Jundishapur Scientific Medical Journal
Year:2007 | Volume:5 | Issue:4 (51)|Papers Count:21

Objective: Major Thalassemia is a chronic haemolytic anemia. It is the most common hemoglobinopathy disorder in Khuzestan province. Hypoparathyroidism is one of its endocrinologic complications due to iron deposition especially in second decade of life. Early diagnosis of this complication can prevent other severe disorders such as seizure, osteopenia, osteoporsis. The aim of this study was to study the prevalence of hypoparathyroidism among this group of patients.Subjects and Methods: In this cross-sectional study, 96 patients with major Thalassemia aged above 10 years old referring to Shafa Thalassemia centre. The following information were collected: age, sex weight, duration and route of deferral injection, duration of transfusion therapy, vit-D and calcium consumption, social and educational level of parents, history of splenectomy, any history of seizure, tingling, chvostek, trousseau, carpopedal sings, plasma level of calcium, phosphorus, ALK.P, PTH, Bun, Cr, Ferritin, and total protein.Results: The age of the patients ranged from 11 to 39 (mean 19.3 years). The prevalence of hypoparathyroidism was 27.1% (26 out of 96). All these inflected patients had low serum calcium; low PTH, high serum phosphours and low to normal ALK P. Tingling, chvostek sings, trousseau, and carpopedal spasm were observed in 46, 38.4, 30.7, and 11.5 % of the patients respectively. Sixty nine % of these only had one clinical sing, while 30.8 % had none. No significant correlation between social and educational level of parents with hypoparathyroidism (p= 0.74). In 58% patients level of serum ferritin was above 4000 ng/ml The average level of serum ferritin in thalassemia patient without hypo-parathyroidism was 2770 ng /ml while in10 patients thalassemic patients with hypoparathyroidism this level was 5020 ng/ml. Seven patients with irregular deferral administration had overt hypoparathyroidism. A significant correlation was observed between irregular deferral consumption with high ferritin level and hypoparathyroidism (p<0.01).Conclusion: The finding of this study suggest that, irrespective of their clinical sings, at 6 monthly or yearly intervals,  the plasma level of PTH, Ca and ALK P of all patients with major thelassemia aged above 15 should be tested.

Objective: Acute appendicitis is one of the most common acute surgical interventions. The base of treatment is surgery but, preoperative and postoperative steps have important role in its outcome. The usefulness of administration of prophylactic antibiotic in acute appendicitis and antibiotic treatment in gangrenous appendicitis and peritonitis has been proved but antibiotic treatment in the first 24h after appendectomy in supurative appendicitis is not clearly defined. Therefore, the aim in this study we try address this problem.Subjects and Methods: In this prospective and blind clinical trial study which was carried out over three years (1379 to 1382) in three educational hospitals affiliated to Ahwaz Jundishapur University of Medical Sciences, on all the cases of supurative appendicitis. In this study 200 patient were divided in two equal groups. The first group was treated with prophylactic antibiotic (cefazolin and metronidazole) in addition to cefazolin and metronidazol 24 h after surgery while the second group only received prophylactic antibiotic treatment. Both groups of patients were followed up for two months and compared for wound infection, post –operative fever, abdominal and pelvic abscess, wound dehiscence and duration of hospitalization.Results: The mean age in was 18.5 y (range 15-40 y) and there was male (56 %). The results showed that there were no significant differences between the selected groups in relation to the rate of wound infection, post-operative fever, and duration of hospitalization which, in group 1 and 2, respectively, were 4 and 6 %, 6 and 8 % and 2.6 and 2.8 days. In addition, there were no cases of abdominal and pelvic abscess and wound dehiscence in either group of patients.Conclusion: The findings from this study show that post-operative antibiotic treatment has no clinical value in reducing the incidence of wound infection, post operative fever, and on the duration of hospitalization. In patients who undergo appendectomy for acute supurative appendicitis.

Lefort I osteotomy is widely used in orthognatic orthodontic surgical operation which fascilitates the easy access to skull base, clavius and first cervical vertebra. Angiofibroma is a highly vascular tumour which, at stage III, can invade skull base or extends into the cranium or the diverticula through natural skull foraminae. In this retrospective study we report 8 cases that were operated upon by Lefort I osteotomy method and the outcome of which was compared with the results from other methods in regards to disease control and prevention of recurrence. Furthermore, because of the instability nature of tumour, particularly after the surgical intervention and manipulation, there is as yet commonly accepted surgical method that can identify and remove the tumour residues at the depth of operation site. So far 65 different methods have been studied for the control of such tumours. At present eight surgical operation approaches have been favoured and regarded by reputed specialists to be the most common and rational ones, namely: trans- nasal, palatal, hyoid, antrum, maxillary, zygoma, craniufronta and lateral rhinotomy. In this paper, we report 8 cases of angiofibroma with wide extention to the skull base. All patients were operated by Lefort I osteotomy with or without endoscopy and monitoring. Seven cases were controlled with no recurrence. This was compared favourably to 33.3% success rate in 15 cases that were operated by other methods in 1375- 80 in Amiralam Hospital and by the conventional surgical approach which had 50% success rate as reported by chandlers in staging III.

Objective: Acute renal failure (ARF) is a clinical state characterized by a rapid (hours to weeks) decline in glomerular filtration rate (GFR) and retention of nitrogenous waste products. ARF is product of a host of diseases and for purposes of diagnosis and management are conveniently divided into three categories including pre-renal, renal and past-renal failure. In this syndrome produces a set of water and electrolyte and acid-base, hematologic, cardio vascular, pulmonary, gastrointestinal and neurologic disorders as well as predspioses to malnutrition and infections. The mortality rate of ARF has changed little over the past three decades. The aim of the study was to determine the causes, complication and mortality rate of ARF in patients admitted in Golestan hospital over a 30-month period (2001-2004).Subjects and Methods: All patients who referred to our centre during the period of study, with definite diagnosis of acute renal failure were studied. Diagnosis of ARF was made based on recent rise in BUN and creatinine or a set of clinical and laboratory evidences which included medical history, physical examination, laboratory, radiography, sonography and finally kidney biopsy.Results: Sixteen out of a total of eighty two patients with ARF had a super imposed chronic renal failure were excluded from the study. The types of ARF were pre-renal in 27.3%, post- renal in 7.6% and renal in65.2% of patients. Oliguria was found in 53%, gastro-intestinal disorders in 77%, numerous metabolic complications in 72%, cardiovascular and pulmonary complication in 53%, haematological complications in 51%, neurological complications in 48.5% and infections in 20% of patients were seen. Total mortality rate was 9.09%.Conclusion: Most common cause of ARF was renal type which contrasts other studies which reported the pre-renal type to be the most common. No significant differences were found in the rate of complications in this study with other studies. The mortality rate in this study was less than other studies which may be due to difficulties of referring of the very ill patients with ARF to our centre or death of patients in primary care centers.

Objective: Laparoscopic procedures have gained a wide acceptance as treatment of choice for many common surgical procedures such as cholecystectomy.  With this new technique, not only did the era of minimal invasive surgery begin, but also the spectrum of complications changed. However, this technique is not devoid of side effects. The aim of this study was to evaluate the patients' complaint and to evaluate the effectiveness medications used to control these problems.Subjects and Methods: We retrospectively, studied the patient files that underwent laparoscopic Cholecystectomy by our team over a fifteen month period (September 2003 to December 2004) for required data, which included post-operative pain, nausea and vomiting.Results: One hundred eighty three patients were included in the study. Sixty nine patients (37.7%) complained from abdominal and back pain. In 31 cases (45%) intramuscular injection of a NSAID (Tramadol) with mean dose of 167.5 mg was sufficient while in remaining 38 cases additional intravenous administration of pethidine was needed. In these cases, mean dose of 50 mg of pethidine was administered. In 29 cases nausea (without vomiting) were reported while there were 14 reports of vomiting which was effectively controlled by metochlopromide. Other complaints were fever (6 cases) and seroma from the trocar inserting site (one case). The mean duration of hospitalization was 28 hours (12-48 hrs) which was significantly longer in complicated cases.Conclusion: In our experience, abdominal pain, nausea and vomiting were the most frequent complaints during post operative period. Although in these cases hospitalization period was significantly longer in comparison with uncomplicated cases (p<0.01). The routine use the intramuscular tramadol was not effective in 55% of the patients, in nausea and/or vomiting cases intramuscular metochlopromide was adequate. These data support further research on more effective ways for manage these complications.

Objective: The aim of this study was to evaluate the quality of life (QoL) among elderly persons aged above 60 years living in Shahinshahr of Isfahan province in the year 2004.Subjects and Methods: One hundred elderly persons aged over 60 years old were included with multistage random sampling and short 36-item questionnaire was used as the tool for evaluation of QoL status. The results were analyzed using descriptive statistics.Results: The results showed 58 % of cases had good QoL. Seven percent of subjects had inappropriately low QoL status. The average of social functioning subscale score was 78.2±25 and somatic pain was 77.6±25.25. However, the health change and vitality were 37.5±19.6 and 42.7±21. The mean score of SF-36 subscales in men were significantly higher than in women. There was significant negative correlation between QoL scales and ages with an increasing in age there was a decrease in QoL scores.Conclusion: Our finding revealed that the QoL in elderly living in Shahinshar had a moderate status. Social and somatic pain had the highest score, while the health change and vitality lowest scores in the SF-36 subscales. The most frequent issues in geriatrics QoL are low mental health level and lack of vitality. It should be considerable that mental health is an important part of QoL in elderly but it not notified in Iran especially among the in the old people.

Objective: Due to the high prevalence b-thalassemia in Khozestan provience and high rate of oral health problems among thalassemic patients, the aim of this study was therefore to estimate the DMF score and OHI-S indices among referring patients at our Thalassemia Centre in Ahwaz.Subjects and Methods: In this descriptive cross-sectional study which was based on observation, interview and clinical examination carried out on 195 b-thalassemia major patients aged 12-36 years old. Out of 195 patients, 166 (80 boys and 86 girls) accepted to enter the study. The DMF and OHI-S was evaluated and the results were statistically analyzed using variance analysis, Students t- test and correlation tests.Results: The mean number for DMF in this study was 9.5, decayed teeth 8.74, filled teeth 0.33 and missed of un-erupted teeth 0.54. The mean OHI-S score was 2.72, DI index 1.20 and CI index 1.54. Occlusion, base on Angle’s classification, was 22.8% in class I, 55 % in class II and 21.6% in class III. There were significant correlations between brushing and OHI-S (P < 0.001), and between dental visits and DMF. Gingival pigmentation was observed among 95.8% of cases. As regard to gingival status: 6.4% had normal, 52.1 % had mild, 36.5 % had moderate and 6 % had severe gingival inflammation. Knowledge of OHI-S was good in 2.4%, moderate in 4.2% and poor in 78%.Conclusion: The results showed that the high prevalence of DMF and D index and moderate prevalence of OHI-S index as well as 88% of b- thalassemia major patients had no awareness about oral hygiene, education of oral hygiene seems to be important in prevention of these oral complications. In addition, due to prevalence of Cl II mal occlusion among more than 50% of these patients which affects their general appearance maybe one of the reasons of not continuing their education? It seems that with improved aesthetic appearances may increase their interest in life and can greatly improve the health level and DMF index in these patients.

Objective: The main object of this study was to investigate the effect of ankle taping on invertor and evertor muscle strength. This study was a non-experimental case control study.Subjects and Methods: With Biodex dynamometer system, invertor and evertor Isokinetic peak torques were assessed eccentrically and concentrically at 2 different speeds; 60 and 120 degrees per seconds before and after taping. 30 subjects (15 healthy and 15 patients with chronic functional ankle instability, aged 18-30) participated for Isokinetic measurement randomly.Results: Statistical analysis indicated significantly less eccentric peak torque of invertors at the speed of 60 and 120 degrees per second. Ankle taping increased invertor eccentric peak torque at 120 degree per second speed in patients group.Conclusion: Chronic functional ankle instability is not associated with deficits in evertor muscle strength. Deficit in eccentric invertor strength was found in the patients group and this may contribute to the symptoms of functional ankle instability. Findings of this study suggested that invertor muscle eccentric training and ankle taping must be placed in rehabilitation program of patients with functional ankle instability.

Objective: Several years pass from the first human attempts for blood transfusion and during these years' different studies and changes have occurred in this regard and today it is considered as a specialty. The aim of blood transfusion is increasing the tissue oxygenation and preventing the bleeding. Transfusion is accompanied with side effects and problems like infectious disease and blood incompatibility reactions and so on. It also has great expenses. For these reasons nowadays we try to reduce the transfusion rate in different ways. In this study, we assessed the necessary cases of transfusion and the wasted packed cell units that were sent to Semnan university hospitals.Subjects and Methods: This study was retrospective and we followed up 1152 packed cell units from blood transfusion organization till just the time of transfusion. This study is a retrospective research based on transfusion notebooks of hospital blood banks and patient files. The data was analyzed by SPSS verrsion 6.Results: From 1152 packed cell units which were sent to hospitals, 759 units (65.9%) were discarded and 393 units (34.1%) were transfused. From 393 transfused units, 322 units (81.9%) were used for thalassemic patients, for whom the decision for transfusion was easy; hence not much evaluation was needed. From the rest 71 units, 52 units (73.2%) had correct indication and 19 units (26.8%) were unnecessary for transfusion.Conclusion: According to these results 65.9% packed cell units were discarded. This study demonstrates an incorrect programming of blood transfusion organization. Unnecessary transfusion cases show a careless and lack of information in this regard, so teaching and forming hospital committees for reviewing patient files and improving transfusion services seem in order.

Objective: So far no epidemiologic study has been done regarding the types of fractures in Khuzestan province. The current study has been performed to discover fracture patterns in upper and lower extremities in patients aging more than 14 years old referring to Ahwaz Imam Khomeini Hospital.Subjects and Methods: The tools for this study were based on data collected from patients hospital files during a 5-year period from 1997-2001 in a retrograde manner and the results analyzed by Epi info software.Results: A total of 9240 patients (77 % Male) were studied with an overall 64% had suffered upper extremity fractures (47.82% male) and 36% had suffered lower extremity fracture (26.41 % male). Among different age groups, 22.8 % were in 14-18 year old group. The causes of fractures were: 55.9 % due to traffic accidents, 33.5 due to falls. Among outpatient referrals: indirect trauma (45.6%) and street fights (37.6%) were the most common causes of fractures. The most common site of fracture in upper lower extremities were distal radius (24.7%), hand phalanges (23.6%), metacarpus (21.4%) and proximal metatarsal (14.7%) foot phalanges (11.8%) and metatarsal shaft (11.43%). Statistically there was no meaningful relationship between upper and lower extremity fractures in male and female patients (p>0.05).Conclusion: This study can be a guide for designing an orthopaedic emergency system for admitted patients concerning their fracture type, educational planning, instructing the patients for follow up of their treatment plan and implementation of other complementary measures.

Objective: The aim of this study was to determine frequency of hepatitis B Virus infection among thalassemia major patients referring to three different Ahwaz thalassemia centers in one year's duration.Subject and Methods: In this crossed sectional and descriptive study thalassemia patients Screened for hepatitis B Virus infections, Analysis were done by Standard Swiss and Germany kites and Western Blot methods. Serum samples of referring Thalassemia patients on blood Transfusion from 3 different Thalassemia centers were sent daily to Ahwaz blood bank laboratory.Results: 634 Samples which were investigated. 133 Samples were infected by HBV (19%) the remainder 501 samples were normal. All data were examined by SPSS and T. test.Conclusion: donor screening by scientific methods is necessary it is already done by the Ahwaz blood banking now. Thalassemia and their family with Negative result must be vaccinated and the patients with hepatitis disease should be treated accordingly.

Objective: Bicuspid aortic valve (BAV) is the most common congenital heart disease (CHD) and the most common anomaly of aortic valve. Aims of this study were to evaluate the planimetry of aortic valve and determine the effective aortic valve area (EAVA) for blood egress to anatomic aortic valve area (AAVA) during systole. Congenitally, in BAV there are 2 cusps instead of 3 cusps in aortic valve.Subjects and Methods: A total of thirty patients were the subjects of this study. AAVA & EAVA were measured by 2D, Doppler-echocardiography and continuity equation. All findings were matched and indexed for body surface area (BSA). This study was done in Tehran Shahid Rajaei Hospital during 2003-2004.Results: Matched mean AAVA was 2.05 Cm2/m2 BSA and matched mean EAVA was 1.41 Cm2/m2 BSA. Maximum aortic valve pressure gradient (AV-PG max) in systole was 56.56 mmHg. Forty percent of patients had aortic stenos is (AS), of them mild AS was seen in 16.66%. Moderate AS in 13.34% and intermediate AS in 10% of patients. There was no case with severe AS.Conclusion: AS is common in BAV, in a significant number of patients aortic valve did not open completely during systole, and caused AS and murmur. We recommend all children with a murmur must evaluate completely for rule out of BAV. Due to serious and significant complications of BAV, such as bacterial endocarditic. Progressive AS and AI, aortic root dilatation aneurysms and dissection, all cased with BAV must be diagnosed and followed-up appropriately.

Objective: There has been less consideration regarding the role of lower limb muscles in Osgood -Schlatter (OS) disease. The aim of this study was to evaluate the tightness of the quadriceps, hamstring and grasterosoleous muscles in OS disease.Subjects and Methods: Fifty four child and adolescents with 69 knees affecting with OS disease were prospectively evaluate over a 3-year period (2001-2004). Ouadricepes hamstring and gastrosoleus muscles were examined by clinical tests of Elay tripod, and passive foot dorsiflexion in knee extension respectively, for tightness and contracture.Results: Tightness of the quadriceps, hamestring and gasterosoleus muscles was noted in 31, 19 and 10 the knees respectively. In 9 other knees the muscles were in normal condition.Conclusion: The tightness of the lower limb muscles may be a predisposing factor to develop Osgood-Schlatter disease. The stretching exercise of these muscles can be considered as a therapeutic method in this disease.

Objective: To study the association between b-thalassemia trait and development of ischemic cerebrovascular events.Subjects and Methods: This is a prospective single centre study conducted at Nemazi hospital, Shiraz-Iran. One hundred fort eight patients with embolic or thrombotic CVA or TIA evaluated for presence of hypertension, diabetes mellitus, hyperlipidemia and b-thalassemia trait (confirmed by hemoglobin electrophoresis). One hundred and fifty six age- and nearly sex-matched control group without cardiac or cerebrovascular diseases were also investigated for above mentioned factors. Results were analyzed by chi-square and t-test.Results: 6.1% of patients with ischemic cerebrovascular attacks and 12.2% in control group had b-thalassemia trait. (p>0.05) However, in male subjects a significant negative correlation was found between ischemic CVA and BTT (p< 0.01). Compared to non-thalassemics, b-thalassemia trait patients had a significantly lower hypertension (p<0.01).Conclusion: b-thalassemia trait may have a protective effect against ischemic cerebrovascular attacks which may be due to lower arterial blood pressure.

Lung abscess is a debilitating disease with high mortality and morbidity that needs medical and surgical treatment with extensive follow up. In this study 82 patients with lung abscess in the Hospitals of Jundishapour medical University of Ahwaz (Imam khomeini– Golestan and Razi) were avaluated in eight years (1374-1381). 62 patients (75.6%) were male and 20 (24,4%) were female.Most patients were in 6th and 7th decade of life. Most were rural (63.4%) and during spring season (84%). Fever and tachycardia were most clinical findings (63%).Definite diagnosis of the disease in 75 cases had been done by chest x-Ray, CT scan and bronchoscope.Most predisposing factors in this study were aspiration of gastric contents and oropharyngeal cavity (60%) that frequently happened after general anesthesia and tracheal intubation. Rt lower lobe is the location of most lung abscess in this study (20 cases). Most treatments were medical therapy by antibiotic alone (84%) and those who needed surgery were 14 cases for which the best procedure was tube thoracostomy.

Long standing primary juvenile hypothyroidism may be associated with multicystic ovaries. In this paper, we report a 12-year-old female presented with abdominal pain, nausea and vomiting. In laparatomy, torsion of right ovary with multicystic hemorrhagic necrosis was seen. Right salpingo-oforectomy was done. Left ovary contained a large cyst. Clinical signs of hypothyroidism such as facial puffiness, nonpiting edema, dry skin, slow motion and short stature were detected in patient. Laboratory evaluation confirmed the diagnosis of hypothyroidism due to chronic autoimmune thyroiditis. After 2 months treatment with L-thyroxin, clinical signs of hypothyroidism and large left ovarian cyst were disappeared. In conclusion when ovarian cysts are found in a young girl, the possibility of associated hypothyroidism should be considered.