Avicenna Journal of Clinical Medicine
Year:2011 | Volume:18 | Issue:2 (SN 60)|Papers Count:12

Introduction & Objective: Undoubtedly reproduction as a means of human survival and recurrent spontaneous abortion being the most prevalent complication of pregnancy with a three percent outbreak and an influential problem on human life have always been the subject of interest among researchers. Different factors are involved in recurrent spontaneous abortion among which immunological disorders are considered the most important ones.Immune cells in uterine endometrium specially natural killer (NK) cells at the menstrual cycle and during pregnancy change considerably indicating their important role in reproductive cycle. The aim of the present study was to investigate and compare NK cells in the peripheral blood of nonpregnant women with recurrent abortion, and non pregnant women with normal pregnancy on the basis of flow cytometry development technology and availability of monoclonal antibodies.Materials & Methods: In a case-control study 30 samples of peripheral blood from nonpregnant women that had three or more consecutive spontaneous abortion with no other medical problems and anatomical disorders (patient group) were obtained.30 samples of peripheral blood from normal nonpregnant women (control group) were also obtained. All blood samples, after lysis of red blood cells, were stained with two type of monoclonal antibodies; anti CD16 and anti CD56 (NK cell specific markers) and then analyzed by flow cytometry. The data from the two groups were compared using t test.Results: NK cells significantly increased in women with recurrent abortion compared with normal nonpregnant women indicating significant differences in the mean average of CD56+CD16+ population between the patient group and control group (P=0.026). The mean average of two CD56+and CD16+ populations significantly increased in the patient group in comparison with the control group (P<0.05).Conclusion: The increase of NK cells in peripheral blood followed by cytotoxicity function of the cells, particularly in relation to emberyo trophobast cells at the pregnancy cycle, can contribute to the recurrent abortion etiology. More investigations including studying the function of these cells, secretory cytokines and their receptors in recurrent abortion, and other disorders of reproductive system such as infertility, endometriosis, preeclampcia are suggested.

Introduction & Objective: b- hemolytic group a streptococcus is the most common cause of acute bacterial pharyngitis in children. Due to the high incidence of this disease and it's difficult diagnosis, we decided to compare clinical scoring and throat cultures for diagnosis of streptococcal pharyngitis.Materials & Methods: This cross-sectional analytic study was done on 3-16 year old patients referred to pediatric clinic with complaint of sore throat. After taking history and physical examination, scoring was done based on clinical findings. The patients with chronic disease or those who received antibiotics or other drugs were eliminated from the study. Analysis was performed using SPSS. Score for each patient was calculated and compared with the result of throat cultures. Sensitivity, specificity, positive and negative predictive values for each clinical finding were determined.Results: 315 patients out of 350 patients with complaint of sore throat referred to the clinic had fever of whom 51.1% had positive throat culture with 51.1% sensitivity and 77% specifity (p<0.01). 127 patients had pharyngeal petechia of whom 67% had positive throat culture with 66.9% sensitivity and 73.5% specifity (p<0.002). 105 children had pharyngeal exudates of whom 65.7% had positive throat culture with 65.7% sensitivity and 58.3% specifity (p<0.001). Anterior cervical lymphadenopathy was detected in 293 patients of whom 53.24% had positive throat culture with 53.2% sensitivity and 73.8% specifity (p<0.002). 182 patients had no signs of upper respiratory infection, among them 65.9% had positive throat culture with 65.9% sensitivity and 70.4% specifity (p<0.001). 130 patients had sore throat, 66.3% of them had positive throat culture with 62.3% sensitivity and 59% specifity (p<0.001). 310 patients had pharyngeal erythema of which 51.6% had positive throat culture with 57.5% sensitivity and 22.7% specifity (p<0.02).99 children had gastrointestinal signs, 66.14% had positive throat culture with sensitivity 64.6% and specifity was 58.8% (p<0.005).Headache occurred in 116 patients of whom 75.86% had positive throat culture with 75.9% sensitivity and 64.9% specifity (p<0.001). From 350 patients, in 155 children scores were equal or more than 7 of whom 83.25% had positive culture. Equal scores of 5-6 were detected in 111 patients of whom 28% had positive culture. In 84 patients scores were equal or less than 4 among them only 7% had positive culture.Conclusion: Findings of this study showed that with increase in clinical score, the probability of positive throat culture increases. We recommend this clinical scoring system for diagnosis of streptococcal pharyngitis especially in areas where throat culture and rapid antigen detection test are not available so it can be useful for better diagnosis and reduces inappropriate antibiotic prescription.

Introduction & Objective: Rapidly progressing medical technology sometimes obscures the importance of physical examination. This study was designed to assess the value of clinical examination in the diagnosis of ligamentous and meniscal knee injuries in comparison with arthroscopic findings.Materials & Methods: Between 2006-2008 we conducted an observational study to assess intraarticular injuries of knee in patients with subacute knee trauma. We evaluated 30 male patients with subacute knee injuries. The mean age was 27 years. After clinical physical examinations, arthroscopic procedures were performed on the patients. Arthroscopic findings were the diagnostic reference.Results: 55% of injuries affected the right knee and 45% the left knee. The accuracy of clinical examination for tears of the medial, lateral meniscus, anterior, posterior cruciate ligaments and articular cartilage was 87%, 90%, 83%, 83% and 80%, respectively. Also the sensitivity was 91%, 83%, 87.5%, 80% and 50% respectively. The specificity for the above mentioned lesions was 84%, 92%, 78.5%, 85% and 85%, respectively.Conclusion: We demonstrated that clinical diagnosis of meniscus tears and cruciate ligaments is more reliable but we recommend the use of MRI for doubtful, difficult and complex knee injuries.

Introduction & Objective: Joint position sense is impaired after Anterior Cruciate Ligament (ACL) tearing. The objective of the present study was to evaluate the effect of reconstruction surgery on position sense in patients with A.C.l tear.Materials & Methods: This study was Quasi- experimental and the patients were selected in a nonprobability sampling manner.30 patients with ACL tear, with mean age of 26.52±8.72 years old were recruited. The patients were 16 males and 14 females. Two centered Electro goniometer were used to test the position sense as a dependent variable. The data were analyzed with Paired T-Test, ICC, SEM and K-S tests.Results: The difference of the position sense before and after the reconstruction surgery on the impaired ligament was significant (p<0.05).Conclusion: Reconstruction surgery in patients with ACL tear at acute phase was effective in improvement of joint positional sense.

Introduction & Objective: There is a need to study the outcomes of admitted patients with primary varicella infections especially for immunocompromised cases like patients with various cancers in our country in which there is no routine vaccination against such a virus.Materials & Methods: We performed a retrospective descriptive-analytic study on the admitted cases with primary varicella infections in Aliasghar children hospital, Tehran, since 1996 to 2009; The patients were put in two different groups for comparison: 1) Immunosuppressed patients including patients with acute lymphoblastic leukemia, patients with other types of cancers, and patients who were receiving high doses of corticosteroids 2) previously healthy patients. Demographic as well as some indicators of poor general condition on admission like respiratory distress, hypotension and decreased level of consciousness were compared within the groups; we also looked for ataxia as an important indication of admission and the time period since the onset of disease up to admission in each group; appropriate statistical methods were used for statistical analysis.Results: 88 cases including 24 cases of ALL (27%), 9 cases with various types of cancers (10.5%), and 13 cases who were receiving high dose of corticosteroid were included. Mean age of the patients was 6 years (SD=3.5.47 cases (53.4%)) were male. Hypotension on admission was significantly more common in patients under four years of age (P=0.006); the patients in the first 3 groups were admitted significantly earlier (P=0.027); Hypotension and ataxia were more significantly seen in the previously healthy group (P=0.01 and 0.04 respectively). Just one case of mortality occurred in a case of ALL during the study period.Conclusion: We concluded that immunocompromised cases comprise more than half of the admissions due to primary varicella infections in our referral center; interestingly, however, in comparison with previously healthy cases they have been admitted earlier with better general condition on admission.In contrast, previously healthy group specially in cases under four years of age wereadmitted with significantly poorer general condition and with more delay; the second result might be due to inclusion of late onset complication of cerebellitis but the former results shows that better educational programs are needed for both parents and practitioners to pay attention to younger age groups with primary varicella infections.

Introduction & Objective: Active lifestyle and regular physical activity have a great impact on improving the health and metabolic control in diabetic patients. The aim of this study was to investigate the factors affecting physical activity and metabolic control in type 2 diabetic women referred to the Diabetes Research Center of Hamadan based on Trans-Theoretical Model (TTM).Material & Methods: 114 women with type 2 diabetes participated in this cross- sectional study. Data were collected from International Physical Activity Questionnaire (IPAQ) and the TTM Questionnaire, using interviews with patients. The data was analyzed by ANOVA test.Results: The findings showed that Glycosylated Hemoglobin (HbA1C) mean in patients was 7.74±1.75. According to IPAQ results, 64.9% of participants had low, 29.8 % moderate, and 5.3% high intensity physical activity. Stages of change constructs were significantly associated with cognitive and behavioral processes of change and self- efficacy (P<0.05). Also decisional balance construct was found to be significantly associated with behavioral change and self-efficacy (P<0.05) but not to be associated with cognitive processes (P>0.05). Self-efficacy associated with cognitive, behavioral processes of change and decisional balance (P<0.05).Conclusion: Results showed that the use of Trans-Theoretical Model can predict physical activity behavior and metabolic control in diabetic patients.

Introduction & Objective: In developing countries, postpartum hemorrhage is one of the preventable causes of maternal mortality. The aim of this study is comparison of the effect of rectal misoprostol and intramuscular syntometerine in the prevention of postpartum hemorrhage.Materials & Methods: This study was a double blind randomized clinical trial and carried on 200 pregnant women referred to Shabiehkhani maternity center in 2010. The first group received 1ml intramuscular syntometrine and the second group received 600 µg misoprostol rectal suppositories after placental delivery. The two groups were matched for confounding variables. All of the study subjects were followed up for 24hrs and their blood pressure, pulse rate, uterine tone, before and after delivery hemoglobin, need to additional uterotonic drugs and drug side effects were evaluated and the results were recorded in an information sheet. Finally all the data were entered into SPSS software and analyzed with statistical tests.Results: The mean age of subjects was 25.61±4.75 years, mean gestational age was 38.8±1.2 weeks, and Mean neonatal birth weight was 3346.2±349.56 grams. The mean fall in hemoglobin level in misoprostol group was significantly lower than in syntometrin group (P=0.009). But there weren' t any significant differences between the two groups in uterine tone, blood pressure, and pulse rate and also in drug side effects.Conclusion: In this study we demonstrated that rectal misoprostol suppository was more effective than injection syntometrin in decreasing postpartum hemorrhage. Thus, it can be used as a choice drug for third stage management

Introduction & Objective: One candidate gene for colorectal cancer susceptibility is exonuclease1 (EXO1).It is a member of RAD2 nuclease family. It plays a main role in mismatch repair. EXO1 acts also in DNA replication and recombination. Single nucleotide polymorphisms (SNPs) are shown to be related with cancer incidence. The aim of the present study was to examine the association between P757L polymorphism at exon 13 of the EXO1 gene and the risk of colorectal cancer in an Iranian population.Materials & Methods: In this case-control study, 81cases and 86 healthy controls were selected from among individuals who were referred to Tehran Taleghani hospital during 2008-2009. The individuals were divided into two groups, case and control, based on their colonoscopy and pathology results. Genotype analysis was performed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method and MNII restriction enzyme. Totally 167 samples were analyzed.Results: Based on our findings when Pro/Pro genotype was reference for the Leu/Leu (TT) genotype (OR=0.168, 95%CI 0.034-0.816), it showed a reverse association with colorectal cancer. While Pro/Leu (CT) genotype did not revealed a significant association with colorectal cancer at the same status. (OR=0.663, 95%CI 0.340-1.294).Conclusion: The results of this study were compatible with other investigations which convey Leu/Leu (TT) genotype of EXO1 has reverse association with colorectal cancer. Therefore TT genotype has a protective effect against colorectal cancer.

Introduction & Objective: Mental health disorders are common problems among hospital personnel and can cause even more psychosocial problems .One of the most significant problems is dysfunction in the quality work life of the personnel. The aim of this study is to determine the items of SCL90 test with quality of work life (QWL) among the personnel of Amiralmomenin hospital in Zabol.Materials & Methods: This is a cross-sectional descriptive study conducted on 200 health care workers working in Amiralmomenin hospital in Zabol who were selected by census method. After the data were collected using questionnaire (SCL-90 and QWL questionnaire), they were analyzed by SPSS.Results: Our findings showed that 65.5% of the personnel had relatively optimal work life. Other findings showed that there was impairment in mental health of the personnel in the domains of anxiety, hypochondriasis, interpersonal sensitivity and aggressiveness.Conclusion: According to the findings, paying more attention to mental health of the personnel to improve their quality of work life is essential.

Introduction: Aneurysmal bone cyst is a rare primary or secondary osseous tumor which is frequently seen in the metaphysis of long bones. Its treatment mostly is curettage and bone graft.Case Report: The patient is a 23 year old man with a left femoral diaphysial and juxtacortical aneurysmal bone cyst who underwent extended curettage after diagnostic work-up and preoperative embolization.Conclusion: Although aneurysmal bone cyst is an aggressive and destructive lesion, it is mostly a treatable tumor by timely and correct measure without sequel