Researcher Bulletin of Medical Sciences
Year:2003 | Volume:7 | Issue:4 (30)|Papers Count:21

Background: Controversies about the improvement of survival in premenopausal breast cancer women's which begun in 1989 with Hrushesky study still continue. With respect to the importance of prognosis in breast cancer and to determine the relation between timing of surgery in menstrual cycle and prognosis, this study was conducted on premenopausal breast cancer women"s treated in Jorjani hospital during a 5-yaer period, 1993-98. Materials and methods: In this historical cohort study, 58 premenopausal women with operable breast cancer and regular menses were analyzed in two groups according to the time of surgery, follicular and luteal phase of menstrual cycle. All patients had lymph node involvement and all of them received exactly the same systemic and local adjuvant therapy. Overall and disease free survival (OS, DFS) curves were calculated according to the Kaplan Meier method and the differences between the curves were compared by Log rank p test. Results: Patients were followed at least for 17 months, where the mean follow up was 58.3 months. There was no statistically significant differences in DFS and OS between two groups (log rank p value=0.41 and 0.57, respectively). The impact of time of the surgery and phase of menstrual cycle was not confirmed by univariate and multivariate analysis. Conclusion: Our finding does not support the hypothesis that timing of surgery in relation to last menstrual cycle date has any influence on patient OS and DFS, but we recommend further prospective studies in which cycle phase at time of tumor excision is biochemically documented.

Background: Hearing impairment is one the most important causes of speech problems in children that in case of delay in diagnosis and treatment could cause developmental, emotional and social problems. With respect to the controversies in hearing impairment incidence and lack of informative data in Iran, the present study was conducted on at risk neonates hospitalized in Mofid hospital. Materials and methods: 150 neonates who had at least one risk factor for hearing impairment were included. They were followed for 3 months after discharge and Auditory Brainstem Response (ABR) was performed. Results: The mean age (±SD) of the candidates was 21.7±14.1 days. 108 (72%) infants had normal hearing whereas the remaining 42 (28%) had different levels of hearing impairment of whom 17 (11.3%) mild, 16 (10.7%) moderate, 4 (2.7%) severe and 5 (3.3%) profound hearing impairment were reported. Asphyxia was the most probable reason for hearing impairment. Conclusion: Results have revealed that hearing impairment is more common among high-risk neonates in Iran. We strongly recommend global hearing test in all infants less than 3 months of age as screening and treat the affected cases as soon as possible.

Background: The role of preoperative dietary support in preventing cervical anastomatic leak in patients with esophageal cancer suffering from albumin level of <3.4gr/dl is controversial. Some studies have failed to reveal any association between malnutrition and anastomatic leak whereas the others had. Materials and methods: We have reviewed the reports of 421 patients underwent esophagectomy during a 12-year period, 1989-2001. Anastomatic leak was determined and the role of hypoalbuminemia and other related factors was judged. Results: Anastomatic leak was reported in 67 patients (15.9%). 16.2% of patients with hypoalbuminemia and 15.9% of non-hypoalbuminemic patients presented with anastomatic leak (NS). 80% of patients who lack blood supply to anastomatic edge had anastomatic leak, however this was reported in 14.4% of patients who had blood supply (p<0.001). Conclusion: Hypoalbuminemia had no correlation with anastomatic leak. Bear in mind the relatively high prevalence of anastomatic leak (16%), further studies are suggested.

Background: With respect to the high prevalence of tuberculosis in Iran, its delayed diagnosis and prior reports of elevated adenosine deaminase activity in the affected patients, this study was carried out in individuals referring to Imam Khomeini hospital in 1999. Materials and methods: During this historical study, we have assessed the ADA activity in eSF of 3 groups: control-I (10 non-tuberculous patients whose CSf was extracted during spinal anesthesia), control-II (6 viral or non-tuberculous meningitis) and case (6 tuberculous meningitis). Meanwhile, ADA activity was evaluated in ascites fluid of 10 non-tuberculous patients and 5 tuberculous patients. Results: The activity of ADA in CSf of the aforementioned groups was 0.64±0.12, 2.08±0.8, and 13.1±5.3 UIL, respectively (p<0.0001). The activity of ADA in ascites fluid of non-tuberculous and tuberculous patients was 13.9±5.7 and 66±12.9 U/L, respectively (p<0.0001). Conclusion: Evaluating the ADA activity in CSf and ascites fluid could be helpful in the diagnosis of tuberculosis.

Background: The use of interstitial radiotherapy to treat brain tumors is well documented. The survival rate of the brain tumor and better outcome in patients treated with interstitial radiotherapy suggests a difference by authors, thus, we have conducted a retrospective study on patients referring to Shohada Tajrish Hospital during a 3-year period, 1998-2001. Materials and methods: Patient's age, sex, operation approach, location and grading of tumor, field of vision, visual acuity, and hormonal changes were all recorded. Results: The study population included 6 males and 6 females developed cystic brain tumor with the mean age of 12.75 years. Of these, 10 had craniopharyngioma and 2 had cystic astrocytoma. Patients underwent stereotaxic surgery and interstitial radiotherapy by radioactive phosphorous was performed. No mortality was reported during or after the procedure. Patients were followed up for 28.8 months (4months- 4 years). During long term follow up visual acuity progressed in 5 patients, remained unchanged in 4 and worsened in 3. Neuroimaging analysis (CT scan and MRI) revealed 10 lesions to be smaller but 2 were enlarged due to the solid part. Conclusion: We have found desirable results in patients with cystic brain tumor who undergone interstitial radiotherapy by radioactive phosphorous. We suggest this technique in affected individuals.

Background: Inactivity is a major cause of cardiovascular disease and osteoporosis. Physical activity can be helpful, however little is known about the role of duration and severity of such programs on heart rate and aerobic power. We have studies the effects of8- and 16-week aerobic training program with 70 and 85% of maximum aerobic power on resting heart rate (RHR) and aerobic power. Materials and methods: Thirty healthy inactive females aged 18-33 years have entered this experimental study. Cases were assigned randomly in experiment (20) and control group (10). RHR and maximum aerobic power were determined before and after 8- and 16-week training program (thrice a week) with 55-70% and 70-85% of maximum aerobic power. Similar tests were achieved in the control group who had no exercise. Results: Having 16 weeks of aerobic exercise, RHR was reduced (71.2±4.5 vs. 65±4.6 beats/s, p<0.04). This showed a significant difference when compared to the control group (p=0.019). Meanwhile, maximum aerobic power was increased (3.57±1.6 vs. 4.25±2.1 l/min, p=0.05). Conclusion: Sixteen weeks of aerobic exercise with 70-85% of maximum aerobic power is necessary to altered RHR and maximum aerobic power in healthy inactive females. Further studies are highly recommended in other patients who are at risk of cardiovascular diseases.

Background: Deficiency of micro nutrients such as vitamin A is one of the nutritional problems in developing countries that could be successfully prevented by fortification of the food products. Since vitamin A is fat-soluble, we have chosen sunflower liquid oil and hydrogenated blend oils as the carriers for vitamin A for our study. Materials and methods: During this study, vitamin A-palmitate (200 IU/gr) was added to the samples and after packing, the hydrogenated and liquid oil samples were stored at the temperatures of 25 and 45 degrees centigrade for 6 months both in darkness and exposed to sun light. All fortified samples were used for cooking (rice) and frying (potato) to determine the effects of these processes on the stability of vitamin A. Results: After 6 months, the highest stability of vitamin A (95%) was observed in hydrogenated oils stored at 25 degrees centigrade, whereas the lowest stability (50%) was seen in liquid oil samples stored at 25 degrees centigrade and exposed to sun light. Cooking and frying processes caused vitamin A losses of 5 and 10%, respectively. Changes in peroxide values and stability of vitamin A were in the opposite direction, i.e, by increasing peroxide values in the fortified oil samples, vitamin A was decreased. Conclusion: Since sun light is the major cause of vitamin A loss in oil samples, we recommend fortification of the liquid and hydrogenated oils with vitamin A and improvement of the products package.

Background: With respect to the complications of high blood sugar, the present study was conducted on type II diabetic patients referred to Research Center for Diabetes in Yazd in 1999 to determine the effects of Basil intake. Materials and methods: Patients who have not received any hypoglycemic drugs were included in this crossover study. Patients were randomly assigned in two groups. During two different periods of 4 weeks with an interval of 14 days (washout period), they were asked to have either their own regular diet or basil (dry powder, 20 grid). Fasting blood sugar and blood sugar 2 hours following the breakfast was determined at 4 stages; beginning of the study, 4, 6, and 10 weeks later. Paired t-test and Hest were used for data analysis. Results: The study population included 10 females and 6 males with the mean age (±SD) of 46.9±8 years, mean weight of 66.8±9.1 kg, and mean awareness of the illness of 3.3±1.7 years. The mean values of carbohydrate and fiber consumed in basil regimen were significantly higher than the regular regimen (242.9±47.1 vs. 204.8±48.4 gr and 20.9±5.6 vs. 9.6±8.5 gr, respectively, p<0.01 and p<0.001). At the end of the period, the fasting blood sugar of the group received basil was significantly decreased when compared to the basic value and also with the regular diet group (1l4.2±12.5 vs. 140.9±l1.9 and 140.4±17.3 gr/dl, respectively, p<0.001). Blood sugar 2 hours following the breakfast in the group received basil was significantly lower as compared to the basic values and also with the regular diet group (160.5±15.8 vs. 195.4±9.1 and 195.6±12.2 grid! respectively, p<0.001). Conclusion: Our results indicate that using basil with one's regular diet is effective to reduce blood glucose level in patients with type II diabetes.

Background: Heat stress is one of the most important factors in staff health. The present study was conducted on staff of Imam Khomeini Port in 1999-2000, to compare environmental and biologic markers in determination of heat stress. Materials and methods: This descriptive-analytical study was conducted in summer and winter and 170 staff of different sections was included. Heat stress was evaluated using environmental (WBGT= wet bulb globe temperature) and biologic markers (heart rate and body temperature). Heat stress-related complications were studied, too. Results: Of 170 participants, environmental and biological monitoring revealed no cases of heat stress during winter. According to the environmental monitoring all except indoor staff experienced heat stress during summer. Biological monitoring, however, revealed heat stress in 12.5% and 16.25% of the staff based on the heart rate and body temperature, respectively. Heat-related complications were heat exhaustion, muscle cramp, and heat stoke that were observed in 23.5% and 6.6% of outdoor and indoor staff, respectively, in summer. Conclusion: Biologic markers could truly reflect heat stress. Meanwhile, heart rate and body temperature can reveal early presentations of heat stress in outdoor staff. To protect staff against heat stress, routine evaluation of heat stress using environmental and biologic markers is strongly recommended. In case of facility shortage, biologic markers can be used for screening of susceptible individuals.

Background: EMG (Electromyography) and NCS (Nerve Conduction Studies) are known as the methods of choice to study uremic neuropathy. They are widely used to evaluate dialysis outcomes. Materials and methods: 14 patients with chronic renal failure have undergone NCS before and after dialysis. Results: Nerve Conduction Studies of ulnar (sensory) and tibial (motor) nerves revealed that their amplitude was significantly increased following the dialysis (p<0.05), however, changes in NCV were slighter. Simultaneous physical examination demonstrated further involvement in vibration sense and DTR (Deep Tendon Reflex). Conclusion: Results have implied that some nerve fibers convert from inactive to active phase during the dialysis and take part in nerve conduction.

Background: Epilepsy is a neurological disorder in which nerve cells of the brain from time to time release abnormal electrical impulses. These cause a temporary malfunction of the never cells of the brain. Materials and methods: In this experimental study, two electrode voltage and current clamp techniques were used to determine the efficacy of a new quinazolinone compound on PTZ induced epileptiform activity and underlying ionic conductance in D5 neuronal membrane of Helix aspersa. Results: The results demonstrated that the convulsant drug PTZ (25mM) changed the shape and increased the frequency of spontaneous action potentials. At holding potential of - 40 m V, PTZ led to a reduction in amplitude of inward and outward currents. Extracellular application of the new quinazolinone compound (0.1 mM) in epileptic model produced a hyperpolarization of the resting membrane potential and a decrease in frequency of action potentials. Under voltage clamp condition, tested new compound decreased the peak amplitude of the inward and increased the outward currents. Application of the new compound added PTZ, caused a reduction in frequency, amplitude and duration potential. Resting membrane, potential was affected and shifted towards more hyperpolarized voltage. At holding potential of - 40 m V, the new compound in the absence of PTZ depressed the total membrane conductance. Simultaneous application of quinazolinone and PTZ produced a remarkable reduction in membrane ionic currents. Conclusion: It may be concluded that new quinazolinone compound causes a reduction in cellular excitability and inhibition of PTZ induced epileptic activity via changing membrane ionic conductance.

Background: Osteoarthritis of knee is one of the most common joint diseases in human. Hyalinetherapy is its latest treatment approach. We have compared the effects of hyaline-therapy and. NSAIDs in patients referring to Akhtar hospital and private clinics in Tehran and Gorgan during a 2-year period, 1999-2001. Materials and methods: Individuals were assigned in two groups: control group (45) using NSAID with/or without arthrosynthesis and case group (23) using hyaline-therapy (3 injections in 10 days).Groups were matched according to the sex, age, and severity of pain. Severity of pain was assessed using ASRA classification. Patients were followed up 3 and 6 months later. Results: Hyaline-therapy was comparable with NSAID and arthrosynthesis in class I and II. In class III, 75% of patients treated with Synovisc got better and were transferred to lower classes (I or II). Simultaneous usage of NSAID and arthrosynthesis was successful to cure 33% of patients. Conclusion: Hyaline-therapy revealed to be effective inpatients with severe knee osteoarthritis. Further studies are highly recommended.

Background: Tonsillectomy is a common operation among children, where hemorrhage is its most frequent complication. Some reports have stated the efficacy of conjugated estrogen on coagulation indices. Thus, in order to study the effects of conjugated estrogen in tonsillectomy, the present study was conducted in Ta1eghani Hospital in 1997. Materials and methods: During this clinical trial, 50 children under 14 years of age were operated. Patients were assigned randomly in either case or control group. Coagulation profile including BT, CT, PT, and PIT was determined before the study. Patients of the case group were given one tablet of conjugated estrogen (0.625 mg). Coagulation profile was determined again. Results: The mean volume of intraoperative bleeding to weight was remarkably lower in case group, but the difference was not statistically significant. Bleeding time was reduced significantly (p<0.002) in the case group. There was no valuable change in other coagulation tests. Meanwhile, no complication has been reported. Conclusion: Conjugated estrogen can improve BT. Further experimental studies are strongly recommended.

Background: Preterm delivery is a major cause of mortality and morbidity in infants. Controversies have arisen about its related factors, thus the present study was carried out to determine the prevalence of preterm delivery and its related factors in females referring to Shohada Tajrish Hospital, 1995-99. Materials and methods: Females who had confirmed diagnosis of preterm delivery were included. Initial data including age, parity, gestational age, neonate's apgar score, presentation, PROM, preeclampsia, maternal systemic diseases, hydroaminos, oligohydroaminos, previous history of preterm delivery, UTI, py10nephritis, and other related factor s were all recorded. Results: Of 5628 recorded deliveries, 407 were preterm delivery (7.2%). The most common related factors were PROM (37.6%), preeclampsia (17.7%), UTI (17%), maternal systemic diseases (9.6%), and hydroaminos (9.6%). Conclusion: Preterm delivery is more common in our hospital when compared to other hospitals.

Background: To evaluate modified method of epidural administration of morphine (via a gelfoam sponge as a depository) for the purpose of extended pain control after lumbar spinal surgery the present study was carried out in Imam Hossein Hospital in 2000. Materials and methods: We conducted a randomized, double- blind, placebo controlled trial on 60 adult patients undergoing lumber laminectomy-discectomy operations. Patients were randomized in two groups. Before the closure of the wound, the neurosurgeon was given a syringe containing 3 mg morphine sulphate or equivalent volume of saline (placebo) and injected it into a small piece (2x3 cm) of absorbable gelatin sponge (gelfoam). The gelfoam was placed on the dura and midline dorsal fascia was closed without any additional wound irrigation. The effects were assessed using postoperative analog pain scores, narcotic consumption, time to first ambulating, length of hospitalization and complications. Results: Groups were matched according to the age, sex, weight. There was no significant difference regarding the mean analog pain scores, consumption of narcotics, time of the first ambulating, and length of hospitalization. Conclusion: This method does not improve postoperative pain control and is not effective in providing extended analgesia after lumbar laminectomy.

Background: Among different epileptic syndromes infantile spasms (I.S) or West syndrome is considered as the most malignant one which causes irreparable brain damage in the child. Consequently the longer this type of epilepsy lasts, the more harmful results will follow. Currently common treatment include drugs such as ACTH, prednisolone, valporic acid and benzodiazepines. Materials and methods: In a randomized control double blind trial, we study 60 children aged 224 months who had IS and were admitted in Mofid Hospital, during a two year period, 1998-2000. In our study patients were assigned randomly in two groups: Nitrazepam (0.5-1 mg/kg/24h, in three divided doses taken with meals, and ACTH (40 U/daily/IM, single dose). At the end of the second, forth and sixth week of the treatment, patients were evaluated for complete control or reduction of seizure and drug side effects. Results: Result revealed that at the end of the sixth week of treatment 63% of NZP- and 30% of ACTH-treated patients had complete seizure control (p<0.05). Following the 6th week the relative reduction of seizure frequency was observed in 26% of NZP and 53% of ACTH group (NS). Complete normalization of EEG was reported in 47% and 30% of the NZP and ACTH group, respectively. Conclusion: This study vividly cleared the fact that NZP has less and negligible side effect compared to ACTH. Considering the better therapeutic effects, fewer side effects and lower cost, NZP is the drug of choice in IS.