JOURNAL OF RESEARCH IN MEDICAL SCIENCES (JRMS)
Year:2007 | Volume:12 | Issue:2|Papers Count:12

BACKGROUND: Congenital scoliosis occurs because of either the failure of formation or the failure of segmentation or both. Evaluation of the incidence and the types of occult intraspinal abnormalities in congenital scoliosis is the subject of this study.METHODS: During a period of 29 years, 103 patients with congenital scoliosis were studied. MRI was used in 46 patients, myelography or CT myelography was used in 64 patients and both MRI and myelography or CT myelography were used in 7 patients for intraspinal abnormalities.RESULTS: In the MRI group, among the 46 patients, 19 patients (41.3%) had intraspinal abnormalities consisting syringomyelia in 9 (19.5%) diastematomyelia in 8 (17.4%), tethered cord syndrome in 6 (13%), low conus in 5 (10.8%) and diplomyelia in 3 (6.5%) of the patients. In the myelography group, among the 64 patients, 17 (26.5%) had intraspinal abnormalities and diastematomyelia was the most common one found in 14 (21.8%) patients.CONCLUSIONS: Intraspinal abnormalities are frequent in congenital scoliosis. Syringomyelia may be associated with congenital scoliosis. In congenital scoliosis, rib fusion may be an indicator of intraspinal abnormalities in MRI. A significant difference between clinical findings and intraspinal anomalies (P<0.05) was noted. Moreover, we believe that total spinal MRI with coronal, sagittal and axial views is a valuable tool in determining the intraspinal abnormalities in congenital scoliosis. This method is highly recommended for detection and neurosurgical intervention before corrective surgeries.

BACKGROUND: According to urology texts, urinary calculi are the third most common affliction of the urinary tract and they pose great expenses on health services. The use of oral herbal medication is one of the cheapest ways of treating this disease (in some societies black radish plant is used as a treatment). The scientific term for black radish is Raphanus sativus nigra. Urinary pH is a prominent factor in any crystallization process in urine. This study was conducted to determine the possible effects of Raphanus on urinary pH as a factor in stone formation and crystallization.METHODS: Thirty healthy people including 11 males and 19 females without any history of drug consumption or urinary calculi in their first degree relatives were chosen and underwent a four days trial. The experiment included 2 days of Raphanus juice consumption during which urinary pH was measured 4 times a day. The averages of Urinary pH with or without Raphanus juice consumption were compared by t-paired test.RESULTS: The Study was carried out using 30 participants including 11 males and 19 females with the mean±SD age of 28.66±10.8 (range 19-55). Out of the eight pairs of urinary pH, only in two pairs P values were 0.05 and 0.028 and the rest were all greater than 0.05 which is not sufficient to show a significant difference between urinary pH with or without Raphanus juice consumption.CONCLUSIONS: In this study, the effect of Raphanus sativus nigra on urinary pH was not proved. However, according to the proved effects of Raphanus as a diuretic and dissolution agent in Rats, it would be reasonable to repeat the same study in a human population.

BACKGROUND: Brucellosis is a zoonotic disease, which involves both animals and human. Although the conventional methods have been widely used for its laboratory diagnosis, the PCR techniques have proved to be useful due to specificity, sensitivity and the rapidness. Various target sequences of brucella bacterium such as OMP2, 16s RNA and IS711 have been used for the primer designing. All primer sets have shown different sensitivities and specificities. In present investigation, PCR protocol and primer designated based on IS711 and a fragment of chromosomal DNA all were optimized with standard genome and clinical samples.METHODS: Numerous tissue samples (liver, kidney, lymph node, and uterus) were prepared and were cultured by the bacteriological standard methods along with the serology positive human samples. PCR protocol was optimized and the primer's sensitivity and the specificity were checked using pure genome of B. abortus. All samples were tested by the standard bacteriological methods. The samples were then subject to PCR amplification and the PCR product was confirmed using the RFLP technique.RESULTS: The culture results indicated a poor sensitivity as it was previously reported. The PCR product 157 bp was observed on the agarose gel indicating that significant number of clinical samples (human brucellosis cases) were positive by PCR but not by the culture method. Although B. abortus DNA was detected in all the culture positive veterinary specimens, some cross-reactions with close related bacteria were observed that might influence the interpretation of the results.CONCLUSIONS: The sensitivity of the present PCR protocol was significantly higher when alk B and IS711 based primers were used in compare to each of the alkB and IS711 based primers alone. More research will be needed to improve the specificity and sensitivity of the PCR protocol before recommending for routine laboratory works.

BACKGROUND: Patients undergoing certain ophthalmic operation are more likely to experience serious postoperative pain. This study was carried out to evaluate the effects of pre-emptive vs. preventive analgesia with oral acetaminophen on postoperative pain in painful ophthalmic surgeries.METHODS: In a double blind clinical trial, 60 patients undergoing strabismus, retinal detachment or deep vitrectomy were randomized into three equal groups. The first group (G1) received oral acetaminophen one hour before induction of general anesthesia and placebo postoperatively. The second group received placebo before induction and acetaminophen after the operation (G2). The third group received placebo at both times (G3). Blood pressure, heart rate and occurrence of oculocardiac reflex (OCR) were recorded during the operation. Pain score (VAS: visual analog scale), the time of the first analgesic use (in hours), and total analgesic requirement (acetaminophen: mg) were determined until 24 hours postoperatively. Data was analyzed using ANOVA, Chi-2 and Kruskal-Wallis tests.RESULTS: The mean pain score was lower in G1 compared with G2 at 2 and 24 hours after the operation (2.1±0.6 vs. 2.7±0.4, P=0.001 and 1.1±0.3 vs. 1.5±0.5, P=0, respectively). The pain score at 2, 6 and 24 hours after the operation was greater in G3 compared with G1 (2.8±0.3 vs. 2.1±0.6, P=0, 2.3±0.7 vs. 1.7±0.5, P=0 and 1.6±0.4 vs. 1.1±0.3, P=0.001, respectively). There was no significant difference among the three groups with respect to the intraoperative hemodynamic changes, occurrence of OCR, the time of the first analgesic use and analgesic consumption.CONCLUSIONS: The use of oral acetaminophen as pre-emptive analgesia one hour before painful ophthalmic surgeries may reduce postoperative pain intensity.

BACKGROUND: The role of the anterolateral abdominal wall muscles (AAWMs) during the vesical filling and evacuation has not been sufficiently addressed in the literature. We have investigated the hypothesis that the AAWMs exhibit the increased electromyographic (EMG) activity on the vesical distension and contraction which presumably assists vesical evacuation.METHODS: The effects of the vesical balloon distension on the vesical pressure (VP), vesical neck (VNP) pressures and the AAWMs' EMG activity were studied in 28 healthy volunteers aged 40.7±9.7 years (18 men, 10 women). These effects were tested after the individual anesthetization of the bladder and AAWMs and after saline infiltration.RESULTS: The VP and the VNP showed a gradual increase upon the incremental vesical balloon distension which started at a distending volume of 120–140 ml. At a mean volume of 364.6±23.8 ml, the VP increased to a mean of 36.6±3.2 cmH2O, the VNP decreased to 18.4±2.4 cmH2O, and the AAWMs EMG registered a significant increase. This effect disappeared in the individual bladder and in the AAWMs' anesthetization. However, it did not disappear in the saline administration.CONCLUSIONS: The AAWMs appear to contract simultaneously with vesical contraction. This action presumably increases the IAP and it assists vesical contraction. The AAWMs contraction on vesical contraction seems to be mediated through a reflex which is called the 'vesico-abdominal wall reflex'. Further studies are required to investigate the role of this reflex in vesical disorders.  

BACKGROUND: It is still controversial whether certain endoscopic features can be used to diagnose Helicobacter pylori related gastritis. Our aim was to determine how macroscopic findings were related to histomorphological changes and the presence of H. pylori in patients undergoing endoscopy.METHODS: The study population involved 501 consecutive gastrointestinal (GI) clinic admissions who underwent esphagogastroduodenoscopy for upper GI symptoms between October 2002 and March 2004. At least 2 antral and 2 body biopsies were obtained from each patient and were examined histologically for the presence of gastritis and were stained for H. pylori using modified Giemsa staining method. Endoscopic findings were reviewed retrospectively by two experts blinded to the H. pylori status and patients history. The endoscopic findings of gastritis, classified by a modification of the Sydney system and histological findings were determined by updated Sydney system. Statistical analysis was done using SPSS 11.RESULTS: A total of 501 consecutive patients (256 females, 245males) ranging from 8 to 91 years (mean, 49.5 years) were studied. H. pylori was found in 326 patients (65.1%). Relative frequency of H pylori in females was 53% and in males was 47%. Rugal hypertrophy, raised erosion and bleeding were observed only in patients with H. pylori infection (specificity=100%). Neutrophil activity also was observed only in patients with H. pylori infection. Among endoscopic findings, erythema showed a high sensitivity (81.3%) and positive predictive value (87.1%) for the diagnosis of H. pylori infection. Gastritis was present in 84.3% of all patients and 97% (316/326) of those with H. pylori and 56.6% (99/175) of those without H. pylori. There was significant statistical correlation between H. pylori infection and gastritis (P<0.001). H. pylori was present in 76% (316/415) of gastritis patients and 5.1% (4/77) of patients without gastritis.CONCLUSIONS: An accurate endoscopic assessment of gastritis according to the Sydney system along with the histological findings is valuable indicator of H. pylori infection.

BACKGROUND: Down syndrome (DS) is a complex genetic disease. Some clinical features of patients with this syndrome could be related to functional folate deficiency. The purpose of this study was to evaluate the total homocysteine (T-Hcy) metabolism in DS children and to determine whether the supplementation with folic acid therapy would shift the genetically induced metabolic imbalance or not. METHODS: Thirty-five infants with DS, with the mean age of 17.66 ±12.24 months were included in this study. They were selected from those attending the Genetic Outpatients Clinic in Children hospital. RESULTS: Our results revealed that Down syndrome children had a significant decrease in serum plasma T-Hcy level after the treatment with folic acid [11.79: ±0.92 vs. 14.41 ±4.93 mol/L]. A significant negative correlation was found between T-Hcy and folic acid serum levels [r = -0.112; P<0.05]. CONCLUSION: We concluded that the regulation of methylation pathways in Down syndrome patients becomes important in the light of possible normalization of the metabolic imbalance and the detection of increased sensitivity to therapeutic interventions.  

BACKGROUND: Although cardiovascular malformations are well-recognized congenital anomalies in Turner syndrome (TS), other clinical features and a great variety of dysmorphic signs can also be observed. There are few studies about different medical problems in pre-selected groups of patients with Turner syndrome. Therefore, in this study we aimed to assess the prevalence of some medical problems in Turner syndrome.METHODS: This was a case series from April to October 2005. We studied 40 patients with TS who attended the Endocrine and Metabolic Research Center. Audiometry, echocardiography, ultrasonography of kidneys and urinary tracts, thyroid function tests, fasting blood sugar, lipid profile as well as anthropometric and blood pressure measurements were assessed in all patients and collected data were analyzed by SPSS version 10.RESULTS: Of the 40 subjects 62.5% (n=25) had cardiac anomalies, 20% (n=8) had high blood pressure, about 60% (n=24) suffered from hearing loss and 15% (n=6) suffered from duplication or dilatation of urinary collecting system.The relative frequency of hypothyroidism, hypercholesterolemia and hypertriglyceridemia was 25% (n=10), 30% (n=12) and 32.5% (n=13), respectively.CONCLUSIONS: Medical problems are common in TS patients and the routine screening of their health conditions should be performed at the time of diagnosis and at regular intervals.

BACKGROUND: Pustular psoriasis is a rare form of psoriasis in childhood. The prevalence of psoriasis in various parts of the world varies from 0.1% to 3% and the most frequently observed variant is the plaque type, followed by the guttate psoriasis.CASE REPORT: A 4-year-old boy with a history of repeated self-limited arthritis, onycholysis, recurrent erythematous skin, diaper rash, fever and pustular lesions, had several hospital admissions with no benefits. After a 2-year delay in the diagnosis, he was treated as a case of pustular psoriasis which was shown by skin biopsy.

Uniparental disomy (UPD) is a situation in which both members of a chromosome pair are inherited from one parent. This study has been conducted on a family with a five year-old healthy girl and a mentally retarded boy. The parents were first cousins and they both had Robertsonian translocation between their long arm of chromosome 13 and 14 [45, XY t (13q14q)]. Their affected son had a similar karyotype. Their daughter’s karyotype revealed the presence of a homozygous Robertsonian 13/14 translocation 44, XX t (13q14), t (13q14q). According to the clinical findings it is possible to conclude that the affected boy suffers from UPD.

The laryngeal mask airway (LMA) is an important addition to the anesthetist's equipments. However, its usage may involve some complications. We have encountered an unusual and potentially serious complication using this equipment. A 45-year old man underwent cataract surgery under general anesthesia. After the induction of anesthesia, a size 4 of the reusable classic LMA was inserted without any difficulties and the cuff was inflated. After a little manipulation, the proximal tube of the LMA was separated from the distal part, leaving the distal mask inside the pharynx. The exit of the remaining portion of the LMA was very difficult and made the ventilation of the patient impossible. The patient's oxygen saturation decreased to 40%. The remaining portion of the LMA was removed by a great clamp and with an extreme effort. Then, an endotracheal tube was inserted and the patient was ventilated with 100% oxygen. After 6 hours, the patient was discharged with no apparent complications. The autoclave was used several times for the sterilization of the LMA.  

The ever increasing diseases developed due to internal / external acute hemorrhages (bleedings) in bleeding time suggest that we shall inevitably prepare an effective medicinal extract as a compound surrogate for blood coagulation. This research thus aims at producing a matter rich in salts, influential on blood asymmetric fibrinogen, which brings about fibrin long strands in agglutination. For measuring bleeding time, egg shell membrane (envelope) medicinal extract can be used: A centrifuge system is used to collect relevant deposit. The sterile extract is then prepared using a chloroform solution as intended. In the process of distillation, at the fixed temperature of 37ºC, the crystallized stable sterile suspension is collected. In the study of bleeding time, the prepared extract was known to cause blood clotting (coagulation) time to decrease. The positive effect of the above mentioned preparation was confirmed on candidates. Under the above mentioned conditions in this research, egg shell membrane medicinal extract influences blood asymmetric fibrinogen, increases the absorption of Ca++ present in the blood and raises the rate of iron absorption consumed to produce the hemoglobin required to increase transferrin iron and betaglobulin. The effect of the medicinal extract as prepared is visible in the hemostasis of bleedings due to surgical operations, dentistry, pilonidal sinus, hemorrhoid, laminectomy, menstruation acute bleeding, bleeding in premature neonates in umbilectomy or circumcision, malignant diabetes, blood cease & blood cells restoration in which bleeding is hardly stopped. It can be totally said that egg shell membrane asymmetric fibrin can be used in research applications to stop any internal/ external acute bleedings.