Researcher Bulletin of Medical Sciences
Year:2004 | Volume:8 | Issue:6 (36)|Papers Count:21

Background: Beta thalassemia is a heterogeneous group of disorders associated with decreased expression of eryhtroid hemoglobin-related mRNA that results in imbalance of alpha and beta chains synthesis. Different drugs have been used to increase HbF and γ glubin synthesis such as hydroxyurea. Hydroxyurea is an effective agent with few side effects; however, there exists controversies regarding its influence on hematologic parameters in patients with thalassemia intermedia. The present study was conducted to determine the effects of hydroxyurea on Hb, MCV, and HbF of patients with thalassemia intermedia referring to the Thalassemia clinic in Tehran in 2002.Materials and methods: This clinical trail of before and after type was carried out on 40 patients. Initial data including sex, age, frequency of transfusion, patient's age at the first and last transfusion, and history of splenectomy as well as Hb, MCV, and HbF of patients before, during and 2 years after the therapy was determined and compared using paired t-test. Drug side effects were checked by CBC and LFT tests.Results: The mean of Hb was increased by 1.7±0.6 gr/dl, MCV by 16.4±8.9 μm3, and HbF by 14±6.8 gr/dl (p<0.00001). Following the therapy, all patients revealed to be transfusion-free. Patients aged 30 or less has shown better response to the drug (31.6%); however, other factors did not influence the hematologic parameters. Fortunately, no side effect was reported.Conclusion: Hydroxyurea was associated with increased hematologic parameters. History of splenectomy did not influence response to the drug, thus, we suggest another study on patients before splenectomy.

Background: Although WHO has defined cut-off-point for anthropometric measures in adults, these can not be easily applied in most societies. The present study was conducted to define cut-off-point of anthropometric measures of waist circumference, BMI, WHpR, and WHtR to predict cardiovascular risk factors in Tehranian adults in 2003.Materials and methods: 10522 adults aged 18-74 years have enrolled for Tehran Lipid and Glucose Study. Demographic data as well as anthropometric measures were determined. Blood pressure was measured and hypertension was defined according to the JNC VI criteria. Biochemical parameters were determined and diabetes was considered if FBS³126 mg/dl was noted, meanwhile, hyperlipidemia was defined according to the ATP II criteria. Cut-off-point of anthropometric measures was determined according to the ROC curve, where sensitivity and specificity were equal.Results: ROC of BMI and waist circumference for different risk factors was recorded between 0.55-0.94 and 0.56-0.93 for men and 0.41-0.94 and 0.53-0.92 for women, respectively. ROC of WhpR and WHtR were altered within 0.58-0.87 and 0.56-0.94 for men and 0.53-0.91 and 0.53-0.90 for women, respectively. Cut-off-point of BMI to predict cardiovascular risk factors was determined 24-29 for men and 25-31 kg/m2 for women. For WhpR these figures were between 0.86-0.97 and 0.78-0.92. Cut-off-point of waist circumference and WHtR to predict cardiovascular risk factors were determined 80-93cm and 0.47-0.56 for men and 79-96cm and 0.50-0.63 for women, respectively.Conclusion: Cut-off-point of anthropometric measures that can be used to predict cardiovascular risk factors seem to be higher in comparison to other Asian countries.

Background: Decrease in iron indices is the cause of different nutritional anemia especially in the third world countries, where infants are more vulnerable to this disastrous situation. In our country, iron supplementation begins at the end of sixth months of age; however, earlier supplementation is a matter of controversy. This study was conducted to determine the effects of earlier iron supplementation on iron indices in infants referring to health care centers of Shaheed Beheshti University. Materials and methods: This randomized controlled clinical trial was carried out on 98 infants at 4 months of age that had birth weight of more than 2/5 kg. Other inclusion criteria were: normal growth pattern, absence of congenital anomaly, negative history of blood transfusion or phototherapy or maternal bleeding before or during delivery, and of course, absence of artificial milk or food consumption. Having completed initial tests, infants with anemia were excluded. Then, 59 infants (case group) received 6-8 iron drops per day; however, 39 infants (control group) did not receive iron supplementation. After 2 months, indices were rechecked and data were analyzed using paired t-test and t-test.Results: Alterations in Hb, Hct, Fr, Hbl, body storage of iron (BSI), and total body iron (TBI) were significantly higher in the case group as compared to the controls after two months of iron supplementation. (p<0.05). Conclusion: Iron supplementation after the 4th month of life increases iron-related indices, thus iron supplementation is highly recommended in infants aged ³4 months.

Background: With respect to the complications of upper extremity anesthesia and reports of less-complicated infraclavicular approach with the guide of coracoid, the present study was performed to determine the efficacy of infraclavicular brachial plexus block in upper extremity anesthesia in Imam Hossein and Akhtar hospitals in 2000.Materials and methods: This clinical trial of before and after type was conducted on 40 patients referred for upper extremity surgeries. Coracoid was determined as the guide point and needle was inserted 2cm below and 2cm medial to the coracoid. Following the paresthesia, 35cm lidocaine 1.5% was injected. Pinprick test was used to define upper extremity anesthesia. Meanwhile, complications were recorded.Results: The study population included 20 males with the mean age (±SD) of 31.9±11.7 and 20 females with the mean age of 36.2±11.8 years. Anesthesia was complete in 90% of cases (p<0.001). Vascular perforation was recorded in 7.5% of patients. Pneumothorax and neuropathy was not reported.Conclusion: Infraclavicular approach under coracoid guide is a suitable technique with few complications. Further studies dealing with the level of anesthesia in comparison to other techniques are recommended.

Background: Since the dorsal aspect of phalanx has a thin skin, trauma may easily result in exposure of the bone and tendon. Different flaps with arterial pedicle have been proposed for reconstructive surgery. The present study was performed to determine the efficacy of reversed pedicled venous island flap containing areolar tissue in phalanx in IS-Khordad hospital in 2002-03.Materials and methods: This clinical trial of before and after type was carried out on 7 patients with traumatic defect of phangeal soft tissue. Patients were followed for at least 4 months and congestion and flap survival were analyzed by sign test.Results: The study population included 7 males with the mean age of 30.6±8.6 years. All patients have received reversed pedicled venous island flap containing areolar tissue. Following the surgery, all flaps revealed to be alive (p<0.05). Venous congestion was noted in one and in another patient the distal part of the flap remained to be darker than the proximal portion for a week; however, finally it was retained. Re-operation was necessitated in one case due to rupture of the flap pedicle.Conclusion: Bear in mind the anatomic details and limitations of the aforementioned technique, reversed pedicled venous island flap containing areolar tissue seem to be suitable for phalangeal defects.

Background: There have been much difficulties in diagnosis and treatment of patients with Cushing's disease. In the present study that is the first large series of these patients in Iran, we present the result of transsphenoidal microsurgery in 29 patients who were sequentially admitted and operated in our center over a 10-year period starting March 1992.Materials and methods: Study was designed as case series on all patients. Diagnosis of Cushing's disease was ascertained with hormonal investigations, adrenal CT scanning, pituitary neuroimagings (MRI, CT scan or both), and thoracic CT scan if necessary. Age, sex, hospital stay duration, clinical presentation and its duration, clinical findings, results of hormonal investigations and imaging findings, intra-operative findings, post-operative complications and follow up and results of surgical intervention were obtained from the medical files and analyzed.Results: The study population included 21 females and 8 males with the mean age (±SD) of 281±10 years. The most frequent presenting symptom was obesity (%52) which was present for 30±29 months. 4 patients had macroadenoma and the remaining 25 (%86) had microadenoma. All patients were operated by transsphenoidal approach. There were no intra-operative complication, however, there were 2 cases of temporary CSF rhinorrhea and 9 cases of temporary diabetes insipidus post-operatively, none of whom candidated for surgical intervention. 8 patients were not followed up and the remaining 2 t were followed for 23±27 months. Remission was achieved in %90 of cases and only 2 patients did not benefit from surgery. Recurrence occurred in 3 cases (% 14), all were re-operated by transsphenoidal approach, of these, 2 had remission.Conclusion: Transsphenoidal adenomectomy seems to be the preferred modality of treatment for patients with Cushing's disease with near zero mortality and acceptable morbidity rate. It is recommended for all patients with proved or highly suspected pituitary ethiology for their Cushing's syndrome following complete endocrinological and imaging investigations.

Background: Chronic recurrent leishmaniosis (also called lupoid leishmaniosis) is one of the least common forms of presentations in cutaneous leishmaniosis that goes to remission during the early stage but relapse later. Different therapeutic approaches have been proposed; however, still there exists controversies. This study was conducted to determine the therapeutic effects of cryotherapy, paramomycin, and local glucantim in patients with lupoid leishmaniasis or chronic leishmaniasis referring to our center in 2001.Materials and methods: For this clinical trial, 24 patients (10 females and 14 males) were selected and received either of the 3 therapeutic modalities: local administration of paramomycin ointment twice daily; intra-lesion injection of glucantim twice a week; and cryotherapy of the lesions every other week. Therapy outcomes were evaluated as complete, partial or none remission at weeks 4th, 8th, and 10th.Results: At the end of the 10th week, 23 patients completed their therapy course, among whom, 15 patients (65.2%) had complete remission, 5 (21.7%) had partial and 3 (13%) had no remission (p<0.01). The mean age of the patients was 22.5±8.5 years. Conclusion: Our results have revealed that cryotherapy, paramomycin, and local glucantim are effective agents against leishmaniosis.

Background: In order to ensure safety of parenterals, international pharmacopoeias and national standard have set up stringent guidelines and standards. Particulate contamination is a potential health risk factor caused by intravenous injection of particles that are large enough to clog the small arteries. Particles could be produced through manufacturing and packaging or even dispensing of the pharmaceuticals via particulate contaminated disposable syringes.Materials and methods: For this study 122 disposable syringes produced by 5 domestic and 2 international producers were examined for the presence of visual size particulates. Three independent examiners tested syringes using USP guideline and a black-white panel. Data were analyzed using t-test method.Results: On average, 46.9% of disposable syringes produced by domestic producers contained particles. This was significantly (p<0.05) higher than that of international producers (3.8%). Average number of particles per syringe (1.5) in Iranian syringes was also significantly (p<0.05) higher than that of international producers (0.1). However, one time washing of the syringes using filtered distilled water substantially reduced the number of particles.Conclusion: Our results have revealed the necessity of observing standard procedures to produce particle-free disposable syringes. Meanwhile, it is also recommended that physicians avoid unnecessary prescribing and administration of injective drugs. On the other hand, in case of injection, usage of injection set or Syringe equipped with micro meter filters are strongly suggested.

Background: Prior investigators have shown that during general anesthesia, tracheal intubation and surgical stimulation may increase maternal mean arterial pressure and heart rate. On the other hand, some other investigators have abandoned the usage of epidural anesthesia because of hypotension and its related extra fluid administration (to improve hypotension). The present study was conducted to compare the effects of general or epidural anesthesia on blood pressure of preeclamptic patients.Materials and methods: 51 females with mild preeclampsia enrolled for this clinical trial. They were assigned in two groups of general anesthesia (26) and epidural anesthesia (25). For epidural anesthesia, lidocaine2% was administered via the epidural catheter to achieve block at T4 dermatome; however, for general anesthesia induction was started by rapid sequence technique with thiopental and succinyl choline and maintained by N2O, O2, and halothane. Maternal blood pressure was checked prior to the induction, each 5 minutes before the delivery, each 10 minutes during the surgery and till one hour following the surgery. For data analysis t-test and paired t-test were used.Results: In general anesthesia group, the mean arterial pressure was decreased following the induction (100.5±3.6 vs. 111.9±3.4mmHg, p<0.001) and continued after the delivery (96±4.6mmHg, p<0.001). However, the mean arterial pressure did not increase significantly (98.5±7.1 mmHg. p<0.06) during the recovery room. On the other hand, in the epidural anesthesia group, the mean arterial pressure was decreased following the induction (102.8±5.5 vs. 110.8±3.5mmHg, p<0.001) and, of course, did not continue after the delivery (NS), but did increase significantly during the recovery room (105.8±5.2mmHg, p<0.001).Conclusion: Blood pressure is more stabilize during the epidural anesthesia, thus, this technique is more suitable for patients with mild preeclampsia.

Background: Regarding the high Production level of watermelon in Iran and lack of industrial processing in this field as well as people"s tendency to drinking watermelon juice, a project for processing of watermelon juice and determination of its acceptability by consumers was performed in our center.Materials and methods: This research was carried out based on a descriptive method (exploring and experimental) on 72 Charleston Gray and local variety of Khorasan watemlelon samples. Watermelons compound and chemical characteristics of their juices were determined based on Iranian standard methods and AOAC methods. About 60 different formulae were obtained from a mixture of watermelon juice and permitted additives (30 formulae of each variety), then their organoleptic characteristics were preliminary investigated by category scale. Three formulae from each variety were selected (A, B and C) and their characteristics for color odor flavor and general appearance were evaluated by scoring method and the suitable formula for each variety were nominated, the selected formula. of Charleston Gray variety concentrated (up to Brix 54) and packed in experimental pilot of Agricultural Faculty of Ferdowsey University. Changes of chemical, microbial and organoleptic characteristics in different condition (room refrigerator and freezer) during 0, 15 30, 45 ... 90 days storage were determined by standard methods.Result: In this study, 72 samples of watermelon were analyzed. Water content of local watermelon and Charleston Gray were 55.9±3.1 gr% and 58±1.12 gr%, respectively Rind was 34.3±0.7gr% and 31.8±1.56 gr% (N.S), seeds was 4.8±1.29 and 2.3±0.32 gr% (p<0.002) and pulps were 4.9±1.3 and 7.9±0.45 gr% (p<0.001). In organoleptic survey the fonnula A of Charleston Gray variety includes 100 ml juice 4gr sugar and 0.1gr citric acid with 68.3% acceptability and the formula B of local variety including 100ml juice. 5 gr sugar and 0.2gr citric acid with 30.4% acceptability were selected as preferred samples. Regarding to the higher quality of formula A of Charleston Gray the mixture was concentrated, however; 90 days storage in different temperatures did not cause any changes in chemical, microbial and organoleptic characteristics.Conclusion: Processing of formula A of Charleston Gray watermelon juice is possible and the concentrate can be stored for a period of time further research in industrial scale is recommended.

Background: Psoriasis is a common genetic, inflammatory and proliferative disease of the skin. Chronicity of the disease and changes of the patient appearance usually cause his/her isolation and depression. In the present study we have evaluated the depression in patients with psoriasis referring to Loghman and Booali hospitals.Materials and methods: This descriptive study was performed on 50 educated patients who didn't use systemic drugs and were referred to Loghman and Booali hospitals. Beck profile was used to determine depression range and its related factors among patients.Result: Fifty patients, 36 males and 14 females, enrolled for our study. Skin involvement was 47.5±28%. Duration of the disease was less than 5 years in 18 and more than 5 years in 32 patients. 25 patients had familial history of psoriasis. Twenty-six revealed to have no depression, 28% had mild, 18% had moderate and 28% had severe depressions. Fifty percent of the patients had history of depression with duration of 5.7±6.5 years, meanwhile, 10 patients used antidepressant drugs.Conclusion: Psoriatic patients had mild-moderate depression. Depression is more common among females. Evaluating patients with psoriasis based on the depression is suggested.

Background: Since use of inflammable materials during the last Wednesday of the year is associated with organic trauma and loss of life or property, the present study was conducted to determine these economic and organic problems in Tehran in 1999.Materials and methods: .It was a descriptive study. Characteristics of injured individuals, injuries and their severity, disability, organic trauma, therapeutic interventions and their expenses, as well as type of the organization the patients were insured by were all recorded. Results: Of 392 subjects referred to Tehran hospitals, 290 had complete data sheet, among whom 87.2% were males and 11.7 were married. 75.9% aged <18 years and 89% aged <30 years. 76.2% were students and 59.7% were not insured by any organization. Most of the subjects (43.4%) were injured between 18PM-22MN. 79.8% were treated as a out-patient, whereas 37.9% required surgical intervention. 24.5% were hospitalized more a week. All the subjects were burned, among whom, 29.3% and 27.6% had bums on face and hand, respectively. 62.1% needed to be followed up, 7.3% were re-evaluated, 3.8% had disability and 1% died. The mean expense of each subject was 327,000 R and totally 546,000,000 R was spent.Conclusion: Organic trauma, disability, and economic problems caused during the last Wednesday of the year are noticeable. Educational interventions are highly suggested.