Avicenna Journal of Clinical Medicine
Year:2004 | Volume:11 | Issue:2 (SN 32)|Papers Count:15

Recombinant human erythropoietin (Epo) is known to accelerate erythropoesis in preterm infants. This study was designed to assess the effect of Epo in treatment of anemia of prematurity. Preterm infants with Hct <30% when infant’s age was between 2 to 3 weeks or Hct<25% when infant’s age was more than 3 weeks, were divided randomly in two groups, each group included 10 babies. The mean gestational age in control group was 32.1±1.85 weeks and birth weight was 1489±218 (SD), grams and in case group was 31.5±2.12 weeks and birth weight was 1367±227 grams. Infants in case group received Epo 500 u/kg twice weekly for 4 weeks. All infants in control and case group were fed human milk and supplemented with entral iron prophylaxy. Levels of hematocrit and reticolocytes were determined for each infant at the beiging of study, 3 days after treatment and one week after the end of treatment. Weight, length and head circomference were determined weekly. The groups were significantly different in hematocrit and reticulocyes count at the end of study (P<0.0001 and P=0.024 respectively). In control group the prophylactic iron supplementation was not sufficient to prevent anemia and we found a significant decrease in hematocrit level at the end of study (P<0.0001). We concluded the early treatment of anemia of prematutiry with rhEpo with iron increase hematocrit and retyculocyte in perterm infants. If we can minimize blood sampling for laboratory analysis in preterm infants, treatment with Epo will reduce the need for blood transfusion in these infants.

Diagnosis of Hepatitis B is important because of the its high prevalence. Recently PCR method, has found greater interest among different diagnostic methods. Several reports emphasis on some false negative results in those laboratories using PCR. The aim of this study was to compare three different procedures for HBV DNA extraction. A total 30 serum samples received from Shariati hospital. Sera was taken from patients having chronic Hepatitis with HBs antigen positive and HBe antigen negative. The sensitivity of guanidium hydrochloride method for extracting the HBV DNA from serum were evaluated and compared with phenol–chloroform and boiling methods. Diagnostic PCR kit was obtained from Cynagene contained taq polymerase, reaction mixture, dNTP, and buffer for reaction. A 353 bp product were amplified by amplification program provided in used PCR protocol. The comparison of results indicated that procedure was successful for amplification of the designed products from Hepatitis B in sera. Number of positive results were 16, 19, 23 and number of negative result were 14, 11, 7 for the boiling, phenol-chloroform and guanidium-hydrochloride extraction methods respectively. PCR method is the fastest diagnosis method and the most accurate procedure to identify Hepatitis B. Guanidium hydrochloride method was the most successful procedure studied in this survey for viruses.

Hemodialysis access recirculation occurs when dialyzed blood returning through the venous needle reenters the extracorporeal circuit through the arterial needle rather than returning to the systemic circulation. It is important to meausre hemodialysis access recirculation for two reasons: The reentry of dialyzed blood into the extracorporeal circuite reduces solute concentration gradients across the dialysis membrane by mixing already dialyzed with undialyzed blood. As a result, the efficiency of dialysis is reduced. High degrees of recirculation can lead to a significant discrepancy between the amount of hemodialysis prescribed (prescribed Kt/V urea) and the amount of hemodialysis delivdred (delivered Kt/V urea). High degrees of access recirculation indicate the presence of access stenoses, the most common cause of access thrombosis. Prospective identification and treamtnet of access stenoses improves long-term access patency rate.

Diagnosis of environmental and psychosocial problems in psychiatric patients is essential because of their significant role in causing or exacerbating psychiatric disorders. This study was carried out to assess the consensus rate in diagnosing axis IV (environmental and psychosocial problems) in DSM-IV system of classification among psychiatric residents. In this study one hundred and seventeen psychiatric patients were examined in daily morning in Razi Mental Hospital in Tabriz. The patients were evaluated individually by residents in regard to mental status and axis IV problems. The obtained datas were analysed by descriptive and inferential statistical methods. Results of the study revealed that consensus rate among residents in assessment of environmental and psychosocial problem(s) was low (ICC: 0.22). Demographic characteristics of the patients did not explain difference between residents. Sex and familiarity of residents with Azari Language were significantly important regarding diagnostic difference, so that consensus rate in female residents was more than male ones and in Azari speaking residents was more than non-Azari speaking ones. No part of mental status examination was remarkable in explaining diagnostic differences. Diagnoses in axis I and III were recognized as important elements in explaining the differences. Based on result of this study diagnosis of environmental and psychosocial problems in psychiatric patients by residents generally is not reliable and the issue warrant further attention.

Breath holding spells (BHS) is a type of syncope in children, most commonly encontered in the early years of life. Although these athacks dont damage the brain, if these are frequent or prolonged cause, parents frighten, so physician should intervent. In this study we evaluated clinical efficacy of piracetam on B.H.S of children in Mashhad Ghaem Hospital during 2001-2002. In this double blind placebo control study, piracetam or placebo on a randomized basis was administered to children with 40 mg/kg/day in 2 divided doses for 2 months. From the 41 children that were enrolled, 21 cases received piracetam and 20 cases received placebo. Parents denoted the numbers of spells two months before and two months after taking drug. Control of breath holding spells were observed in 90.5% of patients in the group taking piracetam as compared with 40% in the group taking placebo (P = 0.002). Of the all patients 10 cases had iron deficiency anemia so they had taken elemental Fe too. The side effects were the same in these two groups. The results of this study indicated that piracetam was efficient for the treatment of children with B.H.S without greater incidence adverse effects than placebo.

UTI is the most common infection in all ages and urinary catheters especially long-term catheterization are important predisposing factors of UTI. Urinary catheters are used in different hospital wards as a complementary curative method for the patients who are undergone various surgical procedures, such as: cesarean, hysterectomy, laparotomy, etc and they who are unable to control their voided urine. 226 urine specimens were collected from 119 catheterized patients which had been hospitalized in seven wards of Razi and Golestan hospitals in Ahwas city. At least two urine specimens were collected from each patient, before and after the insertion of the catheter.  All of the specimens were inoculated to suitable Media, after transportation to the Microbiology Lab. Isolated colonies were identified and their resistance patterns were determined by the standard disk diffusion method (Kirby –Bauer procedure) to 8 different antibiotics. 38 cases (43.6%) out of 87 patients showed Bacteriuria in the end of catheterization. They had no bacteriuria symptoms or sign before the catheterization. The most cases (28.9%) of bacteriuria occured in 30-39 years group and the lowest cases (2.6 %) of them occured in 60-69 years group. Out of 50 bacterial strains isolated from urine cultures, E.coil (with 17 cases) was the highest (34%) and Staphylococcus aureus, Klebsiella pneumoniae, Edwardsiella tarda, Enterobacter sakazakii (with 2% for each) were the lowest cases. E.coli, Enterobacter and Kl. rhinoscleromatis, showed the most resistance to Ampicillin, Penicillin, Cephalexin, and the lowest rate to Nalidixic acid, Gentamicin and Nitrofurantoin.  Staphylococcus epidermidis isolates, also, showed the most resistance (100%) to Penicillin and Ampicillin, and the lowest rate to Gentamicin (with 66.7%), Cotrimoxazol and Nitrofurantoin (with 50%). The results of this study suggested that catheterization, especially long- term catheterization causes the rise of urinary infections and so it is recommended that urinary catheters be avoided whenever possible.

Low back pain is one of the prevalent diseases of the world. In this research, with helping of MRI the incidence of disc herniation in patients of low back pain in our living area was studied. Survey of the specifications of disc herniation was carried out and data was compared with some performed studies in other parts of the world. In this study, for 600 patients referred to HAMEDAN MRI CENTER, who had complaint of low back pain, MRI study was performed. Then, MRI Images of the patients who had disc hernition, studied for number, form, severity and anatomic position of the herniated disc and family history of low back pain. 83.7% of the studied cases was pathologic and 16.3% was normal. Among the pathologic cases, 70.12% had disc herniation. The most common age group in both sex for disc herniotion was 30-50 years. Disc herniation in men was more common than women. The most common anatomic position of the herniated disc was L4- L5 disc, mostly was one herniated disc and centrolateral form. There was not any meaningful relation between family history of the low back pain and lumbar disc herniation. This study showed that lumbar disc herniation is one of the common causes of the low back pain in our living area and MRI is the choice imaging modality for diagnosis and survey of low back pain and disc herniation.

One of the causes of frequent headaches in children is migraine headache. The prevention of headaches, will improve life equality in children. This study was designed to compare between treatment and side effects of sodium valproate and propranolol in preventing migraine headaches. This study was a randomized controlled clinical trial which carried out on 52 children who were reffered to out patient neurology clinic of the Ekbatan and Sina hospitals. All children with migraine who had headache during last 6 months were enrolled, and those who had received sodium valproate and propranolol previously, were excluded. The method was convenience sampling and the patients were divided into two groups with 26 patients: A and B for propranolol and sodium valproate respectively. Group A treated with propranolol and group B with sodium valproate for 8 weeks. The response to treatment was evaluated after 4 weeks. The study evaluated 52 children with migraine from 7-15 year’s old, 38.5% of cases were male and 61.5% female. Before treatment, the mean number of attacks was 5.61 months in group A and 8.73 months in group B. After treatment the number of attacks was declined in 21 cases (80.8%) of group A and 19 cases (73.1%) of group B. Severity of pain was improved in 18 cases (69.2%) of group A and 15 cases (57.7%) of group B. The incidence of vertigo was 3 cases (11.5%) in group A and 2 cases (7.7%) in group B. Abnormal liver enzymes test were detected in 11.5% of cases in the group B. CBC was abnormal in 7.7% of cases in the group B.Sodium valproate and propranolol, both have the same therapeutic effects in prevention of migraine headeache in children. But side effects are different, and choice of either one depended on the effects consideration and contraindications of each one.

Poor inhaler technique is a common problem both in asthma patients and health care providers, which contributes to poor asthma control. The aim of this study was to evaluate the correctness of metered-dose inhaler (MDI) technique in a sample of physicians, pharmacists and nurses practicing in Hamadan University hospitals.A total of 176 healthcare providers (35 internists and general physicians, 138 nurses and 3 pharmacists) were participated voluntary in this study. After the participants answered a questionnaire aimed at identifying their involvement in MDI prescribing and counseling, a trained observer assessed their MDI technique using a checklist of ten steps. Of the 176 participants, 35(20%) were physician, and 3 subjects (2%) were pharmacists, and 138 (78%) were nurses. However only 6 participants (3.4%) performed all steps correctly. Physicians performed significantly better than non-physicians (8.6% vs. 2.13%). The majority of healthcare providers responsible for instructing patients on the correct MDI technique were unable to perform this technique correctly ‘indicating the need for regular formal training programmes on inhaler techniques.

People experience psychological distress after cardiac events such as acute myocardial infarction. Approximately 65 percent of patients with acute MI report experiencing symptom of depression. Symptom of depression predict poor quality of life and reduce return to work and increase risk of mortality. Therefore patients experiencing depression after acute MI should be identified and given targeted psychological interventions. This research was a quasi experimental and clinical trial study and consisted of two groups and three stages. The samples included 22 patients with MI that were randomly put into two equal groups (experimental & control). The objective of this study was to determine the effect of group therapy on patients with MI before, after and one month after the intervention. Depression were assessed using the Beck depression inventory. The data were analyzed with paired T-test and T _ student using SPSS soft ware. The results showed a significant difference between depression of groups before, after and one month after intervention (P<0.001). Not only group therapy had distinguishable effects on the level of depression in patients but also its effects were even noticed one month after intervention. This method is highly recommended for all level of prevention and treatment in MI patients and other patients.

Fibrovascular polyp is a rare disease, usually arise in the upper segment of the esophagus .In the search of medical literature in the recent 20 years only one case of oropharyngeal fibrovascular polyp has been reported. We reported a 63 years old female with chief complaint of incidental protrusion a mass of her mouth, it was a rare presentation of fibrovascular polyp of the base of tongue, who referred to the Imam Khomeini hospital of Hamadan.

Primary malignant lymphoma of the urinary bladder is very rare. Less than 100 cases have been reported. The best treatment approach for this disease remained unknown.In this article we reported a 41-year-old-female who was admitted to Sina hospital with the chief complaint of macrohematuria that was followed by dysuria, frequency, noturia and urgency. Other examinations were normal and there was no organomegaly and lymphadenopathy. In ultrasonography the thickening of trigone zone of the urinary bladder was reported. The patient underwent a transurethral biopsy of the bladder that revealed malignant lymphoma, intermediate grade , diffuse mixed small and large cell type ( B-cell lymphoma). The reports of computed tomography scan of the thorax, abdomen and pelvis and bonemarrow biopsy were normal and results of metastatic work up were negative. Primary lymphoma of the urinary bladder was diagnosed and a combination of systemic chemotherapy and relatively low dose irradiation were done for the patient. The patient is in complete remission with this kind of treatment now.