Researcher Bulletin of Medical Sciences
Year:2000 | Volume:5 | Issue:1 (17)|Papers Count:32

Considering the high mortality as a result of abdominal aortic aneurysm (AAA) and the significance of diagnosing a small-sized aneurysm and its surgical treatment and meanwhile its higher incidence as a result of higher chance to live and higher prevalence of atherosclerotic conditions in Iran, this study was carried out to study the available diagnosing methods (clinical and paraclinical), treatment strategies and its incidence rate in referrals of Ayatollah Taleghani hospital during the years 1991-1996.The descriptive strategy of this study was performed on 56 patients with abdominal aortic aneurysm. Personal characteristics, risk factors, clinical symptoms, clinical and paraclinical diagnosing and surgical methods were collected from their medical records and gathered in research questionnaire. Then after being classified, they were statistically analyzed.Out of 65 studied cases, 48 (73.8%) were male and 17 (26.2%) were female with an average age of6l years. In 27.7% of the cases, there existed a rupture. In patients without a rupture, there had been less values for cigarette smoking, atherosclerotic involvement, average age, involvement of mesentric and renal vessels, creatine level equal to or greater than 2, BUN level, average size of the rupture, and the intra- and post-operative rate of mortality than those persons with a rupture. The most common complications were abdominal pain (64.6%) and the sense of abdominal mass (23%) and back pain (10.8%). In addition, cases of contained rupture were more common than free rupture and vice versa for the mortality rate.In conclusion, it is recommended to perform a thorough clinical examination for decreasing the mortality rate of high-risk patients and to design public training programs to lessen the risk factors.

Considering the difficulty of clinical diagnosis of Kartagener's syndrome and with regard to the absence of a statistically acceptable survey for it in Iran, the present study was performed to analyze and evaluate the present diagnostic methods of this syndrome.The descriptive strategy of the present research was performed on 12 referrals of the teaching center of tuberculosis and pulmonary disease. The considered indexes were age, time of onset of the symptoms, family history, clinical symptoms and paraclinical findings. The results were collected and recorded in research questionnaire and after being classified, were analyzed by descriptive statistical methods. Out of 12 patients, 3 were male and 9 were female. Meanwhile, the maximum and the minimum age for the patients were 27 and 7 years respectively. In 25% of the patients, the symptoms existed from the birth time as infantile respiratory distress syndrome and recurrent pneumonia and in 75% of them, the symptoms showed themselves at the beginning of childhood period. A positive family history existed in 50% of the patients. The most common clinical symptoms included chronic coughs and sinusitis. In addition dextrocardia existed in all of the patients. In 1.3% of the patients, the bronchiectasis was observed that was confirmed by chest CT-scanning.Therefore, all of the patients showed the clinical symptoms of the syndrome. For a definitive diagnosis, biopsies were taken from their bronchi. Further treatment strategies included antibiotic administration, use of inhalational bronchodilator and respiratory physiotherapy. In addition, no mortality was observed in these patients. Because early diagnosis and treatment of such patients can lessen the present irreversible complications and increase the longevity, therefore more attempts should be undertaken for such frequent and recurrent respiratory infections

Considering the high incidence of chronic renal failure in Iran and the fact that most of the affected patients should undergo hemodialysis that can be accompanied with some serious complications in long term, therefore this study was performed to determine its incidence rate and the time of its onset in referrals of the Ayatollah Taleghani hospital in the year 1999.The descriptive strategy of this study was carried out on 40 patients with chronic renal failure, undergoing hemodialysis 3 times a week and each time for a period of 4 hr. The collected data included the personal characteristics, serum calcium, phosphorus, alkaline phosphatase, billirubin and the radiographic results of wrist, pelvis and vertebral column and were recorded in research questionnaire. On the basis of the intensity, the cases were graded into 4 groups, that is mild (I), moderate (II), severe (III) and no osteodystrophy. Then the data were statistically analyzed.Out of 40 studied cases, 19(47.5%) were male and 21(52.5%) were female with an average age of 55.3±13.7 and an age range of 25-76 years. The most common conditions leading to chronic renal failure included diabetes mellitus (30%) and glumerulonephrosis (20%). The incidence rate in patients was 97.5%, from which 14(35%), 11(27.5%) and 14 cases had mild, moderate and severe osteodystrophy respectively and 1(2.5%) had no such a condition. The results also showed that a significant relationship existed between severity of the condition and the time of onset of the maintaining hemodialysis (P<0.05).Therefore it is recommended to perform a follow-up study in high-risk population for early diagnosis of this condition to prevent the ensuing consequences of chronic renal failure.

Approximately 20 to 25% of persons in population have myopia. Considering the religious importance of fasting in Islam and the concern of myopic patient for its progress by fasting, the aim of this study was to determine whether fasting in the holy month of Ramazan can enhance myopia or not. This study was performed on referrals of the optometry clinic, school of rehabilitation in the year 1998.This study was performed on 100male patients with an age from 21 to 40 years and a diopter of 1 to 6. They were divided into two groups, a case group of 50 patients who were fasting and a control group of the other 50 males who were not fasting due to other causes than ocular or systemic disease. The groups were the same regarding age, level of knowledge, marital status and family history. One day before and at the end of the month, a complete examination including visual acuity, refractive errors, intraocular pressure, corneal curvature and weight were measured and recorded. The data were analyzed using paired and unpaired t-tests and for further analysis Mann-Withney test was used.Regarding visual acuity, keratometry, family history, marital status and the knowledge level there was no significant differences between the groups, but for myopia, there existed a significant difference between the right and left eyes of the fasting persons (P<0.05), although clinically visual acuity showed no significant difference. At the end of the experiments, there existed a significant difference for weight (P<0.05). Regarding intraocular pressure, there existed a significant difference at the onset and at the end of the study (P<0.001)Thus it is concluded that fasting can not lead to myopia progression. Since the study was done in winter, it is recommended to perform a similar study in summer.

Considering the ensuing outcome of population explosion and the significance of control of unpredicted pregnancy and attenuating the mortality rate for mothers and children, this study was performed to determine the incidence of unpredicted pregnancies in urban population of nor them Tehran in 1998.The descriptive and cross-sectional strategy of this study was performed on 8661 of female referrals (with an age of 15-49 years) of the health centers. The required information in the questionnaires was age, gender, knowledge level, occupation, and the preventive methods for pregnancy. The data were analyzed by appropriate statistical tests.It was shown that the chemical contraceptives are the ones mostly used (26%) and the vasectomy had the least preventive effect (1%). The rates of unpredicted and predicted pregnancies were 22.4 and 77.6% respectively. The highest rates of preventive methods for unpredicted pregnancy were for withdrawal (59%), condom (30%) and IUD (1%).Unpredicted pregnancy in high-risk groups indicates its significance and a challenge for premarital counseling. Similar results have been obtained for the high usage of withdrawal method among the available ones and it is needed to increase the level of cognition for using contraceptive methods and finally a definitive, low risk, economically acceptable method should be found out.

Considering the high incidence of esotropia (ET) in Iran and the lack of information regarding its prevalence, this study was performed to evaluate the accomodative convergence esotropia in an epidemiologic manner in referrals of Imam Hossein hospital during the years 1994-99.In this descriptive study, we evaluated 90 ET patients by a sequential sampling method. Our exclusion criteria were mental retardation, nystagmus, deep amblyopia, paralysis of ocular muscles, hypertropia more than 5 pd and a history of surgery of previous deviation. For this purpose, their cycloplegic refraction, far and near deviation with prism, AC/A ratio, S.L and fundus were examined. The results were reported as absolute and relative frequencies and confidence nterval or AC/A ratio.Out of 90 ET Patients, 57% were girls and 43% were boys and their presented age was 7±2 years. ET+ high AC/A were seen in 23% of the patients, but it was 40% in patients under 4 years of age and 19% in those between 4 and 7 years. It was 90% grade I and 10% grade II. Except for hyperopia, other individual and disease characteristics for the two groups were matched. 25% of ET+ normal AC/A and 24% of ET+ high AC/A ratios were chosen as candidates for B.M.R. recesion surgery.It is concluded that incidence of ET+ high AC/A ratio was less than previous reports that may be related to their older ages at presentation time, since reduction and normalization of AC/A ratios may be seen in lots of patients with increasing of age. In addition there is a 40% AC/A ratio in our patients who were under 4 years that is equal to some of the previous reports, whose patients were younger.

Considering the high incidence of migraine in our population and its debilitating consequences and the factors affecting its relapse and felt intensity and for an epidemiologic evaluation, this study was performed on 300 migraine suffered patients referred to hospitals and private clinics of Tehran, Karaj andAmol during the years 1996-98. A descriptive method and sequential sampling was chosen for the present research. The criteria of IHS was used for its diagnosis, that is the onset age, duration of attacks, family history, prodrome and postdrome symptoms, aura, the location and quality of headache, the accompanying symptoms and other augmenting factors.Out of 300 patients studied, 226 (75%) and 74 (24.7%) were male and female respectively with an age of 34±11.3 that have had their attacks from their twenties to thirties. 75% out of them was at an age of 10to 30 years. 80% out of them had a positive family history, especially for their mothers and with a decreased incidence at the period of pregnancy. The average period for each attack was less in men and the most prevalent symptoms regarding prodrome, aura and postdrome included irritability, visual disturbance and fatigue. In addition the attacks were strongly relapsed as a result of garlic, pepper, and onion consumption, environmental noise, climate changes and having less sleep. Furthermore the attacks augmented in more than half of the patients during the period of menopause.These findings are different from the previous reports regarding family history and the effect of foodstuffs and other factors. Therefore it is recommended to perform a thorough analytical study to determine the influencing factors.

Considering the prevalence of carpal tunnel syndrome and the uncertainty about the efficacy of clinical symptoms and the absence of general availability of electrodiagnostic tests, this research study was performed on referrals of Loghman Hakim hospital in 1998.The clinical and diagnostic trial strategy of this research was performed on 124 patients (out of a total of 192). Five clinical tests including Phalen, Tinel, Mcmurthy, Gilliat and Vibration were selected and a definitive diagnosis was made on the basis of the results of electrodiagnostic tests and according to it, their diagnosing power for each of the symptoms individually and in combinations of two or three were measured.In total, 101 female (81%) and 23 male with an average age of 42±2 years were studied. The most common cause of references was pain and the most prevalent clinical finding was diagnosed by Tinel test. The Tinel test was the most sensitive with a negative predictive value and the Vibration test was the most specific with a positive predictive value. In addition all of the tests had a high positive predictive value, but none of them had a high negative value. Combination of two or multiple tests can not increase the applicability of clinical tests.A positive result indicates the presence of the syndrome, but a negative result can not negate its existence. Among the applied tests, the Tinel, Phalen, and McMurthy tests are more practical and reliable than Gilliat and Vibration tests. It was also found out that this syndrome occurs at lower age in Iran.

Considering the required respect and key position of elders in the conveyance of culture and with regard to the significance of their nutritional condition, the present study was performed to determine the nutritional style of Tehran-inhabited elders in 1997.The descriptive strategy of this study was performed on 170 of the elder society living in Tehran and with an age greater than 65 years. The cases were randomly and in a multiple stage manner were selected. Evaluation of 3-day food consumption was made by determination of their weight and recording the foods consumed. The consumed foods were analyzed by a computerized system and the DFP software and the standard tables and the results were compared with the and received nutrients, their minimum needs were determined. In this study, the nutritional inadequacy was considered as receiving at least 5 nutrients that are less than 2/3 of the RDA and the energy obtained is less than 90% of RDA.Out of 170 cases, 82 (48.2%) were female and 88 (51.8%) were male with an average age of 72.6±4.7 years. In 52.9% of them, nutritional deficiency existed and calorie intake for all of the nutrients except for vitamins B1 and B12 was greater in elder men than women. In addition, there was a 51 and 42% deficiency for protein intake. In this regard the main responsible causes are loss of appetite, teeth problems and singleness. It can be concluded that Tehran elders have a nutritional deficiency. Therefore it is recommended to perform a complete analytical research to determine the main factors responsible for nutritional deficiency and the ways for its attenuation.

Since the pneumonia as a result of Pneumocystis carinii is the major cause of mortality in patients with AIDS (acquired immune deficiency syndrome) and its diagnosis requires various lung specimens and different specific staining methods, this study was performed to compare different staining methods regarding sensitivity, specificity, rapidity, simplicity and applicability.The present study was performed on 30 rats. In this respect the experimental group (n=20) received 1 ml of cortisone acetate (at a concentration of 25 mg/100 ml) twice weekly for a period of 8 weeks. In this way the immune system of these rats was suppressed. The remaining 10 rats (control group) received no treatment. Then the rats were carefully examined and after taking lung specimens, the related smears were prepared.It was shown that 17 staining methods out of the total were more appropriate for differential diagnosis of Pneumocystis carinii. In this regard the new innovative staining method of cresyl violet was appropriate for visualization of sporozoites and the modified methods of methylene blue, cresyl violet and Gram's were suitable for the rapid diagnosis of Pneumocystis carinii.

Considering the applicability of pelvic dimensions, its special properties and probably not matching the general standards, this study was performed on medical record of referrals of the Ayatollah Taleghani hospital during the year 1998.The descriptive protocol of this study was performed on the radiographic records of 103 patients. For this purpose the non-pregnant cases at an age range from 25 to 40 years old with no sign of disturbance and musculoskeletal system were selected. The records were prepared in an antero-posterior view and the bone landmarks were very obvious, otherwise they were not chosen. The parameters included: the distance between two antero-superior spine of the pelvis, transverse diameter of the inlet, oblique diameter of the upper inlet, the distance between two ischial spines, infrapubic angle, sacral width, height of sacroiliacjoint, height of the symphysis pubis, diameter of the pubic disk, acetabular diameter and the distance between acetabular anterior margin and symphysis pubis. The results were expressed as Mean±SE, CI and CV and compared to the American and Chinese standards with student Hest. The results showed that in Iranian women, there existed a significant difference for the transverse diameter of the pelvic inlet (14.9±11mm) compared to Chinese women. In addition, the distance between two ischial spines was 11.2±8.2mm.It is concluded that there is no match among Iranian, Chinese and American women for pelvic dimensions that can be related to racial, cultural and nutritional factors. Therefore it is recommended to carry out more researched to obtain a general standard for Iranian women.

Abnormal uterine bleeding is one of the common causes for referrals of gynecologic clinics. The routine methods of its evaluation are endometrial biopsy, diagnostic curettage and hysteroscopy. Vaginal or abdominal sonohystography have been presented as a diagnostic method for such cases. This study was performed on referrals of Mahdieh hospital to evaluate the diagnostic efficiency of sonohysytrography for bleeding abnormalities during the years 1998-99.TVSH was performed on 100patients with abnormal uterine bleeding and an indication of diagnostic curettage before surgery. The observations were recorded as a normal uterine cavity, hyperplasia, polyp, cancer and atrophy. Then the results were compared with the pathological findings and its specificity, sensitivity and positive and negative predictive values were determined.It was found out that vaginal sonohystrography is helpful in diagnosis of 32 out of 34 cases of abnormal endometrium (with a sensitivity, specificity, and positive and negative values of 94, 89, 82 and 96% respectively), 25 out of 27 cases of endometrial hyperplasia (with a sensitivity, specificity, and positive and negative values of 83, 93, 83 and 97% respectively), 7 out of 9 cases of endometrial polyp (with a sensitivity, specificity, and positive and negative values of 83, 95,58 and 98% respectively), 3 out of 4 cases of atrophy (with a sensitivity, specificity, and positive and negative values of 75, 100, 100 and 94% respectively) and 2 out of 2 cases (100%) of the endometrial cancer.McNemar test showed that diagnosing efficacy of TVSH is equitable to pathological tests in focal cases. Vaginal sonohystrography is a high fidelity, easy to perform and fast method with no complication and it recommended to be used for early evaluation of patients with abnormal uterine bleeding.

Povidone-iodine (PVP-I) is a complex of iodine and povidone that is one of the best available antiseptic and disinfectant for bacteria, fungi, spores, cysts, yeast, and viruses. Some reports have recently been published indicating that PVP-I can be used against conjunctivitis in infants. The results of researches on more than 3000 infants showed that PVP-I was more effective in reducing the incidence of this condition. than other available drugs such as silver nitrate, erythromycin and tetracycline. PVP-I has fewer side effects and is less toxic and meanwhile no microbial resistance has been reported for it. PVP-I is less toxic compared to the other agents and also is cheaper and more available than other used agents. Therefore it is suitable to be used in infants. .Considering the eye's sensitivity and the stability of the drug, in this study it was tried to formulate a 2.5% (w/v) ophthalmic solution of the PVP-I. Therefore initially pH of the solution was optimized to the desired value (near the physiologic pH of the lacrymal solution and suitable for the stability of the PVP-I) and for this purpose it was prepared at different values of pH, that is 6, 6.5, and 7. Other ingredients of the solution including buffers, isotonic solution and stabilizer were also selected and their appropriate levels were detemlined by various tests.Then, the quality of the solution was assessed in terms of pH, viscosity, available iodine, sterility and stability. The membrane sterilization was found an appropriate method for this purpose. Stability of the solution was tested over a period of 2 months at 40, 25 and 40oC. The results showed that the final solution is stable at pH 6 and at temperatures less than 25oC. The final preparation proved to be a stable, sterile and isotonic solution with proper physicochemical properties and can be used in clinics.

Sciatic nerve injury following gluteal injection is one of the devastating complications, especially in children and lean adults. Considering the progressive incremental trend in referrals of such injury and the absence of reports, this study was designed.This study was performed on 25 cases that were referred to electrodiagnostic center of Shohada Tajrish hospital. For this purpose physical examination, history taking and the electrodiagnostic methods NCS and EMG were done and the obtained data were recorded.Out of 25 cases, 16 (64%) were male and 9 (36%) were female with an age range of 2-70 and an average age of 18±4 years. %64, 4% and 32% of them had involvement of lateral, medial and both parts of the nerve respectively. The injected drugs included penicillins, gentamicine, diclofenac natrium and methocarbamol. The results showed that dicloenac significantly increase the incidence of injuryit is concluded that electrodiagnostic NCS and EMG should be considered as sensitive and specific methods for diagnosing and screening such conditions and considering its high rate of inCidencein children and adults, it is recommended to present the required training regarding injection and its ensuing injuries.

Considering the existing controversy on the efficacy of dexamethazone in attenuation of hearing loss and the absence of evidence in Iran, this study evaluated the effects of dexamethazone in infants and children with bacterial meningitis who were admitted to the wards of pediatric infectious disease of Imam Hossein medical center, Labafi Nejad hospital, Mofid medical center and Tehran Reslat hospital during the years1992-94.This study was a sequential and randomized, double blind clinical trial performed on 50 infants and children. The study was performed on 50 patients with bacterial meningitis that were randomly divided into case and control group. The case group was treated with ampicilin 300 mg/Kg body weight/day and chloramphenicol 100 mg/Kg body weight and dexamethazon 0.6 mg/kg body weight in 24 hours at 4 doses for 4 days. The control group was treated with the same drug regimen without dexamethazone. Hearing tests were done at the onset of the therapy and 3 and 12months after therapy at the Teheran Resalat hospital. The results were analyzed using the Chi-square test.Out of 50 patients, 20 (40%) were female and 30 (60%) were male with an average age of 5.5 years and their age range from 4 months to 13 years. The results showed that the hearing loss in control and case groups was 16% and 4% respectively, and this difference of 12% is statistically significant.Based on the results of this research and similar studies, it can be concluded that dexamethazone may be used in the treatment of bacterial meningitis in infants and children and in this way decrease its consequent risk of hearing loss

Alopecia areata is one of the most common dermatologic diseases that manifest itself as falling off the hairs in a healthy region of the skin such as the head and/or other regions and there is no cause for it. Since the cryotherapy is a simple method with the least complication and the absence of reports regarding its efficacy in Iran, this study was performed on the related patients referred to Loghman Hakim hospital to evaluate the effect of cryotherapy in 1997.The clinical trial strategy of this research was carried out and the data before and after the test were compared and the recovery at the weeks 2, 4, and 8, relapse and possible complications were followed up. All of the patients (30) were at an average age of 27±8.1 years, consisting of 19 female and 11male. Their periods of involvement were less than 6 months for 25 lesions and greater than 6 months for 15 of the lesions. At the 2nd week, there was at most a 50% recovery, but at the 8th week, the recovery rate was 82.5%. Furthermore two cases of recurrence and mild complications such as itch and burning feeling existed.Therefore it is recommended to apply cryotherapy for the treatment of patients with alopecia areata.

Considering the high significance of self-care training, this study was performed to examine the effects of home visit in self care techniques war-injured people with lower limb amputation in Bandar Anzali during the year 1997.The quasi-experimental strategy of this study was performed on 25 war injured people. Since the size of population is very small, therefore no sampling was made. The self care-related data was collected by a questionnaire and checklist. In this regard the parameters knee flexion angle (with an angle meter), femur circumference, strength of femoral muscles (by a dynamometer), BMI and back pain intensity (by numeric visual analogue scale) and the state of stump's skin were used before and after home visit as a means of data collection.It can be concluded that home visits causes an improvement in the self-care regarding stump's skin, prosthesis and musculoskeletal system (P<0.001) and an improvement in the physical condition (healing of stump's skin and musculoskeletal system) (P<0.001) .However there was no significant difference for the flexion angle of the stump after home-visit

Considering the significance of intestinal parasites regarding personal and social health and the role of food manufacturers and retailers in their spread and its high incidence in our country and people's unawareness of this problem, and meanwhile for identification of the present intestinal parasites and evaluation of the efficacy of the available medical treatments, the present study was performed during the years 1997-98.The descriptive strategy of the present research was performed on 3002 cases including food manufacturers and shopkeepers. For this purpose their characteristics were recorded in relevant questionnaire and after instructing them, two specimens of feces were collected from each person and tested by formalin ether precipitation and direct methods. All of the parasite-afflicted patients received medical treatment. Following one month their feces were again tested and the results were recorded in questionnaires. Then its incidence was determined in our population before and after treatment and the final results were reported in frequency distribution tables.The results showed that the incidence of intestinal parasites in our population was 50.9%. In this regard the incidence for Giardia, Amoeba histolytica, Ascaris, Hymenolepis nana, Strongyloides stercoralis was 16.4, 4.5, 1, 0.9, and 0.1% respectively. The maximum incidence was for Giardia (20.3%) and Ascaris (1.9%) in workers of food-producing units and for Amoeba histolytica (5.3%) in workers of confectionery units. After treatment, 5, 4, and 3% of patients with Giardia, Amoeba histolytica and Ascaris had again signs of infestation.The results showed that the incidence of intestinal parasites, especially pathogenic protozoa is high in our country. Therefore it is recommended to perform more researches in this field and the necessary procedures are undertaken to reduce the consequent complication and to provide direct-surveillance treatments for the afflicted persons.

Considering the endemic condition of visceral leishmaniasis in the Ardebil and Fars Provinces and reports on its existence in the water reservoirs, this study was performed in the province of Mazandaran to determine its possible vectors and its frequency during the years 1997-98. The study was carried out on sand-fly fauna in Ramsar and eight other parts of Mazandaran provine (Tonekabon, Kelardasht, Marzanabad, Chalous, Babol, Sari, Neka and Behshahr).Sand flies were collected by sticky and CDC light traps from different regions of the hilly and mountainous areas before sunset. Sand flies caught by the sticky traps were transferred by needle to acetone to remove the oil and after about two minutes, the acetone was poured off and 70% alcohol was added. For determination of species, sand flies were mounted in a specialized medium.One hundred and ninety four specimens of sand flies were caught and identified. They consisted of four species of the genus phlebotomus [124 (64%) Ph. Major, 5 (2.5)% Ph. Halepensis, 1 (0.5%) Ph. Andrejevi, and 2 (1.3%) Ph., Papatasi] and two species of the genus Sergentomyia [6 (31.5%) Ser. Sintoni and 1 (0.5%) Ser. Dentata]. Sergentomyia sintoni was collected for the first time from Abbas-abad region of Behshahr.Phlebotomus major is a well-known and probable vector of visceral leishmaniasis in Iran and predominate in those areas (64%). The activity of Ph. major extended from mid-June to mid-October and there was one peak of activity in mid-September for this species.