Researcher Bulletin of Medical Sciences
Year:2008 | Volume:13 | Issue:4 (64)|Papers Count:18

Background: The accuracy of the pre-hospital care has not been evaluated in Iran so that the purpose of the present study was to evaluate the efficacy of the pre-hospital care performed by Tehran Emergency Service in traumatic patients referred to "Sina Hospital".Materials and Methods: This prospective study was conducted on traumatic patients referred to emergency department of "Sina hospital" by Tehran Emergency Service from September 2003 to September 2004. The accuracy of the pre-hospital care performed by Tehran Emergency technicians, regarding the patients’ general condition was evaluated. The on-call physicians in emergency department of “Sina hospital” were responsible for gathering the data and filling the questionnaires based on their observation and the EMS forms.Results: 994 patients were enrolled in the study. Wound bandage and homeostasis were done correctly in 80% of the cases. Splint was applied correctly in 50% of the patients, while other therapeutic procedures such as collar and spinal bed were not performed among 80% of the cases. IV-line was obtained in 91.2% of the patients, while serum infusion was initiated in only 20% of patients.Conclusion: It is recommended to compile evidence-based protocols for the pre-hospital procedures and train the emergency technicians to follow the rules, in order to improve the efficacy and the accuracy of the pre-hospital care. According to the principal changes recently made in the quality and quantity of the care offered by Iran's Emergency Service, it is necessary to perform a new study to evaluate the present condition and compare the results of these qualitative and quantitative changes with the current study.

Background: Urinary tract infection is the second most common bacterial infection amongst children which could lead to renal scars. It is supposed that during renal inflammation and all types of renal injury, macrophages infiltrate renal parenchyma, whereas their number is directly correlated with the intensity of inflammation. In fact, macrophage migration inhibitory factor (MIF) is widely expressed and secreted in response to inflammatory stimuli, and plays an important role in renal tissue injury. Yet, the role of MIF was not evaluated in patients with pyelonephritis in any studies. Therefore, the aim of our study was to compare urinary excretion of MIF in acute pyelonephritis, acute cystitis and also control group in order to find a non-invasive and sensitive method to differentiate between them.Materials and Methods: In this analytical cross-sectional study 31 children with urinary tract infection (25 patients with acute pyelonephritis, 8 patients with acute cystitis) and 40 healthy children were recruited. Sterile midstream urine samples were taken to measure MIF concentration in all patients and healthy individuals as well. Urine MIF concentration was determined by ELISA and corrected for urine creatinine. The data were analyzed using SPSS 13 software. Independent t-test, One Way ANOVA, correlation and Receiver Operating Curve (ROC) analysis were performed.Results: The mean ratio of urine MIF/Cr was 66.14(SEM=23.78) pg/mmol creatinine in acute pyelonephritis patients, 1.58 (SEM=0.59) pg/mmol creatinine in acute cystitis patients and 1.85 (SEM=0.35) pg/mmol creatinine in healthy individuals. It was significantly higher in pyelonephritis patients than the ones in acute cystitis patients (P<0.001) and control group (P<0.001), respectively. ROC analysis demonstrated that urine MIF/Cr ratio could be considered as a potentially useful index to detect acute pyelonephritis among both healthy condition [P<0.001, Area under curve (AUC) = 0.959] and acute cystitis [P<0.001, AUC=0.960]. Also the optimal cut-point of 5.39 pg/mmol creatinine and 4.90 pg/mmol creatinine for urine MIF/Cr ratio could potentially distinguish acute pyelonephritis patients from healthy individuals and the ones with acute cystitis, respectively.Conclusion: To the best of our knowledge, urine MIF level of children with cystitis, pyelonephritis and control group were compared with each other for the first time in our study. We showed that the urine MIF/Cr ratio was not increased in acute cystitis. Whereas, rising of this ratio in patients with acute pyelonephritis was remarkable. We also revealed that urine MIF/Cr ratio is a sensitive test for differentiation of acute cystitis from pyelonephritis.

Background: Regarding the high prevalence of degenerative disease of the Acromioclavicular joint and invention of new sensitive diagnostic methods on one hand, and several reports approving the influence of arthroscopic Mumford method in affected patients (which we lack the evidence in this regard in our country) on the other hand, we conducted this research on patients referred to Taleqani hospital between 2004-2007.Materials and Methods: This research was carried out by clinical trial comparing pre & post- operative patients accepting this methods due to failure of previous conservative threatments. All patients were operated by Arthroscopic Mumford procedure and range of motion (ROM), strengh and pain were determined in pre-operative and post-operative stages by standard methods. They were followed up for at least three months and the efficacy of this method was measured on the basis of above indices and any changes were judged clinically by statistical tests such as paired t-test and McNemar's test.Results: 41 patients were enrolled (87% male, 13% female) whose mean age were 48 years old. Before treatment, 26.8% oof elderly patients had moderate pain and 73.2% had severe pain, whereas, after treatment 78% of them had experienced no pain and 22% had mild pain (P<0.000). Indices of ROM improved by at least 33%, with the maximum of 60% (P<0.05). Power strenghts of flexion and abduction got better but internal and external rotation remained the same.Conclusion: Arthroscopic Mumford procedure seems to be effective for mentioned cases and can be recommended for them, accordingly.

Background: Vestibular evoked myogenic potentials (VEMP) are short-latency electromyograms (EMG) evoked by high-level acoustic stimuli that recorded from surface electrodes over the contracted sternocleidomastoid (SCM) muscle and are presumed to originate in the saccule. The goal of present study was recording the VEMP response and determining the effects of stimulus type (click and tone bursts) on it's results in a group of normal adult subjects.Materials and Methods: In this cross-sectional analytical study the effects of click and tone burst stimuli on latency and amplitude of VEMP recording were examined by simple randomized sampling over 30 adults subjects ranging in age from 25 to 35 years with normal hearing sensitivity and no history of vestibular disease.Results: VEMP recorded in all subjects using 95 dBnHL tone burst stimuli, and in 26 subjects with click stimulus in the both ears. The response amplitude of VEMP with tone burst stimuli was better than click stimulus, and the largest amplitude was obtained by 500 Hz stimulus frequency. VEMP latency was independent of stimulus type and frequency.Conclusion: Type and frequency of stimulus do not affect VEMP response, and use of 500 Hz tone burst stimulus reveals the largest amplitude, that can be considered in clinical applications.

Background: Bones are one of the high-concentration resources for zinc (Zn). Animal studies have shown that zinc deficiency would result in disturbing the bone growth, bone volume and the force required for breaking one’s bones. The present study was conducted to investigate the effects of Zn supplementation on healing of fractured bones.Materials and Methods: This randomized, double-blinded, placebo controlled clinical trial was conducted on 60 patients with long-bone fractures referred to shohada hospital in the city of Tabriz. Subjects were randomly divided into 2 groups; case group (n=30): receiving one capsule of 220 mg/day zinc sulfate consist of 50 mg zinc each day each day, and control group (n=30): receiving placebo. Subjects received supplement for 60 days. physical activity, individual and clinical information were gathered in a questionnaire. Nutritional intake was determined by a three-day food records both at the beginning and at the end of the trial. Condition of fracture was evaluated by radiographic studies at the beginning and the end of trial.Results: Out of 60 patients, 39 were male and 21 were female. There was no significant change in the physical activity, sex, age, education, history of fracture, the fractured long bone and nutrient intake pattern (especially zinc intake) between two groups. The change in nutrient intake means was not significant. After 60 days, radiologic assessments showed a significant change (P<0.05) in callus formation and fracture healing in case group compare to those of control group. Callus formation and fracture healing in case group was 80% whereas in control group it was 50% .Conclusion: The study suggests that the supplement of zinc for 60 days, stimulates fracture healing in the long bones and since there have been no acceptable pharmacological agent for the therapy of bone fracture, zinc compound may play a unique role in this regard.

Background: snake bite is one of the important medical emergencies and can potentially cause a high mortality rate amongst afflicted patients. Diagnosis of snake bite is often easy but there are several different approaches for its managements. This study was performed to determine epidemiologic aspects, clinical manifestations and management of snake bite.Materials and Methods: In this study 100 cases of snake bite referring to Loghman Hospital were evaluated. Age, sex, job, time of being bitten, site of injury, clinical manifestation and medical or/and surgical management was evaluated.Results: In our study 86% of cases were men and 14% were women. About 60% was between the range of 10-29 years old. The most common occupation among snake bitten patients was farming. Time of injury was evening in 53% and the site of bite was hand and foot in more than 80%. Clinical manifestations were pain, nausea, vomiting, headache, bleeding echymosis and fever. Managements were Tetabulin, Tetanus vaccine, antibiotics, antivenom, FFP and fasciotomy.Conclusion: By appropriate management of snake bite, mortality and morbidity can be curbed to its minimum.

Background: Respecting the prevalence of plantal fasciitis and limited numbers of clinical trials in this field demonstrating the effecacy of ultrasound application in treatment of such patients, this study was carried out to show whether this mode of therapy is of beneficial outcomes.Materials and Methods: Patients experiencing episodes of plantar heel pain were allocated randomly at each episode to receive either true ultrasound (machine calibrated to deliver a dose of ultrasound at 1 w/cm2, 3 MHz, Duty factor=20%, for five minutes), or sham ultrasound (only the timer on the machine activated). Each episode was treated according to randomization, ten times. Furthermore, both groups were given silicone gel heel pad and trained to stretch their posterior calf and posterior thigh muscles twice a day, each time five minutes. Subjects’ pain scores were measured on a 10 cm linear analogue scale, both before the commencement of the ten-session treatments and at the end of the course. Data were analyzed using a Wilcoxon Signed-Ranks test.Results: Twenty nine patients experienced episodes of heel pain (13 bilateral). Both groups showed a reduction in their pain; the first step pain improvement was 31% in the treated group and 23% in the placebo group (P<0.45); the exertional pain improvement was 18% in the treated group and 10% in the placebo group (P<0.65).Conclusion: Therapeutic ultrasound at a dosage of 1w/cm2, 3MHz, Duty factor=20%, for ten minutes is no more effective than placebo in the reduction of heel pain in plantar fasciitis.

Background: Ameloblastoma is the most common odontogenic neoplasm, particularized by its local invasivenes and the destruction of the jawbone. The cause of local invasiveness of ameloblastoma has not clearly identified yet. To clarify the possible role of cell adhesion in local invasion of amelobastoma, expression of E-cadherin and alpha-acatenin was examined in dental follicle and ameloblastoma.Materials and Methods: This research is a retrospective descriptive study and the specimens of 10 dental follicles and 33 Ameloblastomas (conventional amelobelastoma: 20 cases, recurrent ameloblastoma: 5 cases, malignant amelobastoma: 8 cases) were examined immunohistochemically using the streptavidin – biotin method. The data were analyzed using SPSS and statistical tests of Fisher’s Exact and Mann-Whitney. P-value of 0.05 was considered as statistically significant.Results: Expressions of both markers were seen in all dental follicles. For ameloblastomas, expression of E-cadherin and alpha-catenin were detected in 66.7% and 69.7%, respectively. E-cadherin and alpha-catenin expression were lower in ameloblastomas than dental follicles. Rate of expression of both markers was lower in recurrent ameloblastomas and malignant amelobastomas, than conventional ameloblastomas. However, this difference was not statistically significant.Conclusion: Expression of both markers was different in dental follicle and ameloblastoma. Decreased expression of both markers relatively explains invasive biological behavior of ameloblastoma but due to its scarcity of the recurrences and malignancies, further investigations of more cases should be carried out.

Background: Extended-Spectrum b-lactamases (ESBLs) are plasmid-mediated enzymes that hydrolyze the oxyimino β-lactam substance such as third-generation Cephalosporins (Ceftazidim, Ceftriaxone, Cefotaxime). Presence of ESBL-producing organisms results in decrease in efficacy of extended-spectrum Cephalosporines in treatment of serious clinical infections caused by these organisms. So the treatment options are limited and failure treatment and antibiotic resistance are the consequence of inadequate options.Materials and Methods: A total of 160 isolates of Escherichia coli were collected from clinical samples of three hospitals in Tehran. MICs for Ceftriaxone, Ceftazidim and Cefepime were determined by standard agar dilution method. A MIC above 1 mg/L to any of these three was subjected to confirmatory testing as per CLSI method.Results: Primary phenotypic tests revealed that 56.68% (n=89) of E.coli isolates produced extended-spectrum beta-lactamases. Using of clavulanic acid in confirmatory tests, ESBL production was confirmed in 96.7% (n=86) of isolates with primary positive phenotype. The presence of an ESBL was not confirmed in 3.3% (n=3) of the screen positive isolates.Conclusion: This study showed that ESBL productions in clinical isolates of E. coli in Tehran city's university hospitals were extremely high and it is suggested detection of ESBLs as routine tests in order to increase the effectiveness of treatment.

Background: To determine the occurance of cerebral infarction in full-term newborns who were admitted during a one year period in Mofid children hospital due to seizures and to assess the role of the neuroimaging to elucidate the etiology and the possible risk factors in these patients, this study was performed.Materials and Methods: From December of 2004 to December of 2005, all the term neonates who were admitted due to seizure attacks in their first 3 days of life in the neonatal intensive unit, prospectively studied. They were followed up to 18 months.Results: Of 31 neonates who developed seizures during the study, 5 out of them (16%) had seizures because of cerebral ischemic lesions. There were focal seizures in 3 and generalized in 2 of them. All patients were controlled with Phenobarbital, except one who needed a second anticonvulsant agent (phenytoin). Neurological examinations were normal in all except in one neonate who had mild spasticity in his right extremities. Ultrasonography was abnormal in one, while cranial CT scan showed focal cerebral lesions in all five patients. They occurred mostly in the left side. EEGs were abnormal in 3 and normal in 2 neonates. During their follow up, one patient developed sever mental and motor disability and another one had mild delay in his developmental milestones.Conclusion: Neonatal cerebral infarction is the second common cause of seizure in full-term infants. The etiology is not accurately known. Neuroimagings (Brain CT scan or preferably MRI) were the potential diagnostic tool in this study. Thus, we recommend it for those neonates that have seizures with normal APGAR scores and apparently normal neurologic examination without any convincing evidence for its etiology.

Background: Emergency wards are the key points of the hospitals which admit 75% of hospital patients and quick, efficient, and effective care of them can therefore, rescue more people. So the management of this department is very important. Respecting the information is one of the main sources of managing emergency department, which its management is attained by quick and on-time access of emergency department managers to by Emergency Management Information System (EMIS). Thus in this research the situation of emergency management information system of hospitals affiliated to medical universities of Tehran has been studied.Materials and Methods: In this descriptive study, 12 hospitals affiliated to medical universities of Tehran were selected by random stratified sampling method. Data were gathered through observation by check-list tool and they were analyzed by descriptive statistics.Results: Findings of this research indicated that in all the selected hospitals, emergency department information systems have related to all health information systems. Just in 11.1% of emergency management information systems of studied hospitals, data of emergency situations management have gathered wherein at 33.43% of them data processing have done and reports have given only in 39.55% of these systems. In all the studied hospitals, emergency department managers in all the emergency management information systems were the users of the system, whereas only 8.3% of directors of admission departments were system users. In these systems, there were only 29.78% information indicators which users need. Also all of these systems were manual. Although in all of them emergency department information systems and telephone were used for data gathering, medical records, admission, statistics, index notebooks, but Global Positioning Systems (GPS), Geographic Information System (GIS), wireless phone and computer network were not used in them. None of these systems were applying data process tools. They also were using from emergency medical records and telephone to distribute information. There was no standard related to emergency management information system in these studied hospitals.Conclusion: Our results indicated that data gathering, processing and information distributing were not performed completely. In these systems most of data elements were considered whilst they were not useful in internal functions and thus, external functions of emergency department were not considered. Also system users have less knowledge about structure and its process which needs a comprehensive introduction and planning to conduct the system’s function in a more better way.

Background: The scoring systems are helpful to monitor the PICU performance. One of the most important scoring systems is PRISM-III scoring system. Today PRISM score is used to evaluate the quality and quantity of the performance. The goal of this study was to show the prognosis of the patients admitted to Mofid pediatric intensive care unit (PICU) according to PRISM-III and PIM scoring systems.Materials and Methods: This study was a prospective descriptive one. Sampling method was sequentional and the sample size was 121 patients whom admitted to Mofid Hospital's PICU between Dec 2005 till May 2006. Results of PRISM-III scoring system were recorded in prepared sheets. Then, information transferred to computer for SPSS analysis. We used several statistical tests such as Chi square, t-test, Correlation and Regression, ANOVA, and Post-Hoc test.Results: Our study showed that 54% of patients were male and 46% were female and the most causes of admission to PICU were respiratory distress and central nervous system diseases, respectively. Sepsis was the main cause of death in PICU. The mortality rate was 33%. The mean PRISM-III score was 7.57 and this score had 80% of sensitivity and 75% of specificity to predict the mortality.Conclusion: According to ROC analysis the PRISM-III score has good predictive value in assessing the probability of mortality in Mofid's PICU and increase in PRISM-III score corresponds to the higher incidence of mortality.

Background: Post term pregnancy is one of the most significant problems. Considering the importance of pregnancy duration and different records upon effects of membrane sweeping on decreasing pregnancy duration, this study have been conducted to determined the effect of membrane sweeping on the duration of pregnancy in Taleghani hospital between 2006 and 2008.Materials and Methods: A randomize-controlled trial study was performed on 100 pregnant women over 40 weeks of gestational age who had no complications. Women were assigned to have their membranes swept or not, in accordance with their inductions. The main outcome measures included duration of pregnancy, possible complications of sweeping of membranes including rupture of membranes, postpartum infection and vaginal bleeding. Patients have been randomly divided into two groups and evaluated by interval stripping or vaginal exam up to their delivery. Complication and delivery type were recorded as well. Chi square or Fisher’s exact test, Group t-test, survival analysis (Kaplan-Meier) was used to analyze data. P-value of less than 0.05 on two-tailed analyses were regarded as statistically significant.Results: The mean age in control and study groups were 26.2±4.8 and 25.4±4.4, respectively. Also Gestational age of control and study groups when stripping or vaginal exam were performed, was 281±1 and 282±1 weeks, respectively. There were no statistically significant differences between the subjects. The mean interval time declined significantly from 6.2±1.9 in control group to 3.7±1.2 in cases (P<0.001). There were no statistically significant differences between complications like vaginal bleeding, PROM and fetal distress, but Cesarean section rate was significantly lower in study group (34% and 14% in control and study groups), respectively (P<0.02).Conclusion: Sweeping of membranes could lead to decrease the duration of pregnancy and Cesarean section rate. Also, sweeping of membranes had no other complications such as PROM, bleeding and fetal distress. Therefore, through this study we can recommend the process of sweeping the membranes.