Journal of Kermanshah University of Medical Sciences
Year:2001 | Volume:5 | Issue:2|Papers Count:12

History & Objective: Febrile morbidity is the most common complication of cesarean section, but the dose of antibiotic for prevention of infection is a controversial issue. This study is aimed to determine the effects of two doses of prophylactic antibiotic on prevention of post cesarean infection among women referred to Motazedi Hospital in Kermanshah in 1377.Materials & Methods: This study is a randomized clinical trial on 200 patients who were divided into two groups of 100 patients. They were matched in terms of age, parity, weight and height. One group received the first dose of 2 gr IV. Cephalotine immediately after umbilical clamp and the other dose, 3 to 4 hours later; while the control group received antibiotics according to the surgical ward protocol. All of the patients were evaluated for febrile morbidity in the first ten days.Results: Analysis of the collected data indicated the febrile morbidity in the two-dose group and the other one were 10% and 11% respectively. Hospitalization period in the two-dose group was 3.4± 1.2 days while this figure for the routine group was 3.5±1.5 days.Discussion: In the light of this study it became clear that administration of 2 doses of prophylactic antibiotics can have the same effect as that of routine prophylaxis in prevention of post cesarean febrile, morbidity. The effect of two doses of antibiotics and even no prophylactic antibiotics in high-risk patients requires further studies.

History & Objective: Thalassemia is a heterogeneous group of hereditary hemolytic anemia which has a decreased rate of synthesis of one or more hemoglobin (Hb) polypeptide chains in common and classified according to the chain involved. In homozygous state the manifestations are profound and encountered with major psychosocial, health and economic problems. Therefore the carrier identification at premarital stage is a program aimed to decline the birth of affected homozygotes. The final step to discriminate between microcytic patients with a high probability of thalassemia minor and those with a low probablity, is the comparison of HbA2 and HbF levels in the suspected individuals with reliable reference ranges. However the reference values for each at-risk group may be affected by variables such as test procedure, geographical location and Hb variants and genetic backgrounds. Materials & Methods: The blood samples obtained from 38 parents of transfusion-dependent thalassemia major patients were analyzed for hematological parameters by Helena cell counter, electrophoresis on cellulose acetae, column chromatography on DEAE-cellulose and Hb alkaline denaturation test. The nonparametric method was used for statistical analysis and 2.5 to 97.5 percentile was chosen as the reference intervals.Results: The obtained reference ranges in this special group of patients are: HbA (91.4-93.5%; by electrophoresis), HbA2 (5.3-7.1% by electrophoresis), HbA2 (4.9-6.2% by column), HbF (0.6-2.2% by electrophoresis) and HbF (1-4.1% by denaturation test) and MCV (56-65 fl).Discussion: Although no overlap in HbA2 levels was noted between this special group of patients and normal individuals, the values may overlap with the levels in patients with thalassemia intermedia.

History & Objective: Considering iodine deficiency, its recognized disorders and positive effect of iodinized salt in decreasing the rate of iodine deficiency this study was aimed to measure the iodine level of consuming dietary salt in Kermanshah in 1999.Materials & Methods: The research was carried out by descriptive method within 129 iodinized salt samples. The studied samples were taken randomly from shops and immediatly the data collection forms including information about: storage condition, production and expiring dates, the name of producing factory and the type of packaging were completed. Iodine rate of the collected samples was determined in Kermanshah University of Medical Sciences Food Laboratory by using standard titration method. Iodine rate of 30 to 50 gama/gr salt was accepted as an optmized level. Furthermore, the role of packaging and storing condition of iodine level of salt was studied. Results: Analysis of the collected samples revealed iodine level was at optimain level only in 59.7% of samples. It also became clear that 34.9% of salt with unacceptable iodine level was produced in Kermanshah Prevince. The average iodine level of the salt produced in Kermanshah was 18.2±5.9 while this figure for the rest of samples was 34.5±4.3 which is statiscally significant (P<0.0001). 34% of samples were well-packed and have anverage iodine level of 35.3±4.5 gama/g while the average iodine level for the others was (26.5±6.7) which is statistically significant (P<0.01). With respect to the storing condition and date of expiry no significant difference was identified.Discussion: Thus further attempt must be paid to increase the iodine level in consuming salt in Kermanshah and at the same time improve the packing system.

History & Objective: Tuberculous (TB) lymphadenitis is the most common extrapulmonary presentation of TB which can be either primary or secondary. Although different mycobacteria can cause TB in different climatic zones, it’s a curable disease. Meanwhile lack of treatment or inadequate treatment may lead to certain known complications such as spreading to other sites of the body and formation of fistula and sinus tracts. This study was done conducted to findout the frequency of TB lymphadenitis in Kermanshah between 1995 and 1999.Materials & Methods: The study used the existing data of all the cases referred to the pathology laboratories in Kermanshah for analysis of lymph node sampling. The diagnostic criteria were merely according to the histopathologic findings and no bacteriologic methods were used.Results: The study showed that TB lymphadenitis was the second most common diagnosis among 814 studied cases (207 cases or 25.4%); while reactive lymphadenitis was recognized as the first common group. It also became clear that TB lymphadenitis patients were between 17 months and 68 years of age (with the highest frequency among 20-25 year old subjects). The samples were mostly from cervical (65.2%) and axillary (23.7%) areas. Female to male ratio was 2.6 to 1. Discussion: There was no significant difference in the findings of this study and those which were done formerly. Since TB infection is very common in Kermanshah, more attention should be paid to the diagnosis of TB lymphadenopathy among women and those between 20-50 years of age. The problems with the patients with adenopathy in Kermanshah are as follows: lack of tissue culture and PCR for mycobacteria, which may lead to failure in diagnosis. On the whole inappropriate treatment necessitates the establishment of more reliable and complex diagnostic techniques.

History & Objective: Echocardiographic evaluation including two-dimension and color flow imaging in patients with mitral valve disease frequently provides sufficient information to allow a therapeutic plan without performing cardiac catheterization which is supposed to be an aggressive method. But in our country catheterization is almost always performed before any interventional procedure.Materials & Methods: This study was aimed to compare echo cardiographic and surgical measurement of mitral valve area (M.V.A) in 54 patients operated successively in Shaheed Beheshti Heart Center in Kermanshah (1997-1999). Pressure half time is the method that is usually used for the measurement of M.V.A.Results: This study showed that in all cases of mitral stenosis, with or without tricuspid regurgitation, there was no significant difference between echocardiography and surgical measurements of the M.V.A. But in cases of mitral stenosis with moderate to severe aortic insufficiency, specially severe mitral regurgitation, the difference between surgical and echo cardiographic data was significant. (P<0.0078 and P<0.0002).Discussion: Thus it can be concluded that pressure half time method is not a reliable method for M.V.A detection especially in cases with MR and AI and it is recommended to use other methods such as planimetery and Gorline formula instead.

History & Objective: Since the introduction of public participation in health programs and its implimentation, attempts have been made to evaluate its effectiveness. Thus, the present study was carried out to evaluate impacts of guidance on mother's health awareness in Kermanshah community oriented medical education center during 1999.Materials & Methods: The subjects of this cohort study included 200 women who were matched demographically and divided into two groups of 100. The women in the first group were litrate and received health guidance from literate volunteer health-workers. The members of the other group, who served as a control group, however, didn't receive any guidance from volunteer health-workers. Results: Analysis of collected data showed awareness of the subjects in the control group was 27% while this figure for the other group was 90% which is statistically significant.Discussion: This study revealed volunteer health-workers attempts can definitely improve women's health awareness and open up a new horizon to us.

History & Objective: Iron deficiency anemia (IdA)is the most known form of nutritional deficiency, which is quite common in developing countries particularly among women. Although taking iron supplement may prevent IdA among pregnant women, it is by no means a sure way to stop or eradicate it. This study is done to estimate the prevalence of IdA among a group of full-term pregnant women who had had delivery at maternity hospitals in Kermanshah during 1999.Materials & Methods: The subjects of the study included 326 healthy full-term pregnant women whose blood samples were taken for hematologic tests including: CBC, Hb, HCT, RDW, MCV, MCH, MCHC and ferritin. Subjects with serum ferritin of less than 12ng/ml were considered as IdA sufferers. Results: This study indicated that the prevalence of anemia and IdA among subjects were 17.2% (CI=13.2-21.2) and 25.8% (CI=21.1-30.5) respectively. Although 82.8% of the subjects had received iron supplement and 17.2% of them had had iron -- supplement compounds, there were no statistically significant differences with respect to age, job, education, parity, and the amount of iron supplement and anemia among them.Discussion: This study revealed a high prevalence of IdA among pregnant women. Since ldA is apparently a serious problem among pregnant women, further studies are required to have a better understanding of it.

The highest mortality rate in the human's lifespan occurs during neonatal period. There are many risk factors. The present study determines some of these risk factors.From 1996 to 1999(40 months), 12840 deliveries were performed in Imam Khomeini hospital in Sari. 31% were by cesarean section. 30% of the cesareans were due to fetal distress. Out of 16% of hospitalized newborns were meconium-pass cases and 21% sufferred from jaundice. Cyanosis and asphyxia were other less common causes of the newborn hospitalization. Prematurity constituted 16% of the hospitalizations and overall of 160 deaths were recorded in this period. Prematurity had the greatest relative risk (163). The relative risk of low Apgar score, cyanosis and meconium pass was 30. Newborn mortality rate (NMR) was 12 out of 1000 deliveries. Premature mortality rate was 20 out of 1000 deliveries.At least 50% of the risk factors of the newborn morbidity and mortality are preventable.

History & Objective: One of the most common complications of injection in gluteal region is a lesion of sciatic nerve, in-general, and a lesion in common proneal nerve, in-particular, which in turn leads to "foot-drop". Materials & Methods: In this study 8 children, between 2.5 and 9 years, who sufferred from foot-drop, resulting from Sodium Diclofenac injection, were examined by some physicians in Kermanshah. Neurological examinations along with electrodiagnostic tests were performed for all of the patients. Results: Analysis of the collected data revealed toxic effects of Sodium Diclofenac have been the only reason for incidence of foot-drop among patients. The major treatment of foot-drop included physiotheraphy and use of brace. Discussion: Thus, it is recommended that Sodium Diclofenac injections not prescribe for children under 12.

History & Objective: Neural tube defects (NTD) resulting from failure of neural closure during early embryogenesis can lead to a spectrum of cranial and spinal defects. While prevalence of these anomalies is decreasing in developed countries, no reliable data is available with respect to the prevalence of NTD in Kermanshah. This study was designed to determine the prevalence of NTD among babies who were born between 1997 and 1998 at Motazedi Maternity Hospital in Kermanshah. Materials & Methods: Diagnosis of malformation was done through clinical examination of the babies by a pediatrician. The data of this descriptive analytical research was obtained from the existing files at the hospital. The data included information about sex and vital signs of the baby, mother's age and her residence; time and kind of delivery, history of diabetes, abortion and gravida. Statistical analysis of the collected data by X2-test showed 65 of 9769 babies who were born during 1997 and 1998 suffered from NTD (i.e. NTD prevalence in alive and still-births was 6.7 per 1000). Results: This study revealed the highest prevalence of NTD was 8.9% and in fall. 43% of NTD cases were still-born. Female to male ratio for anencephaly was 3.9% but this ratio with respect to other anomalies was 1.4%. Discussion: Since the result of this study is not congruent with other studies done in Iran, further studies 'are required to gain a better understanding of the prevalence of NTD.