JOURNAL OF RESEARCH IN MEDICAL SCIENCES (JRMS)
Year:2001 | Volume:5 | Issue:4|Papers Count:24

One of the current problem which medical staff engaged in is the responsibility in contrast to patient and law. It seems that some explanation about the ways which a physician has to obey then it never face any problem with lawsuit. In this regard Permission of legislator, intention to treat and legitimate medical action, in response on his medical action, consent, aquittance, exceptions of consent and aquittance are discussed.

Introduction.With respect to the importance of nutritional counselling during pregnancy, the improtance of knowledge, attitude and practice of health care providers is undisputable. In this study the knowledge, attitude and practice of the health care providers in the city of shiraz with respect to the nutritional counseling in pregnancy was investigated. Methods. The survey was done upon all who practicing in MCH unit of heath care centers in the city of shiraz. The intended information was gathered using a checklist and questionnaire from 75 heath care providers.Results. Knowledge is in middle level in 60 percent, attitude is positive in 98.7 percent and practice is poor in 90.67 percent of samples. Midwifery school graduations have more knowledge than other (P<0.05).Discussion. Education of nutritional sciences for health care providers has an important role in health promotion. During special situations such as pregnancy, this matter is more important.

Introduction: Almost all patients with coetaneous leishmaniasis have little knowledge about prevention and transmission of the disease. Clearly health education is an important factor and a new strategy for the control and prevention of the disease. High expenses of vaccines and little improvement in the production of vaccine persuaded us to focus on health education for parasitic disease control. Methods: At first, the level of knowledge about different aspects of leishmaniasis was determined in 232 mothers in experimental group (social community medical center in Haftoon) and 239 mothers in control group (zeinabieh) by a questionnaire with 26 questions. The level of knowledge about disease was checked in both groups after educational programme for health volunteers of experimental group in Haftoon. Knowledge levels were graded in Good (13-20), middle (7-12) and weak (0-6) categories.Results: Mothers knowledge about control and prevention of leishmaniasis was in middle level in both group. There was significant relationship between educational degree of mothers and husbands and the job of husbands with their knowledge about the disease. Increasing the mean knowledge of mothers after education of health volunteers were 0.91 (12.6 percent) in experimental group and 0.42 (5.72 percent) in control group. So, education of health volunteers had no significant effects on increasing the mothers knowledge (P>0.05).Discussion: This survey showed that the knowledge about control and prevention of leishmaniasis in endermic area is low. Health volunteers as related group between the health center and women have no acceptable functions. So, it is suggested that education to women should be applied in endemic area and health volunteers must be activated by the health centers.

Introduction: Malnutrition is a major determinant of mortality risk in infant and children so it is important to determine the mortality of a given degree of malnutrition assassed by anthropometric indices. Two Indices that may be employed to evaluate the accuracy of a screening test are sensitivity and specificity.Method: This study selected 1498 children between the years 1369 (1990) and 1371 (1992) in rural area of shahreza and followed them from birth to 1372 (1993). mode of their selection was cluster random sampling. the data of weight, hight and all deaths were recorded by a questionair. two methods centile and Z-score to evaluate the accuracy were used for analysis. The sensitivity and specificity of wt/age and wt/ht and ht/age are illustrated and compared.Result: By centile method senstivity of malnutrition for 3 indicators were 75,94 and 56 percent respectively and specificity were 18,6 and 33 percent.By Z-score method sensitivity were 40.4, 25 and 19.3 percent for 3 Indicators were 93.8,78.9 and 97.4 percent. Discussion: Sensitivity and specificity are two indices that be employed to evaluate the accuracy of a screening test to identify children at high risk to mortality.

Introduction: According to the reports 2175 million people are suffering from anemia including developing countries. That is the most common problem in pregnant women, children of primary school age. Anemia caused by iron deficiency is one of the most common nutritional disorder in the world. Methods: In a field trial, two separated random samples in Shahin Shahr were consumed fortified bread for six months. Serum ferritin and erythrocyte indices determind before and six months after fortified bread consumption.Results: There was no significant decrease in erythrocyte indices, but, the percent of cases with ferritin less than 18 ng/ml were significantly decreased after six months of fortified bread comsumption (P<0.05).Discussion: There are some important difficulties in flour fortification with iron sulfate witch can decrease its effectiveness in prevention of iron deficiency anemia at least in short period.

Introduction: Transferred fats from utroplacental barrier have different concentration about their saturation degree. So, the diet during pregnancy seems to have an important role in determining the serum lipid level of the fetus. This study investigated the influence of modifying the maternal dietary fat on the serum lipids of the cord and one year old infants. Methods: This single blind randomized clinical trail was done on 180 pregnant women who was at 4th month gestational age. All subjects proved to have a fat unmodified diet through a 4-day food record dietary questionnaire. We divided them randomly in two groups. The intervention group was kept on a fat-modified diet including saturated fatty acid < 10 percent, monounsaturated fatty acids: 10-15 percent, polyunsaturated fatty acid up to 10 percent and cholesterol <300 mg/day as well as a dietary advice for the pregnancy period. The control group were given. only the latter advice. All subjects were followed up monthly. The blood samples were done at delivery from cords and after one year from infants. The serum lipids including total cholesterol (T.cho), triglyceride (TG), and HDL cholesterol (HDL-C) were analyzed through enzymatic methods. The level of LDL-cholesterol (LDL-C) was calculated by Friedewald formula.Results: The mean level of T.cho in the interventional and control group was 70.3±15. 9,81.4±17.2 mg/dl, respectively (P<0.01). TG (85.3±16.7 VS 97.5± 18.2 mg/dl), LDL-C(27.8±15.2 VS 34.8± 17.1 mg/dl) and non-HDL-C (44.5±7.2 VS 54.5±8.1) wre higher in cord blood samples of unmodified dietary fat. In one year old infant the comparison of serum lipids were as follow: T.cho (145.7±51.4 VS 161.4±56.2, P<0.003), TG (90.1±31.8 VS 98.3±33.1, P<0.02), LDL-C (85.6± 20.4 VS 92.3±19.6, P<0,05) and non-HDL-C (113.6±30.2 VS 128.8±34.8,P<0.04). There was no significant difference in HDL-C.Discussion: According to the results, there is a significant decrease of T.cho, TG, LDL-C and non-HDL-C levels with no significant increase of HDL-C in the intervention group with the fat-modified diet. We conclude that the modifying maternal fat diet could be suitable way to prevent cardiovascular disease.

Introduction: Inguinal hernia is one of the most common disease in pediatric surgery. Operation is the only definite treatment for it, yet. Bilateral inguinal exploration is recommended by some authors due to high incidence of bilateral inguinal hernia in children.Methods: In a cross sectional study 336 children (99 female and 237 male) with inguinal hernia were investigated. Contralateral exploration was done in all patients after repair of involved side. Data was categorized and analyzed according to sex and age. Results: Positive exploration in females and males was 76 and 62 percent, respectively. 44.3 percent of patients younger than one year old and 55.7 percent of patients between 1 to 3 years old had hernia in both sides. Sex and age correlated to coexisting of inguinal hernia in both sides (P<0.03).Discussion: Contralateral exploration is more positive in lower age group. Contralateral exploration is recommended in ipsilateral inguinal hernia, specialy in girls with left sided hernia.

Introduction: In this study amnesic and anesthetic effects of Midazolam used to reduce awarness and recall of neurolept Anesthesia. Methods: The study was clinical trial with simple random sampling. Patients were studied in four groups of 30 numbers. Each preparation and induction of anesthesia was identical in all groups. Bolous Thiopental (BT) group received 0.3mg/kg NaThiopental during induction of Anesthesia. Infusion thiopental group (IT) 0.3mg/kg Na thiopental was given during induction plus 100mg/kg/min for Maintaince of anesthesia. Bolous Midazolam (BM) group recieved 0.1 mg/kg Midazolam during induction and Infusion Midazolam (lM) groug 0.1 mg/kg during Induction plus 0.1mg/kg/h for maintainance of Anesthesia. All groups were observed for signs of awareness and recall. Also hemodynamic variables and duration of recovery were measured and compared between groups with analysis of variance and Chi square tests.Result: Signs of Awareness (tachycardia and Lacrimation) in IM group was significantly less than other groups. (P<0.05)Percent of patients reported recall were significantly lower in IM group. (P<0.05)Discussion: Infusion of Midazolam can reduce signs of awareness and recall during neurolept anesthesia without increase in complications or duration of recovery period

Introduction: Nasocomial infections threat any hospitalized patient, specially in intensive care unit. Incidence of these infections has been reported from 1.9 to more than 25 percent. The most common nasocomial infection in intensive care units (ICU) is pneumonia caused by endotraheal intubation and mechanical ventilation. The best procedure for pneumonia prevention in patients under mechanical ventilation is utilization of suitable and proper techniques for equipment sterilization: The goal of this study is determination and comparison of disinfectant materials (cidex, savlon and hydrogen peroxide) about their effects on incidence and type of mechanical ventilators breathing tubes contamination in intensive care unit.Methods: This is an experimental trial which was done on three groups of mechanical ventilator breathing tubes. Each group contained 20 samples. These three groups of breathing tubes were disinfected with cidex, savlon and hydrogen peroxide. Samples were obtained from tubes for microbial culture berore and after disinfection. Samples were cultured on blood agar. The results of microbial culturing were compared between three groups.Results: There was no significant difference between three groups of breathing tubes about microbial types and number of colony counted before disinfection. There was no significant difference between cultured colony numbers in three groups before and after disinfection. Cidex, savlon and hydrogen peroxide could decrease incidence of contamination to 100, 98.09 and 100 percent, respectively. Discussion: All of tested chemical materials have the same results in disinfection. Hydrogen peroxide has less adverse effect on human and environment than cidex. It is less expensive than cidex. So, we recommend to use this material for disifection of mechanical ventilator berthing tubes.

Introduction: Operation is the most common treatment for hydatid cysts. However, operation would be useless in some patients with diffuse organ involvement, special anatomic spaces or poor general conditions. So, drug therapy is considered in some studies. Albendazole is a benzimidazole derivation can gain high plasma level. It absorbed quickly after oral intake and most of it metabolized to Sulfoxide.Methods: Ten randomly selected patients with 39 hydatid cysts in different organs were treated by albendazole. Patients received 10-15 mg/kg/day of albendazole in two different divided doses for 1-4 periods of 30 days duration. Periodic clinical and paraclinical examinations were done. The cysts were in the liver, lung, spleen, peritoneum, pelvis, pericardium and chest wall.Results: Except for one cyst in lung and two in abdomen which therapeutic results have not clarified, all of the cysts died. Drug systemic side effects were negligible. Patients had good tolerance to it. Local complication such as inflamation, tenderness and rupture of cyst were the main side effects. Discussion: It is recommende to pay more attention to drug therapy in management of hydatid cyst. It is helpful for complicated cases that we cant operate them.

Introduction. Hypertension is one of the most common causes of cardiovascular problems in our society. Diet is the cheapest and the most accessible method of blood pressure (BP) control. BP is associated with arterial stiffness which affects cardiac afterload. This study evaluate the effect of diertary Na and K on vascular compliance.Methods. We selected ninty six patients referred to Isfahan cardovascular Research center (affiliated to IUMSHS). Inclusion criteria were mild hypertension (90 <OBP< 99 mmHg and/or 140 <S.BP< 160 mmHg), age between 35-65 years old, body mass index (BMI) between 20-25, and no existing of any other chronic disease or medications. We divided samples into three equal diet group, randomly (A, B, G). The dietary content of sodium and potassium in each group was described as: moderate Na restriction + normal K content (group A), moderate Na restriction +high K content (group B), normal Na content + high K content (group G). Regimen was followed by each group for 16 weeks. Physical examination and anthropometric paramaters, lab data (e.g. FBS, Lipid profile, Uric acid, Serum Na & K, BUN, Gr and Ga), 24 hours urine sample for Na & K were compared before and after of intervention. In echocardiography the left ventricle dimensions and stroke volume were determined. Stroke volume: pulse pressure ratio was assumed as vascular compliance (1: arterial stiffness).Results. Measured indicies were changed in groups as follow. Group A: Δ SBP = -8.43 mmHg; Δ DBP= -5.03 mmHg; Δ SV:PP= -0.28 ml/mmHg per beat (P> 0.05). Group B: Δ SBP= -0.82 mmHg; Δ OBP= -7.09 mmHg; Δ SV/PP= -0.22 ml/mmHg per beat (P> 0.05). Group G: Δ SBP=-7.22 mmHg; Δ OBP= -4.63 mmHg; Δ SV/PP= -0.01 ml/mmHg per beat (P>0.05).Discussion. We recommend the above diets specially type B, as the first step in the treatment approach of mild HTN in our society. These dietary modifications didn't have any effect on arterial stiffness in 16 weeks of follow up. It is may be necessary to continue this intervention for changing arterial stiffness. 

Introduction: Preterm delivery remains a major source of perinatal morbidity and mortality. The patient at risk for preterm delivery could be identified before the onset of uterine activity. Cervical shortening associates with increased risk of preterm delivery. Vaginal ultrasound for measurement of the cervical length can contribute to the prediction, diagnosis and management of preterm delivery.Methods: 780 women attending the antenatal clinic of the Shahid Beheshti and Alzahra hospitals (January 1997 - February 1998) were selected. They had no complications. pregnant with gestational ages between 28-30 weeks were recruited in to the study. Cervical length was recorded by vaginal sonography. They followed up to delivery time. Results: The mean cervical length of the term and preterm groups were statisticaly significantly different. The likelihood ratios of cervical length at various cutoff points were calculated. The appropriate cutoff point based on the receiver operating characteristic curve (35mm) was associated with a significant increased likelihood of preterm delivery.Discussion: A single transvaginal sonographic measure of cervical length at 28-30 weeks gestational age can be used to predict the risk of preterm delivery using a cutoff point on 35mm.

Introduction: There is no definite acceptible method for cranioplasty among neurosergens, yet. We examined Mersilene Mesh for cranioplasty and evaluate its efficacy.Methods: Forty traumatic patients with cranial depressed fracture were studied. They were divided two group randomly. Interventional group was treated by Madrilène Mesh. Cranial fractured bones were sutured to each other with silk. Patients were followed in 1, 3, 6 and 12 month continually. Results: Only two patients in interventional group and seven patients in control group had some looseness in cranial bone after 9 months follow up (P<0.05). There was no evidence of infection, graft rejection and wound dehisence in two groups.Discussion: It seems that Mersilene mesh use in cranioplasty is effective and useful.

Introduction: Leishmania recidivans, also known as Lupoid Leishmaniasis is one of the uncommon clinical picture of cutaneous Leishmaniasis occurs in 5-7 percent of patients. In this clinical picture the lesions reactivate after a few months or years. The reason for reactivation is not clear, yet. The most popular hypothesis is the impairment of cell mediated immunity. It may be relate on HLA antigens of the patients. Methods: We selected 30 Lupoid Leishmaniasis patients (18 females and 12 males, aged between 4 to 70 years old). One hundred healthy peoples were matched to patients according to standardized criteria.Results: HLA A3, A11, A24 and A30 were more frequent in patients (P<0.05).Discussion: Our study demonstrate a significant association between Lipoid Leishmaniasis and HLA antigen.

Introduction: Due to the prevalence of beta thalassemia and iron deficiency anemia in Irana need for an accurate, quick, inexpensive and simple method for differential diagnosis between these two disorders is felt. In this study the value of zpp measurement as a tool to distinguish iron deficiency from heterozygous beta thalassemia in microcrystal patients was evaluated.Methods: In this study on 140 persons with microcytosis, the hemoglobin electrophoresis, serum iron, TIBC and serum ferritin and protoporphyrine relating to zinc (ZPP) were measured.Results: ZPP had been increased in all iron deficient patients and in 53 percent of Heterozygote beta thalassemia patients. Using combination of MCV and ZPP in iron deficient anemic patients and heterozygote beta thalassemia show the 99 percent accuaracy in differentiation of these two disorders. Discussion: According to the results, this method has better accuracy than red blood cells formulation in the screening programs for beta thalassemia and iron defficiency anemia.

Introduction: There are different ways for identification of Mycobacteria. One of the most sensitive method is HPLC of phenacyl esters of mycolic acids of Mycobacteria for rapid identification of them after their primary cultures. This study uses HPLC for rapid identification and dissociation of Mycobacterium tuberculosis complex. Methods: In this study we use HPLC patterns of mycolic acids for identification three important species of mycobacteria (M. tuberculosis, M. bovis, M. bovis BCG) from other mycobacterial species. All the strains were obtained from Tuberculosis and Pulmonary Diseases Research Center. HPLC conditions was as follows: HPLC: Model 1200 Cecil, Column: URP C-18 25X4.6 mm, Detector: U.V variable wave length at 254 nm, Elution: Gradient of methanol/chloroform. Flow rate: 2.5 ml/min.Results: HPLC leads to obtaining chromatograms which on its X-axis retention times (of different peaks which exist in the sample) and on its Y-axis U.V absorbance (of these peaks) were drown. These chromatograms in M. bovis and M. tuberculosis samples are similar with each other but differs from BCG ones.Discussion: On the basis of different retention times and numbers of the peaks which present in each chromatogram, we can differentiate between M. bovis, M. tuberculosis and BCG from other Mycobacteria. Also, with this method we can identify BCG from M. bovis and M. tuberculosis (because BCG has 9 and M. bovis and M. tuberculosis has 7 characteristic peaks in their chromatograms).

Introduction: As many as 35 percent of the world population suffer from some degree of iron deficiency anemia. According to recent reports published by WHO and ICN (International Congress of Nutrition) 20-40 percent of women are suffering from iron deficiency. Iron deficiency anemia is caused by lack of intake of the necessary doses of Fe+2 called Heme. The recommended intake dose is 10-17 mg Fe+2/day. In Iran, bread is the main source of daily iron intake. However, the iron content of bread is Fe+3 which is not absorbable. The objectives of this study is to determine the levels of absorbable iron (Fe+2) in two common types of Iranian bread and identify the means of raising these to an adequate levels. Methods: Random sampling method together with the normal distribution curve was employed in testing 120 samples of flour and bread. Quantification was carried out on each sample in duplicate using spectrophotometer at 510 mu, micrometer wave length. The effect of three organic acids (lactic ascorbic and acetic acid) converting of Fe+3 to Fe+2 was investigated. Two groups of bread was tested. One group was baked in tratitional oven (Noon-e-Tanoori) and the second group through the common Iranian hot rotating iron plate baking machine (Noon-e-Machini).Results: Our results showed that the amount of absorbable Fe+2 in breads baked in rotatory oven (Noon-e-Tanoori) is 0.8±0.32 mg and the amount of unabsorbable Fe+3 in dried bread is 2.34±0.25 mg/100 gm while the amount of absorbable Fe+2 baked in traditional ovens is only 0.3±0.11 mg versus of unabsorbable Fe+3 1.9±0.13 mg/100 gm of dried bread. Meanwhile it was found that lactic and ascorbic acids can convert Fe+3 to Fe+2. Therefore, addition of one of these two acids to bread can catalyze conversion of unabsorbable Fe+3 to absorbable Fe +2.Discussion: On the average an Iranian consumes 370 gm of bread per day. This translates into 3 mgm and 1.1 mgm of Fe +2 if the bread is baked by rotating hot iron plate and by traditional oven (Tanoor), respectively. As only 10 percent of this amount is converted into absorbable Fe+2 the daily iron intake through bread alone is not sufficient. Yogurt and Garagorout are main sources of lactic acid. Therefore, it is recommended to add one of these to yeast in order to increase the level of absorbable Fe+2 in bread. Furthermore, Yogurt is highly recommended to be added to daily diet, and garagorout as a seasoning.

ntroduction: Post operative care in newborn and infants are different from other ages.Methods: A retrospective study performed in 140 patient during one year period (1998). The selected patients were under 2 years old. Results: Data from our study showed 54 percent of the operations was palliative and 46 percent of them was corrective type. Cardiac side effect of poeration was 39 percent and bronchopulmonary 29 percent. The Mortality rate in our study was 15.7 percent that 45 percent of them due to cardiac etiology. Mortality rate of infants was twice of the other ages.Discussion: Because the cardiac factors was the most important, post operative care should be performed.

Introduction: In order to reduce invasive cervical cancer, it is necessary to follow presisly the patients with abnormal pap smear. Simply, repeating the cytologic assessment in patints with atypical pap smear will result in missing 26-83 percent of squamous intraepithelial lesions and most alarming 50 percent of invasive cancers. Considering the contraversy of different study reports about the diagnostic value of colposcopy in confirming the abnormal papsmear, this study was conducted to determine the sensitivity and specificity of colposcopy based on the results of biopsy in women referred to hospitals of Isfahan University of Medical Sciences (IUMS).Methods: In a prospective study, we selected randomly 210 women from 700 patints who reffered to the hospitals of IUMS. These women were examined and biopsied simultaneously. The data was collected by a structured interview according to the demographic characteristics and then was analyzed using EPI software. Results. From 210 subjects, only 125 were reported to have abnormal cervical cytologic. The sensitivity came out to be 97.29 percent and specificity was 43.20 percent.Discussion. In Iran, according to the sensitivity and specificity for colposcpic examination, it can be suggested that in final evaluation of abnormal papsmears, colposcopic assesment of the cervix can be considered as the next appropriate step.