred to radiotherapy ward of Be'sat hospital, from 1990 to 2000.Mterials and Methods: Data have been registered from 2651 patients' folders who were referred to this center.Results: From 1990 to 1995, the average number of referred patients was 107 per year. From 1996 to 2000, this number reached to 402 cases per year. There was no obvious different between the number of males and females, referred to our center. Most of the referred cases were from Tehran (1196 patients). The most common cases were malignancies related to skull and brain (79%). Colon and mediastinal malignancies were detected in 0.45% of cases separately.Conclusion: According to the increase in patients numbers who were referred in past years, registration and developed referral system seem to be necessary.

Background: Acromegaly is an uncommon disease with various manifestations including cardiovascular presentations. This case-series study is designed for evaluation of electrocardiographic and echocardiographic findings in patients suffering from active acromegaly who had been visited in Imam Khomeini, Shohadaye Tajrish and Imam Hussain hospitals.Materials and Methods: Patients were called among the information's obtained from archive and if there was a 6 month length from eradication treatment. Then they were underwent physical examination including blood pressure measurement, electrocardiography and echocardiography evaluations.Results: Seventy patients were included. Mean ages of the patients were 46 years and 52 percent of them were male. Mean duration of their illness was 6 years. Forty one percent of the studied group were hypertensive. Electrocardiography abnormalities were seen in 61 percent of the patients (including ST-T pattern, ST depression or inverted T wave, left ventricular hypertrophy, and pathologic Q wave) and in 43 percent abnormal findings were found in echocardiography (including left ventricular hypertrophy, resting low ejection fraction, diastolic dysfunction, aortic regurgitation, and symmetric septal hypertrophy) Conclusion: With the respect of high prevalence of cardiovascular disorders in these patients, it could be recommended that more accurate cardiovascular assessments must be employed. It is recommended to pay more attention to electrocardiographic and echocardiographic studies for early diagnosis of symptoms and prompt treatments.

Background: Today more than 20 blood-borne pathogens have been transmitted via a needle-stick injury (NSl). Three are of particular concern; hepatitis B virus, hepatitis C virus and human immunodeficiency virus. Thus, the present study was conducted to determine the knowledge, attitude and practices of medical staff in 505 army hospital in November 2002.Materials and Methods: For this descriptive study, questionnaire filled for 88 medical staff. The knowledge and related factors, HBV vaccination status, anti HBs level after complete vaccination, history of NSI, management and follow up after NSl all were determined.Results: Eighty- eight persons Were enrolled in this study with a manage of 30 years (range 16- 50 years ), of whom 52 were males (59%) and 36 were females (41%) with a mean 10 years duration of occupation. (Range, 1 month - 29 years). Sixty one have had vaccination against HB of whom only 15 had serum level of anti HBs antibodies. Twenty nine people have 1-100 times of NSl. Nurses had the greatest number of NSl (55.2 %), followed by physicians with 20.7%. Overall rate of NSl in our hospital was 28.5 per 100 health care workers per year.Conclusion: Unfortunately, knowledge of staff about NSl and BBP was not satisfying. Further education is needed. Vaccination for HBV was satisfactory, but serum level of anti HBs antibodies must be checked regularly.

Background: The incidence of plasmacytoma in age group over 25 years is 30 per 100.000.Plasmacytoma presents in three clinical patterns: 1- MultipleMyeloma (MM) 2-Solitaryplasmacytoma of bone 3-Extramedullary plasmacytoma (EMP). One hundred eleven cases of laryngeal plasmacytoma had been reported to 1995. Twenty one cases of these patients were metastases of multiple myeloma. Radiotherapyis treatment of choice and in some cases surgery and adjuvant chemotherapy is added.Case: We report a 57 years old woman with multiple myeloma. She was treated by chemotherapy but she raftered with hoarseness and respiratory distress. Extramedullary plasmacytoma was diagnosed in our clinical examination and laryngeal biopsy. The mass disappeared completely with radiotherapy.Conclusion: Chemotherapy in multiple myeloma doesn't prevent of laryngeal metastasis definitively and still the treatment of choice for EMP is 4000 CGY radiotherapy.

Background: Despite development of Surgical and diagnostic Techniques mortality of breast cancer has been continued. As the disease is developing rapidly, its recognition in initial steps can change the death rate. A series of certain family cancers can be related with hereditary mutated genes. for in stance BRCA1 and BRCA2 are related to breast and ovary cancers. This paper is focused on contradictions of various methods which can be used as prophilactic ways.Materials and Methods: For this review article, we have searched through the site www. Pubmed com by the following keywords: Prophylactic Surgery, increased Surveillance, Hereditary Predisposition, Breast cancer, ovarian cancer, chemoprevention, prophylactic surgery. BRCA1, BRCA2 the complete essays have been searched in ovid and proudest sites from 1994 - 2003. Finally, we have found 50 related article.Results and Conclusion: The risk of breast cancer is increased in women who carry BRCA1-2 mutation genes. Women with hereditary susceptibility for breast cancer have been recommended different policies from close surveillance till prophylactic mastectomy (PM) and prophylactic oophorectomy (PO) However, future studies are strongly recommended.