Journal of Kermanshah University of Medical Sciences
Year:2001 | Volume:5 | Issue:1|Papers Count:14

Serum Level of Immunoglobulin and Complement Components are dependent on genetic background and environmental factors. In order to have reliable reference range of IgG, IgA, IgM, C3, C4 and CH50 in Kermanshah population a random sample (n=878) was selected. The sample consisted of healty people between 1 to 50 years old. Serum level of IgG, IgA, IgM, C3 and C4 were determined by single radial immunodiffusion (Mancini) method. Hemolytic power of complement system was determined by CH50 method. Because serum level of immunoglobulin are age dependent, for each class of them, three reference ranges have been obtained. these include group1 (1-5 years old), group2 (6-18 years old) and group3 (19-50 years old). Results are summarized as below.IgG (mg/dL): groupl (600-1800), group2 (700-2000),  group3 (800-2300)IgA (mg/dL): groupl (80-225), group2 (60-375), group3 (90-450)IgM (mgldL): group1 (90-260), group2 (90-350), group3 (85-410)For C3, C4 or CH50 only a basal reference range (1-50 years old) was determined. The reference range for C3 is 50-170 mg/dL, for C4 is 15-65 mg/dL and for CH50 is 62-170 units/ml Results of this study were compared with reference ranges of American and European populations presented in reference books. IgG and IgM levels of Kermanshah population are higher than the foreign populations (p<0.01), but C3 and C4 levels are lower than published levels for the foreign populations (p<0.01). These differences may be results of ethenic and environmental factors such as more recurent infections in my population.

Bone marrow transplantation is the therapeutic method of choice in aplastic anemia. Immunosuppressive agents can be used as a substitute in whom bone marrow transplantation is impossible. since marrow transplantation is not easily available in our country for many of the patients we studies the effects of combined immunotherapy as a choice in our patients.During 1997 to 1999 18 patients with aplastic anemia, hospitalized in Taleghani hospital in Kermanshah received combined immunotherapy. the patients were 13-55 years old. Anti thymocyte globulin (ATG) 20 mg/Kg for 5 days, cyclosporine 6mg/Kg daily for 12-18 months, danazole 10mg/kg daily for 6 months & prednisolone 1mg/kg for 14 days were administered. the patient's response to therapy was monintored by WBC & platelet count (& increment) and hemoglobin measurement. regarding the recovery state they were divided in to three groups (complete recovery, relative recovery and weak response).One of the patients was dead with cerbral hemorrage due to thrombocytopenia.another one was not available for follow - up. of the remaining 16 who were followed( 6 to 30 months) 6 had complete response, 6 relative and 3 weak. Eatly complications were severe thrombocytopenia, leukopenia, hypertension, polyarthralgia, allergy, headache & covulsion. Our experice achieving 93.8% response suggests that combined immunotherapyis a good substitute for bone marrow transplantation in treatment of aplastic anemia.

This study was conducted to compare the effect of conventional episiotomy & the method of WHO on perineal lacerations in referees of Moatazedi hospital in Kermanshah at 1995. In this experimental study 532 patients were randomly selected. they were divided in two matched groups (266 in each group).Severe perineal lacerations occurred in 3.1% of control group in compulsion 10 1.2% in case group. Episiotomy was performed in 97% of patients in control group while ill 46% of cases (P<0.0001). The rate of severe perineal lacerations was nearly equal in both methods.Considering the high rate of episiotomy in conventional method use of WHO method (Criteria) is recommended.

Vaginitis is one of the most common causes of refer to physicians regarding the controversies on supplemental zink therapy in vaginitis this study was done on patients referring to javaheri hospital during 1998 to 1999. As a trial matched double blind study 74 patients complaining of vaginitis with three recurrences in the last year were selected. the patients were matched and divided in to two groups (case & control) 42 patients were in case group and 32 in control group. patients in case group were 32.3+/-8.9 years old. patients in control group were 37.5+/-10.4 years old. Supplemental zink therapy decreased burning sensation in 76.4% of Patients (P<0.001). therapy without zink decreased burning sensation in 72.2% (P<0.05).The differences between zink & non- zink therapy are not significant but since the patients are more satisfied with zink therapy addition of zink is recommended.

Regarding the prevalence of acute appendicitis and complications and the need of early diagnosis sonography can be a helpful and effective procedure.To evaluate its ability in diagnosis of acute appendicitis, abdominal sonography was performed for 79 patients admitted in Taleghani hospital, Kermanshah, from 1996 to 1997, with clinical diagnosis of acute appendicitis. Toshiba sonography with high frequency probe was used.73 of the patients had histopathologic - proved acute appendicitis. Sonography was able to predict acute appendicitis in 65 of them positive predictive value of sonography in diagnosis of acute appendicitis was 100% in our center. Use of sonography as a non - invasive tool in diagnosis of acute appendicitis is recommended.

This study was undertaken to determine development of secondary resistance in NIDDM patients followed by diabete research center in Kermanshah & also to compare three different therapeutic protocols in them. After diagnosis of resistance three different therapeutic protocols including metformin & sulfonylurea, Insulin & oral agent and insulin by itself were prescribed for the patients. patients were evaluated every 3 months. BMI of the patients before & after therapy was compared.In this study 100 (10.5%) of 1053 NIDDM patients developed secondary resistance (High FBS, Bs, HbA1c). 17 of them were not available for follow-up studies. 47 were put on two oral hypoglycemic agents 18 on insulin & oral drug and 18 on insulin by itself. control of blood sugar was achieved in 57.4% of the 1st group. 55.9% of the 2nd & 61.1% of the 3rd group. effective control of HbA1c was 44.7, 33.3 & 55.6% in three groups respectively. BMI of the patients receiving insulin increased and in those receiving oral drugs decreases (P 0.05) The percentage of 2ndary resistance in our study is similar to those described in references. the results of comparing therapeutic protocols are also similar. Regarding the BMI and its changes another research on very obese, obese, & non - obese patients is recommended.

To determine the results of microinjection in patients referring Sarem to medical center from 1998 to 1999 the existing data of 197 cases were reviewed.Success rate was 18.3% with maintance and continue of pregnancy in 75% of them. Age, therapeutic method, cause of infertility, serum estradiol level and number of embryos had no significance in success rate but follicles larger than 16 mm in left ovary wrer present in grater amount in those who maintained pregnancy (74%) in comparison to others (66%) (P<0.05).We recommend an analytical research to define relationship between the number of follicles in right and left ovaries and pregnancy rate with microinjection.

Regarding the increased probability of the presence of minor blood group alloantibodies in patients receiving repeated transfusions & the risk of hemolytic reactions we conducted this study on B- Thalassemia major patients admitted in Shahid Fahmideh hospital in Kermanshah during 1999.Alloantibody identification tests including antibody screening and identification (According to AABB standards in 4, 22 & 37°c) were done on patients' specimens.Alloantibodies of minor blood groups were present in 9.2% of the patients. The most prevalent alloantibodies were Anti- lua (61.5%) & Anti-p1 (23.1 %).Because of the higher prevalence of minor blood group alloantibodies in thalassemia patients compatibility testing (WHO) & warming of the blood before transfusion is recommended.

Comparing acceptance for residency between graduates from Azad University & Governmental universities of 3830 Azad university graduates from 1991-98 538 were accepted for residency (14%). Most were from Tehran (26%) & The least from Kazeroon units (6.2%).The acceptance rate for residency was a little bit more in Azad university graduates but they were accepted mainly in non-surgery fields which need less.grade for acceptance. More research is necessary for definition of the causes.

Elevated levels of creatine kinase are have been reported in schizophrenia. To evaluate the relationship of this enzyme with schizophrenia we measured serum creatine kinase level in patients admitted at taleghani and Imam Hosein hospital (Tehran) during between 1998 and 1999.Serum enzyme level was measured in one hundred (100) cases including 50 patients and 50 controls. The schizophrenia was diagnosed according to DSM- Iv criteria. the controls were matched with the patients by age, antipsychotic drug usage, trauma history and date of admission. the method used to determine serum creatine kinase level was that of IFCC/DGKC. Levels above 170IU/L for females and 190IU/L for males were considered abnormal.The mean creatine kinase value plus or minus the standard deviation in the control group was 238±311.8 while in schizophrenia group was 397±538.5IU/L which indicates that serum creatine kinase of schizophrenia patients is 66.8% higher than non- schizophrenias.More studies for determination of creatine kinase effect in scizophrenia are recommended.

Cryptococcus caused by Cryptococcus neoformans is an opportunistic fungal infection which is becoming a very common clinical entity in patients with AIDS. It is believed that the patients are being infected by inhaling the aerosolized yeasts in excreta of pigeons. This study was conducted to estimate the rate of infection of excreta of 1000 pigeons by C.neoformans in Kermanshah at 1999-2000.Droppings of 1000 pigeons were collected in aluminum foils.The specimens were incubated at 30C for 3-10 days. The colonies were examined macroscopically and microscopically.Encapsulated yeasts of C. neoformans were present in eight of the specimens (0.8%). Lower rate of infections is identified in Kermanshah study in comparison with Isfahan (8.1 %) and Tehran (2.1 %) studies. we recommend similar studies in other areas.

This study was preformed to determine the rate of CMV primary infection & previous exposure & infection in pregnant women referring to Moatazadi hospital in Kermanshah during 1998.Serum concentrations of CMV IgG and IgM were measured in 257 patients (Eliza). Age, history of abortion, transfusion, surgery, febrile illness (during pregnancy) and socioeconomic status were evaluated and their relationship with serologic test was studied. chi square and fisher test were used for statistical analysis.The patients were 15-50 years old. 23% were CMG IgG positive. none were CMV IgM positive. positive CMV IgG was present in 42.5% of those with history of transfusion and surgery (P<0.05). No relation with previous abortion, febrile illness and socioeconomic condition was identified.This study shows that CMV infection is of low prevalence in Kermanshah. More studies for confirmation of this finding in women in reproductive age and also in newborns are necessary.

One of the important ways of disease transfer to human is contaminated rater. The literature indicated that in urban societies, the drinking water has associated with diseases epidemics such as Ultor. Today, with regard the extensive use of urban drinking water distribution system, the quality control of water supply will be indispensable. Therefore this research was aimed to determine the microbial pollution of Kermanshah drinking water distribution system during 1998-99. The type of research was descriptive. The water samples were taken based on one sample in each month per 5000 no. of population and classified according to Iranian drinking water standard. The samples were obtained from 20 centers of drinking water supply system throughout the city. The microbial tests were as probable and complementary diagnostic ones. by definition, the disinfected water which enters the distribution system should have MPN=0, otherwise it's considered as undesirable or contaminated. The results presented by descriptive statistics.In total, the some of 3087 samples (in 1998) and 3092 ones (in 1999) were selected from Kermanshah drinking water distribution system in accordance to standard method. The laboratory findings suggested the presence of Escherichia Coil, enterobacter, citerobacter, klebciella and psoudomonas in contaminated samples. The no of contaminated samples were 85 and 86 during the years 1998 and 1999, respectively. The mean amounts of microbial contamination in the water suply system were 2.7% (in 1998) and 2.2% (in 1999). The most contaminated months were Shahrivar (7.2%) in 1998 and Khordad (5.6%) in 1999. The permanent contamination in different points of the urban drinking water distribution system and presence of thermophilic coliforms demonstrated the fecal contaminations in Kermanshah drinking water distribution system. Most of the contaminated samples were concerned to the older parts of the water supply network which was probably caused by the defects (decays or breaks and pressure losses) in the system. Consequently it is proposed to eliminate or rednce the contamination by repairing and reconstructing the older drinking water distribution system.

Dermatosis papulosa nigra is a common lesion, found almost exclusively in black adults with a female preponderance. 4 white patients have been reported.we report the 5th patient.A 22 years white female with several brownish papules was referred. Skin biopsy was in favor of DPN. Similar lesions were present in two sisters, grand mother and grand father of the patient.The patient was treated with superfical curettage & electrocutte.