Jundishapur Scientific Medical Journal
Year:2005 | Volume:- | Issue:44|Papers Count:12

Hepatitis A is a common disease in Ahwaz and it seems that most of children have immunity against this disease. At the present time, human gamma globulin is recommended for post-exposure prophylaxis. The aim of this study was to determine the immunity status of children against hepatitis A and need for post-exposure prophylaxis. For this purpose, during a period of 5 months, sera anti-HAV antibody levels were measuned in 800 (357 males and 443 females) students, aged 10-15 from four educational districts of Ahwaz city, using ELISA method. The results showed that 81.2% of children were seropositive and 18.8% were seronegative. The lowest rate of positive cases was in the forth district. The most positive cases were in low socio-economical class and the least positive cases were in high socio-economical class. Since more than 80% of cases were seropositive, therefore, if personal hygiene, specially hand washing, is practiced routinely, post-exposure prophylaxis may not be necessary and prophylactic gamma globulin injection is only advised for those cases who do not practice this habit routinely.

According tos evidences from historical records, the old, now ruined, Jondishapur University was built by the inspirations of the Persians and Roamns in the town of Jondishapur, a town located in the Northwestern part of present Ahwaz and Southeastern part of Susa in Khozestan province, was one of the first universities in the world. However, the ruling of Abbasit in Bagdad, this university gradually became a ruin and only its name remained. In the year 1334 of Persian calendar (1955), the present Jondishapur university was built with two faculties namely the medical faculty in Ahwaz and Agriculture faculty in Vaise and Rameenm. This year we celebrate the golden jubilee year of its establishment With much efforts made by the scientific community of the university, the first Scientific Medical Journal of Jonshishapur university was first published 34 years earlier in 1350 (1971). The publication of the Journal can be divided into four eras according to editorial board members, its general layout, its size, front-page cover, type of paper used, and lithography. All the papers published are research-based, reviews or case reports and have English abstracts. The first era: Entitled: the Medical Journal of Jundishapur, was published quarterly by the medical faculty in 1350-1355 (1971-1976). In year 1976, two independent medical centres were running, namely Jondishapur Medical Centre and Golsetan Medical Centre. Each had their own independent editorial staff and published two medical journals namely: Jondica and Medical Journal of Golstan Medical Center respectively. Their publication ceased in 1357 (1978) The second era: The journal was re-published twice a year in 1364 (1985) and named The Scientific Medical Journal of Medical Faculty of Ahwaz Shaheed Chamran University. The third era: In 1367 (1988), with separation of the medical faculty from Shaheed Chamran and became an independent Ahwaz Scientific Medical university under the Ministry of Health and Medical Education, was published twice a year until 1380 (2001). The forth era: Stated from 1381 (2002), the Journal has a new was built by the inspirations of the Persians and Romans layout and has been published quarterly with glossy cover page and colour was added for illustrations. It is currently being typographed semi electronically. We are planning for full electronic version and linking via internet for future publications.

Childhood obesity is an increasing problem world-wide with important health consequences. This cross-sectional study aimed to determine the prevalence of obesity and overweight among 7-14 year old students and clinical status of obese students in Ahwaz. For this purpose a randomized cluster sampling was undertaken. Students with BMIs at the 95th percentile or more for age and sex or whose BMIs are more than 30 (whichever was smaller) were considered obese and" students whose BMIs were at the 85th percentile or more but less than 95th percentile were considered overweight. Assessment of 4793 students showed that the prevalence of obesity and overweight was 2.2% and 6.0% respectively. Obesity was most prevalent in 12-14 year old students. Assessment of obese students showed that 66.7% of obese students at least had one obese parent and 73.1 % had family history of type 2 diabetes in their first degree relatives. Only 8.3% of obese students had considerable physical activity. 76.8% were spending 3-6 hours per day watching television. Physical examination of obese students showed that 25.9% had genu valgum (medial angulation of the lower extremity at the knee). Systolic hypertension was detected in 31.5% of them. None of them had signs of endocrine diseases. According to these results, prevalence of obesity in our city is low compared with other countries but for prevention purposes, it is necessary to educate health care providers in schools and inform parents about obesity and its complications. Furthermore, screening of obese children for hypertension is recommended.

Thyroids hormones (T3 and T4) play an important role in fetal and postnatal development. Deficiency of these hormones during fetal development which is caused by maternal hypothyroidism in early gestational period, results in severe damage to embryo especially to the central nervous system. In this investigation, 3-month-old female Wistar rats were used. The animals divided in two experimental and control groups. The experimental group was made hypothyroid by chemical thyroidectomy with propylthiouracil. From days 14 to 20 of gestation, some of the rats in experimental and control group were sacrificed and their embryos were collected for fixation. The same procedure was carried out for the brains of newborns from 1 to 20 postnatal days and some adults at 2.5 month of age. The brains of all specimens were processed, serially sectioned and stained for histological studies. The results showed that the numbers of purkinje cells in cerebellum decreased significantly in the experimental group. Furthermore there was a significant difference in their distribution between experimental and control groups. On the other hand the external granular cells, in the cerebellum of experimental group, remained until 5th week after birth or even during puberty. These data indicate that maternal hypothyroidism may result in severe damage in development of central nervous system during childhood and even at puberty.

Testosterone enanthate (TE), due to its anabolic effects, is widely used by athletes as a stimulating drug for the muscle strength. Previous studies showed that high doses of TE may have some effects on the secretion of metabolic hormones. In this study we evaluated the effect (s) of high doses of TE administration on histomorphology of the thyroid gland. For this purpose, forty male Charles River rats (210-220g) were divided into five groups of 8: group I, non-treated control group, group II rats were gonadectomized and received TE (5mg/100g b.w, i.p, weekly), group III was sham operated non-gonadectomized rats receiving the same dose of TE as group H. Group IV was gonadectomized rats, which received vehicle (olive oil), and group V was sham-operated non-gonadectomized rats receiving vehicle. In each group, blood samples were taken from rats after 60 days and the thyroid glands were removed and prepared for histomorphological studies. The serum levels of testosterone were measured by ELISA technique. The results show that diameter of thyroid gland follicles of the groups that received a high dose of TE, was increased significantly (P<0.05) compared to those of the control group. These results suggest that testosterone, at high concentration, stimulates proliferation of follicular cells of thyroid gland, however, it also attenuates their functional activities.

Retrospective studies have shown that using JJ stent after uretheroscopy and lithotripsy is not necessary. At present, urethral JJ stent insertion after uretheroscopic lithotripsy is recommended. by some surgeons in order to prevent urethral stricture and urethral colics. They believe that this method decreases the chances of urethral colic, urethral edema and secondary stricture. The aim of this study was, therefore to evaluate the indications for using JJ stent after lithotripsy and uretheroscopy. For this purpose, this randomized controlled trial was carried out in 1998- 2002. Two hundred and ten patients (150 males and 60 females) with mean age of 39 (ranged from 25 to 60 years) were included in this study. The criteria for selection were the size of stone and it"s location, which were determined with sonography by an expert sonographist and had a 2-week period of pain and mild hydronephrosis Patients with positive history of previous uretheroscopy or coaggulopathy were excluded from this study. All routine laboratory tests were carried out. Urine culture was normal. Ceftriaxone (lg IV) was injected in all patients 30 minutes before surgery. After successful surgery, patients were divided into two groups. JJ stent (4.8 F) was used for 30 patients. Pethidine was used when patients had severe pain. Belladona-PB was prescribed for all patients at the time of hospital discharge. Student"s T -test was used for data analysis. The results showed that the maximum and minimum size of the stones were 10mm and 7mm respectively. In 108 cases, stone was located in the left side and in 102 cases in the right side. Stone was located below the uretheropelvic junction in all cases. In 60% of cases, stone was detected below the sacroiliac joint. Size and location of the stones in both groups were same. Duration of the surgery for control and case group were 23.92±3.64 and 27±3.68 minutes respectively. Bladder irritative symptoms were 13.33% and 2.17% in case and control groups respectively. Pethidine (50mg) was injected to 15 patients in the case group (8.33%) and 2 patients in the control group (6.6%). The findings from this study suggest that the use of JJ stent not only increases the economic burden on these patients, but also it carries greater risk of bladder irritation symptoms. Furthermore, it is not recommended in patients who undergo intracorporeal lithotripsy and who do not show any complications.

The recent rate of cesarean section rate is greater than universal standard and is on increase. It is therefore of interest to find out the influencing factors on choices of the methods of surgical termination of pregnancy in our province In this cross-sectional study which was carried out simultaneously in nine hospitals (educational, governmental and private) in Golestan province. The method of sampling was by simple randomization and a questionnaire was completed for 1128 women. The data were analyzed with EPI-info 6 software package using students T-test and chi-square, confidence level of 95% was considered significant. The results showed that the percentage of pregnancies terminated by cesarean section in private, educational and governmental hospitals were 62.3, 47.1 and 49.75% respectively. Fetal distress, elective, sterilization, CPD and repeated cesarean section were the most common indications. Vaginal delivery was more common among rural women and Cistany race. Elective cesarean was low in this groups (P <0.05), as well as in women under 18 years with low literacy and during night shifts (P<0.05). The  majority of women who had labor pain or premature rupture of the amniotic membrane and who had interventions such as amniotomy or induction and long hospitalization, ultimately deliveryed vaginally (P<0.05). These findings suggest that many factors influenced the mode of delivery and the most suitable way for decreasing of surgical termination of pregnancy by cesarean section is recognition of these influencing factors, then we can hope that the trend of elective cesarean section rate be decreased.

Simple goiter is one of the most prevalent endocrine disease all over the world. Before iodine supplementation in 1990, Khuzestan province was an endemic area for goiter in Iran. This study was performed in 2002-2003, about 13 years after iodine suplementation, to determine the prevalence of goiter and urinary iodine excretion among 1800 school children (6-10 years old) in Ahwaz. The subjects were chosen by cluster sampling. Physical examination and goiter staging according to WHO criteria was done by 4 medicals student trained in endocrinology department. A questionnaire included: age, sex and level of iodized salt consumption, was filled out for each person. Urinary iodine excretion (by digestion method), was assessed in 75 person by random sampling. In addition, thyroid function tests which included: T3, T4, T3RU by RIA and TSH and serum ferritin by IRMA method were assessed randomly in this selected population. The results showed that 52.5% of the subjects were males and 47.5 were females. 712 school children (39.6%) had goiter (17.3% stage la, 18.4% Ib, 3.7% stage H). There was no case of stage HI goiter. Prevalence was higher in girls (43.5% versus 35.9%) (P<0.01). 90.4 % of study group consumed iodized salts. The mean urinary iodine excretion was 31µg/dl in normal children, 26µg/dl in person with stage la goiter, 21µg/dl in Ib goiter and 14µg/dl in stage H goiter. Urinary iodine was significantly higher in normal children than those with goiters stage Ib or H. 9.3% of studied persons had urinary iodine excretion lower than 10µg/dl, 18.7% between 10 20µg/dl and 72% had urinary iodine more than 20µg/dl. The mean T4, T3, T3ru and TSH in normal and goiterous persons were 7.7 versus 8.02µg/dl, 184 versus 186ng/ml, 32% versus 33% and 2.5 versus 3.4miulml respectively. Only TSH showed  significant difference between normal and goiterous persons (P<0.01). There was no significant difference in the mean serum ferritin concentration between normal and goiterous children (29 versus 23µg/dl). These findings suggest that after 13 years of consumption of iodized salt, more than 90% of studied persons had urinary iodine excretion more than l0µg/dl, and goiter still has a high prevalence of 39.6%, therefore, other goitrogen factors should be sought for in this area.

To evaluate histopathogical changes in the urinary bladder after ileocystoplasty, an experimental model of five healthy mixed breed dogs weighing between 15-25kg, underwent partial cystectomy and immediate ileocystoplasty were used. One dog showed neobladder perforation and died ten days after operation. The remaining dogs did well, no digestive or voiding problems, no intestinal obstruction and urinary leakage were observed. Gross observations and histological sections were studied on day 45 after cystoplasty. Autopsy revealed distinct margin in the grafted area between bladder and the intestinal cap. No inflammatory exudative discharges, adhesion, leakage or fistulus formations were observed. The histological findings in neobladder showed original mucosa of the bowel persisted 45 days after cystoplasty in spite of its entirely new environment. Goblet cells hyperplasia were seen in the mucosa of the bowel. The other morphological findings were congestion, edema, inflammatory cell infiltration, metaplastic changes in the urothelium, cryptitis, calcification, heterotropic bone formation in graft area and the presence of fibroblasts, fibrocytes and collagen fibers in submucosa, muscular and serosal layers of the neobladder. Although the exact etiology of the histological changes is unclear, it seems that direct contact of the intestinal mucosa with urine is essential for the development of the morphologic changes and it has been showed that, in the absence of exposure to urine, morphological changes are not evident in the inner parts of ileal segments.

Insertion of transient catheter can save the life of patients who need emergency or urgent hemodialysis. The aim of this study was to study the incidence and types of acute complications following transient catheter insertion among patients who required them in Golestan hospital nephrology department. For this purpose, 800 temporary catheters were inserted for 670 patients who need emergent or urgent hemodialysis and who had no other available routes. Most of the patients were newly diagnosed with ESRD without any vascular access. Other cases included ARF patients, kidney recipients with early transplanted kidney dysfunction, patients with drug poisoning and a few patients who were candidated for plasmaphresis or parentral nutrition. Five hundred and eighty catheters were inserted in the subclavian vein, 150 in the internal jugular and 70 in the femoral vein. Of 670 patients (400 males and 270 females, aged between 4 to 91 years, average 49), one patient died with sever hemothorax. Eleven patients developed complications with pneumothorax, two of whom were treated conservatively and the remaining underwent chest tube insertion. Two patients had massive hemoptesia who were controlled with conservative management. Arterial puncture occurred in 160 cases among whom 6 progressed hematoma necessitating drainage, others were controlled with conservative management. Ventricular arrythmia occurred in one case who was controlled by medical treatment. Sixty cases suffered from pain at the site of puncture which was controlled by analgesics. The major dangerous complications, hemothorax and pneamothorax, were more frequently observed with subclavian catheters. The findings from this study suggest that although temporary catheters can save lives, but may also cause significant morbidity and mortality. In order to reduce these acute complications, appropriate training of residents is recommended. Furthermore, catheters should be only be inserted by trained experts and internal jugular approach is the preferable route of insertion.

Facial nerve palsy is a very rare complication of Kawasaki syndrome and has been reported in only 25 patients world-wide. None of the 25 previous reported cases with this complication were treated with IV immunoglobulin. We treated a 2-year old boy with bilateral coronary artery aneurysms due to Kawasaki syndrome. In our patient, the duration of disease was 7 to 9 days. He developed a marked unlilateral peripheral fascial nerve pulsy on the third day of his illness and was treated with aspirin (80 mg/Kg) and gamma globulin (2 g/Kg), which resulted in complete resolutio; of facial nerve palsy within 48 hours. Review of pervious cases demonstrates that children with Kawasaki-associated facial nerve palsy have more than twice the risk for coronary artery aneurysm (52% vs 25%) as compared with children without facial nerve palsy. Unexplained facial nerve palsy in young children with a prolonged febrile illness should provoke consideration of Kawasaki syndrome and dictates taking an echocardiography to exclude coronary artery aneurysms. Although facial nerve palsy appears likely to be resolved in all patients surviving the acute phase of Kawasaki syndrome, treatment with IVIG appears to shorten considerably the time for full recovery and provides an important clue to the underlying mechanism of neurological injury in this illness.