JOURNAL OF MEDICAL RESEARCH (JMR)
Year:2004 | Volume:3 | Issue:1|Papers Count:9

Background: The therapeutic effect of methotrexate (MTX) and doxycycline (DOX) in the treatment of rheumatoid arthritis (RA) patients has been documented previously. However, only limited studies have compared the therapeutic effects of these two drugs in RA. This prospective, double-blind study was conducted to compare the therapeutic as well as side-effects of MTX and DOX in patients with RA. Patients and Methods: From June 2003 to July 2004, one-hundred eligible patients with active RA were enrolled in to a 16-week clinical trial and were randomly assigned to two treatment groups. Seventy-eight patients finished the study (39 patients in each group). All patients received less than 10 milligram per day of oral prednisolone. Group I (DOX group) received 100 milligram of oral DOX twice a day and Group II (MTX group) received 7.5 milligram of oral MTX weekly. Clinical symptoms and signs including tender swollen joint counts, Ritchie Arthicular Index, morning stiffness, visual acuity scale of pain (VAS), grip strength, and laboratory measurements including hemoglobin level, platelet and white blood cell counts, erythrocyte sedimentation rate, C reactive protein and rheumatoid factor were evaluated in each patient. Results: Demographic, clinical and laboratory measurements were statistically similar in both groups. At week sixteen, 78 percent of the patients in each group continued to receive the medications. At week 16, both groups showed statistically significant improvement in clinical and laboratory measurements. No statistically significant differences were detected between the treatment groups in the clinical and laboratory variables except for VAS that showed more improvement in the MTX group (p=0.09). Also, there was no significant difference in physician overall assessment. Minor adverse effects (gastrointestinal versus skin) were more frequent in the DOX group (46 percent in the DOX group versus 28 percent in the MTX group) (p=0.001), although withdrawals because of severe adverse effects were similar in both groups (2.5 percent). Conclusion: Except for a higher improvement rate in the visual acuity scale of pain, methotrexate did not demonstrate any advantage in efficacy over doxcycline within the time frame of the study. Although doxycycline administration was accompanied with more frequent minor adverse effects, severe adverse effects were similar in both groups.

Background: Oral metronidazole (OM) has been used in elective colon surgery and appendicitis as a prophylactic agent to reduce the chance of wound infection. However, for ethical reasons it has not yet been advised in humans in the presence of bacterial peritonitis. The efficacy of OM in rabbits with fecal peritonitis is shown in this study. Materials and Methods: The study was conducted in three groups of rabbits (14 in each group). Fecal peritonitis was induced by injecting one milliliter solution of human feces containing 1010-1011 organisms per milliliter into the peritoneal cavity. About 8 hours later, at which time clinical signs of infection (septicemia) were established, a treatment course lasting for 5 days was started as follows: Group I (GI) received no metronidazole, Group II (GIl) received OM (syrup) 50 milligrams per kilogram per day (q12h); Group III (GIII) received parenteral metronidazole subcutaneously with the same dose as in GII. Gentamicin 5 milligrams per kilogram per day (q12h), used for eradication of gram negative aerobic organisms, was also given intramuscularly to all rabbits for five days. The rabbits were followed clinically. General condition, activity, appetite, daily weight, heart rate, respiratory rate and rectal temperature were recorded. All rabbits were supported with parenteral solution as long as required. Autopsy was performed two weeks later (9 days after the treatment course) for any evidence of pelvic collection. Results: Five rabbits died in GI, 1-3 days after peritonitis was induced but no death was recorded in GII and GIII (p<0.04). Autopsy revealed pelvic collection in 1 out of 9 alive rabbits (11%) in GI while no collection was present in GII and GIII (p=0.39).The mean duration of fever (>38.5° C), tachycardia (>150/min) and tachypnea (>60/min) in days, in GI, GII and GIII were as follows respectively, 4\3\4, 3\1\1 and 3\1\1 days. Mean daily weight loss (grams per day) during the treatment course in the same order was 30\10\0, after which daily weight gain was 30\40\46 grams per day, respectively. All rabbits in G1 remained inactive and were also severely anorexic for 3-6 days (mean 5.3 days), while this condition lasted for an average of 4.2 and 3.2 days in GII and GIII, respectively. In other words, recovery time in GII and GIII was much faster than GI (4.2 and 3.2 versus 5.3 days). Conclusion: OM is an effective drug in bacterial (fecal) peritonitis induced in rabbits.

Background: Fracture of neck of femur has always presented great challenges to orthopedic surgeons. Redisplacement and impending non-union can occur almost immediately or up to several months after fixation. Avascular necrosis (AVN), the major complication, can be Seen as early as 6-9 months but most typically occurs during the second year after fracture. Patients and Methods: Over an eight-year period (1993-2001), 78 consecutive cases of femoral neck fracture who were referred to Chamran Hospital, affiliated to Shiraz University of Medical Sciences, were treated by a single surgeon by closed reduction under fluoroscopy and fixed by three cannulated screws. Then, miniarthrotomy was performed for removal of hematoma and joint decompression. Fractures were classified according to Garden classification and clinical evaluation was done by Hams Hip Scoring. Results: From 78 patients with an average age of 40.3 years, 42 were female and 36 were male. At follow-up of about 2.5 years, 42.3 percent were rated as excellent, 33.3 percent as good, 15.4 percent as fair and 9 percent as poor. Avascular necrosis of the femoral head was seen in 16.66 percent, and delayed union in 6.4 percent of the patients. No non-union was recorded. Conclusion: It seems that joint decompression may decrease the rate of AVN in femoral neck fracture. Aspiration of joint hematoma by angiocatheter or miniarthrotomy in the treatment of fracture of neck of femur may reduce the avascular necrosis.

Background: One of the most common surgical procedures is colorectal surgery and subsequent colectomy and anastomosis. Oral intake has usually been withheld for these patients for several days after operation which causes impairment in healing of the anastomosis due to mucosal atrophy and reduction of immune capacity of the bowel. Also, it increases the possibility of post-operative complications such as prolonged ileus and intra-peritoneal adhesion. This study compares early and late-onset postoperative enteral feeding after colon anastomosis in rabbits. Materials and Methods: This study was carried out in an animal laboratory during a 5-monthperiod on 30 rabbits that were randomly divided into two equal groups of 15 rabbits, Group I as the control group and Group II as the case group. All the rabbits had a pre-operative mechanical bowel preparation by ingestion of milk of magnesium, and then, they were anesthetized and underwent laparatomy, cutting of the transverse colon, and end-to-end anastomosis. Oral intake was started 72 hours after surgery in Group I (control) and 12 hours after surgery in Group II (case). At the tenth post-operative day, all the rabbits underwent autopsy and the sites of anastomosis were examined for assessment of the healing process and evidence of leakage and the peritoneal cavity was checked for adhesions. The anastomotic segments were removed for histopathological evaluation. Results: The frequency of anastomotic leakage at the site of anastomosis and subsequent death were 6.6 percent in Group I and zero in Group II. All of the rabbits in Group II tolerated oral feeding after 12 hours. Autopsy of the rabbits showed intra-peritoneal adhesion in Group I, which was very severe in 14.2 percent, severe in 21.4 percent, moderate in 25.7 percent and minimal in 28.5 percent. In Group II, the severity of adhesion was as follows; no case with very severe adhesion, severe in 20 percent, moderate in 26.6 percent and minimal in 53.3 percent (p<0.05). The histopathological study showed complete healing in two-thirds of the samples in both groups (64.2 percent in Group I and 66.6 percent in Group II) and the remaining had partial healing. Conclusion: Early oral feeding after colon anastomosis not only has a favorite effect on anastomotic healing but also may reduce post-operative complications such as leakage at the site of repair and adhesion band formation.

Background: Rhegmatogenous retinal detachment (RRD) is a common cause of reduced visual acuity which may be prevented or treated in most situations. Knowledge of epidemiological characteristics of RRD can lead to an increase in the insight of physicians in the management of these patients. The aim of this study was to evaluate the epidemiological characteristics of RRD and long term outcome of primary scleral buckling in patients who underwent this procedure as a routine management for RRD at Khalili Hospital in Shiraz. Patients and Methods: In this retrospective study, charts of 400 eyes belonging to 360 patients with RRD who underwent scleral buckling from 1991 to 2001, with complete follow-up data were reviewed. In this study, results of first scleral buckling were evaluated. Reattachment of retina at sixth postoperation month was defined as late anatomical success and visual acuity of ≥20/400, 6 months post-operatively, was defined as the late functional success. Results: Forty percent of the eyes were aphakic or pseudophakic, 32 percent had lattice degeneration, 23 percent were myopic, 14 percent were post-traumatic and 18 percent were without the mentioned risk factors. The mean age of patients was 47±19.84 years (4-80 years). Most of the patients were more than 60 years old but there was another peak in 10-19 year-olds. RRD was more common in males (62.5%). Retinal detachment with aphakia or pseudophakia was more common in males (p=0.01) but lattice degeneration was' more common in females (p=0.01). There was no significant male predominance in traumatic patients (p=0.1). There was no significant difference between warm and cold seasons in initiation of the detachment (p=0.067). Seventy-three percent of the eyes had subtotal RD and in 86.5 percent of eyes, macula was detached. Preoperatively, proliferate vitreoretinopathy (grades B or Cl) was seen in 49.5 percent of the eyes. Round hole was seen in 49.3 percent of the eyes, flap tear in 38.9 percent, operculated tear in 2.9 percent and dialysis in 8.9 percent. In 20 percent, no hole was detected. The most common site for holes was infratemporal, but for tears, it was supratemporal and for dialysis it was infratemporal. Bilateral detachment was seen in 11.11 percent. The late anatomical success rate was 79.5 percent and late functional success rate was 46 percent. In comparison to other risk factors, success was lower in aphhakic or pseudophakic patients (p<0.001). Conclusion: Scleral buckling is a successful method in treating RRD. Exact determination of risk factors and attention to them preoperatively, can increase the success rate.

Background: Thalassemia is a common genetic disorder resulting in reduced hemoglobin synthesis. Left ventricular (LV) dysfunction is the main cause of death in β-thalassemia major patients. The objective of this study was to determine LV dysfunction risk factors in β-thalassemia major. Patients and Methods: One hundred and forty-four β-thalassemia major patients on regular blood transfusion and iron chelation treatment with subcutaneous deferoxamine were divided into 3 groups according to echocardiography findings. Group 1 included patients without any cardiac impairment, Group 2 with LV dilation but normal LV function and Group 3 with LV dysfunction. Hematological data and echocardiographic findings were compared among the three groups. Results: inty-five patients (66%) were included in Group 1, 29 (20%) in Group 2 and 20 (14%) in Group 3. The three groups had different LV end systolic diameters (LVESD) (p<0.001). In the comparison of LV shortening fraction (SF) and LV ejection fraction (EF) among the groups, Group 3 showed the lowest value (p<0.001). No correlation was observed between the number of blood transfusions and both SF (r=-0.181, p<0.05) and EF (r=-0.202, p<0.05). Age at the beginning of deferoxamine treatment had a positive correlation with both LVESD (r=0.200, p<0.05) and LV end diastolic diameter (LVEDD) (r=0.260, p<0.005). Conclusion: Since there was a lack of significant correlation between serum ferritin level and echocardiographic findings, ferritin can not be regarded as a determining factor for cardiac iron storage. Those patients who had severe anemia and who underwent deferoxamine treatment later in life had a higher risk for LV involvement.

Background: The effect of glucose 6-phosphatedehydrogenase (G6PD) deficiency on the hematological indices of beta thalassemia minor is not fully understood. Because both genetic disorders are common in our region, the effect of one on the other may cause some misinterpretation of hematological indices during screening programs for beta thalassemia minor. Patients and Methods: From the summer of 1998 to the summer of 1999, 4750 individuals were screened for beta thalassemia minor and G6PD deficiency before marriage, in Walfajr Reference Laboratory affiliated to Shiraz University of Medical Sciences. Results: Out of 4750 individuals, 475 (10%) were found to have thalassemia minor and 309 (6.5%) were deficient in G6PD.Among the 475 individual with thalassemia minor, 53 persons (11.15%) were G6PD deficient (Z=4.27, p=0.041), which showed a statistically significant difference between this group as compared to the general population. Patients with thalassemia minor were divided into two groups; Group I included individual with thalassemia minor and G6PD deficiency (53 persons) and Group II included thalassemia minor cases with normal G6PD activity (422 persons). Hematologic indices were compared and there was no significant difference between mean RBC count, Hb, MCH, MCHC and hemoglobin distribution width (HDW) between these two groups, except that mean MCV was slightly higher in Group I than Group II (64.03±3.34 fL vs. 63.23±4.60 fL, p=0.07) which could be due to reticulocytosis that is present in G6PD deficiency. Conclusion: In our region, the frequency of G6PD deficiency is significantly higher in thalassemia minor individuals (nearly two-folds) but it has no significant effect on hematological indices. Therefore, screening Methods for beta thalassemia minor needs no revision.

Giardia lamblia, is one of the most common pathogenic parasites worldwide. Chlorination systems hava no effect on the cyst of this parasite. Hence, one of the most common ways of transmission of Giardia lamblia, is contaminated tap water. The aim of this study was to determine the effect of direct electricity current (DC) on disinfection of Giardialamblia from tap water. Tap water was used to decrease any probable bias. Water was boiled for about 30 minutes for decolonization and sterilization. 105per milliliter of Giardia lamblia cysts were prepared and added to 9 milliliters of boiled water in a semicylindrical tank which had two platinum plates at the two ends of the main slot. Then, DC electricity current of 10 and 15 milliamperes (mA) were switched on for 1, 2 and 4 minutes. The light absorption of the following samples were obtained with 15 mA: a- samples of suspension before initiation of electricity current. b- samples of suspension after initiation of electricity current. c- samples of washed tank with 10 milliliters after emptying the recent solution and using reversed current. Using elctrodiagnostic setups, circuit impedances were measured from the tank solution, near the electrodes and the whole circuit. With 10mA DC currents, even after 4 minutes, the giardia counts were reduced to 1/10 of its previous level but, when 15mA current was applied for two minutes, no giardia was seen in the water or the samples from surfaces of the electrodes. Light absorption increased in samples of the solution after initiation of electricity current. Also, reverse electricity current had some absorption. Impedance measurements showed that the maximum current and highest disinfection was around the electrodes which had minimum electrical resistance. The results indicate that DC currents can purify tap water from Giardia lamblia in a short time and with low intensities of electricity current without any major effects on the pH and temperature of water.