Researcher Bulletin of Medical Sciences
Year:2002 | Volume:6 | Issue:5 (25)|Papers Count:21

Background: Prior investigators have reported successful surgical methods of obstetrical brachial plexus palsy. We have evaluated the efficacy of surgical methods in infants with obstetrical brachial plexus palsy, referring to 15-Khordadand some other hospitals in Tehran since 1993 till 1996.Materials and methods: 86 infants with obstetrical brachial plexus palsy had entered this clinical trial. Patients were distributed in either of the 3 following groups: 1-those who had no surgical indication and received adequate physiotherapy, 2-those who had surgical indication but have not undergone operation, and 3- those with surgical indication underwent operation. Patients have been followed for at least 5 years. Therapeutic outcomes were presented according to the Mallet criteria.Results: Patients were distributed as below: 44, 24, and 18 in the first, second and third group, respectively. Excellent outcomes were reported in all patients of the first group and 77.8% of the third group (p<0.0001).Conclusion: Surgical treatment is strongly recommended for patients with obstetrical brachial plexus palsy who have been really indicated for surgery.

Background: Low back pain is a frequent problem with known complications. The present study was designed to determine the therapeutic outcomes of surgical treatment in patients referring to a private clinic in Tehran since 1979 till 2000.Materials and methods: In this study of existing data type, initial data including early complications, clinical and preclinical findings, therapeutic approach, period of follow-up, and results of surgery were all recorded. The outcome of surgical treatment was reported as either excellent, good, fair, and poor.Results: Among 55000 patients visited by the senior author from1979 till 2000, 19599 had low back pain or sciatalgia. 95% of the patients responded to medical therapy, whereas the others (1141 cases) were treated by various surgical procedures. The most common symptom was pain (98%), and the most common sign were positive SLRT (75%), and motor dysfunction (53%). L4-L5 interspace was more frequently involved. Surgical complications were seen in 6%, where superficial wound infection was reported in half of the patients. Patients have been followed up for at least one year. In 67.6% of surgically treated patients, the results were excellent. 15.7% had good and 3.4% had fair outcomes. Poor results were recorded in 2.2% of the cases.Conclusion: Accurate selection of the cases for surgical approach and preventing predictable complications during the operation are of utmost importance to obtain favorable outcomes.

Background: Chronic suppurative otitis media is a prevalent problem. Medical therapy and various systemic or local antibiotics are of controversies in the treatment of chronic suppurative otitis media. The present study was carried out over the patients referring to Loghman Hakim hospital with the diagnosis of chronic suppurative otitis media, to compare the therapeutic effects of local gentamicin and ciprofloxacin.Materials and methods: It was a double-blinded randomized clinical trial. 50 patients were randomly distributed in 2 groups of case (received local ciprofloxacin drop. 0.3%) and control (received local gentamicin drop, 3mg/ml). Therapeutic outcomes and drug side effects were recorded on the 5th and 10th day. Bacterial cultures were obtained before and after the therapy. Results: Excluding 10 patients, the remaining 40 cases were equally divided in 2 groups. They have been matched according to the age and sex. Pseudomonas aueroginosa and Staphylococcus aureus was the most common microorganism cultured in both groups. Symptoms were improved in 15 (75%) patients of the control group and 19 (95%) of the case group. No complication was reported during the study. Conclusion: Regarding the therapeutic outcomes and also availability and low cost of gentamicin, it is highly recommended for chronic suppurative otitis media.

Background: Controlling hyperlipidemia and hypertension could cease mortality among hemodialysis patients. Controversies have arisen regarding the effects of vitamin E and omega-3 fatty acid on these parameters. We have designed the present study to determine the effects of supplementary vitamin E, omega-3 fatty acids and combined regimen on serum lipids and hypertension in hemodialysis patients. This was done in National Nutrition Institute in 1998-99.Materials and methods: It was a double-blinded sequential clinical trial. The study population included 36 hemodialysis patients with hyperlipidemia (triglyceride 2³200mg/dl or cholesterol³240mg/dl). Subjects were matched according to the age, sex, body mass index, cholesterol, and triglyceride. Then, they have been randomly allocated to 4 groups of control, vitamin E, omega-3 fatty acid, and vitamin E + omega-3 fatty acid. For 10 weeks, the candidates have received the following regimen; "Vitamin E" group: 300mg/d alphatocopherol acetate (three 100mg tablets), "Omega-3 fatty acid" group: 2 grid icosapentaenoic acid (two 1gr oil capsules), "Vitamin E + omega-3 fatty acid" group: 300mg/d alphatocopherol acetate + 2 grid icosapentaenoic acid, and "Control" group: placebo. Fasting blood samples were collected in the beginning and at the 5th and 10th week of study. Then, total cholesterol, triglyceride, LDL, and HDL were determined enzymatically and vitamin: E was measured through HPLC method. Blood pressure was measured one hour after hemodialysls. Meanwhile, dietary pattern was assessed by means of a 24-hour dietary recall questionnaire and anthropometric measurements were also recorded at the aforementioned times.Results: We have found no significant alteration in body mass index and dietary pattern during the study. Basic serum vitamin E levels in control, vitamin E, omega-3 fatty acid, and vitamin E + omega-3 fatty acid groups were 77.88±16.16, 80.15±30.86, 83.18±25.92, and 103.14±35.43 mg/ml, respectively. Significant increase was reported after 5 and 10 weeks of supplementation in "Vitamin E" and "Vitamin E + omega-3 fatty acid" groups. (p<0.001) Meanwhile, LDL level was reported 84.6±25.3, 110.7±41.1, 117.6±46.6, and 113.3±50.9 mg/ml, respectively, at the beginning of the study. The only significant reduction observed after 10 weeks in the omega-3 fatty acid (p<0.05). The other changed in other lipidemic parameters and hypertension was non-significant.Conclusion: Since supplementary omega-3 fatty acid resulted in LDL cholesterol reduction, it is highly recommended according to the individual's requirement.

Background: Hyperlipidemia and its related complications are among the most frequent problems during the menopause. Controversies have arisen regarding the effects of hormone replacement therapy on serum lipids during the menopause, so the present study was conducted over the menopausal women referring to the hospitals of Shaheed Beheshti University of Medical Sciences in 1998-99.Materials and methods: 40 menopausal females ahd entered this clinical trial. Including criteria were: non-obesity (BMI<30), normal uterus, blood pressure<160/90mnHg, no previous history of diabetes, hypothyroidism, renal failure, acute liver disease, and breast cancer. Meanwhile, candidates should have no obligation for estrogen-therapy (such as thrombophlebitis, ...). 8cc blood sample was obtained for FSH, FBS, LFT, triglyceride, cholesterol, HDL, and LDL measurement. FSH was measured through radioimmunoassay and lipid parameters were determined enzymatically. Hormone replacement therapy was administered for 3 months as below: conjugated estrogen 0.625mg/d, first to 25th day of each menstrual cycle as well as medroxyprogestrone acetate 10mg/d, 15thto 25th day of each menstrual cycle. Then, blood samples were obtained and lipidemic parameters were determined and compared with the previous results.Results: The mean age (±SD) of the candidates was 53.9±2.83 and the mean age of menopausal was 51.9±1.45 years. Serum cholesterol level was reported 197.4±37.9 mg/dl before the hormone replacement therapy, but was decreased by 17% (162.4±31.5mg/dl) after that (p<0.001). However, HDL level has shown 14.91% increase after the therapy (50.3±12.2 vs. 57.8±14.5 mg/dl). Meanwhile, LDL and triglyceride levels have shown 21.4% and 9.56% reduction following the procedure (124.5±44.5 vs. 97.8±34.3 mg/dl, and 163.4±55.98 vs. 147.7±52.47 mg/dl, respectively, p<0.001).Conclusion: Hormone replacement therapy could reduce serum lipid level in menopausal females. Another study regarding the efficacy of hormone replacement therapy on hyperlipidemic menopausal females is strongly recommended.

Background: Clavicular fracture is the most common fracture in neonates. It has been linked with shoulder dystocia, macrosomia, and birth trauma. The current study was designed to determine the incidence of obstetric clavicular fracture and its related risk factors in Mahdieh hospital, 1996-99.Materials and methods: It was an existing data type study. Live-born singleton neonates with clavicular fracture between 1996-99 were compared to neonates born directly before or after them with the same obstetric attendant and same route of delivery. Groups were compared regarding the following criteria: age, sex, race, gravidity, parity, macrosomia, use of oxytocin, obstetric maneuvers, instrumental delivery, meconium, shoulder dystocia, 1-and 5- minute Apgar scores lower than 8, and brachial plexus palsy.Results: Of 27678 live-born neonates, 56 had clavicular fracture, so the incidence of clavicular fracture was 2.02/1000 live-born neonates, all of which occurred during normal vaginal delivery. Shoulder dystocia, macrosomia, obstetric maneuvers, instrumental delivery, brachial plexus palsy, and 1-minute Apgar score lower than 8 were significantly higher in the group with fracture. 39 neonates (70%) of this group have revealed no risk factor. Conclusion: The reported incidence of clavicular fracture is almost the same as previous studies. Although shoulder dystocia, macrosomia, obstetric maneuvers, instrumental delivery, brachial plexus palsy, and 1-minute Apgar score lower than 8 have revealed to be risk factors for clavicualr fracture, most of these fractures occur during a normal vaginal delivery. Thus, surveying other factors, such as rapid delivery and attendant's experience could be helpful.

Background: Congenital heart disease (CHD) is among the most common disorders of neonates. The present study was carried out in Imam Hossein hospital in 1998-99 to determine the echocardiography results of newborns.Materials and methods: 800 live-born neonates had entered this descriptive study.Following the echocardiography, the incidence of CHD was determined. Neonates with PDA, TR, or calcified heart muscle were excluded. Results: 74 (9.3%) have revealed to have CHD (40 girls and 34 boys). Small VSD is the most frequent disorder, reported in 34.3% of the cases. Meanwhile, cyanotic heart disease was found in 1.25% of the neonates.Conclusion: Regarding the high prevalence of CHD, early diagnosis and management is of utmost importance, where echocardiography could be of great help hereby.

Background: End -to end anastomosis is a time-consuming procedure that seeks expert surgeon. Lauritzen had invented a new and easier technique, called telescoping anastomotic technique with external sutures. Complications have been reported in large and mid-siz arteries, thus, this technique is recommended for microscopic surgeries.Materials and methods: 18 sheep carotid arteries were excised and telescoping anastomotic technique was achieved through fixing proximal end in distal end. 3 carotid arteries were sent for microscopic studies at each of four time points: 3, 7, 21, and 56 days postoperative. 90 days after the procedure, 5 carotid arteries were excised and sent for pathologic studies.Results: Following the anastomosis, the blood flow was provided and arterial pulse was present. True or false aneurysms have not reported. Proximal intimal hyperplasia was prominent at day 7 and 56, however, no stenosis was noted. At day 90, the aforementioned hyperplasia was significantly reduced.Conclusion: Telescoping anastomotic technique could reduce the procedure to less than 3 minutes. This would limit the hot ischemia and is strongly recommended for organ transplantation.

Background: Nowadays, the major causes of death are attributed to vascular disease, of which the most important form is atherosclerotic heart disease. Some prevalent causative factors are smoking, stress, obesity, and high level of lipids in serum. Atherosclerotic disease could be treated either by medical therapy or diet. Clofibrate and its analogs are highly effective drugs used to reduce serum cholesterol.Materials and methods: It was an explorative study. Having the isobutiric acid, 1,3 dibromo propane, and 2,5 dimethyl phenol purchased from Fluka company and isobutanol, dioxane, dimethyl sulfoxide, diisopropylamin and tetrahydrofuran purchased from Merck company, the procedure was performed.Results: Gemfibrozil [5-(2,5 dimethyl phenoxy) 2,2 di pentanoic acid] was synthesized through Williamson method. Its reported yield and purity were 70% and 80%, respectively.Conclusion: Method that is explained in this article, is by far the most suitable way of gemfibrozil synthesis due to its simplicity, price, yield (70%), purity(80%), and scale up.

Background: With respect to various therapeutic outcomes achieved in the treatment of patients with knee dislocation, the present study was performed with the aim of determining the epidemiology and therapeutic outcomes of knee dislocation in patients referring to Taleghani hospital, 1989-2001.Materials and methods: It was an existing data type study. Initial data including personal characteristics, therapeutic approach, period of follow up, and therapeutic outcomes were all recorded.Results: Between 1989 and 2001, 25 patients have been referred to Taleghani hospital with the diagnosis of knee dislocation. The study population included 24 males and 1 female with the mean age of 35±13 years. Vehicles in 60% of the cases caused trauma. Knee dislocation was reduced within 5 hours in 25% of the patients. 12 (48%) had popliteal artery injury, of which 7 (58%) required vein graft and 3 (25%) led to amputation. 12 (48%) were treated by prompt reduction and splitting. Reduction, ligament reconstruction and meniscal repair were performed by orthopedic surgeon in 16 (64%).Transient proneal nerve injury was reported in 7 (36%) patients, of which 2 (28%) were recovered within 5±3 months. Proneal nerve injury was accompanied by fracture of femur and tibia in 48% of the patients. Posterior knee dislocation was seen in 8 (32%) patients. 5 cases were presented with simultaneous occurrence of floating knee and ipsilateral knee dislocation. Radiography had detected dislocation in 20 (80%) cases, however, autobiography and surgical exploration had revealed arterial injuries in 36% of the cases. 88% of the patients had maintained mean range of motion of 104±4.7 degree. The limb salvage success rate was 88% with the 12% remaining limbs required amputation.Conclusion: The reported incidence of knee dislocation was a little bit higher than previous studies. Motor vehicle accidents were the most common cause of knee dislocation. Immediate diagnosis and reduction as well as accurate follow up are of utmost importance.

Background: Intestinal parasites are of great importance in personal and social health. Intestinal parasitism has various prevalence in different cities, so the present study was carried out to determine the prevalence of intestinal parasitism in food-sellers in Sanandaj. Materials and methods: Between June and July 1997,260 food-sellers had been interviewed for this descriptive study. Stool examination was performed in three different time points and samples were studied by direct observation method.Results: The study population included 252 males and 8 females with mean age of 40.17±15.79 years. Intestinal parasitism was reported in 88 (33.8%) candidates, where the most common microorganisms were Ascaris (23.5%), Giardia (5.8%), Entamoeba Histolytica (1.9%), Entamoeba Coli (3.8%), Blastocystis Hominis (0.8%), Hymenolepsis nana (1.2%), and Trichocephalus (0.4%). 15-24 year-old individuals were more frequently affected, whereas those older than 44 years old had minor infection. There was no significant correlation between level of education and intestinal parasitism.Conclusion: Results have revealed high prevalence rate of intestinal parasitism specially ascariasis. Recognizing those affected individuals and promoting educational programs could be helpful.

Background: Prior investigators have reported psychological and stressful factors in asthmatic patients who have resisted medical therapy. The present study was designed with the aim of determining the rate of stress in asthmatic patients referring to Loghman Hakim hospital in 1998-99.Materials and methods: The study population included 60 drug-resistant asthmatic patients who have definite diagnosis of asthma according to the bronchoscopic and spirometeric studies. An expert psychologist evaluated their psychological problems and existence of any kind of stress.Results: The mean (±SD) age was 40.5±13.2 years. They have experienced asthma for 6.2±2.1 years. Results have revealed that all of the patients were under stress, of which 15 (25%) had "severe stress". Increasing age increases the severity of stress. (r=0.51).Conclusion: A variety of stressful factors were reported. In patients suffering from asthma, stress should be taken into account. An analytical study is highly recommended to determine the role of stress in asthma incidence.

Background: Obesity and overweight are highly prevalent in Iranian population especially among females, probably due to changes in lifestyle and social structure. The present study was designed with the aim of determining the prevalence of obesity and body fat distribution among female workers in Shaheed Beheshti University of Medical Sciences in 1999.Materials and methods: 503 females, aged 25-45 years, have been selected for this descriptive study through a randomized clustering sampling. Anthropometric measurement including weight, height, waist and hip circumferences were performed. Body mass index of 25-29.9 was considered as overweight and that of ³30 as obesity. Meanwhile, WHR³0.8 was considered as central obesity. Initial data including age, marital status, level of education, smoking, parity, use of oral contraceptives, age at first labor, number of meals and snacks, food frequency and physical activity were all recorded. Results: The mean (±SD) of BMI and WHR were 25.3±4 and 0.84±0.08, respectively. Overweight and obesity were reported in 39% and 11% of the females, and central obesity was found in 357 (71 %) females.Conclusion: Multiple regression analysis revealed the most important factors in BMI to be: age, marital status, number of meals and snacks, physical activity, and fat consumption frequency. Meanwhile, BMI, age, and level of education are associated with WHR. Regarding the effects of lifestyle and environmental factors, preventive interventions are strongly recommended.

Background: The yearly incidence of diabetes mellitus is growing and self-care is of utmost importance for the affected patients. We have evaluated the status self-care of type I diabetic patients referring to Diabetic Clinics in Semnan province in 1998-99.Materials and methods: In this descriptive study, all the diabetic patients who had the following criteria were enrolled: age³14 years, lack of diabetes-induced ulcer or a chronic disease requires especial dietary habit. Personal characteristics, period of treatment, and self-care status considering insulin injection, foot care and nutritional status were all recorded.Self-care status was classified as favorable, fair, and poor. Statistical analysis was performed. Results: The study population included 15 males and 21 females with the mean age of 28.4±7.9 years. Favorable self-care considering the injection of one type and two types of insulin was reported in 53.3% and 55.6% of the cases, respectively. 20 (55.6%) patients had revealed to have favorable foot care and 17(47.2%) had favorable self-care of daily energy intake.Conclusion: Patients have poor self-care considering the nutritional pattern. Further studies to promote self-care status among diabetic patients are highly recommended.

Background: Urticaria is an eruption of transient erythematous or edematous swellings of the dermis or subcutaneous tissues. Angioedema describes the similar but larger swellings of the subcutaneous tissue. Typical clinical lesions are transient erythematous papules and plaques that may vary in size, from pinhead to many centimeters.Materials and methods: 53 patients with clinically proven urticaria and 53 patients that were admitted to our dermatology department for other cutaneous diseases excluding urticaria, served as control, were included in this case-control study. They have been matched according to the sex, age, and occupation. LFT and HCV-antibody tests were performed.Results: Non of the patients with urticaria or the patients of the control group were HCV antibody positive. Abnormal LFT results were reported in 2 and 4 patients of the case and control groups, respectively. Fisher's exact test had revealed no significant difference. Conclusion: There was no significant correlation between urticaria and hepatitis-C infection.

Background: Spinal cord injury is a complex problem involving human beings. In Iran, with respect to the 8-year imposed war, this problem seems more serious. In the present article, we have evaluated the effects of FNS and knee joint posture on cardiovascular responses of paraplegic and normal individuals during wheelchair ergometery.Materials and methods: We have compared 16 paraplegic males with 11 normal males. Wheelchair ergometery was achieved with steady speed for 5 minutes. This was done on 3 different postures: knee in flexion, knee in extension, and knee in flexion with FNS.Cardiovascular responses including heart rate, RPE, and blood pressure were all determined. Results: Heart rate has shown statistically significant differences in different postures. In fact, FNS and knee posture reduced heart rate in paraplegic individuals. There was no significant difference in blood pressure and RPE during wheelchair ergometery.Conclusion: Employing FNS and knee in extension posture could reduce heart rate in paraplegic individuals during physical activity. Thus, FNS and different limb postures should be taken into account when designing the brace, wheelchair, etc.

Background: Bone and joint involvement in brucellosis is one of the most common complications that is reported in 20-85% of the cases. This study has been carried out to determine the rate of osteoarticular complications in patients who have been admitted in Booali hospital due to brucellosis, in 1995-2000.Materials and methods: 109 patients had entered this descriptive study. Brucellosis was determined based on the clinical picture accompanying the raised titer of specific antibody measured by standard agglutination test (STA). Radiography and bone scans were obtained as needed.Results: Of 109 patients, 92 (84.4%) were presented with osteoarticular complications (49 males and 43 females). Spondylitis (78.3%), sacroiliitis (52.2%), and knee involvement (22.8%) were the most common complications. 39 (42.2%) patients had experienced the involvement of more than one joint at the sametime. Complications were more frequent in 19-24 years old individuals. Spondylitis affected older individuals.Conclusion: Spondylityis was the most common osteoarticular complication of brucellosis that was seen in older patients. Radiography and bone scans are highly recommended in susceptible cases.