Researcher Bulletin of Medical Sciences
Year:2001 | Volume:5 | Issue:4 (20)|Papers Count:19

The vast majority of people undergone operations each year have experienced postoperative pain of varying intensity. Regarding the wide usage of indometacin as a NSAID in such patients, this study has been conducted with the aim of comparing the effects of indometacin suppository with IM injection pethidine on post operative pain after cesarean section in Mahdieh Hospital, 1999-2000. This double-blinded clinical trial has been conducted on 90 pregnant women undergone cesarean section through spinal anesthesia with sequential sampling. They were divided in two groups of case (indometacin supp.) and control (IM injection pethidine). The case group has received 100 mg indometacin supp. and the other group was given 0.5 mg/kg pethidine, 1.5 hours later after spinal anesthesia with marcain. Then, the-case group has received 100mg indometacin supp. 8 hrs later whereas the control group was given 0.5 mg/kg pethidine PRN. The NRS (Numerical Rating Scales) pain scores were collected every 4 hrs for 16 hrs. Patients were distributed in three groups of; no pain (0), moderate pain (1-5), and severe pain (6-10). 84% of the patients using indometacin have experienced no to moderate pain in the first visit and the remaining 16% had severe pain, however, in the control group moderate and severe pain were recorded in 53 and 47% of the patients, respectively (p<0.0005). During the second visit, no or moderate pain was seen in 95.6% of the patients receiving indometacin and the remaining 4.4% had suffered severe pain, whereas in the control group moderate pain was recorded in 75.6% of the patients and the remaining 24.4% experienced severe pain (p<0.0005). Third visit has revealed the following results: in the case group 49% of the patients were painless and 51 % had moderate pain, but in the other group moderate pain has been recorded in 95.6% of the patients and the remaining 4.4% had severe pain. During the fourth visit 69% of the patients in the case group were painless and 31 % had moderate pain, but in the control group all the patients have suffered from moderate pain (p<0.00005). Out of bed time was significantly shorter in women who received indomethacin versus pethedine. In case of clockwise usage of indometacin, especially before post-operative pain return, it is strongly recommended in comparison with PRN usage of IM injection pethidine due to its cost benefit and lack of opioids complications.

Regarding the hazard of the issue of suicide, concerning as a psychiatric emergency, and also its known stresses and side effects, this study has been conducted on children referring to Loghman Hakim Hospital due to suicide, 1999-2000. We have reviewed the existing data of children certainly diagnosed as suicidal cases. Age, sex, the exact time and means of suicide, the way of parents" awareness and source of suicidal behavior were all collected in a data sheet. In case of file impairment, it would be removed. 60 children, 6-13 years old, had met our criteria where 62% were male and the remaining 38% female. Results have revealed that autumn was the most common season, in the meantime, suicide attempts occurred in weekends and during 6pm till 11 pm more frequent than other time. We have faced disintegrated families and academic difficulties as the main stress factors. Suicide attempts were mainly practiced through the use of drugs (93.4%). Depression comprised the most common underlying disease. Meanwhile, children had learned about suicide attempts by watching TV, or witnessing suicidal attempts in their family members, especially their mothers. More studies to determine the exact role of psychiatric, social and biological aspect of this problem are strongly recommended, however, an experimental study to assess family training could be helpful.

Regarding the relative high prevalence of hydatid cyst in our country and lacks of general knowledge in this field, and also to survey 32 cases of hydatid cyst in children, this study has been conducted on patients referring to Taleghani Hospital, Tehran, 1988-2000. Existing data were studies with respect to the age, sex, clinical manifestation, type and site of cyst, and also the therapeutic procedure. Finally, the results of this survey and follow up of the patients undergone surgery were analyzed by descriptive statistics. 32 patients met our-criteria. 62% were male and 38% were female, with the mean age of 8.2±2.2 years old. Increasing age was strongly correlated with infectious prevalence. Echi nococous granolosus has comprised 94% of the cases. In 56% of the cases, cysts were found in the lungs, where liver included 28% of the cysts. Clinical manifestations in pulmonary hydatid cyst were cough, fever and dyspnea, but in hepatic hydatid cyst abdominal mass, hepatomegaly and fever has been reported. 94% of the infected children had undergone surgical procedure and cyst recurrence has been noted in 8%. In children, increasing age accompanies by- higher prevalence rate of hydatid cyst infection. Here lungs are more susceptible (contrary to the adults). More studies to find out the etiologic factors in children is strongly recommended.

Regarding the relatively high prevalence of lymphomas in Iran and variety of classifications in this field and also lack of sufficient studies, we seek more studies according to the modern laboratory facilities such as immunohistochemical markers and molecular genetic knowledge. In this descriptive study, biopsied specimen of 255 patients diagnosed as lymphoma (Hodgkin and Non-Hodgkin's lym.) were collected from 6 centers. Common histochemical dyes (such as H&E, Giemsa, Pos) and immunohistochemical markers were used to confirm or made the true diagnosis. Non-Hodgkin and Hodgkin's lymphomas were classified according to the updated Kiel and Rye classification, respectively. Their related prevalence was studied regarding age, sex, and site of sampling and then our results have been compared with 1284 cases of lymphomas recorded in Kiel center. Among all the cases, definite diagnosis had been made in 225 patients where 170 cases of Non-Hodgkin and 55 cases of Hodgkin's lymphomas have been reported. Most of the Non-Hodgkin's lymphomas were B type (69%), however, T type has been recorded only in 6.5% of all cases and the remaining 24.5% were Hodgkin's lymphomas. With respect to the grading of Non-Hodgkin's lymphomas, H.G. lymphomas are more common than L.G. ones in Iran (contrary to the western countries). Needless to say, surveying Iranian lymphomas according to the reliable classifications and statistical comparisons with other countries could lead to more clear horizons in this field.

Patients with tracheal stenosis have critical condition. Limited diagnostic facilities are noted and surgical approach requires high expenses and tolerating surgical stress for the patients. Post-intubation tracheal stenosis, due to its preventability, is of great importance, then this study has been conducted with the aim of determining the etiologic factors in this field. In this descriptive study, all the patients with post-intubation stenosis referring to Masih-e-Daneshvari and Modarres Hospitals during 1995-2000- had undergone bronchoscopy to determine the main etiologic factor(s). 108 patients with mean age of 27.9 (3-83 years old) were included where 75 patients were male and the remaining 33 were female. Tracheal tube cuff was the main etiologic factor in 83 patients, however, injuries due to tracheotomy tube tip and/or tracheal tube on tracheal wall and at the entrance of tracheotomy were reported to be the main etiologic factors in 13 and 9 patients, respectively. We were unable to explain the etiologic factor in 3 patients, meanwhile, age and sex have shown no correlation with this problem. Tracheal tube cuff compromises the vast majority of etiologic factors in airways' post-intubation stenosis. In case of observing the minimum safe pressure in the cuff, this problem seems to be preventable. Needless to say, special considerations to care this part of the tube should be applied.

Regarding the prevalence of skull base fractures and paradoxical approaches for administering or not administering antibiotics as prophylaxis, and also with respect to lack of experimental reports in this field, this study has been conducted over the traumatic patients referring to Shohada-e-Tajrish Hospital, 1999-2000, to determine the effects of ceftizoxim as prophylactic agents on meningitis. This sequential clinical trial performed on all head trauma patients with skull base fractures referring to Shohada-e- Tajrish Hospital. Patients were distributed in 2 groups of case (A) and control (B), randomly. In the case group, ceftizoxim Amp, was administered by dose of 150 mg/kg/day either for three days or up to the cessation of rhinorrhea or otorrhea, but the control group received no antibiotic. Among 65 patients with skull base fracture, 11 who had not met our criteria were eliminated. The remaining 54 patients were distributed as follow: 26 in the case group (receiving antibiotic) and 28 in the control group (not receiving antibiotic). Patients in both groups were matched according to the sex, age, site of fracture and the" incidence of CSF fistula. 4 patients (14.3%) in the case group and 3(11.5%) in the control group have been diagnosed with meningitis, but no significant statistically difference has been noted. The presence of fistula was accompanied by higher rate of meningitis incidence, where the difference was not significant. Culture was shown to be positive in 3 patients of 4 in the control group, whereas in the case group all of the patients have been proved to have negative culture. The study revealed that administering the antibiotic has no effect on meningitis prevention. In the meantime, as none of our neurosurgical departments are faced with high numbers of patients with skull base fracture multicentric research to survey the effects of prophylactic antibiotics, especially in case of CSF fistula, is strongly recommended.

With respect to widely usage of new neuroimaging devices (such as MRI), brain lesions are revealed in primary phases, where definite diagnosis in this phase could lead to employing necessary therapies which in turn prevent their progression to untreatable phases. For definite diagnosis, sampling with stereotactic procedure is strongly recommended. A study conducting during 1990-2000 in Shohada-e- Tajrish Hospital had surveyed 90 brain lesions with definite spectrum of infectious, tumoral and demyelinating. This study has shown different types of these lesions with their related prevalence. Among these patients, 60 were male (66.6%) and 30 were female (33.3%), where mean age was 42.1 years old. Pathologic prevalence of different brain lesions were as below: Lymphoma, which had ascending movement, comprises 30 cases (33.3%), metastatic lesions 20 cases (22.2%), glial tumors 14 cases (15.5%), brain abscess 6 cases (6.66%), non specific pathologic feature 5 cases (5.5%), gliosis 4 cases (4.4%) and 11 cases (12.2%) of other rare lesions such as germinomas, tuberculomas, leuko encephalopathy, infarction and demyelinating lesions. Different brain lesions comprise a wide specirum of disease, each require specific therapeutic approach whereas obtaining biopsy and the pathologic features of these lesions could lead to better therapeutic outcomes.

Anesthetic drugs' side effect on IVF outcome is a major problem originated in anesthesia during IVF. Regarding controversy reports about the effects of propofol on this process, this study has been conducted in a private laboratory to determine the effect of the drug presence in infertile women's follicular fluid on the growth of mouse embryo in 2000. It was an experimental study, human and animal variety. Performing the induction, 1 mg/kg of propofol was administered after 50 µg of fentanyl and 0.5 cc of thalamonal. 1/4 dose of propofol was administered each minute as maintenance. Samples were collected on 5th, 10th and 15th minutes after the induction. Then, 68 bicellular mouse embryos were put adjacent to the follicular fluid obtained from infertile women anesthetized with propofol. A culture was considered as control and embryonic growth was assessed. Infertile women in this study were all matched according to the age and the infertility cause. Embryonic growth has been reported as below: Control group: first day 50%, second day 50% and the third day 40%. Case group: 26.3%, 35.3% and 22.7% on 5th, 10th and 15th minutes after induction, respectively (p<0.05). No embryonic growth has been reported during the 2nd and 3rd day in the case group. Therefore propofol seen in the women's follicular fluid may cause growth retardation.

Pemphigus is a chronic bollous life-threatening disease which has still relatively high mortality rate despite applying different therapeutic methods and significant reduction in its mortality and side-effects. Although using systemic steroid consists our treatment basis, no unique treatment has been introduced till now. In the meantime, long period of hospitalization is another weak point of common therapeutic procedures. Since 30 years ago, steroid pulse therapy has been introduced as a modem therapeutic procedure for some diseases including dermatologic ones, but no unique treatment and precise follow up have been reported despite conducting various studies, however, a few patients have been studied in the previous researches. This study has been conducted with the aim of comparing pulse therapy with the conventional oral steroid therapy regarding its effects and side effects. 71 patients, considering their clinical and pathologic presentations, were randomly distributed in 2 groups of intravenous pulse therapy (case) [group 1, n=36] and the conventional oral steroid-therapy (control), [group 2, n=35]. The case group has been received 3 courses of intravenous pulse therapy following cyclophosphamide and oral steroid, where the control group was given oral steroid and azathioprine. Clinical and laboratory conditions were similar in both groups, before the treatment. After the treatment, no significant statistically difference has been reported considering remission, recurrence and complications, but oral prednisolone intake (p<0.0001 to p=2%), hospitalization duration (p<0.0001) and weight gain (p<0.0001) were much less in the case group (pluse therapy). These findings imply that pulse therapy could be considered as an alternative for conventional oral steroid-therapy in pemphigus disease, at least when long hospitalization is not available.

Considering the relatively high incidence of poisoning in children and alteration in its caustic factors during the recent years, this study has been con-ducted in Loghman Hakim Poison Control Center in 1997. This retrospective study was carried out on medical records of poisoning in children. For this purpose, 2986 cases of poisoning in children referring to this center were studied, where only 501 (16.77%) cases are due to chemical detergents. Among these the bleachers, hygienic materials, disinfectants, and cosmetics comprised 348 (69.4%), 80 (15.9%), 50 (10.1 %), and 22 (4.3%) of the cases, respectively. The high incidence of poisoning with these chemicals necessitates determining their exact composition so that necessary maniPulations take into consideration. Meanwhile, most of the cases were referred within the first 2 hours and had age range of 2-5 years old. Different approaches have been performed including liquid and emetic administration, gastric washing, and intravenous saline injection. Reviewing the data, good prognosis.

Protein-energy malnutrition is a common nutritional problem in children under 5 years old in our country. National survey during 1991 and 1995 had revealed that malnutrition in children under 5 had relatively high prevalence in urban and rural areas. Regarding the harmful outcomes of malnutrition including higher mortality and morbidity rate, eliminating learning ability, and finally fading physical and mental abilities, and also with respect to the lack of a clear epidemiological picture of malnutrition in our country, this study has conducted on children under 5 years old in 1998. 34200 children less than 6 years old had entered this descriptive study. Then malnutrition prevalence has been estimated with probability of 95% based on the following indices: weight for age, height for age, and weight for height. To match and compare with the international data, results related to the children less than 5 years old have taken into account. Results have revealed that 15.4% of the children suffered from moderate to severe nutritional stunting (less than 2 SD from standard mean). According to the weight for height index, 4.9% of the children had wasting. Moderate to severe under weight had been recorded in 10.9% of children according to weight for age index. Regarding the obtained results, protein-energy malnutrition is still a major problem in our country. As a multiple problem, united cooperation of different authorities specially the health department to develop nutritional interventions is highly recommended.

With respect to the relatively high incidence of brain lesions, the importance of early diagnosis, surveying the anatomic distributions and also controversies about using or not using contrast agents in CT imaging, this study has been conducted over patients referring to Shohad-e- Tajrish Hospital, 1998-2000, to determine the effects of contrast agents on CT imaging of brain lesions. It was a clinical trail and 204 patients have entered our study. All the patients were candidates for CT imaging and operation, according to neurosurgeons' orders. Our samples have had CT imaging with and without contrast agents, using GE9800 or other similar modem CT imaging units. Data referring to lesions" morphology, enhancement shape, observability, number of lesions and diagnosis were all collected before and after contrast administration. According to the pathologic reports of biopsied lesions, the predictiye value (positive or negative) of using or not using contrast agents has been determined. Among all the patients, the observability grade of +4 has been recorded in 11% of CT imaging without contrast arid 82.8% of CT imaging with contrast. This difference revealed to be statistically significant (p<0.005). Positive predictive value in CT imaging without contract was 98.4 where negative predictive value in this group was 6.7. There figures in CT imaging with contract were 95.7 and 14.3, respectively. In CT imaging without contract the number of tumors was 1.48±1.18, where in the other group it was 1.77±1.78. This difference of 19.6% (p<0.01) was statistically significant. Using contrast agents can promote our brain diagnostic imaging technique. More studies to determine the side effects of contrast are highly re commended.

Polycystic ovarian syndrome (PCOS) is a clinical state associated with chronic anovulation and infertility. Its prevalence is estimated about 5%. To overcome infertility problem in these patients, ovulation-stimulating drugs are widely used. Some new therapeutic techniques have been introduced including, diathermy or laser vaporization of ovary through a laporoscopic approach which may lead to ovulation and pregnancy. Success rate is variable and under consideration. This study has been conducted with the aim of determining the effect of laparacopic electrocautery of ovaries on fertility state of patients with drug-resistant poly cystic ovarian syndrome (PCOS) referring to Mahdieh Hospital, 1998-2000. It was a clinical trail of pre- and post-treatment type, studied 41 women with PCOS who had failed to response ovulation stimulation with clomiphene and HMG for at least 3 months. After recording initial data including age, duration and type of infertility and menses regularity, all the patients had undergone laparacopic electrocautery of ovaries, then the fertility rate and menses" regularity have been surveyed during a three-month follow up. Finally, Mc Nemart statistical test has evaluated our findings. Among 41 patients, regular menses reported-m 17%, however, after ovarian cautery it has been reached to 68.3%. This increase is statistically significant (p<0.05). Fertility rate in patients who have refused common medical therapy was reported 26.8%. Age distribution was 19-38 years old. The greatest rate of post-operation menses" regularity was seen in 20-30 years old patients, in the meantime, pregnancy has just reported in this group. So, regarding the results obtained, laparascopic electrocautery of ovaries is strongly recommended in infertile women suffering from PCOS who had refused all therapeutic techniques.

Chronic hemodialysis patients are highly susceptible to hepatitis B, where different factors associate with this problem. Determining these factors and employing preventive care could be helpful. This study has been conducted with the aim of determining the effective factors in chronic hemodialysis patients in Tehran during the academic year 2000. This descriptive study has performed through an observation-interview technique on 56 hepatitis B infected hemodialysis patients. Among the patients, 82% were male and the remaining 18% were female. Mean age was 44.5.68% have settled in urban areas and 32% in rural areas. Dialysis duration of less than one year has recorded in 19.5%, where the duration of 1-3 years and 13-15 years has recorded in 28.6% and 5.5%, respectively. Positive history of blood transfusion, dental procedure and surgical operation has reported in 75%, 66%, and 52% of the candidates, respectively. 40% of the patients were HBs Ag positive during the dialysis course and none of the patients have received vaccination. 12.5% coinfection with hepatitis C, 80.35% use of separate room, 100% use of separate equipment and 7% use of separate dialysis staff have been reported. Pathologic studies have revealed renal failure as the main etiologic factor in 87.4% of the patients, where hypertension was the main reason in 25% of the cases. 66% of the patients have a positive history of dental procedure that in case of observing sterilization rules, hepatitis B seems to be preventive. Meanwhile, vaccinating HBs Ag negative patients and using separate dialysis staff could be helpful.

Vaginitis is the most common gynecological diseases. Due to its known side effects of leaving untreated or mistreated and also with respect to controversies in its diagnosis, this study has been conducted on symptomatic women referring to Taleghani Hospital in 1999, to determine the efficacy of rapid clinical and laboratory diagnosis including wet smear, direct smear and Amsel criteria, in diagnosis of different types of vaginitis (candidiasis, trichomonasis and bacterial). This study of clinical type, performed on 106 patients with vaginitis. First of all, clinical diagnosis based on signs, symptoms, observations and physical exams has been made and then sampling of vaginal secretion to study vaginal PH, whiff test, wet smear, direct smear, and culture has been achieved. Vaginitis was confirmed in 23% (24 patients) based on culture, and in 71 % (76 patients) based on physical examinations (without microscopic studies or culture) (p<0.0001). The specificity and sensitivity of clinical diagnosis were 79% and 31%, where positive predictive value and negative predictive value were 26% and 83%, respectively. We believe that conventional methods of diagnosis, based on clinical manifestation, are not reliable in definite diagnosis, as a matter of fact it just brings the suspicion of disease.

Morphine and other opioids are among the most useful drugs for pain relief, but their usage has been limited due to the side effects specially fear of tolerating and addiction. This study has been conducted with the aim of surveying the effects of amitriptyline and imipramine on morphine-induced pain relief, in patients undergone abdominal operations. Meanwhile, changes of vital sign have been recorded. 270 patient undergone abdominal operations (appenditis, inguinal hernia, hydrocele, and varicocele) had entered our study. After complete consciousness, 3mg morphine has been infused that repeated 8 hrs later. Placebo (group I), 10mg of amitriptyline (group 11), and 10mg of imipramine (group Ill) have administered intramuscularly along with morphine. Pain score and vital sign were collected each 2 hrs for 24 hrs. Mean of pain score was reported in control group, group II and III, 2.18, 1.11, and 1.54, respectively (p<0.01). In the meanwhile, control group has shown increase in respiratory rate, pulse rate, and systolic blood pressure that were statistically significant. Changes in these parameters were not statistically significant in group II and III except of pulse rate. This could be due to relatively high pain relief in patients using antidepressants with morphine. Increased pulse rate in group II may be associated with anti cholinergic effects of amitriptyline. Results have implied that using antidepressant and morphine together could be helpful in pain relief and eliminates morphine dosage.