پژوهش در علوم پزشکی
سال:1377 | دوره:3 | شماره:1 |تعداد مقالات:16

Background: This study was conducted to compare the efficacy of enzyme-linked immunosorbent assay (ELISA) for detecting anti-Helicobacter pylori (H. pylori) specific IgG antibodies in specimens of oral fluid and serum with bacteriological tests. Methods: Antral biopsy specimens, as well as serum and oral fluid samples were collected from 97 patients who underwent upper gastrointestinal endoscopy. The presence or absence of current H. pylori infection was determined by culture, histology and urease detection. Anti-H. pylori specific IgG was detected in serum and oral fluid, using an established lab-made, and a commercial ELISA kit. The obtained data were compared with results of bacteriological tests. Results: In all, 62 (64%) of 97 patients were positive for H. pylori by one or more of the gold standard tests (culture, histology and urease detection). Lab-made enzyme-linked immunoassay of oral fluid had a sensitivity and specificity of 92% and 83% respectively. A sensitivity and specificity of 87% and 83%, respectively, was obtained with the commercial kit. Lab-made enzyme-linked immunoassay of serum samples had a sensitivity and specificity of 90% and 88%, respectively. A sensitivity of 86% and specificity of 86% was obtained with the commercial kit. Conclusion: Detection of anti-H. pylori specific IgG in oral fluid by ELISA is comparable in sensitivity and specificity with serum based methods. Oral fluid based ELISA could provide a reliable, non-invasive method for the diagnosis of H. pylori infection. Saliva testing may have a role in epidemiological studies.  

Background: Preeclampsia is the second cause of maternal mortality in the United States and accounts for 25% of perinatal mortality. Mild Preeclampsia could be treated without hospitalization, however in some cases, hospitalization seems necessary. Administration of magnesium sulfate (MgSo4) in mild preeclampsia is a matter of controversy. It is obvious that replacing intravenous magnesium sulfate with an oral preparation of magnesium, of course if it gains a sufficiently high serum level, can be easier to use and less expensive. Up to the present time, we have not been able to find any previously done studies using oral magnesium preprations to treat preeclampsia. Thus, we tried to compare serum magnesium level with oral magnesium chloride and intravenous (IV) magnesium sulfate therapy. Methods: This was a comparative experimental study. From January 2002 until April 2003, pregnant patients with mild preeclampsia admitted to Al-Zahra and Beheshti hospitals,Isfahan,Iran, between their 27th and 38th weeks of gestation were divided into 2 groups randomly. There were 33 patients in each group. The first group was treated with IV magnesium sulfate (2 g/h) and the second group received oral magnesium chloride (4 g/2h). Magnesium level was checked in 0, 3, 6, 12 hours. The collected data were analyzed with t-Student test on a computer applying SPSS software. Results: There was no statistical difference between the two groups regarding age, gravidity and gestational age. Magnesium level rose in both groups (P<0.01). Increase of magnesium level in IV magnesium sulfate group was greater than in the other group, and in the magnesium chloride group, therapeutic level could not be achieved. Conclusion: Increase of serum Mg level in IV Mg sulfate group and reaching the therapeutic level was the same as reported before. Increase of Mg level with oral Mg chloride, though measurable, did not reach the therapeutic level. Perhaps with more cases or higher amounts of the drug or other types of Mg preparations we could reach the therapeutic level.  

Background: Lateral osteotomy is a major part of rhinoplasty for remodeling external facet of the nose and narrowing of nasal base and dorsum after removal of the hump. There are two techniques for lateral osteotomy known as external and internal. Each of these provide advantages and impose limitations. The purpose of our study was to compare the severity of postoperative edema and ecchymosis between internal and external osteotomy techniques. Methods: This study was designed as a clinical trial on 30 cases. With randomization, one side of the nasal bone was selected for internal approach, and the other side, for external approach. Then, on the 1st and 7th days after surgery, the patients were scored for the severity of edema and ecchymosis. Results: On the first day after surgery, not only edema, but also ecchymosis was lower with the external osteotomy than with the internal approach (P = 0.037, P = 0.002, respectively). The severity of ecchymosis, on the 7th postoperative day, was lower with the external approach, and the difference was significant (P = 0.011). The severity of both edema and ecchymosis on the first postoperative day was evaluated higher in females, with statistically significant differences (P = 0.05 for edema and P = 0.003 for ecchymosis). The extension of ecchymosis on the 7th postoperative day was higher in women (P = 0.05). There were no significant differences between the two approaches in medialization of the involved bones and no apparent asymmetries either. Conclusion: According to the results of this study, external osteotomy seems to be the approach of choice, provided that the surgeon has enough experience in doing it.  

Background: The antihypertensive drug, clonidine, is a centrally acting alpha 2 agonist, useful as a premedication because of its sedative and analgesic properties. We examined the effect of clonidine given as an oral premedication in producing a bloodless surgical field in patients undergoing endoscopic sinus surgery. We also evaluated the relation between bleeding volume and consumption of fentanyl and hydralazine to control hypotension. Methods: This prospective double - blinded clinical trial was performed on 113 patients (ASA I, ASA II). Fifty-two patients received oral clonidine (5 μ g/kg) while the other 61 patients received placebo. During general anesthesia, the hemodynamic endpoint of the anesthetic management was maintenance of hypotension (MAP) at 70 mmHg for producing a bloodless surgical field. The direct control of MAP was attained with inspired concentration increments of halothane up to maximum of 1.5 vol % as needed. When it was unsuccessful, an intravenous fentanyl bolus of 2 μ g/kg was also added. When both drugs failed, hydralazine , was given intravenously as a bolus and intermittently, 0.1mg/kg up to a maximum dose of 40 mg. Intraoperative bleeding was assessed on a six – point scale from 0 (= no bleeding) to 5 (= severe bleeding). Data were compared with chisquare test, fisher's exact test and Student t-test. Results: There was less bleeding volume in the clonidine group (mean ± SD) than in the placebo group (144 ± 75 Vs 225 ± 72 ml, P<0.05). Frequency of bleeding severity scores 3 and 4 (troublesome with repeated suction) were lower in the clonidine group than in the placebo group (12% Vs 35%, P< 0.05). Fentanyl requirement was significantly lower (112 ± 18 Vs 142 ± 21μ g, P < 0.05) in the clonidine group. Hydralazine requirement was significantly lower (0.45 ± 1.68 Vs 2.67 ± 4.33 mg, P<0.05) as well. Conclusion: Premedication with oral clonidine reduces bleeding in endoscopic sinus surgery and also decreases fentanyl, and hydralazine consumption for controlling hypotension.  

Background: corneal thickness is an important factor in refractive surgeries such as Radial Keratotomy (RK), Photo Refractive Keratotomy (PRK) and Laser Insitu Keratomileusis (LASIK). This study evaluated the correlation between this factor and the degree of myopic refractory error. Methods: In this cross-sectional study, 224 myopic eyes (112 patients) which had undergone LASIK operation were assessed. These patients had referred to Aban Eye Clinic, Isfahan, Iran, during August and September 2002. Corneal thickness was measured by ORB SCAN Topoghraphy, and cycloplegic refraction was performed with autorefratometery and retinoscopy. Suspected keratoconus cases and hyperopic patients were excluded. Results: The patients' age was 27.2 ± 1.36 in men (N = 35) and 30.13 ± 1.04 in women (N = 77). Mean value of myopic refractory error in male patients was 5.1 ± 0.24D and in female patients was 3.8 ± 0.36D. Mean of corneal thickness was 540 ± 5.25 μM and 530 ± 5.88 μM in male and female patients respectively. There was no correlation between the degree of myopia and corneal thickness in any of the patients. Also in this research, no relations between the age and myopia were found. Right eye (P > 0.5, r = 0.124) Left eye (P > 0.5, r = 0.104). Conclusion: Based on our findings, corneal thickness and myopic refectory error do not seem to have any relations. (r = 0.039, p = 0.684).  

Background: Meningococcal diseases occur with a worldwide distribution as endemic or in epidemics with an overall mortality rate of 8% to 10%, mainly in patients with signs and symptoms of meningococcemia. Several investigators have devised scoring systems using clinical and laboratory parameters available at the time of presentation to prognosticate the outcome of the infection. This study was designed to determine the distribution of demographic, clinical and laboratory parameters among our patients and the relative frequency of individual Stiehm and Damrosch components. Methods: This was a prospective descriptive study, performed on patients with definite diagnosis of meningococcal infection admitted to Al-Zahra University hospital (adult and pediatric wards), Isfahan, Iran, between 1997 and 2002. The cases were 140 patients [99(70.7%) males and 41(29.3%)females] from 1 to 50 years old (25.5±1.32). Data were collected by filling checklists. SSPS software was applied to analyze the data using chi-square test. Results: In this study, the relative frequency of individual Stiehm and Damrosch components were as follows: hypotension (10.7%), peripheral white blood cell count <10,000/mm3 (39.3%), leukopenia (11.5%), ESR<10 mm/hr (19.3%), coma (6.4%), early widespread petechiae (18%), absence of meningitis (13.6%). Overall mortality rate was (10.7%). Conclusion: Meningococci are still killers, they affect men more than women. Teenagers are at more risk than other age groups. Mortality in our study was a little higher than what is suggested (10.7%). we recommend using scoring systems for early separation of poor prognostic patients to provide them with more special care.  

Kaposi's sarcoma rarely involves penis and is usually accompanied by other cutaneous, mucous or visceral lesions. We report a case of Kaposi's sarcoma of penis. Although Kaposi's sarcoma is known to be associated with an altered immune status, acquired immunodeficiency syndrome (AIDS) and other causes of immunodeficiency were not found in this case.  

Although osteoid osteoma is a relatively common lesion, it rarely occurs at elbow. We report two cases of osteoid osteoma of elbow in trochlea. Diagnosis was delayed because of non-specific clinical and radiological features. The two patients suffered from flexion contracture of elbow due to synovitis, while at the same time, pronation and supination remained normal. Only one of the patients complained of specific nocturnal pain. Both patients had latencies between the onset of symptoms and the appearance of radiological signs. Open surgical excision of the nidus resulted in complete relief and motion recovery in both cases. Diagnostic difficulties and treatment options are discussed below.