Razi Journal of Medical Sciences
Year:2012 | Volume:19 | Issue:105|Papers Count:13

Background: Empyema remains a challenging issue for thoracic surgeons. In the early stages of empyema antibiotic therapy and pleural space drainage are the treatment of choice. In organized empyema with pleural peel and re-expandable underlying lung, decortication is the procedure of choice. There is agreement about the value of Video Assisted Thoracoscopic Surgery (VATS) in the management of stages I and II empyema, but there are doubts about its efficacy in stage III empyema. We seek to evaluate the comparative merits of thoracoscopic versus open decortication in the surgical management of patients with chronic postpneumonic pleural empyema.Methods: From March 2004 to December 2010, 50 patients (43 males, 7 females, mean age: 37.6 years, range: 13-75 years) with chronic postpneumonic pleural empyema underwent decortications. It was a retrospective cross-sectional study. The data was gathered by investigating the patients medical records and analysed by SPSS17.Results: Decortication was performed by open thoracotomy in 29 (58%) patients and VATS in 21 (42%). Mortality was 6.5%.There was no difference in terms of re-operation, mortality and success rates. The operation time in (OT) thoracotomy group was shorter (p=0.03). Hospital stay, drainage duration and antibiotic therapy in VATS group was shorter. There was no statistical difference in regard to the success rate between the two groups.Conclusion: According to the results of this study we found that success rate of VATS decortication is comparable to open thoracotomy, however, a multicentric-randomized trial should be performed before video thoracoscopic decortication becomes the gold standard for the treatment of pleural empyema.

Background: Myasthenia gravis is an autoimmune disorder mainly caused by antibodies to the muscle acetylcholine receptors (AChR-Ab) at the neuromuscular junction. Loss of these receptors leads to a defect in neuromuscular transmission with muscle weakness and fatigue. This antibody is not detected in all the patients and electrophysiologic study is necessary in some patients as a diagnostic tool. The serologic and electrophysiologic tests in Myasthenia gravis are evaluated in this study.Methods: One hundred twelve patients entered in a cross-sectional study. Serum AChR-Ab was measured andRepetitive nerve stimulation (RNS) was done. The frequency of positive AChR-Ab and abnormal RNS and the relationship between them were determined.Results: Thirty (26.8%) patients were males and 82 (73.2%) were females. Mean of age was 37.6±15.4 years. AChR-Ab was positive in 71 (63.4%) and negative in 41 (36.6%). RNS was done in 101 patients and was abnormal in 74 (73.3%) and normal in 27 (26.7%) patients. Ratio of abnormal RNS was 84.4% and 53.7% in seropositive and seronegative patients, respectively (p=0.001).Conclusion: There is significant relationship between serologic and electrophysiological findings in Myasthenia gravis. Combining electrophysiological and serological tests could increase the accuracy of Myasthenia gravis diagnosis.

Background: Multiple sclerosis (MS) is the most prevalent central nervous system demyelinating disease. There are known risk factors for MS. However, there is uncertainty in its protective factors. Few studies have demonstrated that some chronic infections may have protective effects on this disease. We carried this study to investigate the relation between Helicobacter pylori (HP) infection and the prevalence and severity of MS.Methods: In this case-control study, 163 MS patients and 150 sex- and age- matched controls were included. Blood samples for IgG and IgM anti HP antibodies were collected from all individuals. Also the Expanded Disability Status Scale (EDSS) was used to evaluate the MS patients. Suitable statistical analysis was applied.Results: A significant difference was observed in seropositivity between these two groups. (p<0.001), but no significant difference was seen in seropositivity between conventional and opticospinal MS (p=0.522). No significant difference was observed in seropositivity among ages (p=0.075) and between genders (p=0.204). A significant difference was seen in EDSS value between seropositive and seronegative patients (p=0.017).Conclusion: We concluded that patients with HP infection had lower incidence of multiple sclerosis and MS patients with HP infection showed lower neurologic complications, which can demonstrate that HP infection may have a protective influence on MS pathogenesis.

Background: With the innovative idea of Central Vein Catheter at the end of 80's, treatment of hemodialysis patients faced a significant change. Nowadays CVC's are widely used and as a result CVC related complications have become important for surgeons. In this study survival and complications associated with CVC's have been studied in End Stage Renal Disease (ESRD) patients referring to Shahid Hasheminejad Hospital during 2010-11.Methods: In this cross- sectional and descriptive study, all documents of ESRD patients’ that had catheter insertion at Hasheminejad Kidney Center during 2010-11 were included and demographic data, catheter related side effects, site of catheter, and duration of catheter utilization were taken from the records and major catheter related complications, reasons of catheter removal were obtained by descriptive analyses. We also calculated survival of catheters by Kaplan-meyer analytic method.Results: In this study 150 records were enrolled with 122 male and 28 female patients, and a mean age of 56±15 years (range of 19-87 yrs). Regression analyses had shown that increasing age (p=0.003, RR=0.78), Hb (anemia), (p=0.04, RR=0.34), increased BUN (p=0.014, RR=0.37) and Cr (p=0.023, RR=0.45) levels had significant correlation with the side-effects. One and two months catheter survival were 88% and 69%, respectively.Conclusion: Side effects were not higher than similar western studies. Studied patients had higher rates of anemia. Catheter thrombosis was reported as the second and local infection as the first common side effects. Survival of central vein catheters in Iran was similar to earlier conducted studies.

Background: This study was conducted to summarize the main accomplishments of implementing the first phase of health system financial reform (establishment of accrual accounting) from the management development and resources assistants points of view in universities affiliated with Ministry of Health and Medical Education (MOHME).Methods: This was a cross-sectional descriptive research that was performed in a census way in 2011. An instrument tool was a teacher made 23-item check list in 8 dimensions that was approved for its face and content validity with expert view and split half was applied confirming its reliability. Data was analyzed using Excel.Results: The highest ratio of stated accomplishments was related to recognition of revenues (86.5 out of 100) versus the lowest one belonging to external effects (37.9 out of 100). Moreover the most rate of diversion in answers was seen in units' financial autonomy.Conclusion: According to the significance of establishing accrual accounting accomplishments in units affiliated with MOHME and in order to achieve a broader spectrum of expert views, it is recommended to conduct similar studies with a qualitative approach on this study population.

Background: Changes in load during asymmetric holding may be associated with particularly high risk of loss of balance and spinal injury. Therefore, in order to assess occupational lesions and to make preventive rehabilitation programs in such conditions like holding dynamic loads in asymmetric postures could be important.Methods: In a cross-sectional study, COP amplitude and velocity sway were studied in 14 normal male volunteers during holding static and dynamic load in symmetric and asymmetric postures.Results: Similar Anterior-Posterior responses to the postures were seen, although asymmetric postures showed a larger Medial-Lateral COP amplitude and velocity sway (p<0.05). While dynamic load increased Anterior-Posterior and Medial-Lateral postural parameters in asymmetric posture (p<0.05), we observed increase only in Anterior-Posterior direction in symmetric posture (p<0.05).Conclusion: The results showed that dynamic load challenges the postural stability control, with a higher effect in asymmetric posture.

Background: Shoes is the first point of contact between the foot and the ground in walking. Any change in that could affect the balance and postural stability. The risks associated with slipping and falling is related to the materials of footwear, surface condition, and geometric design of the shoe sole. The aim of this study was to measure the effect of different shoe sole tread groove depths on the stability during walking on dry and slippery surfaces.Methods: In this semi-experimental study, 22 healthy young men with average age 24.5±3.43 years wore the oxford standard shoe and walked on two different surfaces (dry and slippery) with three different groove depths (1, 2.5 and 5 mm). In fact, there were six different test conditions. Data was collected by the VICON Motion Analysis system and Force plate set. The Paired T-test was performed to study the effects of groove depth and surface contamination on the Coefficient of Friction (COF) and Fluctuations Rate of Ankle (FRA).Results: The results showed that on slippery and dry surfaces, increase in groove depths leads to increase of COF and decrease of FRA (p<0.05). Also values of COF on slippery surface were less than dry surface significantly (p<0.01).Conclusion: The aim of this study was to find the groove depth which has the optimal stability. In our study, the deepest groove (5 mm) was better for reduction of FRA and increase of COF during walking on slippery and dry surfaces.

Background: Tuberculosis (TB) is one the oldest known diseases in human. According to its high prevalence in Iran, using a diagnostic procedure with more rapid result than culture, more sensitive and specific than smear and near to culture can help us to diagnose and treat the disease rapidly and accurately, and thus control it in the community. So we decided to evaluate PCR for the diagnosis of Tuberculosis in Broncho-alveolar Lavage (BAL) and compare it with smear.Methods: Patients who were admitted at Hazrat Rasoul Akram Hospital during 2 years of 2010-11 with the impression of tuberculosis and underwent bronchoscopy were included. Their BAL was sent for smear, culture and PCR for tuberculosis diagnosis. Data were analyzed by mean and standard deviation and p Value under 0.05 was considered significant.Results: Forty seven patients with probable pulmonary tuberculosis underwent bronchoscopy. BAL cultures were positive in 6 (12.8%) patients, smears in 5 (10.6%) patients and PCR in 3 (6.4%) patients. According to this result smear had 83% sensitivity, 100% specificity, 100% PPV and 98% NPV. However PCR had 50% sensitivity, 100% specificity, 100% PPV and 93% NPV.Conclusion: Although PCR is a rapid and new tool for TB diagnosis, smear- which is an older way is simpler has lower cost and is feasible in all points of Iran and still is a better method for TB diagnosis.

Background: The aim of this study is to evaluate the prevalence of sexual dysfunctions and their related factors in women referring to health clinics in Tehran.Method: The study was performed as a descriptive analytic study. For this purpose, 405 married women were selected from 4 clinics of four geographic areas (north, south, west and east) in Tehran city (30 people from each center) through randomized and multistage sampling. The assessment was done by using demographic questionnaire and Sexual Function Questionnaire (SFQ). The research data were analyzed by independent t-test and one-way ANOVA and correlation test.Results: The results of data analysis showed general prevalence of sexual dysfunction in women were 31%, so that the prevalence of hypoactive sexual desire was 33%, the prevalence of sexual arousal disorder was 16.5%. The prevalence of orgasmic disorder was 25% and the prevalence of painful sexual disorder (dyspareunia) was 45.5%.Conclusion: The assessment of related factors showed that age of women, duration of marriage, positive history of psychiatric disorders and using psychotropic medication and also history of sexual abuse had significant correlation with sexual dysfunction.

Background: Hypertension is a common chronic disease with increasing prevalence worldwide. Regular close monitoring of blood pressure is key point of hypertension management. Home monitoring of blood pressure has its own problems such as lack of early access to a physician in case of emergency. In this study we have designed a device that could send the patient's self-measured blood pressure to physician.Case report: A 56 year old woman with a 6 year history of hypertension was enrolled to the study. After giving information about using the device, we gave it to her. With each use of device at home we received an SMS (Short Message Service) on patient's blood pressure that were coordinated with self-recorded blood pressures. This device consisted of a designed electronic board and installed components (such as programmed mobile board and micro controller) placed on the board and attached to a blood pressure measuring device. After pushing a button, the blood pressure was measured spontaneously and data shown on an LED monitor and sent through GSM (Global System for Mobile Communication) by a sim card to the physician.Conclusion: This new device helps physicians to control patients’ blood pressure closely without any extra cost. Also using this device will decrease the rate of complicated hypertensive attacks.