JOURNAL OF RESEARCH IN MEDICAL SCIENCES (JRMS)
Year:2000 | Volume:5 | Issue:2|Papers Count:26

Introduction. Ear discharge drying before tympanomastoid surgery is an expensive procedure, time wasting. However, some of wet ears never become dry. In this study, we investigated surgical outcome in patients with chronic otitis media (COM) in two kinds of operation field; wet versus dry.Methods. Fifty three cases with mucopurulent discharge (wet) and forty seven cases without discharge since last 3 months (dry) were operated under tympanomastoid surgery. Surgical outcomes were compaired between two groups in a period (4 to 15 months; mean about 5.5 months).Results. Graft success rate was 97.6 and 93 percent in wet and dry ears, respectively (P>0.05). Severe post operative discharge (failure of surgery) was similar in two groups. According to the types of ossiculoplasty, hearing recovery was 8.6±15.6 db and 13.8±8.8 db in wet and dry ears, respectively (P>0.05). Radical operation without grafting was performed in nine cases of wet group. Discussion. High successful grafting in a wet ear may be due to middle ear's hypervascularity. Controversies were denoted in different studies about successful grafting rate or hearing recovery. It may be due to unawareness of pathology or type of ossiculoplasty. In this study, surgical outcomes were similar in wet and dry ears due to mentioned factors in data analysis.

Introduction. Emergency Departments (EO) have a highly variable workload and need to highly expertise for a critical decision making in an emergency situation. This study was designed to find some of the golden times lost in AL-Zahra Emergency department (the greatest referral emergency center in Isfahan province, affiliated to Isfahan University of Medical Sciences and Health Services).Methods. In an observational study, we recorded all times spent by each 2212 patients referred to EO. The study was conducted in 30 days period (1999 June) and data was collected by full time secret observers.Results. About 55.1 percent of patients came by own and others were referred by physicians or other medical centers. Forty four percent of them were managed ambulatory. About half of the admissions were during 4 to 12 PM. Mean waiting times for each stage of patient management were as follows: waiting for patient's first visit by intern of screen room, 2 min; second visits by referral intern visit, 7 min; third visit by related resident, 37 min; patient arrival at EO. till admission, 41 min; hospital registration of patient, 11 min; ordering by intern or physician, 14 min; patient arrivalat EO. till ward admission, 189 min; performing procedures for outpatient's, 95 min; patient arrival at E.O. till receiving prescription (as an ambulatory care), 97 min. Mean waiting times for preclinical procedures were: EKG, 10 min; ultrasonography, 50 min; X-ray or CT scans, 36 min and lab tests, 117 min. About 51 percent of admissions were in field of internal medicine (including neurologic and infectious disease). In 88.8 percent of the admissions, physicians who were engaged in patient screening were not matched to their specialty and expertise. Primary diagnosis was correct in 31 percent and wrong in 6 percent of hospitalized patients. In 41 percent of cases, ultimate diagnosis was obscure. The average of CPR incidence was 2.7 times per day.Discussion. The most rate limiting stages in our E.O. were paraclinical procedures, making decision for admission and finally, registration process. Foremost of the cases, physicians who were engaged in screening process had not sufficient expertise in patient management due to inappropriate specialty and/or inadequate knowledge.

Introduction. Car accident mortality is the third order causes of death in the USA, following cardiovascular diseases and cancers. Given present survival and outcome Iranian data, more than 14,000 patients die annually in road accidents. Having a valid and reliable data could be useful in reduce mortality and morbidity reduction.Methods. Twenty five percent of total traumatic patients in Isfahan were selected (N=2809) at the time of study (1997-1998). Forty five percent of them with car accident were asked about causes of accidents and risk factors for the severity and type of injuries were recorded based on International Classification of Disease 10.Results. Most of the victims were young (10-20 years old), students and industrial workers. Statistically unreasonable numbers of cars without extension of roads and high ways, using old and unsafe cars will affects on accidents.Discussion. In comparison with European and some Asian countries, Iran has unacceptable road accidents and it seems necessary to pay more attention to stop the current increasing data.

Introduction. Malignancies occur word wide with variety of patterns depending on an individual's environmental situation and life style. Having data about the distribution and incidence of different malignancies is necessary for the formulation of an effective prevention plan for any specific area. Methods. In the central part of Iran (Isfahan Province) a retrospective study was designed to describe cancers' epidemiologic factors by collecting patients' data from the Isfahan Oncology center for the period of 1981-1996.Results. The frequency of malignancies was as follows: Skin cancers 5111 cases with a frequency of 20.9 percent (62.9 percent males and 37.3 percent females). Leukemia 3108 cases with a frequency of 12.7 percent (59.9 percent males and 40.1 percent females). Breast cancer 2796 cases with a frequency of 11.4 percent (6.5 percent males and 93.7 percent females). cancers of the digestive system 2017 cases (60.5 percent males and 39.5 percent females). Non Hodgekin lymphoma 1953 cases with relative frequency of 8 percent (66.9 percent male and 33.1 percent females). cancers of the urinary system 1567 cases with a frequency 7.6 percent (82.5 males and 17.5 females). Head and neck cancers 1545 cases (6.3 percent). Cancer of the reproductive system 1313 cases with a frequency of 5.37 percent. Tumors of the central nervous system 1276 cases with a frequency of 5.22 percent. Lung cancers 933 cases with a frequency of 3.7 percent (80.7 percent males and 19.3 percent females). Hodgekins 913 cases with a frequency of 3.7 percent. Sarcoma of the soft tissue 801 cases (3.28 percent) and bone tissue 657 cases (2.7 percent). Endocrine malignancies 422 cases and 1.73 percent of all was at the bottom of categories during the period of study.Discussion. In the present study, the prevalence of acute leukemia and also lymphatic and hodgekine malignancies were more frequent than the world wide data presented in the literature. The frequency of lung tumors, however, was less than in the developed countries.

Introduction. The present study was coducted to evaluate the outcome and complications of Z plasty in pilonidal cyst repair.Methods. Sixty patients with pilonidal cyst were selected and repaired by Z plasty method in Al-Zahra hospital (affiliated to Isfahan University of Medical Sciences and Health Services). The patients were followed for 6 months and complications such as seruma, infection and replapse wre evaluated.Results. The incidence of seruma, infection and relapse after Z plasty was 6.6, 1.6 and 3.4 percent, respectively.Discussion. Z plasty is a choice operation for pilonidal cyst repair.

Introduction. In spite of several advantages of home therapy in terms of chronic disease and self-treatment in hemophilia its use is unfamiliar in Iran, yet. To achieve this goal the participation and acceptance of patients has a basic role.Methods. For the first time, we have done an investigation about the hemophilic patients aged more than six years old for a six months period in Urmia city in Iran. We used training as a means of transferring the information and evaluate the rate of self-treatment acceptation for hemophilic patients and their family members. Regarding the population size for study (42 cases), 21 cases were selected randomly. Data was collected before and after training by a valid questionnaire.Results. From twenty one cases, sixteen cases (75 percent) succeeded in self-treatment. There was a significant relation between the acceptation and the level of literacy. But no relation was found between the numbers of family patients, sex and duration of disease.Discussion. Our findings indicate that the rate of acceptation and participation of patients are ideal. It is suggested to consider the self administration training in hemophilic patients.

Introduction. Pilot plant study of anaerobic composting of the organic fraction of municipal solid waste (MSW) in Isfahan was performed using sequential batch system. The anaerobic composting were compared with the conventional aerobic composting of MSW using windrow system in 1998-99.Methods. An experimental study was performed on samples of household refuses, anaerobic composts, aerobic composts and leachate of anaerobic composts. Inert materials, heavy metals concentration and physical characteristics of anaerobic and aerobic composts were compared.Results. There was not significant difference between physical and chemical characteristics of anaerobic and aerobic composting. The study showed that the heavy metals concentration in the anaerobic compost was less than aerobic compost and inert materials in both composts were more than standard concentration.Discussion. Sequential batch anaerobic composting (SEBAC) system is stable and has a good flexibility for organic materials with high total solids and a good way for MSWs composting. Amounts of heavy metals (e.g. Pb, Zn, Cu, Ni, Cr, Fe, Cd) in compost of the separated municipal solid wastes were low and about the standard ranges, but in the compost of unseparated MSWs were significantly higher than standard compost (P<0.05). Therefore, separating the municipal solid waste in houses is essential for conservation of agricultural soil pollution.

Introduction. Regarding to the absence of doccumented studies concerning medial brachial coetaneous nerve conduction, the present study was conducted to evaluate this parameter as a diagnostic method for injuries to medial cord and lower trunk of brachial plexus.Methods. The sensory nerve action potential of median, ulnar and medial antebrachial cutaneous nerves were recorded to show these roots (Cs-TV are intact. Then, the medial brachial cutaneous nerve was stimulated on the line that connects axilla to medial epicondyle (parallel with mid axillary line) at the junction site of coracobrachialis muscle to humerus recording was done 2 cm above the medial epicondyle (10 cm under stimulating site).Results. In all cases the wave was biphasic with primary negative phase. The latency was 2±0.3 ms-1 (range 1.4-2.6 ms-1) and the amplitude of SNAP was 30±10 mv (range 10-50 mV). The nerve conduction velocity was 61±4 ms-1 (range 53-69 ms-1).Discussion. With regard to the intensity and site of stimulation and recording area, this wave is not due to compound nerve action potential of median or ulnar nerve. This study may be useful in evaluation of T1 root and in differential diagnosis of medial cord and lower trunk lesions with ulnar and medial part of median nerve injuries.

Introduction. Bladder cancer is one of the most common urinary system malignancies. There are contraversies regarding priority and intensity of its risk factors according to the health behavior and life style of different societies. Therefore it seemed necessary to investigate the risk factors of bladder cancer in Iranian society.Methods. A case-control study was done in 284 bladder cancer patients and hospitalized controls. The case group was 142 primary bladder cancer patients based on pathological results and control group was 142 patients selected randomly from medical-surgical wards, excluding oncologic and urologic patients, also those had hematuria in their urine analysis. Two groups were matched according to their sex, age and their hospitalization site. The data was collected via interview and questionnaire.Results. The mean age of patients at diagnosis time was 64.4 years. The bladder cancer frequency in men was 3.7 times more than women. There was a significant relationship between bladder cancer and educational level, the place of residence, cigarette smoking, tea drinking, and consumption of high fat foods, frequent and chronic urinary infection and family history of cancer. Discussion. In this study many known bladder cancer risk factors were approved again. The relation between bladder cancer and opium addiction needs further investigation. It is recommended that early detection, screening tests such as urine analysis should be done in high risk individuals.

Introduction. The most important goal in radiation therapy is treating the tumor while protecting the surrounding healthy tissue. To achieve this goal the difference between prescribed and deliveredtumor dose has to be less than±2 percent. This study evaluated the necessity of using output factors for changing output of a reference field to the output of other field sizes.Methods. Scp was measured in water and Se in a narrow cylindrical phantom built in this research for cobalt and 12 MV beams. The separation of Scp to Sc and Sp parts for blocked fields was evaluated by comparing the measured and calculated Scp values for blocked fields. Results. Results of this study indicates that if output factors are not used for a 12 MV beam the difference between delivered and prescribed tumor dose is from 13 percent (in largest field) to – 6 percent (in smallest field) ( difference was 8 percent for cobalt beam). The 'method of separating Scp to Se and Sp was verified (maximum difference from measured values was 1.3 percent).Discussion. In the method of using phantom field size for selecting Scp, tumor dose was more than prescribed dose from 2.4 percent (for a 27 percent block) to 7.8 percent (for a 90 percent block) for a 12 MV beam (the error increased by block size and proximity of block to the center).

Introduction. Antistreptokinase antibodies in sera of individuals with previous streptococcal infection might theoretically influence the thrombolytic activity of streptokinase. Streptokinase as the only thrombolytic drug is used in MI management in Iran. Since, the prevalence of streptococcal infections are higher in Iranian population, it seems that high level of antibodies in sera of patients would decrease the thrombolytic effect of Streptokinase.Methods. Antistreptokinase antibodies were measured by Home Made EL/SA method before streptokinase administration in 126 patients with MI who were admitted to Noor hospital (affiliated to Isfahan University of Medical Sciences and Health Services). The effect of drug with regard to ECG changes in following days were studied and compared.Results. In seventy patients of 126 (13.5 percent), the drug was ineffective and the antibody level was high. While in 25 patients with effective response to drug (no appearing of Q wave), 3 patients have a high level of antibody against streptokinase.Discussion. It seems that high level of serum antistreptokinase antibody titer has no significant interaction with thrombolytic activity of streptokinase in management of MI. However, most accurate study is required to test this hypothesis.

Introduction. Arsenic is one of the most hazardous elements that associate with airborne particulate matter in the atmosphere. Among the different species of arsenic, ASIII has the most toxic and carcinogenic property between any other kind of this element. Arsenic speciation is important in environmental studies.Methods. We collected 59 samples of airborne particulate matter from the atmosphere in Isfahan in a three months period by a high volume air sampler with a flow rate of 1 m3 min-1. Air particulates were collected on the paper filter (Whatman No.41). Four different digestive procedures were examined in order to find the best method. At last we chose digestion of filter with HCI (10-4N) due to its feasibility, cost benefit and efficacy. Other methods that examined were digestion of filter with a mixture of HN03 and H2O2, with a mixture of HNO3 and H2O2 and with HCI (1 N). The determination of As3+ and As5+ concentrations were performed by hydrIde generation atomic absorption spectrometry. The effect of Ph on the absorption signal was also investigated in arsenic speciation.Results. Average of total saspended particles (TSP) in July, August, and September 1998 were 223, 172, and 247 mg.m3 respectively. The recovery of arsenic from airborne particulate matter was almost the same for the different digestion methods. The concentration and volume of NaBH4 was optimized for determining of different species of arsenic. At pH=5, Asv didn't produce any absorption signal. So, the determination of ASm was carried out easilyat the above mentioned pH.The concentrations of total arsenic were determined in 47 samples. The mean concentrations of total arsenic in July, August and September were 3.31, 2.01 and 2.6, respectively.Discussion. More than 50 percent of total atmospheric arsenic exists as ASIII which is the most toxic and carcinogenic forms of this element. So, it is recommended to make a suitable policy for decreasing of this hazardous pollution in our environment.

Introduction. Bifid uvulae is a silent abnormality in children which can almost exist without clinical problems but in some instances it is accompanied with either sub mucosal cleft and hypernasality.Methods. In a cross sectional study, the examiners carried out oral examination of 3000 children and the structure of the uvulae was evaluated as normal or bifid.Results. The prevalence of bifid uvula was 0.8 percent (25 children). Positive family history, familial marriage and positive teratogen exposure history were detected in four, twenty and eight percent of bifid uvalae cases, respectively.Discussion. Bifid uvulue prevalence in European and American children was reported more than our findings. This gap may be due to different cultural habits as well as environmental factors.

Introduction. This study was conducted to define some standard measures for interpupillary distance (PD) in different age groups of an Iranian population.Methods. This study was performed on 1500 patients aged between 5 to 80 years (947 cases older than 19 years) referring to Farabi hospital (Ophtalmologic Center affiliated to Isfahan University of Medical Sciences and Health Services) during 1992-1993. Complete ophtalmologic examination was done for each patient including interpupillary distance measurement by objective autorefractometer. Non of the cases had any other ocular pathology except primary refractive error.Results. The mean of P.D in adults was 62z3.73 mm. This mean was 61.13±3.47 mm in women and 63.57±3.90 mm in men (P<0.001). In 96.2 percent of adults PD was in a range of 55-70 mm. This study indicates the association between PD and age (r=0.33 in women and r=0.47 in men). Discussion. PD is larger in men than women. The increasing of PD is continued even after 30 years old.

Introduction. Asthma is the most common chronic disease in children. Unfortunately there are not exact epidemiologic data concerning the prevalence of this disorder in Iranian children. The purpose of this study was to estimate the prevalence of asthma or respiratory symptoms in Isfahan Junior high school children.Methods. From 1998 Oct. to 1999 May. 3986 children from urban junior high schools children were selected by a proportional random cluster sampling. A self administered questionnaire prepared by International Study of Asthma and Allergies in Childhood (ISSAC) modified by several supplementary questions was distributed among the selected children. The response rate was 98.5 percent (N=3924). Of these children, 2588 pupils who had at least one positive answer referring to respiratory symptoms were invited to AL-Zahra medical center for further evaluation, but 1710 pupils (66 percent of the invited) attended the clinic and underwent complete medical interview, physical examination and post-exercise pulmonary function testing. Those children who failed to attend the clinic were examined at their schools (774 cases) and 104 absent pupils were not examined. Our criterion for the diagnosis of asthma was the positive history of wheezing and dyspnea.Results. The overall prevalence of asthma was 19.6 percent with a male to female ratio of 1.7:1 (P<0.0001). The frequencies of wheezing ever in life and sleep disturbed by wheeze were 31.7 percent and 9.5 percent, respectively. Wheeze and rhoncus on chest auscultation while the children were examined in clinic or school was recorded in 4.2 percent and 3.5 percent of the population, respectively. Pulmonary function tests revealed FEV1:5,80 percent of predicted value (prd) in 5.9 percent, FEF 25-75£70 Percent prd in 9.6 percent and FEF75£70 percent prd in 20.5 percent of tested children. The three later findings correlated to history of wheezing and dyspnea (P<0.0001). Discussion. The prevalence of asthma in the students of the junior high schools of Isfahan is more than average rates reported in many parts of the world, and it seems necessary to pay more attention to poorly controlled air pollution in Isfahan as an industrial city.

Introduction. Convulsion is a dangerous occurrence in pediatric disease that requires immediately intervention. It is one of the common causes of referring children to emergency room and must be controlled as soon as possible for prevention of systemic complications and the brain damages. We compared the effect of intravenous (IV) versus rectal diazepam in control of convulsion in children.Methods. Study group included eighty patients with seizure (from 3 months to 12 years old). Forty patients received rectal diazepam and other ones received diazepam intravenously.Results. The convulsion was controlled with rectal diazepam in less than 5 minutes (N diazepam less than 2 minutes) and this method was not difficult even for parents.Discussion. Control of convulsion less than one minute has no relation to the route of diazepam administration. The important factors for control of seizure are dose of diazepam and the prompt use of it after seizure.

Introduction. Sludge is a broad term used to describe the various aqueous suspensions of solids produced during wastewater treatment. Raw sludge can be broadly classified as primary sludge, secondary sludge and mixed sludge (mixtures of these two sludge). Raw sludge contains a variety of pollutants creating potentials for environmental pollution and must be treated and disposed properly. Sludge produced in Isfahan South Wastewater Treatment Plant is treated by anaerobic digestion. This method generates nuisance odors and has many operational problems.Aerobic digestion is an alternative process for stabilizing sludge. Because the operational control of aerobic digesters is simple and many other advantages, it appears that aerobic digestion will increase in popularity. Methods. Aerobic digestion was carried out in a 7.5 liters bioreactor (rectangular glass tank 23*16*21 Cm) that was loaded with 5 liters mixed sludge from this plant. This experimental research was conducted at the Environmental Health Laboratory of Isfahan Faculty of Health. Aeration of bioreactor content provided through three air stones that each of them connected with one aquarium air pump (RENA101). The aeration rate was set to maintain a minimum residual dissolved oxygen concentration of 1.5 mg/I and aeration was sufficient to keep the solids in suspension. This research was continued for 5 period from autumn and winter 1998 through end of spring 1999. In each period the sludge was aerated for three weeks and in each week two times samplings are accomplished and were analyzed.Results. The measurements of TS, TSS, TVS, VSS, and COD concentration and percent reduction of them were performed to monitor the progress of aerobic digestion process and determination of design parameters. Standard Methods (APHA, 1992) were used for all analytical procedures. After the 18 days of detention time of aerobic digestion the decrease in TS, TSS, TVS. VSS, and COD reached 45.22, 49.30, 52.36, 52.28, and 43.03 percent respectively of its primary value.Discussion. The results of this study were shown that mixed sludge from Isfahan South Wastewater Treatment Plant were stabilized effectively by aerobic digestion and during of these process significant decreases in any form solids and organic matters were occurred. Determining endpoints in digestion of sludge is carried out by determining the TVS reduction. A 40 percent TVS reduction (EPA's regulations) was achieved with a minimum hydraulic detention time of 11 days at maximum TVS loading rate of 1.45KgTVsm-3d-1.

Introduction. Malignancy is seen in pediatrics, frequently. Radiotherapy as a common procedure in malignancy management may has many side effects and complications, especially about endocrine system. In this study, we evaluate the incidence of post radiotherapy hypothyroidism In malignant pediatric patients.Methods. In a cross sectional study one hundred and eighty children between 1 to 20 years old that survived of malignancy were selected. They have been treated in Sayyed-Alshohada hospital (affiliated to Isfahan University of Medical Sciences) from 1993 Sep. until 1998 Sep. by radiotherapy.Baseline characteristics (e.g. sex, age, dose, location and number of radiotherapy fraction, type of malignancy) were derived from medical records. Subjects were invited by letters to evaluate their thyroid functions in 1999. Serum T4 and FT4 concentrations assayed by RIA and TSH by IRMA methods.Results. The incidence of hypothyroidism was 13.3 percent (1.2 percent secondary hypothyroidism and 12.1 percent primary hypothyroidism). There was no statistical difference in age and sex distribution between patients with or without hypothyroidism. History of cervical region radiotherapy was taken in 45.8 percent of hypothyroid patients. There was no significant difference in dose and number of radiotherapy fraction between hypothyroid and euthyroid patients.Discussion. Radiotherapy may have a role in developing hypothyroidism in patients who received radiotherapy. This role has no relation to age and sex, dose and number of radiation fraction in development of hypothyroidism. Region of radiotherapy is important. It is suggested that this study continues and data will be collected during several years in future. Of course, many of hypothyroid patients will become euthyroid spontaneously.