Researcher Bulletin of Medical Sciences
Year:2001 | Volume:6 | Issue:1 (21)|Papers Count:26

Background: Fetal loss and recurrent abortion are among the most common disease, which has known side effects. Regarding the etiologic importance and previous reports of antiphospholipid antibody role in recurrent abortion and fetal loss, and also controversial reports, this study has been carried out to determine the prevalence of antiphopholipid antibody in women with recurrent pregnancy loss referring to Shahid Beheshti hospitals, 1996-98. Materials and methods: This descriptive study had been carried out on 210 women with definite diagnosis of recurrent abortion or fetal loss. They have been asked to refer to a determined laboratory, where their demographic and other useful data have been collected. Then, 7 cc bloods have been taken for VDRL and antiphopholipid antibody studies and another 3 cc of citrated blood for aPTT. In the meanwhile, 40 matched women with at least 2 successful deliveries and negative history of fetal loss or recurrent abortion have been studied. Normal individuals were those who have GPL of less than 10, then, the prevalence of antiphopholipid antibody has been determined in our society. Results: 210 women who met our criteria entered our study. The mean age was 28.9+4.5, the number of pregnancies was 3.3+ 1.4 (2-10) and the number of abortions was 2.6+ 1.3 (max. of 10). The antibody level was below l0 in forty normal and matched women. 44 women have been reported to have abnormal antibody level, so the prevalence of antiphopholipid antibody was 21%, however, the overall prevalence in the society has been estimated to be between 16 and 26%. Results have implied that increasing antiphopholipid antibody level is associated with increasing pregnancy loss. Conclusion: The prevalence of antiphopholipid antibody in our country is the same as other countries. Analytic studies are strongly recommended to determine the position of this antibody in fetal loss and spontaneous abortion, however, experimental studies are required to find out suitable and effective treatment.

Background: Regarding the prevalence of mycobacterial infection and delay in diagnosis of tuberculosis and also with respect to the lack of reports considering PCR in paraffin sections in our country, this study has been carried out to determine the efficacy of PC; R in detection of Mycobacterium Tuberculosis in formalin-fixed and paraffin- embedded tissue in NRITLD (National Research Institute of Tuberculosis and Long Disease), 1999. Materials and methods: This experimental double-blinded study has been performed on 71 formalin fixed and paraffin-embedded specimens- of bronchial biopsies, TBLB, and pleural biopsies with mean diameter of 0.3cm. Tiny sections have been prepared and standard DNA analysis and PCR protocol has been carried out using IS 6110 and 38KD antigen. Specificity, sensitivity, and positive and negative predictive value were determined. Results: Group I composed of 29 biopsied specimens of patients who were definitely diagnosed with tuberculosis according to positive sputum culture, BAL or pleural tap. Group II composed of 14 biopsied specimens of patients who had established tuberculosis according to the positive response to drug therapy and group III including 28 biopsied specimens of non-tuberculous patients reported to have other malignancies. Finally, among 43 specimens of bronchial biopsies, TBLB or pleural biopsies who had definite diagnosis of tuberculosis according to positive culture or drug response, 33 had positive response to IS 6110 (PCR II) and 34 had positive response to 38KD antigen (PCR 1).1,0 and 9 negative response had been seen with PCR II and I, respectively. Among 28 negative controls 3 false positive has been reported. Conclusion: Results have implied that PCR in paraffin sections has sensitivity of 76-79% and specificity of 89-92.8% according to the primer type. Meanwhile, PCR has positive predictive value of 91-94% and negative predictive value of 72-73%.

Backgrounds: Regarding the prevalence of injuries to flexor tendon in Zone II and its known side effects after routine repair, and also with respect to the possible diameter increase of repaired region after repairing with modified Kessler core suture followed by epitenon peripheral suture which in turn could cause problems in tendon motion in Zone II. This study has been developed to determine the efficacy of deep peripheral first suture technique (D.P.F.S.) in patients referring to 15 Khordad Hospital during the academic years of 1996 till 1998. Materials and methods: This clinical trial of semi-experimental type has been carried out on 50 patients suffering from tendon rupture of 70 digits in Zone [I. Patients were followed for 6 months. Strickland classification has been used for result analysis. Results: Among 50 patients with mean age of 30, 70% were male and the remaining 30% were female. Left hand was hurt in 70% of the cases and right hand in 30%. Third finger was the most common site of injury. Rupturing of both superficial and deep tendons was reported in 72% of the cases. Injury to the digital nerve was seen in 34% of the patients. Conclusion: Regarding the satisfactory results obtained in our study, deep peripheral first suture technique (D.P.F.S.) revealed to be a successful method in primary flexor tendon repair in Zone n. In the meanwhile, another clinical trial to compare this technique with other successful routine methods is strongly recommended.

Background: Regarding the high prevalence of coronary artery disease (CAD) and to determine the relationship between the height and severity of CAD, this study has been carried out on patients referring to Angiography Center, Shahid Moddarres Hospital, 1997-1998. Materials and methods: 2387 pateints had entered our descriptive-analytic study. Cardiomyopathy, moderate height, and congenital or vavular heart disease were our exclusion criteria. Then patients with CAD have been distributed in two groups of tall and short. The tall group composed of patients with height above X+SD and the short group included those with height lesser than X-SD of that society. The coronary artery disease was studied according to the number of atherosclerotic arteries, site of stenosis, and the involvement of left main coronary artery. Meanwhile, the correlation between height and obesity (Body Mass Index>27) was assessed with severity of CAD. Results: 596 patients were left out due to cardiomyopathy, and congenital or vavular heart disease, meanwhile another 1112 patients were put aside due to moderate height. Finally, our study has been conducted over 661 patients composed of 320 tall and 341 short patients. Conclusion: Results have implied that CAD is relatively 18% more common in short patients comparing with tall ones, however, left main coronary artery stenosis and proximal stenosis of coronary arteries are more common in short patients. Obese individuals are more susceptible to severe CAD. The number of atherosclerotic arteries are 1.91±0.62 and 2.43±0.59 in tall (>174 cm) and short (<166 cm) male patients, respectively (p<0.005), however these figures were 1.95±0.53 and 2.35±0.41 in tall (>166 cm) and short (<154 cm) female patients, respectively (p<0.01). Higher involvement of coronary artery in short individuals may promote cardiovascular disease. So future studies are strongly recommended to determine the relationship between height and CAD. In case of positive relation as found in our study, more care should be taken for eliminating risk factors in short individuals.

Background: Eliminating the period of hospitalization and promoting outpatient facilities in order to reduce expenses and increase hospital turn over is one of the main goals trying to achieve in modern medicine. Cesarean section is the most common gyneocological operation. Early post operative solid food alimentation could be effective in eliminating the period of hospitalization. This study has been carried out to determine the efficacy of early postoperative alimentation after cesarean section on GI complications and prognosis, Mahdieh hospital, 1998-99. Materials and methods: This randomized controlled clinical trial has been conducted over 402 pregnant women undertook cesarean section due to obstetric problems. Patients were randomly distributed in two groups of case, early alimentation 6 hours after cesarean section, and control, late alimentation 24 hours after cesarean section. Initial data including gestational age, parity, weight. operation period, the reason for cesarean section, type of anesthesia, days of hospitalization, the exact time of gas passage and defecation and fever were all recorded in both groups. Meanwhile, patients were studied for cramping pain, tenesmus, nausea, vomiting, and abdominal distension. In case of presenting 1 to 2 signs, it considered as a mild, 3 to 4 signs as a moderate and all the 5 signs as a severe complication. X2 and Hest assessed our results. 208 patients were put in the case group and the remaining 194 patients were in the control group. Results: Patients in both groups have shown no statistically differences considering gestational age, parity, operation period, the reason for cesarean section, and type of anesthesia. Patients in the case group were hospitalized significantly lesser than the other group (56.1±13.9 hrs vs. 68.9±19.9 hrs, p<0.0001). In the case group gas passage occurred 1.8±0.5 days after the operation, however, in the control group it occurred 2.05±0.5 days after the operation (10% difference, p<0.001). Mild and moderate complications were similar in both groups, 21% and 3-4% respectively. No severe complication has been reported. Fever incidence was much higher in the control group (22% vs. 11%, p< 0.005). Conclusion: Early post operative alimentatibn after cesarean section may not only cause no GI complications but also could eliminate hospitalization, expenses and fever incidence, so it is highly recommended in routine cares after cesarean section.

Background: Evaluating the quality of food proteins is of great biological and economical importance, where, several biological, microbiological, chemical and combined methods have been developed. RNPR (Relative Net Protein Ratio) seems to be the most suitable method, however, no reports exist in this field in our country. This study has been conducted with the aim of using RNPR method to evaluate the protein quality of an industrial baby food (Wheat Shadamin). Materials and methods: We have chosen 24 male Razi's NMRI rats, aged 21-23 days and distributed them randomly in 3 groups of Wheat Shadamin (8% protein), Casein supplemented with L- Methionine (8% protein) and control (no protein). They were fed for 14 days, during which the intake of water and food was ad libitum. Food intake and weight change was used to determine the NPR of protein sources. Results: The mean of NPR was calculated 4.05±0.37 and 3.94±0.76 for Wheat Shadamin and Casein+Methionin, respectively. Conclusion: RNPR for Wheat Shadamin is at the highest level of 100.

Background: Regarding the prevalence of pheochromocytoma and controversies in patients" characteristics, diagnosis and prognosis and also with respect to the lack of sufficient insight in this field, this study has been conducted over the patients referring to Taleghani, Shahid Modarres, Shariati, and Imam Khomeini hospitals during the academic years 1985-2000. Materials and methods: Existing data of the patients with definite diagnosis of pheochromocytoma were collected. Initial data including age, sex, chief complaint, clinical manifestations, laboratory findings, tumor status (type, site, and size), type of anesthesia and operation, post-operative complications and the outcome of treatment were all recorded. Results: 53 patients over 17 years old had entered our study, where 29 (54.7%) were female and the remaining 24 (45.3%) were male. Patients were all 30±13 years old and 75% of them have referred with headache, palpitation, excessive sweating and hypertension. Blood pressure was controlled by means of alpha-blocker before the operation. Tumor was discovered in 3.8% of the patients incidentally, where no hormonal function has been detected. 24 hour urinary VMA (Vanil Mendelic Acid) was positive in 74% of the patients. Positive family history of pheochromocytoma had been reported in 5.6% of the patients, however, none of them had been diagnosed as MEN syndrome. In 49.1% of the cases tumor was located at right adrenal, but multicentricity was not found. Post-operative complications including hypertensive crisis, hemoglubin depression, oliguria, hypotension, fever and atelectasia were reported in 25% of the patients. Conclusion: 11.3% of the patients were died within a month after surgery. Mean age of the referred individuals was younger than other studies. MEN syndrome and multicentricity was not detected in our study. We have found higher rate of mortality and morbidity, so further research is highly recommended.

Background: Pica is a disease defined as compulsive eating of nonnutritive or unordinary substances. Regarding its known complications recognizing the underlying factor is of great importance. With respect to the controversies about the correlation between iron deficiency anemia and pica during pregnancy, this study has been carried out on women referring for perinatal care to Loghman-e-Hakim hospital, since March 1998 till June 1999. Materials and methods: This analytical study was performed on 50 women, distributed in two groups of case (20 women with pica) and controls (30 women without pica). The control group was matched according to age, parity, weight, height, smoking, economical status, parents' education, underlying diseases, and receiving no iron components as supplement. Iron deficiency anemia was investigated with the following indices: HGB, HCT, MCY, MCH, MCHC, serum iron, TIBC, and Ferritin. Results: Geophagia (60%), amylophagia (20%), and pagophagia (20%) were the most common habits in the case group. Regarding the effective factors on iron deficiency anemia no differences have been detected. Indices of iron deficiency anemia had shown no statistically significant differences between the two groups. Conclusion: Iron deficiency anemia has no correlation with pica. So further studies to determine the etiologic factors are strongly recommended.

Background: Regarding the strong relationship between duodenal ulcer and helicobacter pylori infection, eradication of this organism seems to be inevitable to maintain complete treatment. A combined regimen of bismuth, amoxicillin and metronidazole is the most commonly used therapeutic regimen. With respect to the reports of successful usage of furazolidone-containing drugs and also its lower price, this study has been carried out to compare the efficacy of furazolidone-containing and bismuth-containing drugs in patients with duodenal ulcer referring to Shohada-e- Tjrish hospital since January 1997 till June 1998. Materials and methods: This clinical trial had performed on 151 patients, 83 men and 68 women. After documenting duodenal ulcer with upper GI endoscopy and proving H. pylori infection by means of rapid urease testing, patients have been randomly distributed in two groups of A (bismuth+amoxicillin+metronidazole) and B (furazolidone+amoxicillin+metronidazole). These regimens were continued for two weeks. One month later all the patients have undertaken another upper GI endoscopy. This time if the rapid urease test was negative an antral biopsy was sent for pathologic evaluation. Patients were considered treated only if no microorganism was seen. Results: Among 151 patients, 70 had completed their treatment course, where 36 of them belonged to group A and the remaining 34 to group B. The mean age was 43.5 and 38.6 years for group A and B, respectively. Conclusion: At the end of the study, 23 patients (63.8%) in group A and 30 patients (88.2%) in group B became free of organism. Serious side effects including confusion and dyspnea were reported in 4 patients (all in group B). Results have revealed that furazolidone-containing regimen is much more effective than bismuth-containing drugs in eradicating of H. pylori.

Background: Regarding to the high prevalence of brain tumors, different incidence and distribution in human being, various histopathology and clinical manifestations, the importance of appropriate and timely diagnostic and therapeutic techniques, and also the prognosis of these patients this study has been conducted to determine the epidemiology of brain tumor in Rafsanjan, 1991-2000. Materials and methods: Existing data of the patients undertook operation due to brain tumor who had the tissue diagnosis confirmed by histipathologic studies, were the basis of our study. Initial data including age, sex, family history, clinical manifestations, diagnostic procedures, anatomical site and pathologic kind of the tumor, and the therapeutic techniques were all collected. Results: 192 patients with definite diagnosis of brain tumor, composed of 109 men and 83 women with mean age of 35.8f 18.5 years were entered our study. 40-50 years old individuals are the most susceptible group. Supratentorial region had located 68% of the tumors, where glioblastoma multiform was the most common malignancy over here. Meanwhile, meduloblastoma was the most common tumor in infratentorial region. 92% of the tumors reported to be primary and unfortunately, 13 patients had died during their treatment course. Conclusion: Brain tumor has high prevalence in children below 10, in the meantime, no significant differences between sex ratio have been reported in patients with meningioma and meduloblastoma. These findings are in contrast with previous studies.

Background: Testis torsion is an emergency medical situation, requiring decisive action for diagnosis and treatment. 40% cases of scrotal pain are due to this problem. The most important differential diagnosis includes testis appendix torsion, idiopathic scrotal swelling, epididymoorchitis, and epididymal torsion. Materials and methods: This retrospective-descriptive study has performed on 63 children referring to Mofid hospital during 1994-1999. Epidemiological characteristics, clinical manifestations and the age of the candidates were all collected. Results: Diagnosis was made mainly by clinical manifestations. Testis torsion (33.3%) and its appendix torsion (27%) were the most common forms. Meanwhile, most of the candidates had less than one year old (22.2%). The most common presenting sign was pain and swelling (27%), whereas pain itself and swelling itself were reported in 23.8% and 25.4% of the cases, respectively. Among those who undertook operation (73%), 11.1 % had orchidectomy and 20.6% had appendectomy. All of these patients presented with pain, swelling, and redness whereas 80% came over 12 hours post the occurrence of the presenting signs. Conclusion: The study revealed that prompt diagnosis and treatment of the patients with scrotal pain or swelling could prevent from orchidectomy or appendectomy.

Background: Regarding the highly usage of laryngeal mask for ventilation in general anesthesia, its easy manipulation and lesser complications comparing with facial masks, and also the importance of exhaled CO2, this study has been carried out in Mofid hospital in 1998 to compare the efficacy of laryngeal and facial mask on exhaled CO2. Materials and methods: This clinical trial of cross over type has performed on 30 patients between 1-12 years old undertaking general anesthesia for a minor surgery less than one hour. Pre anesthetic drugs were similar an all candidates. Patients were randomly distributed in two groups: In the first group 15 patients were given laryngeal mask and after 15 minutes the respiratory rate and exhaled CO2 were measured, then for 5 minutes the facial mask was replaced and the same indices were measured. In the second group the other 15 patients were given facial mask and after 15 minutes the above indices were measured, then again for another 5 minutes the facial mask was remained and finally the respiratory rate and exhaled CO2 were measured. T-test was used for analyzing these two parameters. Results: Among 30 patients, 10 were girls and the remaining 20 were boys aged 2±6 years old who had undertaken operations including herniorraphy, undescended testis, and orchiopexy. Exhaled CO2 was measured 37±5.2 and 44.3±6.2 mmHg in the facial and laryngeal mask, respectively. Meanwhile, respiratory rate was reported 30.6±8.2 and 31.5±7.9 per minute in the facial and laryngeal mask, respectively. Conclusion: Using laryngeal mask despite its easy manipulation and relatively few complications may lead to higher exhaled CO2 which in turn could cause problems.

Background: Regarding the severity of post cesarean section pain and its known complications if remained untreated, and also the availability of petidine, this study has been carried out on patients referring for cesarean section to 1mam Hossein and Shohada-e-Tajsish Hospital during the academic year 1999, to determine the efficacy of intrathecal petidine added to 5% lidocaine on post cesarean section pain. Materials and methods: This clinical trial of sequential double-blinded type has performed on 80 patients distributed randomly in two groups of case (40) and control (40). The surgical procedure, spinal anesthesia technique and patients' characteristics were similar in both groups. All the patients have received 500 ml of ringer lactate intravenously and then 75 mg of 5% lidocaine (1.5 ml) was injected through L4-Ls in lateral decubitus position with special needles (No. 25) prepared for this purpose. At the same time, the case group has received 0.5 mg/kg of 5% petidine (0.6-0.8 ml), however, the control group was given the same amount of normal saline. Patients were observed carefully during and after the operation, then within the first day, they have been examined for vital sign and post-operative pain, using V AS and OAS criteria. Results: Patients were weighed 61.3±1.1 kg. Mean age of case and control group was 26.3±4.4 and 27.2±5.2 years old, respectively. The number of pregnancy was 2.8±1.4 and 2.6±1.6 in the case and control group, respectively, however, the number of delivery for these groups was 2.1±1.2 and 2.1±1.1, respectively, According to the VAS criteria, in the case group, 10% were free of pain, 50% have reported mild pain, 36.7% felt moderate pain and the remaining 3.3% suffering from severe pain whereas in the control group moderate pain was reported in 10%, severe pain in 76.7% and extremely severe pain in 13.3% of the patients (p<0.0005). In the meantime, regarding GAS criteria, in the case group, 13.3% were free of pain, 56.7% have reported mild and the remaining 30% had moderate pain, whereas in the other group, moderate pain was reported 13.3%, severe pain 66.7% and extremely severe pain 20% (p<0.0005). No significant statistically difference has been shown regarding the first and fifth apgar score between our groups (p< 0.2). Side effects were: itching (16.7% vs. 0), nausea (70% vs. 43.3%), vomiting (43.3% vs. 30%), hypotension during the operation (66.7% vs. 50%), bradycardia (20% vs. 13.3%). (First figures referred to the case group and second to the control). Conclusion: Adding intrathecal petidine could significantly eliminate post-operative pain, and its side effects including itching, hypotension, nausea and vomiting are treatable. These criteria have been reviewed by anesthesiologists and checked by means of X2 and Fischer tests.

Background: HCY is a virus causing hepatitis. According to the previous studies it could be transmitted through occupational exposure. So this study has been carried out to determine the relationship between occupational exposure and hepatitis C infection in Imam Khomeini, Taleghani, and Labafi nedjad hospitals in 1998. Materials and methods: This cohort study has been performed on 240 surgeons and nurses (case group) who were in close contact with needle, dealing with dyalitic and leukemic patients or drug abusers or even patients referring due to hepatitis C. The control group was composed of 400 hospital staff not dealing with blood or other infected materials. Groups were matched according to the sex, age, and job history. Previous HCY infection, tattooing, transplantation, positive family history of HCY infection, blood or blood products transfusion were all exclusion criteria in our study. Initial data including age, sex, job history, hospital, history of needle stick, dealing with hepatitic C, dyalitic and leukemic patients or drug abusers were all recorded. Anti-HCY was assessed by ELISA technique, and those positive samples were reconfirmed by immunoblotting test, finally the relationship between occupational exposure and hepatitis C infection was investigated. Results: Mean age was 36.2±8.9 and 35±9.5 years old in the case and control group, respectively. The case group was composed of 54.6% women and 45.4% men whereas the control group had 51.2% women and 48.8% men. The mean year of employment was 11.4±8.2 and 11.3±8.4 in the case and control group, respectively. Conclusion: Anti-HCV was detected in 0.8% of the individuals in the case group which doesn't show significant difference with the control group (0%). So no significant relationship has been revealed between relationship between occupational exposure and hepatitis C infection. Now regarding the lack of enough knowledge about viral genotype in Iran, future studies are strongly recommended.

Background: Regarding common problems occurring during "specialized English" tests and also using "general English" test instead of "specialized English" tests in some countries, we have tried to determine the correlation between these two tests. Materials and methods: To meet this demand, in 1998 candidates participated in the entrance exam for 18 Ph.D. courses of medical related science, were given 30 "general English" questions in addition to 30 "specialized English" questions. Results: Scores of both tests have shown correlation of 0.71. The least correlation was reported in "Environmental Hygiene" candidates (0.56) whereas the highest correlation was seen in "Bacteriology" course (0.62). In residency courses maximum and minimum correlation was reported in "Epidemiology" and "Mother and Child Hygiene" candidates, respectively. (0.84 vs. .82). Conclusion: The relatively high correlation ratio encouraged more studies in non medical courses exam in the ministry of Science, Research, and Technology.

Background: Regarding the relatively high prevalence of iron deficiency anemia and paradoxical reports of maternal anemia effects on neonatal indices of anemia, this study has been conducted on patients referring to Booali hospital during the academic year 1998-99, to determine the relationship between maternal anemia and neonatal indices of anemia. Materials and methods: This cohort study was performed on 15 newborns of anemic mothers and another 15 newborns of normal mothers. Anemic mothers were those with HGB<11 g/dl and serum ferritin <15 m/l. Both groups were matched according to the age, number of children, using iron supplement, disease during pregnancy, gestational age, and neonatal weight (>2500). Then serum iron, serum ferritin and HGB level were measured and the correlation between maternal and neonatal indices was determined. Results: HGB level was 10.5±0.38 gr/dl and 13.1±1.17 gr/dl in the case and control group, respectively. It was 15.9 gl/dl in neonates. No significant difference has reported between HGB, serum iron and ferritin of neonates. Meanwhile, no relationship has detected between HGB and ferritin level of mothers and neonates. Conclusion: Maternal anemia has no effect on neonatal anemia indices. The same study on mothers not receiving iron supplement is strongly recommended.

Background: Regarding the relatively high prevalence of hydatid cyst in Iran and paradoxical reports in this field, this study has been carried out on children referring to Taleghani and Mofid hospitals due to hydatid disease during the academic year 1989-1995. Materials and methods: In this existing data study, initial data including personal data, place of settlement, reason of referral, clinical manifestations and received treatments were all collected. Totally, 20 patients aged 4-13 years old were admitted with hydatid cyst and 37 cysts were found in liver, lungs and pelvis. Among these, 35 were univesicular and the remaining 2 were multivesicular. The largest cyst measured 10×10×15cm. 7 cysts were detected in a patient located in liver, lungs and pelvis. Results: M/F ratio was 11/9 in our study. 45% of the cysts were detected in lungs, 25% in liver, 25% in both lungs and liver, and the remaining 5% in other organs. Lung involvement was mainly manifested by cough, dyspnea, and fever whereas liver involvement was mainly manifested by abdominal pam, anorexia, and weight loss. Conclusion: Surgical removal of cyst was the treatment of choice. No mortality was seen, but two recurrences were reported who undertook second operation. Plain CXR and liver sonography is the best method of diagnosis.