Researcher Bulletin of Medical Sciences
Year:2007 | Volume:12 | Issue:2 (56)|Papers Count:16

Background: Recently, the high prevalence of Helicobacter pylori infection has been reported in adult patients with chronic immune (idiopathic) thrombocytopenic purpura. Furthermore, after Helicobacter pylori eradication therapy in such patients, their platelet counts have been observed to increase, suggesting that Helicobacter pylori may be a causative agent of adults’ chronic idiopathic thrombocytopenic purpura. However, there have been only a few reports of this subject in children with chronic thrombocytopenic purpura. The purpose of this study is to determine prevalence of Helicobacter pylori infection in Iranian children with chronic thrombocytopenic purpura and role of Helicobacter pylori eradication in rising platelet count of these patients.Materials and Methods: This descriptive-clinical trial study was performed in 31 children under 14 years old with chronic thrombocytopenic purpura who attended hematology ward of Mofid pediatric hospital. After determining platelet count, and filling the results patients referred to gastrointestinal ward of the hospital to perform urea breath test for evaluation of Helicobacter pylori infection, then Helicobacter pylori-infected patients who were diagnosed by this test, received eradication therapy using triple therapy regimen (containing Omeperasole, Amoxicillin & Clarithromycin) for 2 weeks and their platelet counts were recorded during the follow up period.Results: Mean age of the patients was 8.9±3.2 years old ranging from 3.5 to 14 years old. They were 17 (54.9%) girls and 14 (45.1%) boys. Mean platelet count of the patients was 51.4 ±34.3 × 109/ L ranging form 125×109/ L to 8×109/ L. Mean duration of disease in the patients was 27.7±20.2 months ranging from 7 to 96 months. Helicobacter pylori infection was found in only 4 children (12.9%) and Helicobacter pylori eradication therapy was not effective in rising platelet count to achieve complete or partial remission. Comparing Helicobacter pylori-positive and negative patients, there were no significant differences regarding their age, platelet count and duration of disease.Conclusion: This study shows that prevalence of Helicobacter pylori infection in children with chronic immune thrombocytopenic purpura is less than that is in adults. Furthermore, we have found that platelet count in Helicobacter pylori-positive children have not been risen after eradication therapy. We suggest that more studies in different gender groups and different zones in the world with more number of samples should be performed, especially in children in order to determine both the exact role of Helicobacter pylori‘s pathogenesis in developing the chronic idiopathic thrombocytopenic purpura and the effectiveness of eradication therapy in rising platelet count in these patients.

Background: Attention Deficit Hyperactivity Disorder (ADHD) is a prevalent disorder among children and stimulant remedies are the drugs of choice for its treatment. A substantial minority of stimulant-treated patient does not respond adequately or cannot tolerate the associate adverse effects and these difficulties highlight the need for alternative effective medications. This study was conducted to evaluate the efficacy and tolerability of reboxetine compared to that of methylphenidate in treatment of children and adolescents with ADHD. Materials and Methods: Thirty three children (7-16 years of age) diagnosed with ADHD, participated in a 6-week double-blind clinical trial with reboxetine (4-6mg/d) and methylphenidate (25-50mg/d). The principal measure of the outcome was the Teacher and Parent ADHD Rating Scale. Patients were assessed by a child psychiatrist at baseline of treatment and 2 , 4 and 6 weeks of medication, respectively. Results: No significant differences were observed between two protocols of the parent and teacher ADHD rating scale scores and in terms of the dropouts and both groups showed a significant improvement in ADHD symptoms over the 6 weeks of treatment. The most common adverse effects seen with reboxetine were sedation/drowsiness and mild to sever decrease in appetite. Conclusion: Our finding must be considered preliminary; however, they do suggest that reboxetine may be beneficial in the treatment of ADHD. Further research is needed to clarify the potential benefit for comorbid depression and anxiety with ADHD and profile of side effects.

Background: Endoscopic variceal ligation (EVL) is an effective option in treatment of esophageal varices bleeding or elective ablation. Although the after-EVL ulceration is well recognised, the effect of acid suppression on ulcer healing is not determined, definitely. In this study, we tried to evaluate the efficacy of Omeprazole as the most available protone pomp inhibitor (PPI) on the numbers and size of after-EVL esophageal ulcers in patients electively underwent this procedure. Materials and Methods: We performed a randomised placebo-controlled trial of Omeprazol after elective EVL. Fifty consecutive cirrhotic patients who were cadidated for EVL randomly enrolleded in and were divided equally into case (25) and control (25) groups. After endoscopy and EVL, case subjects received Omeprazole (20 mg twice a day) for 2 weeks and control subjects received placebo for the same period as well. All the patients underwent a follow up endoscopy 13-15 days after EVL. Results: Forty two patients (20 cases and 22 controls) completed the study. Numbers and size of ulcers were evaluated throughin the follow up endoscopy. Numbers of ulcers were significantly higher in control group (3.15 vs. 2.59, p=0.03). The ulcers in Omeprazole group were on average half as large as in the placebo group (37.08 mm2vs.73.74 mm2, p<0.0001). Conclusion: After elective EVL, Omeprazol-treated Patients experienced a significant reduction in number and size of their post-banding ulcers. It seems that Omeprazole reduces the numbers and size of after-EVL ulcers.

Background: Considering some controversies in performing anterior cervical discectomy with fusion and particularly several methods of fusion (interbody cage and autograft iliac crest bone fusion), we performed this study between 1383-1384 in order to compare these two type of fusion. Materials and methods: In this randomized clinical trial study we divided forty sequentially enrolled patients into two distinct groups. Diagnosis was made based on clinical examination and MRI findings. All patients underwent anterior cervical discectomy and fusion, using cervical interbody cage or outograft iliac crest bone. Efficacy of fusion, complications relate with bone graft harvested site and also the time between operation and returning to daily activity was evaluated. Results: two groups were fairly similar in variables such as age, sex, clinical presentation and involved disc level distribution. In the first post-opertive day, 90% of patients in the cage group complained of Neck pain which was reduced to 60%, 25% and 5% at the end of the first week, first month and first post-operative year, respectively. These results were 95%, 55%, 35% and 10% in iliac group patients, respectively. Although segmental kyphosis was observed in one patient in cage group and two patients in iliac bone group, there was no evidence of progression requiring further surgical intervention. Time of operation was shorter in cage group. Conclusion: Regarding the soild fusion achieved in cage group and lack of any significant pain corresponding bone graft harvested site complications in this group, cervical interbody cage can be a reasonable alternative method for iliac crest bone graft in anterior cervical discectomy and fusion.

Background: Steroids are effective medications for controlling the infantile spasms, but there have been few reports of steroid effect in other childhood epileptic syndromes, especially refractory syndromes. The objective of this study was to determine the efficacy of prednisolone in 35 children with intractable epilepsy. Materials and Methods: This prospective, uncontrolled study was undertaken at the Mofid pediatric Hospital from September 2004 to September 2005. Thirty five children (12 girls & 23 boys), aged between 1 to 12 years old with intractable epilepsy were enrolled. Prednisolone (1 mg/kg/day) was prescribed for 12 weeks (Once a day for 6 weeks followed by every other day for another 6 weeks) in addition to their regular antiepileptic medications. The parents kept seizure diaries. Results: after 1 year of follow up, 17 patients (49%) became seizure-free on prednisolone, whereas another 8 (23%) experienced a significant decreases more than 50% in seizure frequency. In contrast, ten patients (28%) had no changes in seizure frequency. The best response was seen in idiopathic epilepsy (95%) and atypical absence ones (86%). The least therapeutic effect was seen in symptomatic myoclonic epilepsy (54%). Side effects such as behavioral disturbances, weight gain and gastrointestinal bleeding were developed in 8 patients and also 14 patients were found to have cushingoid face. All the side effects were regressed after drug discontinuation. Conclusion: Prednisolone therapy is a safe and effective adjunctive treatment for children with intractable epilepsy and it should be considered as an alternative treatment for older children with refractory epilepsy.

Background: Shigatoxin-producing Escherichia coli (STEC) is an emerging foodborne pathogen of worldwide public health importance. This bacterium has been reported as an etiological agent of many outbreaks and sporadic cases. Studies in different countries have shown that food items maybe contaminated by this pathogen. The present study was carried out to determine the frequency of STEC contamination of meat samples, collected in Tehran, as well as defining genotype and antibiotic susceptibility patterns of isolated bacteria. Materials and Methods: In a period of one year (from 1 July 2004 to 30 June 200, 250 beef samples were collected from different markets of Tehran city. For detection and isolation of STEC from beef samples, conventional culture and PCR were applied. Then, Antibacterial resistance patterns of isolated strains were determined by standard disk diffusing method. Results: Among 250 beef samples, 47(18.8%) were positive for stx genes by PCR. However, only 30(12%) successful isolations of bacteria were made. Of the 30 STEC isolates, 24 (80%) carried the stx2 gene only, while 2 (6.7%) isolates gave positive results for both stx1 and stx2. Four isolates (13.3%) possessed stx2 and eae genes. According to the antibiotic resistance tests, all isolates were susceptible to Gentamicin, Imipenem, Norfluxacin , Enrofloxacin, Nalidixic acid, Ciprofluxacin and Ceftazidime. The percentages of isolates that were resistance to the other antibacterial agents were as following: Olendeomycin: 100, Erythromycin: 100, Cephalothin: 67, Amoxycillin-Clavulanic acid: 46.6, Chlortetracycline: 13.3, Tetracycline: 10 and Streptomycin: 6.6. Conclusion: Results of this study indicate that retail raw meats may often be contaminated with antimicrobial-resistant STEC and cautionary efforts are necessary in order to prevent them from contaminating with this bacterium.

Background: Odontogenic keratocyst (OKC) and dentigerous cyst are two most common developmental odontogenic cysts involving jaws. OKC has a high growth potential in contrast to its minor clinical manifestation. It has also a high degree of recurrence rate. The purpose of this study was to diagnose the OKC and dentigerous cysts and also differentiate them based on their immunohistochemical criteria. Materials and Methods: To provide the materials for this research, we preliminarely reviewed the records of the patients referred to pathology lab of shahid Beheshti Dental College between March 1999 and March 2003 and 60 paraffin-embedded biopsies (20 OKC, 20 dentigerous cysts and 20 dental follicles) were selected. Then immunhistochemical staining was applied to identify cytokeratin-10 (CK-10) and cytokeratin-19 (CK-19) and their conditions, as well. Results: The expression of CK-10, CK-19 is seen in OKC and dentigerous cyst. CK-10 was found more in OKC, along with CK-19 in dentigerous cyst. The expression of these cytokeratins was more in upper half of the epithelial lining of these cysts. One of the dental follicles expressed CK-19, but not CK-10. Conclusion: CK-10 is more specific for OKC as well as CK-19 for dentigerous cyst. These cytokeratins are usually seen in the upper layers of the cyst lining. If an expression of cytokeratin-19 is found in a dental follicle, it may correspond the cystic transformation of the latter one.

Background: Considering the and importance of formation of atrial Thrombus (AT) in patients who had developed atrial fibrilation (AF) and its early diagnosis, and with some regards to several reports on benefits of applying the D-Dimer test in such conditions, this study was carried out to detemine the accuracy and value of this test compared to the gold standard method of Trans-Esophageal Echocardiography (TEE) in patients referring to Modarres hospital. Materials and Methods: This clinical trial was performed on 73 patients whom were diagnosed as having AF. A more accurate method of TEE was applied to confirm if they had atrial thrombi. For determination of value of D-Dimer test in diagnosis of AT, 5ccof blood was taken from any subjects. The results were regarded normal if the D-Dimer level was less than 500 ng/ml. Then positive and negative predictive values (PPV & NPV) were calculated as diagnostic measurements. Results: Of the 73 subjects of this study (67% women versus 33% men) with mean age of 44.7±12 years old, there was 53.4% who had the history of Warfarin usage. According to the results of D-Dimer test, 33% had reached to positive levels, whereas 67% revealed to have no thrombus. The PPV of this test was calculated 48.6% and the NPV was 81.6%. Conclusion: Regarding the present condition of our patients and the excessive use of Warfarin among them and also probable failures of D-Dimer test, this test does not have the acceptible capability (particularly duringin these situations) in diagnosing AT.

Background: Several studies have indicated that compared to non-familial marriage, familial marriage would increase the incidence of congenital abnormalities. Since the rate of consanguinity marriage is high in our country, this study was performed to determine the prevalence of congenital anomalies between familial and non-familial marriage. Materials and Methods: For this analytic descriptive study, 928 couples were participated as the population of this investigation. Of them, 358 were familial-marriage couples and 570 were non-familial-marriage couples. We evaluated the variables such as parent's age, familial and non-familial marriage rate and rates of congenital abnormalities between both groups. Both the questionnaire and face to face interview technique were applied in this study. Results: Congenital anomalies were identified in 26 (7.26%) children of familial marriage group and 11(1.92%) ones in non-familial marriage group. The average rate of consanguineous marriage in this study was found to be 38.57%. Conclusion: Considering that the rate of congenital anomalies in familial marriage was more than that of non-familial marriage, it seems that it is essential to consult and teach families and young couples about the risks of familial marriage.

Background: Maxillary constriction and high palatal vault can change the location of soft palate and may cause Eustachian tube dysfunction and even stenosis. The purpose of this study was to evaluate the relationship between maxillary constriction and conductive hearing loss. Materials and Methods: This case-control study included one hundred twenty patients whom were divided into two equal groups. The patients’ ages ranged from 7 to 40 years. Hearing level was measured in all patients with a digital audiometer. The control group consisted of sixty participants with normal hearing level (under 15 db), whereas patients who had the hearing level of more than 15 db were the cases with conductive hearing loss. Then maxillary constriction was examined in both groups according to skeletal posterior cross bite and high palatal vault. These two groups were compared applying of chi-square test. Results: This study showed that maxillary constriction was seen in 7 patients (11.7%) in control group and 19 patients (31.7%) in case group (P<0/05). People suffering from hearing loss were faced with maxillary constriction 3.5 times more than others. Conclusion: There is a significant relationship between maxillary constriction and conductive hearing loss. Thus, it is recommended that to prevent from hearing loss, maxillary constriction should be treated appropriately.

Background: Since the first successful report of endotracheal surfactant administration in 10 neonates with RDS in 1980 by Fujiwara, several studies have shown that surfactant administration would decrease neonatal mortality and morbidity such as Pulmonary Air leak (PAL) or Brochopulmonary dysplasia (BPD). This study was conducted in NICU of Mahdieh hospital between March 2002 and March 2005 to evaluate the mortalitiy rate and complications of neonates with RDS who have recieved mechanical ventilation and surfactant. Materials and Methods: Between March 2002 and March 2005, 124 neonates (36% females & 64% Males) with RDS, admitted in NICU were enrolled in this study. 25% of the patients were fullterm and 75% were preterm. All of them underwent mechanical ventilation due to either O2 requirement of more than 60% (through Hood) or arterial PH of less than 7.25. Surfactant was administered as 4 cc/kg per dose (Maximum 2 doses) if mean Air way pressure (MAP) was equal or more than 7 cmH2o or fiO2 equal or more than 40%. Results: Neonatal Mortality Rate (NMR) in these 124 patients was 27%. PAL was noted in 23.3% and BPD in 12.9% of cases. Conclusion: This study showed that with administration of surfactant the incidence of NMR was the same as several previous studies, albeit BPD incidence was lower and the incidence of PAL was higher than that of recent studies. Higher incidence of PAL may be due to late low dose surfactant administration or the quality of medical and nursing care, which must be impressed. The lower incidence of BPD in our study may be resulted from preliminary administration of prenatal dexamethasone.

Background: Atherosclerosis is a common cardiovasclur disease and particularly in industrial societies, is the first cause of mortality. Since many factors and some molecular changes (like enzymes, lipids, lipoproteins, free radicals, peroxidation, of lipids and coagulation factors) have have a great influence on development of atherosclerosis, considering these factors is important in management of the mentioned disease. Since changes in coagulation factors are effective as well, this investigation was done to obtain more information about this concept, which may help us in identification, treatment and prevention. Materials and Methods: This investigation was carried out in cardiovascular ward of Taleghani hospital on 200 cases (94 males & 106 females) age between 35 and 70 years old, without the history of tromboembolic disease, OCP consumption, cancer and diabetus mellitus. We obtained 6cc of venous blood from each participant and in heparinized it in a test tube. After serum removal, the value of coagulation factors (II, VII & XIII) was measured by radioimmunoassay method. Results: According to our results, among females with mean age of 56.76 years old and mean weight of 68.91 Kg, the mean values of plasma coagulation factors (II, VII & XII) were 99.2, 136.9 and 109.7 Iu/dl, respectively. In male group who had the mean age of 55.2 years old and mean weight of 72.9 Kg, the mentioned values were as 101.8, 1040.3 and 110.6 Iu/dl, respectively. Conclusion: Based on above results, we may say that coagulation factors II, VII and XII, have no specific relationship with atherosclerosis and the levels of these factors do not change in atherosclerotic patients. In several previous reports, there has been a debateful controversy about the increase or decrease of the levels of these factors. However, some have reported no considerable changes. Nevertheless, in some cases, variation in the levels of these factors has been related to the polymorphism, the phenomenon which may affect Iranian people, as well.