Razi Journal of Medical Sciences
Year:2007 | Volume:14 | Issue:55|Papers Count:29

Introduction: Henoch-schonlein purpura (HSP) is the most common form of acute vasculitis with unknown causes, primarily affecting children. Clinical features include skin rashes, arthritis, abdominal pain and nephritis. It is frequently triggered by a streptococcal upper respiratory tract infection. Other bacteria's have been implicated as triggering agents. Case Report: We report a case of HSP in a patient with pseudomonas septicemia. Conclusion: Pseudomonas infection should be added to the list of bacteria that can trigger HSP.

Background & Aim: Normal vaginal delivery (NVD) is defined as the best method of delivery of most times; but unfortunately its rate is decreasing because of increasing rate of cesarean section(C/S). Fear of NVD on one hand and preferring C/S on the other causes some difficulties in labor. In one study in Babol city (1998) only 5% of women had appropriate knowledge about kinds of delivery, showing their low level of knowledge. The object of this study is to define the knowledge level of pregnant women about advantages and disadvantages of normal vaginal delivery and cesarean section.Patients and Methods: In this cross sectional study, 1100 pregnant women in Tehran attending one of the governmental hospitals or private centers and that were not physicians or midwives were assessed. Considering the importance of topic questions they were divided in two groups (having 1 or 2 scores). According to their knowledge score, personal knowledge level was classified in to three levels: low level of knowledge (score range 0-16), good level of knowledge (score range 17-32) and satisfactory or high level of knowledge (score range 33-48).Results: The mean age of cases was 29.46 years with SD=7.2. Total mean score of knowledge level was 27.6(SD=8.98). Meanwhile 119 cases(10.8%) had a low knowledge(score range 0-16), 612 cases(55.6%) had a good knowledge(score range 17-32) and 369 cases(33.5%) had a satisfactory or high level of knowledge(score range 33-48) about types of delivery.Conclusion: According to our findings total knowledge of women in Tehran was in an appropriate level but their knowledge is limited and showed bias. We suggest setting up of workshops for general population in order to increase their knowledge about types of delivery, advantages and disadvantages.

Background & Aim: Chlamydia trachoma is is one of the most prevalent causative agents of sexually transmitted diseases. It causes a variety of genital tract complications such as urethritis, cervicitis, endometritis, epididymitis and lymphogranuloma venereum. The prevalence rate of chlamydia induced cervicitis varies in different societies. In a recent study, the prevalence of Chlamydia cervicitis in sexually active American women was in the range of 5-15% and in pregnant women was 1.2%. The purpose of this study was to evaluate the prevalence of different detection techniques, such as ELISA, MIF, DIMA rapid test and direct microscopy after Gimenez staining.Patients and Methods: A total 137 women with cervicitis (diagnosed according to established gynecological protocols) who referred to Rasool Akram hospital and Nilo private clinical laboratory were admitted for this study. Two end cervical swabs were obtained. One of them was used for the rapid Dima test and the other swab was subjected to Gimenez staining. Blood samples were also obtained for serological tests.Results: ELISA tests indicated that 18 patients had positive IgG antibody levels in their blood and 4 of them had IgM antibodies against Chlamydia trachoma is. Ten patients had significant IgG levels and 3 of them had anti-Chlamydia IgM according to the MIF test results. Dima rapid detection test was able to show positive results for only 5 patients. We were not able to detect any Chlamydia inclusion bodies with direct microscopy after Gimenez staining.Conclusion: According to the results obtained with MIF technique which is generally considered to be the "Gold standard" serological detection method, the prevalence of Chlamydia induced cervicitis was shown to be 7.2%. There was no statistically significant difference in IgM titers detected by ELISA and MIF methods. But there were statistically different IgG titer rates between ELISA and MIF techniques. Therefore, it is suggested that any ELISA positive IgG titer samples to be rechecked and reconfirmed by MIF method. Due to the lack of Chlamydia inclusion body detection by direct microscopy, Gimenez staining is not recommended as a diagnostic tool.

Background & Aim: When comparing bone auto graft and allograft, conditions like performing two surgeries at the same time in individual, size limitations of autografts, bleeding etc. forced specialists to think about the possible substitution of autografts with the allograft. In this study considering the importance of the kind of the chosen bone for graft, its embryologic origin, its histological structure and also the effective factors that increase the success rate of allografts including the deantigenization method, the healing process of all kinds of Corticocancellous and cortical allografts originating from endochondral bones are compared with each other and with Corticocancellous allografts originating from intramembranous bone. Also the efficiency of deantigenization method is assessed.Materials and Methods: In this experimental study performed on New Zealand white rabbit 42 grafts including 30 grafts in experimental group (including 10 Corticicancellous intramembranous allografts from skull bone (COI), 10 Corticocancellous endochondral allografts from Hip bone (COE) and 10 cortical endochondral allografts from Tibia bone (CE)) were implanted 2cm below the rabbit knee joint. Six autografts, after deantigenization were implanted in Sham group to assess the effects of deantigenization over repair and healing process. Six autografts were implanted in Control group without deantigenization to assess the effects of surgery method and operation room conditions over repair and healing process. They were compared with presence or absence of bone callous and histological decalcified microscopic sections were used to assess the healing process. The results were evaluated by SPSS, Version 11.5 and by Odds ratio Analysis and Fischer's exact test.Results: The success rate for (COI) grafts was 80%, for (COE) grafts was 60% and for (CE) group was 70%. In sham group healing process was extremely fast (in eight weeks). In control group healing process was obviously slower (till 12 weeks), but after 12 weeks it was compensated. The vacant holes weren't repaired even after three months. Conclusion: The success rate for (COI) grafts was more than (COE) and (CE) but according to statistical analysis this difference is meaningless (Pv>0.05). According to microscopical survey intramembranous allografts have higher rate and speed in union and healing process.

Background & Aim: Drug abuse in prisons is a serious problem and the high risk methods of drug abuse are even more dangerous, causing greater threats such as the outbreak and spread of HIV/AIDS in the prisons. This indicates the need for treatment of drug abuse and harm reduction in prisons. The aim of this study was to examine the role of medical and psychological interventions in reducing the risks of drug abuse and improving the psychological status of prisoners.Patients and Methods: The effects of methadone maintenance therapy(MMT) and other traditional methods of treatment were compared in a case-control and qualitative study to examine their role in reducing drug use, drug dependence, needle sharing, injections using un-sterilized objects, high-risk sexual behaviors, as well as the psychological well being of the prisoners and their satisfaction with the treatment process. The instruments used in the study were SCL-90-R (farsi version), High-risk questionnaire, Drug dependence scale, Anger scale and client satisfaction questionnaire. The experimental group (n=38) was provided with MMT and psychological and psychiatric treatment while the control group (N=31) received only the usual psychiatric treatment.Results: Data were analyzed using independent T and Chi-square tests. Six months into the project, the results showed significant changes in the amount of drug use and the extent of needle sharing in the experimental group. However, high-risk sexual conduct remained as prevalent as before. Methadone maintenance therapy also greatly improved the psychological health indicators. In addition, the subjects in the MMT group were considerably more satisfied with the services they received. Conclusion: The findings of this study revealed the advantages of MMT over the traditional psychological and psychiatric approaches in the imprisoned, in helping drug addicts in prisons to overcome their addiction. Based on the results of this study, it can be concluded that not only providing methadone to addicted inmates is safe and harmless, but also can lead to harm reduction and solve many dangerous problems which they face.

Background & Aim: Abdominal surgery may lead to intra-abdominal adhesion. Therefore scientists suggest different methods to prevent this problem. Use of heparin, by its mechanism of coagulation pathway inhibition, is one of these methods. The aim of this study was the comparison of various methods of heparin administration in prevention of post surgical abdominal adhesion.Materials and Methods: In our experimental guinea pig model, Forty guinea pigs were divided into eight groups in randomized manner: A (1-4) and B (1-4). A1 and B1 were negative control groups and did not receive any medications. All guinea pigs were anesthetized, laparotomy was performed on each one and 1.5cm midline incision was given. Then peritoneal inflammation was induced in the exposed bowl and peritoneum. After that, experimental infection was induced with inoculation of 100 cfu of Escherichia coli in peritoneal cavity of B (1-4) group. Each guinea pig from A2 and B2 groups received 80mg/kg/day heparin subcutaneously for three days, A3 and B3 groups received one dose of 100IU heparin intraperitoneally and A4 and B4 received 80mg/kg/day heparin three days subcutaneously and one dose of 100 IU heparin intraperitoneally concomitantly. Then the incision was sutured. On the 21th postoperative day, guinea pigs were euthanized and peritoneal adhesions and specific inflammatory and regeneration reactions were evaluated.Results: The results were analyzed with Fischer's exact test in SAS (version 6, 12) software. Peritoneal adhesions and inflammation reactions in experimental groups had reduced significantly (P<0.05) in comparison with controls, but insignificant differences were seen between experimental groups (P>0.05).Conclusion: Results revealed that subcutaneous, intraperitoneal and concomitant administrations of heparin are effective in reduction of adhesion formation in infectious and non-infectious experimental peritonitis without significant differences. Therefore since the method of intraperitoneal administration is much easier and more convenient than other methods it is recommended.

Background & Aim: According to the variable progression of rheumatoid arthritis(RA) determination of factors related with poor prognosis is necessary for appropriate treatment of these patients. In this cross section analytical study the aim was to determine the correlation between IgA RF, anti-MPO, anti-PR3 antibodies and clinical, radiological severity in patients with RA. Patients and Methods: Serum samples from 48 patients with RA, who were seen regularly in this clinic were tested. IgA RF, anti-MPO, anti-PR3 titers were estimated by enzyme linked immunoabsorbent assay (ELISA). Hand radiographs were read using the Larsen method as modified by Rau and Herborn; also carp metacarpal ratio was calculated. For statistical analysis frequency, percent of frequency indices, mean, median, mode, standard deviation, standard error and for analytic analysis, pearson's correlation coefficient have been used.Results: IgA RF was detected in 33.3% of patients [24.4% of RF (agglutination test) negative patients] and was significantly correlated with low blood hemoglobin(r=-0.311, p=0.02), but not with radio logic damage(r=-0.078). Anti-MPO and anti-PR3 antibodies were detected in 4.16%, and 2.08% of patients respectively. According to small number of positive sera no correlation was assessed.Conclusion: IgA RF is significantly associated with disease activity and more sensitive in detecting serpositive patients.

Background & Aim: In a variety of diseases thumb opposition is absent. Opponensplasty is the transfer of tendon to thumb in order to regain opposition in hands. This operation is perfumed with different tendons and operation techniques; results of surgeries are different with various surgical techniques. In this study result of these operations in different patients was assessed in Shafa Rehabilitation Center, between 1984-2005. The aim was to evaluate the results of this type of surgery in different diseases and also to determine the procedure that has the best results.Patients and Method: Ninety five patients with opponensplasty were assessed for results of surgery in Shafa Yahyaeeyan hospital between 1984-2005. Because of varity of diseases such as polio, CP etc. these patient were unable to perform thumb opposition and underwent surgery with different techniques. In this study long term results of these surgeries were assessed with evaluation of patient satisfaction and thumb opposition.Results: Among CP patients, 8(75%) demonstrated good or excellent results. Among Polio patients(35 cases), response was weaker and 62% showed good or excellent results. Meanwhile Burkhalter technique was excellent or good in 80.6%; when compared with other methods it was better.Conclusion: Result of opponensplasty was good or excellent in more than 70% of cases; Burkhalter technique was better. Results of surgery were better in traumatic disorders as compared to other diseases.

Background & Aim: Chronic otitis media (COH) refers to change of middle ear mucosa, usually associated with perforated tympanic membrane. However it may be accompanied by some etiology without tympanic membrane perforation. It presents with persistent or intermittent otorrhea, hearing loss and acute and serious complications may occur in its course. Chronic infection, due to it's nature, is irreversible and usually surgery is indicated, and various pathologies are noted. The aim of this study is to evaluate various pathologies in cases of COH that have undergone surgery, so a better clinical diagnosis prior to surgery is reached.Patients and Methods: In this prospective cohort study, one hundred patients with chronic otitis media were evaluated; 73 males and 27 females in various age ranges, by most frequency 20-30 year olds were evaluated. Preoperative eudiometry and radiology were done and then patients were operated.Results: After data collection and analysis, this result was obtained: 86% granulation tissue, 18% cholesteatoma, 32% tympanosclerosis, 4% cholesterol granuloma and 71% ossicular change.Conclusion: Chronic otitis media presents with hearing loss or otorrhea and may be due various etiologies, most commonly by sequence granulation tissue, cholesteatoma, tympanosclerosis, and cholesterol granuloma. Clinical evaluation of the pathology is useful for clearing matters such as treatment strategy, type of surgery, prognosis, and surgical outcome.

Background & Aim: One of the most important points in the pharmacology of Anesthetic drugs is their effect on the depth anesthesia and for its assessment recently an important marker BIS is used. In this study we evaluated the effect of three drugs namely Halothane, Isoflurane and Sevoflurane on depth of anesthesia using BIS monitoring.Patients and Methods: This study was performed on 114 patients in ASA-2, who were candidates for cochlear implantation surgery in Hazrat-e Rasool Akram Hospital. The patients were divided in three groups randomly. In the first group who were 36 patients, Halothan was administered for induction. In second group there were 24 patients, Isoflurane was administered and in third group with 54 patients Sevoflurane was administered. For close monitoring of depth of anesthesia BIS technique was used. Time needed for inducing general anesthesia during laryngoscopy, intubation, blood pressure and heart rate were recorded by BIS in collecting data sheet. The study was a randomized clinical trial and tests used for data analysis were one way Anova and Tukey tests.Results: BIS values for patients anesthetized with halothane were 42±1.6 and 42.7±1.5 (laryngoscopy and intubation, respectively), with isoflurane were 43±0.3 and 42.1±3.7 (laryngoscopy and intubation, respectively) and for sevoflurane group the BIS valves were 42.1±1.3 and 42.4±1.3 (laryngoscopy and intubation respectively) (Pv<0.0001).Conclusion: Analysis of data using one way ANOVA and Tukey test showed that there is no difference in regard to the effect on depth of anesthesia and vital signs between three groups but with sevoflurane time was decreased for achieving general anesthesia.

Introduction: Albinism refers to a group of inherited conditions. People with albinism have little or no pigment in their eyes, skin and hair. Albinism doesn't occur together with other anomalies with the exception of a case associated with microcephaly and digital hypoplasia. VACTERL is a syndrome consisting of multiple anomalies such as vertebral anomalies, anal atresia, cardiac anomaly, tracheoesophageal fistula, renal and limb abnormalities. Incidence of VACTERL is 1.6 in 10000 live borns and occurs sporadically. Occurrence of albinism and VACTERL together has not been reported yet.Case Report: A 3 day-old term neonate with oculocutaneous albinism phenotype associated with VACTERL syndrome underwent surgery for correction of his anomalies, but because of post operative sepsis and its complications died after few days.Conclusion: Albinism includes a group of clinical conditions that occurs sporadically without associated anomalies. This is the first report of association between albinism and VACTERL syndrome.

Background & Aim: Blood clot during hemodielysis is a reason for blood loss and interference in hemodialysis solution clearance. Therefore during hemodialysis heparin is used for anticoagulation. The aim of this study is to compare the effect of heparin versus fragmin (a type of low molecular weight heparin) on serum lipid levels.Patients and Methods: This is an experimental research performed on two groups of patients on hemodialysis. In group I, there were 11 patients (5 men and 6 women) with average age of 62.5 years old and average of 76.8 months duration of hemodialysis therapy in 15 th Khordad Hospital Hemodialysis Center; all received the same dose of heparin. In group II, there were 11 patients (5 men and 6 women) with average age 55.6 years old and average duration of hemodialysis was 80.8 months performed in the same center. They all received the same dose of fragmin, for 9 months continuously. None of the patients in either group received lipid lowering drugs. At times 0, 3, 6 and 9 months, serum levels of cholesterol, triglyceride, HLD and LDL of all patients were checked. With the hypothesis that fragmin does not have the hyperlipidemic effect of heparin, the heparin used group was selected as "control group" and the fragmin used group was selected as "experimental group". T-test was used for data analysis.Results: The results of study show that there was no significant difference between serum cholesterol levels of these two groups (p=0.59). There was no significant difference between serum triglyceride levels of two groups (p=0.18). Similar results were seen with LDL (p=0.74) and HDL (p=0.09).Conclusion: This study showed that fragmin and heparin have similar effects on serum levels of lipids.

Background & Aim: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of gastrointestinal tract. They are known to express c-kit, which is important in their diagnosis and treatment. The aim of our study was to assess the morphologic and immunohistochemical features of gastrointestinal stromal tumors and the significance of c-kit expression in them.Materials and Methods: The study was descriptive and simple method for sampling was used. Files from pathology laboratory of National Iranian Blood Transfusion Organization were searched for cases referred as GIST between April 2002 and April 2005. Clinical data were recorded and their H&E and IHC slides studied. The results were analyzed by SPSS 10 software.Results: C-kit expression is a key confirmatory marker for GIST diagnosis. Therefore out of 31 referred cases only 22 cases of GISTs (12 males, 10 females) were included in this study. The patient's median age was 51 years. GISTs most frequently occurred in the stomach (12 cases) followed by small intestine (9 cases) and colon (1 case). The size of tumors ranged from 2.5 to 15 cm. Also 72.7% of tumors were hypercellular. Benign spindle cell tumors were 31%, malignant spindle cell tumors 23%, benign epithelioid tumors 23% and malignant epithelioid tumors constituted 23%. Mucosal invasion and tumoral necrosis were present in 22.7% and 27% of cases, respectively: 72.8% of tumors had mitotic activity exceeding 5 per 50 hpf. The expression of other IHC markers were: Vimentin 63.1%, Desmin 13.1%, Smooth muscle actin 22.7%, S-100 protein 22.7% and CD34 63.6%.Conclusion: With regard to the crucial role of c-kit in the pathogenesis of GISTs, c-kit expression is essential for their diagnosis and therapy; therefore, tumors which are negative for c-kit, especially those with spindle fascicles, most probably are other mesenchymal neoplasms such as leiomyomas, schwannomas, etc., and should be classified according to their IHC markers. Long-term follow up of all GISTs patients is recommended.

Background & Aim: In radiographic evaluation of carpal instability, the standard method has been the measurement of a series of angles and the new triangulation ratio on lateral wrist radiograms. This study was undertaken to compare these indices in normal and unstable joints.Patients and Methods: Nineteen normal wrist radiograms along with 21 with plamar and 19 with dorsal instability patterns, taken in true lateral position, were enrolled in the study. In each radiogram six variants were measured: capitolunate, radiolunate, radiocapitate, scapholunate and radioscaphoid angles and the triangulation ratio.Results: Between the palmar and normal groups the difference between radiolunate and capitolunate angles and the triangulation ratio, and also between the dorsal and normal groups the difference between the radiolunate and scapholunate angles and the triangulation ratio was statistically significant. In addition, there was no discrete border between normal and abnormal angles.Conclusion: According to these results, it seems that the measure of these angles in itself is not adequate proof for instability of the wrist; however among the indices, radiolunate angle and triangulation ratio are more precise than the others.

Background & Aim: Septic discitis is an inflammatory process of the intervertebral disc which usually involves the disco vertebral junction and may extend in to the epidural space and para spinal soft tissues. The aim of this study was to evaluate spondylodiscitis cases (clinical, microbiological, radiological, treatment and complication features) in Firoozgar and Rasool-e-Akram hospitals during 1998-2003.Patients and Methods: The present research was an observational study done in periodic cross-sectional way on 50 patients with spondylodiscitis. Data collection including age, gender, predisposing factors, radiography, CT.Scan, MRI, CBC, ESR, and CRP was done. The results of aspiration or biopsy, prescription of drug and etc. were recorded through a checklist. Statistical analysis was done with spss 11.5 software.Results: Fifty cases of spondylodiscitis were identified, 25 patients were women (50%). The mean age of our patients was 48.20±20.70 years; 75 percent of patients were aged ≤65 years. The most common presenting symptom was back pain (86%). ESR was increased in 91.1% of patients. Diagnosis was originally made by MRI. TB spondylodiscitis was the commonest form of disease. The major predisposing factors were invasive procedure and frequent UTI (22% each of them).Conclusion: Spondylodiscitis should be considered in any patient who has severe localized pain at any spinal level, especially if accompanied by fever and elevated ESR. In developing countries such as Iran one of the important causes of this disease is Tuberculosis.

Introduction: From 1986 to 2005, for 20 years about 2010 renal transplantations (TX) have been performed in our center mainly from unrelated kidney donor. Various bacterial, viral, fungal infections and malignancy after transplantation have been reported due to use of suppressive medications. After 20 years of experience with kidney transplantation in Iran, there are many reports of various malignancies.Case Report: The patient was an 18 year old girl who had been under maintenance hemodialysis (HD) for 6 months. She underwent renal Tx from her father in March 2004. Pathological diagnosis of her native kidney was reflux nephropathy. She had an episode of rejection during the first month and was treated with anti lymphocyte globulin (ALG). Two months after renal Tx we planned to discharge the patient on triple immunosuppressive therapy with excellent allograft function. (Cyclosporine 150mg per day, Mycophenolate Mophtyl 1mg per day, Prednisolone 7.5 mg). Patient was readmitted in our center with fever, severe hirsutism and lower extremity weakness; cyclosporine toxicity and CMV infection was suggested. Treatment with gancyclovir was started and cyclosporine dosage reduced. CMV serologic test was positive significantly. IV gancyclovir and 2 months oral anti CMV therapy was initiated for the patient and dosage of cyclosporine reduced to 100 mg/daily. Five months after renal TX, patients was readmitted for progressive lower extremity weakness without focal neurological symptoms; 2 episodes of convulsion was noted clinically with normal renal function. On the first day of admission, CT of brain was done. Three space occupying lesions with different sizes were noted. Brain abscess, toxoplasmosis and CNS malignancy were 3 differential diagnoses in neurologic and neurosurgical consultation. Unfortunately under severe investigation and therapeutic strategies, patient died 2 weeks after admission with functional graft. Brain biopsy showed glioblastoma of brain.Conclusion: With the very interesting CT finding we conclude that in patients with lower extremity weakness other diagnoses besides drug toxicity must be considered. Also it is possible that occult glioblastoma, which is a rare and uncommon malignancy, was provocated with immunosuppression.

Background & Aim: Evaluation and classification of many renal lesions particularly glomerular diseases are only on the basis of renal biopsy. The clinician's request from the histopathologist is a timely and accurate diagnosis of renal damage which in addition to light microscopy is dependent on the assessment of immune deposits in renal biopsy and verification of immune deposits in Electron microscopy. IF (Immunofluorescence) method which is simple and rapid is gold standard. Due to limitation of this method, received paraffin blocks can be used for detection of immune deposits in IHC (Immunohistochemistry). Other advantages of IHC method include: permanence of stained slides, possibility of morphologic assessment of the lesion and correlation of deposit location and glomerular anatomy. Undoubtedly IHC method has disadvantages including complexity of the technique in comparison to IF, background staining, few numbers of available antibodies as well as being time consuming.Materials and Methods: In this comparative study renal biopsy specimens from Hasheminejad hospital, which were reported according to IF and light microscopy, were separated and then IHC with IgG, IgM, IgA, C3 and C1q, was performed on these blocks. IHC was based on Immunoperoxidase(IP) method. Presence, kind and location of deposits were recorded by light microscopy. At the same time, H&E, silver, trichrome and PAS stained slides were evaluated.Results: Immune deposits similar to IF were detected by IHC method in 20 out of 26 samples. IHC method couldnot detect visible immune deposits in 4 cases including amyloidosis, MGN (1 case) and IgA nephropathy (1 case). Therefore, sensitivity, specificity, accuracy, positive and negative predictive values of IHC method in diagnosis of renal biopsy specimens is 91%, 100%, 92%, 100% and 65%, respectively.Conclusion: It seems that due to high rate of sensitivity, specificity and accuracy, IHC method which is used by experienced technical staff, can be used as an alternative method for IF when there are no glomeruli in IF specimen or there is difficulty in taking a renal biopsy. Thus according to these finding, the renal pathological lab, should be equipped with both methods, and accountable pathologist, should recognize which method to be used on the basis of clinical state of the patient and adequacy of received specimen.

Background & Aim: With early detection of hearing loss at younger ages, there is a better chance for normal language and speech development. Delay in diagnosing hearing loss severely affects language/speech development, social abilities, academic progress, psychological status, job opportunities etc. The present study sought to determine the average ages of suspicion, diagnosis, and amplification of profound hearing loss and intervention in deaf children and to compare at-risk and not-at-risk children based on the studied ages.Patients and Methods: This descriptive-analytic study was conducted on 86 children under 6 years of age with profound bilateral hearing loss in Newsha Aural Rehabilitation Center in Tehran from July to December 2005. Data were gathered through the completion of a questionnaire by the children's parents. Also children's medical and rehabilitative records were utilized in order to determine the kind and degree of hearing loss.Results: The mean ages of suspicion, diagnosis, amplification, and intervention were 12.61±8.96, 15.24±9.32, 20.59±11.10, and 22.33±11.64 months, respectively; there being statistically significant differences between them. Also 47.70% of the children were in the high-risk group, and statistically there were no significant differences between the at-risk and not-at-risk children in the studied ages. Of all the neonatal diseases investigated, hyperbilirubinemia was the most frequent (40.70%), and there were also 4 cases of meningitis and 6 cases of measles. In terms of consanguinity, mating of first cousins was 41.90%; and mating of second cousins and farther familial relationships 14%. After suspecting hearing loss in their children, the parents had visited physicians (57%), audiologists (37.20%), speech therapists (2.3%), or other specialists (3.50%) for the first time. The economic circumstances of the families had a significant bearing on the average ages of suspicion, diagnosis, amplification, and intervention.Conclusion: Despite the remarkable improvement in the average ages of suspicion, diagnosis, amplification and intervention in comparison with those reported in a previous study carried out in Iran (2002), there is still noticeable difference between these ages and those suggested by the Joint Committee on Infant Hearing.

Background & Aim: Human parechovirus is a genus of picornaviruses which includes a number of important viruses of clinical significance. Recent sequence analysis suggests that human parechovirus type 1 (HPEV-1) is distinct from other picornaviruses and lacks the motives believed to be involved in the protease function of 2A. The aim of this study was to analyze proteolytic activity of 3C protein in human parechovirus type 1.Materials and Method: The region of HPEV-1 cDNA that was coded for 3C protein was inserted into plasmid pUBS by Ligase enzyme and pFG3 recombinant plasmid was prepared. After transformation and replication of this plasmid in E.coli MC 10.22, DNA was isolated by phenol extraction and then expressed in prokaryotic (E.coli BL-21) and in vitro systems under T7 promoter. The results were detected by SDS-PAGE and analyzed. Results: The products of expression of recombinant plasmid (not included 3C gene) in both prokaryotic and in vitro systems were analyzed. Just one large band (90 KD) was observed, but with plasmid including 3C gene, several small bands were detected. These results indicated proteolytic activity of 3C protein. After addition of anti protease to the products of plasmid with 3C gene the result was the same as the plasmid without 3C gene.Conclusion: The results showed that HPEV-1 has a processing strategy different from other members of picornaviruses, and 3C protein seems to be the only virus encoded protease that can catalyze cleavages of all sites in the parechoviruses primary polyprotein.

Background & Aim: Preterm infants born at less than 34 weeks postconceptional age are not as neurologically mature as their term counterparts and thus have difficulty coordinating sucking, swallowing and breathing. As a result, they are traditionally gavage fed until they are able to oral feed successfully. The aim of study was to evaluate comparative effect of orogastric and breast feeding on oxygen saturation in very low birth weight infant (<1500gm).Patients and Methods: In this clinical trial all babies admitted in the Neonatal Research Center of Imamreza Hospital, Mashhad during a 4 months period were elected. Criteria for entrance to study included birth weight ≤ 1500 grams, exclusive breastfeeding, having no special problem after 48 hours, receiving only routine care and intake of milk was 100cc/kg/day. Each neonate received two rounds of orogastric and breast feeding in the morning and in the afternoon, during which mean oxygen saturation was measured by pulse-oxymetry. During the study the heart rate and temperature of the neonates were monitored, and in case of hypothermia, bradycardia (less than 100 per minute) or apnea the feeding was discontinued and the study was repeated the following day. Data analysis was carried out using SPSS and EPI. For comparison & averages of qualitative and quantitative data one-way variance test and for studying the relation between qualitative data Chi Square test was used.Results: Fifty neonates were studied. The average birth weight was 1267.20±165.42 grams and average gestational age was 31.81±1.92 and female/male ratio was 1.2. There was no significant statistical difference in arterial oxygen saturation in orogastric and breast feeding in the morning and in the afternoon. (p=0.16 in the morning and p=0.6 in the afternoon). There was no complication of apnea, hypothermia or bradycardia.Conclusion: There was no significant statistical difference between the two methods in arterial oxygen saturation. It seems that oral feeding (which is a natural route) and skin contact between the mother and neonate causes a strong emotional bonding between the two and brings about better social adaptation for the neonate. Also shorter period of stay in hospital is more preferred, and breast feeding should be started at the earliest possible time after birth.

Background & Aim: Patients with congenital renal abnormality are more prone to calculus formation and have less chance of spontaneous stone passage. Percutaneous treatment of patients with calculi in an abnormal kidney can be challenging due to the altered anatomical relationship in the retroperitoneum. Therefore, we performed a review to assess the safety and efficacy of this minimally invasive technique in patients with congenital renal abnormality.Patients and Methods: We performed percutaneous nephrolithotomy (PCNL) in 15 patients with calculi in anomalous kidneys. Mean age was 34.8 years and 53.3% of the patients were males. The type of anomaly, size of stone, tract site, number of tracts, stone-free rate, transfusion and complication rate and need for secondary intervention were evaluated.Results: Majority of patients had horseshoe kidney (46.7%), 2 cases had ectopic pelvic kidney and 6 others had malrotated and miniaturized kidney. Renal access was obtained through upper pole calyx in 53.3% of the cases, a lower calyx in 33.3% and a middle calyx in 13.3%. Only two cases needed 2 tracts and re-PCNL was performed in 3 cases. Pleural injury occurred in 2 patients and was managed conservatively. There was no need for transfusion. Meanwhile 13 (87%) were completely and 2 (13%) were relatively stone-free after first or second look procedures.Conclusion: Percutaneous treatment of patients with renal calculi in an anomalous kidney is technically challenging, usually requiring upper pole access. The high stone-free rate and a relatively low incidence of major complications suggest that this minimally invasive method is an effective means of stone management in this complex patient population.

Background & Aim: In spite of the fact that many human beings suffer from chronic pain such as neuropathic pain the present clinical methods for treatment of neuropathic pain are not completely successful. 1,25 dihydroxy vitamin D3(1,25 Vit D3) the biologically active metabolite of vitamin D, can increase neurotrophin levels and inhibit the synthesis of nitric oxide synthase which both have potential roles in nociceptive processing. The presence of nuclear receptors of vitamin D in central nervous system indicates the role of this hormone in brain and spinal cord. Vitamin D deficiency in young people is one of the reasons of chronic pain such as musculoskeletal pain. The present experiment was conducted to identify the effects of 1, 25 Vit D3 on pain behavior in neuropathic rat model.Materials and Methods: For this reason 40 male Wistar rats weighing 200-250 g were allocated to four groups each including 10 rats. A mononeuropathy was produced by chronic constrictive injury (CCI) of the sciatic nerve. 1, 25 Vit D3 was administered by an i.p. injection every 2 days during a month after CCI. In order to evaluate mechanical and cold allodynia, Von frey and acetone tests were used respectively. Rats were tested before CCI, the day after CCI, and every week following CCI. For statistical comparison, ANOVA and Newman kules were used and P<0.05 was considered as significant.Results: Injection of Vitamin D in normal rats did not change pain threshold. Findings revealed the exaggerated responses in the group which received CCI. The group which was treated by 1,25 Vit D3 showed a significant reduction in responses in comparison with the other groups. Injection of Vitamin D increased cold allodynia from the first day of experiment and there was a signifficant difference between Vitamin D with vehicle group which lasted until the end of experiment. In regard to mechanical allodynia, there was a significant difference between vitamin D and the Vehicle group in the fourth week of experiment.Conclusion: Our results suggest that 1, 25 dihydroxy vitamin D3 does not affect the pain threshold in normal animals but reduces abnormal pain in the rat model of neuropathy. The effect of Vitamin D on mechanical and cold allodynia came up with different initiation times and abolishes cold allodynia more effectively than mechanical allodynia. So administration of Vitamin D in clinic may provide new approach for treatment of chronic pain.

Introduction: Tuberculosis is a common disease in developing countries. Extra pulmonary tuberculosis with involvement of pancreas is rare. Abdominal pain especially in epigastrium, fever, night sweat, jaundice and weight loss with pancreatic mass especially in young people is suggestive of pancreatic tuberculosis.Case Report: We report a 51 year old lady with fever, epigastric pain and weight loss from 2 months prior to admission. On sonography and abdominal CT scan a mass lesion was seen in head and body of pancreas with lymph node involvement. Workup with CT guided BX of pancreatic tissue and laparatomy was done. Pathologic report showed granolumatous lesion with caseous necrosis in pancreatic lesion and lymph nodes compatible with tuberculosis.Conclusion: Patient was put on 4 anti tuberculosis therapy; response was good. Patient improved.

Background & Aim: Chemotherapy may induce mild to moderate glomerular or tubular disorders. We evaluated tubular and glomerular function in children who underwent chemotherapy.Patients and Methods: Between 2003 and 2005 all pediatric cancer patients were entered in a cross sectional prospective study. Demographic data, cumulative doses of anticancer drugs, history of antibiotics, nephrectomy, radiotherapy, and acute renal failure were recorded. Fractional excretion of magnesium, calcium, phosphate, amylase, creatinine clearance(KL/Pcr), and urine protein to creatinine were calculated. The nephrotoxicity was graded from 0 to 9. Pvalue less than 0.05 was considered significant.Results: A total of 233 children(140 males, 93 females) aged 10.5 years(±5.5 SD) on average were enrolled in the study; 154 out of 233 patients had lymphoproliferative malignancies and 79 cases has solid tumors. The mean duration of treatment was 28.65 months and the mean duration of therapy discontinuation was 25 months. According to stage of treatment three groups were identified including initial(n=22),  during(n=63) and discontinuation(n=148); 28 children had hypertension. The observed renal disorders were as follows glucosuria(n=3), magnesuria(n=9), diluted urine(n=96), metabolic acidosis(n=125), creatinine clearance less than 80ml/min(n=51), phosphaturia(n=55), hypercalciuria(n=96), Amylasuria(n=36) and proteinuria(n=62). Also 207 had mild to severe renal nephrotoxicity. The grade of nephrotoxicity was higher in children<5 years, with history of nephrectomy, radiotherapy, or use of nephrotoxic antibiotics(Kendall-tau, P<0.05). Renal dysfunction was higher during chemotherapy especially with platinium, epipodophylotoxin or ifosphamide (P<0.05).Conclusion: Frequent evaluation of renal function is highly recommended in children during and after termination of chemotherapy.

Background & Aim: Postoperative pain is a bad experience which can cause many complications for patients. Nowadays many methods are used to eradicate or decrease pain and the most common methods are use of analgesics and other drugs. One of these methods is infiltrating local anesthetics in the surgical field. The aim of this study was to evaluate the effect of time of administration of analgesics (i.e before incision or before repair of incision) on post operative analgesia.Patients and Methods: Sixty patients undergoing herniorrhaphy were randomized to one of the three treatment groups. The patients were assigned randomly to three groups: Group A (preincisional): "pre" contained 10ml of 0.25% bupivacaine and "post" contained 10ml of 0.9% saline. Group B (postincisional): "pre" contained 10ml of 0.9% saline and "post" contained 10ml of 0.25% bupivacaine. Group C (control): both syringes contained 10ml of 0.9% saline. All patients underwent a general anesthesia induction and maintenance. After positioning and draping 10ml of the "pre" was infiltrated into the incision site; after surgery and prior to closure of incision the "post" was infiltrated in the incision.Results: The rate of pain and its scoring were significantly lower in the first group (preincisional) then two other groups (P<0.05). Hemodynamic variables had no significant difference in the three groups. In the first group, patient's rate of pain at the first and second analgesic requests was significantly lower than the second group; both being lower than control group. Also the mean dose of analgesia in the first 24 hours after the operation was lower in the first group then in the other two groups (P<0.05).Conclusion: The results show that postoperative analgesia gained by infiltration of local anesthetics in the surgical field before herniorrhaphy can reduce the rate of pain and the need for administering analgesics significantly.