Avicenna Journal of Clinical Medicine
Year:2006 | Volume:13 | Issue:3 (SN 41)|Papers Count:19

Introduction & Objective: One of the standard therapies in neonates with severe respiratory distress syndrome (RDS) is surfactant administration in early course of therapy that cause reduction in mortality, pneumothorax and need to mechanical ventilation. In this study that was carried out in Aliasghar Hospital NICU in 1994-1995 & 2001-2002, the goal was to compare two groups of neonates with severe RDS that had been ventilated in the first 24 hours but one group had received surfactant and the other group (7 years ago) was deprived of this substance.Materials & Methods: In our study, 36 neonates that received surfactant and 52 neonates with only mechanical ventilation therapy were compared. Data collected and analyzed using SPSS.Results: We found that mortality in patients with surfactant administration was significantly lower compared to the second group who did not receive surfactant. There were not any significant differences in incidences of HIV, pneumothorax, sepsis, and PDA and also course of hospitalization and need to ventilation between two groups.Conclusion: As a result, all of these findings reflect obligatory surfactant administration in sever RDS in NICU under observation of an educated expert.

Introduction & Objective: The role of free radicals in reperfusion injury has been revealed in the previous studies. Protective effects of endogenic antioxidants include glutathione has been shown in cardiomyocyte. Intracellular L-cysteine availability is one of the major rate limiting factors in glutathione production. This study aimed to investigate the role of L-cysteine in the preservation of cardiac function after cardioplegia in the isolated rat heart.Materials & Methods: For this purpose Wistar male rat in two control (n=10) and test (n=6) groups were used. Hearts were isolated according to working heart method and perfused by Kreb's solution. Different cardiac parameters include aortic pressure and flow, left atrial pressure and coronary solution flow were recorded during the experiment. Experimental protocol for each heart composed of three following stages: First, basal stage for stabilization of cardiac function (25min), second, cardioplegia (25min), finally, reperfusion (30min). Lcysteine (5mmol/lit) was added to the solution in the test group for 10min before and after cardioplegia. Unpaired Hest and ANOV A were used to analysis and comparison between control and test groups.Results: The results showed that the recovery percentage of aortic pressure and flow after cardioplegia in test group were 91.2±1.69 (%) and 61.176±3.98 (%) respectively, and they were significantly higher than those of control (85.74±1.28 and 44.495±4.85 (%), p=0.0213 and p=0.0324 respectively).Conclusion: Therefore these results indicate the better cardiac function after cardioplegia in cysteine group in comparison to control that is probably due to antioxidative effect of cysteine. With regard to importance of cardio protection, complementary experiment for elucidation of cellular mechanisms of this effect and its clinical usage are suggested.

Introduction & Objective: Post operation pain is one of the most common compliant in every surgery. The objective of this study was to determine whether the prophylactic use of rectal sodium diclofenac produces effective analgesia after cesarean section.Materials & Methods: This randomized single blind controlled trial was carried out in Hamadan Fatemieh Hospital. The study period was from August 2000 to May 2001. Eighty patients undergoing both emergency and elective cesarean section were studied. They had uncomplicated operations that prolonged less than 90 minutes. They were divided in two groups; the test group (40 patients) received 100 mg rectal diclofenac immediately before cesarean section followed by 50mg at 6 hours after surgery. The second forty patients as control group received 50mg pethidine during recovery but they did not receive any diclofenac suppositories.Results: The results indicated that the severity of pain according to visual analogue scale (VAS) in the study group was not significantly lower than those of control group at recovery, 6 and 12 after surgery but the received analgesic in the study group was dramatically less than control group (P<0.05). The number of consumed pethidine was significantly lower in test group as compared to those of control group (16 and 64 times in test and control group respectively). The incidence of sedation and constipation was significantly lower in the test group (P<0.01). Also the incidence of nausea and post-operative pyrexia was comparable in the 2 group.Conclusion: Rectal diclofenac provides effective analgesia when given after cesarean section. It also reduces the patients' opioid sedative needs.

Introduction & Objectives: A laboratory study was carried out to investigate the insecticidal, irritant and anti-feeding effects of nets treated with various pyrethroids against susceptible and highly pyrethroid resistant strains of An. stephensi.Materials & Methods: Tests were carried out inside a mosquito cage measuring 25 x 25 x 25 cm where mosquitoes were offered the opportunity to feed blood on an arm through the top face of the cage which had been pyrethroid treated.Results: With all the pyrethroids tested, the resistant strain spent a longer time in contact with a treated net, which was in contact with a human arm, than did the susceptible strain. With permethrin the resistant strain fed significantly more successfully through the treated netting than did the susceptible strain. With deltamethrin there was a non-significant tendency in the same direction in comparing the two strains. However with alphacypermethrin there was a non-significant tendency in the reverse direction. After 15min in the cage which tested for the ability to feed through a pyrethroid treated net, observed mortality was higher with the susceptible than the resistant strain.Conclusion: Thus there was no sign that the longer resting of the resistant strain on treated netting would compensate for the fact that a higher dose was needed to kill this strain. Such compensation had been suggested with the West African An. gambiae where treated nets continue to work well against a highly resistant wild population. However this does not seem to apply to our resistant An. Stephens.

Introduction & Objective: Jaundice is the most clinical finding in the neonatal period. Prolonged indirect hyperbilirubinemia, beyond 10 days, occur in 20% to 30% of all breast fed infants and, in some of them, may persist for up to 3 months.American academy of pediatrics does not recommend evaluation for infection in such infants. Our goal was to determine the incidence of urinary tract infection in asymptomatic infants older than 10 days and younger than 60 days with prolonged unconjugated hyperbilirubinemia.Materials & Methods: We prospectively evaluated 163 infants with prolonged jaundice for UTI. First, the urine samples were collected by urine bags. All infants with bacterial count³10000 were re-examined by suprapubic aspiration of urine. Results: Only one of 163 patients (0.6%) had UTI. Conclusion: According to the prevalence of UTI in asymptomatic newborn (0.1% to 1%), we suggest that testing for UTI is not indicated as a part of diagnostic evaluation of asymptomatic infants with prolonged indirect hyperbilirubinemia.

Introduction & Objective: During oogenesis, mRNA is actively transcribed and accumulated in the growing oocytes, and then the transcription stops. Transcription silencing will continue during early embryonic stages at least up to the time when the embryonic genome is activated.Thus the earliest stages of embryogenesis in mammals and other animal species are depending on stored maternal RNAs and proteins. Degradation of maternal mRNAs is a way to control their translation. The aim of this study was investigation of the degradation pattern of some of these mRNAs.Materials & Methods: In this experimental study, some oocyte specific genes including Hloo, cmos, tPA and Gdf9 were selected and relative amounts of these transcripts were examined in oocyte (metaphase II) and one-cell mouse embryos, 3, 6, 9 and 12 hours after insemination using Real-time PCR, and compared with Cyclin A2 and Hprt mRNAs.Results: The results showed that oocyte specific mRNAs had low stability and degraded in 12 hour embryo and excluded from oocyte cytoplasm while Cyclin A2 and Hprt mRNAs did not.Conclusion: These results indicated different stability of mRNAs in oocyte and embryo.

Introduction & Objective: Supra condylar humeral fractures are frequent in children at 5-8 years old and its neurovascular complications are more than other fractures. Treatment of displaced fractures (type 3) is surgical with open reduction and internal fixation, through posterior, medial, lateral or anterior approach. This study is performed for comparison of the effect of posterior or lateral approach over range of movement of elbow in type 3 supra condylar humeral fractures that were treated with open reduction and internal fixation.Materials & Methods: This study was clinical trial and the studied subjects were consisted of 50 patients at 5-12 years old with type 3 of supra condylar humeral fractures. Patients were operated randomly by one of posterior or lateral approaches. Average range of movement of operated elbows in each group were measured post operatively 3 times and compared with un-injured elbows at the same patient. Information was analyzed using Hest and SPSS soft ware.Results: Our findings showed that average range of movement at operated elbows in comparison with normal elbow at 3rd and 6th wks post operatively were meaningfully better in elbows operated through lateral approach (p=0.002) but at 12th week of postoperative the average range of motion at both groups did not have any meaning full statistical difference (p=0.4).Conclusion: The lateral approach does not have any superiority over posterior approach in post operative limitation of range of movement of elbows. However due to simplicity and lesser neurovascular complication posterior approach is better than lateral approach.

Introduction & Objective: Staghom renal calculus is still common in our community. Open surgery and/or combination of endourology and ESWL are used for staghom treatment. We report our results of PCNL monotherapy for staghom renal calculus.Materials & Methods: During 3 years, 107 patients with staghom renal calculi underwent PCNL operation. We tried to remove all stones using only this method. The best accessing rout selected and more tracts were used if needed.Results: 107 patients (79 male and 28 female), 8-87 years old (average 42.38 year) undergone PCNL operation. 33 cases had no hydronephrosis and various grades of hydronephrosis present in other 74 cases. Operation was done through one tract in 95 cases and 2 tracts in 11 cases and 3 tracts in one case. Re-operation was needed in 19 cases. Complete and relative stone free rate was 82% and 18% respectively. Mean hospital stay was 48 hours. No any significant complication occurred.Conclusion: With technologic development, open surgery period is going to be ended.Although a combination of PCNL and ESWL is acceptable but removal of the staghorn with PCNL monotherapy is a great help for patients. 

Introduction & Objective: Drug abuse is one of the complicated phenomenons in the human communities that it produces health problems. The effect of applying fear appeal message on attitudes and intention against drug abuse, drug resistance skills, knowledge about side effect of drugs and drug abuse related behaviors among male high school students was studied based on applying extended parallel process model as a theoretical framework.Materials & Methods: Two high schools were chosen from six state high schools as an intervention (n=86) and control (n=97) groups. Educational curriculum, that was designed, based on students' educational needs, appealed students' fear and recommended messages developed students' ability for resisting against drugs. Before intervention 5-6 students who were known as a favourite and leader of students, were selected by student's opinion in each class as students' leaders. The each leader of the group had a coordinator and mediate role between his group and health educators. Henceforth a favourite teacher was chosen by students' vote for helping health educators and participated in the educational intervention program.Results: The result showed that educational manipulation had significant effect on intervention group's average response for intention (t=-4.03, p<0.000) and attitude against drug abuse (t=-6.19, p<0.000), peer resistance skills (t=-0.82, p<0.000), and knowledge (t=-10.88, p<0.0000). In addition, it was not found positive urinary rapid immune-chromatography test for opium and marijuana in the intervention group whereas 6.3% in the control groups.Conclusion: This findings suggest that applying fear appeals theories and effective health risk message would be an efficient tool for preventing drug abuse education programs but further studies are needed to define function of EPPM as a effective model for creating social inoculation against drug abuse among non- drug expose adolescents.

Introduction & Objective: Immunodeficiency duo to HIV infection can produce unusual diseases in infected individuals and CD4 count is the main predictor of the disease progression. In this study the clinical syndromes resulting hospitalization were considered according to CD4 count for the better diagnosis and treatment of clinical complications in HIV infected patients.Materials & Methods: This cross-sectional study was performed from March 2002 to March 2003 in Kermanshah Sina Hospital. HIV infection was confirmed with positive double ELISA and Western Blot. CD4 count was measured by flucytometery, clinical syndromes were collected with final diagnosis, and the rest of the data were gathered according to the patients' interviews. Statistical analysis was performed by SPSS 11.5.Results: During this study, 72 out of 215 admitted patients were enrolled. All of them were male with the mean age (±SD) of 33.4±9.1 years. 64 cases (88.9%) were addicted and 40 cases (55.6%) had prison history. Clinical and/or laboratory indicators of AIDS were observed in 32 cases (44.4%). The average of CD4 count was 356/mL. Patients with lymphadenopathy, neurologic and pneumonia syndromes had the least count of CD4 with the averages of 90, 241 and 269/mL and patients with sepsis, endocarditis and hepatitis syndromes had the highest CD4 average count of 646, 394 and 373/mL respectively. Statistical correlations were observed between pneumonia syndrome and CD4<200/mL (P=0.005), and addiction history (P=0.0001). Suffering from hepatitis syndrome was also statistically correlated with being at pnson.Conclusion: High prevalence of AIDS in our study was a trait which means high prevalence of asymptomatic HIV infection in general population. Also in patients with CD4<200mL, especially those who are addicted, pneumonia syndrome may occur. Lymphadenopathy, neurologic and pneumonia syndromes are more common in CD4<300/mL whereas sepsis, endocarditis and hepatitis syndromes are common in CD4>300/mL, that shows the effect of CD4 count in appearance of clinical syndromes. Unsafe injections in prisoners may cause acquisition of viral hepatitis in these patients.

Introduction & Objective: Recent studies have presented evidence that periodontal disease in pregnant women may be a determining factor for newborn's low birth weight. The present investigation was carried out to verify whether there is an association between maternal periodontal disease and low birth weight of newborns.Materials and Methods: This was a case-control study on 330 women, containing 110 mothers having live newborns with weight <2500 g (case group) and 220 mothers having live newborns with weight> 2500 g (control group). The existence of an association between periodontal disease and newborn's low birth weight was evaluated by means of analytic statistics that considered other risk factors for low weight. The two groups were compared with regard to urinary infection, preeclampsia, premature rupture of membrane, placenta previa, primiparous, smoking, age, height, socioeconomic status and periodontal disease.Results: There were no statistically significant differences between the case and control groups for any of the covariables (P>0.05), but there was significant differences for principal independent variable (periodontal disease) P<0.05.Conclusion: Results indicated a positive association between periodontal disease and newborn's low birth weight. Thus periodontal disease is a possible risk factor for low birth weight.

Introduction: Bilateral hip dislocation (especially asymmetric type) occurs rarely. By review of literature (published since 1951 till 2004), we found 15 cases of bilateral asymmetric hip dislocation (age between 3 and 36 years) that contained 12 cases in males. All of the patients were treated using closed reduction and then traction. There was no considerable difference between the results of treatment in these patients and unilateral hip dislocations.Case Report: The case was a 39 years old man who had bilateral hip dislocation in a head on automobile collision while standing at the back of a van. The position of left hip was in adduction, flexion and internal rotation and the position of right hip was in abduction, flexion and external rotation. Closed reduction was conducted, first for left hip and then for right hip using traction and counter-traction. Then skeletal traction was applied for 8 weeks. The patient started PWB during 4 weeks after the end of traction, then FWB.Conclusion: After 6 months, control radiography did not show any sign of AVN or other lesion and patient's walking was painless.

Introduction: Botyroide sarcoma is one of the rhabdomyosarcoma which is usually seen in infant's vagina. However, it rarely originates from uterine cervix. Rhabdomyosarcoma is a heterogenic tumor and it is usually diagnosed in second decade of life.Case Report: The patient was a 17 years old virgin girl with the complaint of a mass protrusion from vagina with bleeding and vaginal discharge. Biopsy samples and immunohistochemistry assessments showed embryonal rhabdomyosarcoma. Surgery combined with chemotherapy, significantly increased the survival of patients with uterine cervical rhabdomyosarcoma.Conclusion: The patient underwent radical hysterectomy with restored ovaries and then combined chemotherapy. In the 9 months follow up recurrence has not been observed yet.