JOURNAL OF RESEARCH IN MEDICAL SCIENCES (JRMS)
Year:2000 | Volume:5 | Issue:1|Papers Count:27

Introduction. Although so many studies and trials have been done on stroke and possible therapies for it, but the number of studies done specifically on posterior circulation stroke are very little.Methods. A descriptive study was done on patients diagnosed clinically as posterior circulation infarct and confirmed their diagnosis by MRI. All the patients treated with intravenous heparin (1000 units per hour) replaced with warfarin which continued for 3 months and replaced by aspirin at the dose of 500 mg daily orally.Findings. Thirty patients included in study. All of them are followed at least for six months. No death, no recurrence, no hemorrhagic transformation of ischemic stroke occurred with 95 percent confidence interval of zero percent to ten percent.Conclusion. Our results showed that our regimen maybe able to decrease death and recurrence rate without increasing the risk of hemorrhagic transformation of ischemic stroke.

Introduction. Detection of the common allergens in any region is critical for prevention and treatment of allergic diseases. The objective of this study was to identify the common allergens causes of clinical symptoms in allergic patients in Isfahan.Methods. In this clinically-based cross-sectional study, 1077 patients with allergic diseases, underwent skin prick test with thirty extracts of allergens (Aestallergen Co.) at Asthma and Allergy Clinic of Issa Ibne Maryam (Isfahan) during 1999.Findings. Positive skin reactions were observed in 85 perdent (914) of patients. Reactions to weed, fungi, mite and tree were 48, 37, 35 and 30 percent, respectively. Reactions to grass, barn dust and cockroach are about 20 percent for each. Positive reactions to pollens were seen more in males (P>0. 05), whereas, positive reactions to mite, mould and cockroach were more seen in females (P>0.05). Reactions to moulds, pollens and barn dust seen in adults more than other age groups. Seventy percent of positive tests in patients with allergic rhinitis were related to pallens. In asthmatic patients reactions to pollens, mite, cockroach and moulds were 30, 38, 37 and 11 percent, respectively. In allergic skin disorders, positive tests to fungi, mite, pollens, cockroach and barn dust were 22, 18, 16, 12 and 10 percent, respectively. Negative responses seen in allergic skin disorders, asthma and allergic rhinitis were 36, 15 and 7 percent, respectively. Russian thistle and chenopodium among weeds; timothy and ray of grasses; willow and ash of trees, cladosporium in fungis were more common than other subtypes of these allergens. Pollen reactions were seen more in spring and summer, mould and mite reactions seen more in autumn and winter (P<0.05).Conclusion. Avoidance of common allergens (russian thistle, chenopodium, timothy, willow, cladosporium, mite, cockroach, barn dust, nut) is highly needed for patients. Determination of these agents are useful for allergen extract productions. According to clinical datas of each patient, a limited number of extracts is suggested for skin test.

Introduction. This study was conducted to find that, is there any advantage from (5000 IU/6h) in patient with non-Q wave MI and unastable angina.Methods. In a randomized clinical trial two group of patients with non-Q wave MI and unstable angina were compared about their prognosis and management outcomes. In interventional group (n= 145), heparin (5000 IU/6h) was administered and in another group (n= 133) no treatment with heparin was used. Duration of chest pain, recurrent angina, intrahospital mortality were indices for patients outcome study.Findings. Anticoagulant complication was not report in any patient in interventional group. There is no significant difference between two groups about prognosis factors.Conclusion. Heparin administration (5000 IU/6h) may have not any role in improving management outcome in patient with non-Q wave MI and unastable angina at least in acute phase. So, it is recommended that heparin have been administered to these patients in continuous regimen (1000-1500 U/hour continuously effusion).

Introduction. There is no published data regarding prevalence of obstructive airway diseases in Iran. We have investigated the prevalence of respiratory symptoms in Shahre-kord to be compared with those in Europe and USA.Methods. Two thousands subjects (977 male and 1016 female) were selected by proportional random cluster sampling from Shahre-kord residents aged 1 to 87 years. They were interviewed to complete a respiratory questionnaire and those who were suspected to have airways disorders were invited for physical examinations and spirometry.Findings. The most frequently reported symptoms were: chronic cough (7/4 percent), wheeze ever in life time (5/5 percent), morning cough (6 percent), history of chronic bronchitis (1/8 percent), dyspnea associated with wheeze (3/2 percent), exertional dyspnea (2/9 percent). Cigarette smoking was less popular in our group than the Europ-American populations.Conclusion. Obstructive pulmonary disease are less prevalent in Shahre-kord than those reported in Europe and USA. This finding may be due to smoking habits and less polluted air in Shahre-kord.

Introduction. For future health planning of our country, the type and amount of drugs used for treatment of chronic diseases should be known. Therefore, in the present study the treatment regimen of asthmatic children in the city of Mashhad was studied.Methods. To study the different types of drugs in the treatment regimen of asthmatic children in the city of Mashhad, we evaluated the treatment regimen of 366 primary school children with asthma disease. Starting, maximum and duration of action of three different bronchodilators (salbutamol inhaler, salbutamol syrup, and theophylline syrup) were compared.Findings. The results of the first part of this study showed that only 31.6 percent of asthmatic children had history of treatment and only 10.6 percent had current medication. In addition, most of the treated children (38.8 percent) had only bronchodilator (salbutamol syrup) in their treatment regimen. The effect of salbutamol inhaler on lung function tests starts in 5 min, salbutamol syrup in 15 min and theophylline syrup at 30 min after administration. The maximum response to salbutamol inhaler, salbutamol syrup, and theophylline syrup occurred 15 min, 4 hr and 3 hr after administration, respectively. The reduction of response to salbutamol inhaler occurs after 3 hr, but there was no any reduction in response to salbutamol and theophylline syrup during study period. Conclusion. The prevalence of asthma among children in the city of Mashhad is relatively high, but most of asthmatic children are not treated. Although the oral bronchodilator in mild asthma is effective, salbutamol inhaler is needed for emergency use.

Introduction. Unwanted pregnancy is one the most important subjects in family planning programme. Physical and psycological problems for mothers, children and family are the consequences of this matter. In this study we are trying to evaluate the rate of unwanted pregnancies and their consequences in Najafabad villages.Methods. In a descriptive study, all 788 pregnant women aged between 15 to 45 years old were considered. The data was collected by using a questionnaire and their record files. Descriptive and analytic statistics were used.Findings. Near fourty percent of the pregnancies were unwanted at least for one of the couple. Although 96.3 percent of women had knowledge about the advantages and disadvantages of contraceptive methods, only 29 percent of them had knowledge about injective of plaintive methods. Fifty one percent of women who had unwanted pregnancy liked to terminate it and 31.7 percent of them had attempt to do it at least one time.conclusion. Knowledge level is really high in these women, however, they have 42 percent unwanted pregnancies. It is necessary to promote attitudes and practices of family planning in the field study by interventional methods.

Introduction. Thoracolumbar fascia has neural ends in normal positions. It has sensory role and by inhibitory and or excitatory reflexes helps to protect vertebral column. In this research, it has been studied neural ends in thoracolumbar fascia in 42 cases. Our aim was to compare the presence of neural ends in normal individuals and those with lumbosacral discopathy.Methods. The samples were taken from one centimeter of midline at the level of L4-L5 vertebrae, since in this region the posterior layer of thoracolumbar fascia is thicker. Seven of the cases were normal and 35 were patients with lumbosacral discopathy. The samples were processed and serial sections were prepared. Six hundred and thirty sections from the serial sections were selected and 90 percent of these were stained with H&E and the rest of them were stained with Bielschowsky method. The sections were studied by light microscopy.Findings. Unlike the normal individuals, nerve corpuscles were not seen in none of our patients with lumbosacraldiscopathy.UsingBielschowsky,nerveendingswerepresentin normal individuals but they were not visible in patients with discopathy. Conclusion. It is concluded that thoracolumbar fascia in patients with discopathy had insufficient neural ends. Loss of these neural ends may be cause of decreasing proprioceptive information to nervous system and can be an initiating factor to damage the bones, ligaments and muscles.

Introduction. According to report of 1996, the most common cause of neonatal mortality in our country were low birth weight, immaturity and trauma during delivery period. Estimation of fetus weight during delivery is not easy in primary care by first line of health care provider. We try to introduce three scale (maternal fundal height, arm circumference and body mass index) as an easy tools for prediction of neonatal weight.Methods. In a cross sectional study, 1110 pregnant women, their husbands and their neonates were selected by random sampling. Data were collected in question sheet, observation and physical examination.Findings. Neonatal weight before delivery had significant correlation with maternal fundal height, arm circumference and body mass index (P<0.001). Predictive value fundal height was better than other two indices.Conclusion. Fundal height can be used as a good estimator for neonatal weight in primary health care centers. Suspicious mothers must be referred for complete investigation.

Introduction. Modern IUDs are as effective as surgical contraception long acting, reversible and medically safe. This study was performed to evaluate efficacy and complications of IUD TCU 380 among users of this IUO in referred women to Isfahan health centers.Methods. In this study, we inserted IUD TCU 380 A in 767 porous women who get their health cares in Isfahan health centers. They were followed for one year in four visits (1 week, 1, 6 and 12 months after insertion).Findings. Success rate was 99.3 percent. The most frequent complication was hyper menorrhea (44.4 percent), and the majority of complications occurred 7 to 8 months after IUD insertion. Pap smears were normal in 55.3 percent of women. Removal rate was 13.8 percent and the most frequent cause of it, was hyper menorrhea. Expulsion rate was 3.4 percent and PID was seen in 0.4 percent of them. The major recommended sources for putting IUD were health centers (76.7 percent), and 90 percent of couples were satisfied with this method.Conclusion. IUD TCU 380 A is safe and effective and represents a suitable contraceptive method for the appropriate patient.

Introduction. Usually, infusion of intermittent doses of succinylcholin is used for relaxation of muscles in the preeclamptic pregnant women treated with magnesium sulfate during cesarian. section This drug has complications such as hyperkalemia, phase 11block, etc. On the other hand non depolarizing muscle relaxant in these patients should be used only in the presence of nerve stimulator and with careful titration.Methods. Duration of clinical action of a medium acting non depolarizing muscle relaxant "atracurium" with succinylcolin's infusion was studied in 86 preeclamptic pregnant women who received therapeutic doses of magnesium sulfate.Findings. Magnesium sulfate did not prolong clinical action of atracurium.Conclusion. Based on this study it can be concluded that administration of atracurium in the pregnant women who received therapeutic dose of magnesium sulfate in the absence of peripheral nerve stimulator is not contraindicated.

Introduction. Long term exposure to trace amounts of anesthetic vapors and gases may produce hematologic and hepatic disorders in human. Since operating room (OR) staffs are exposed to these agents, we decided to study their hematopoietic and hepatic systems in comparison with ordinary ward staffs.Methods. Seventy staffs from OR were compared with a matched similar number of ward staffs about their hematologic and hepatic laboratory findings in a historical cohort study.Findings. Mean of leukocyte and platelet counts were significantly lower in OR staffs, but in normal range. Mean of monocyte count was significantly higher in OR staffs. No significant differences were found between two groups for other hepatic and hematologic tests. Fatigue and headache were reported in OR staffs more than others.Conclusion. These findings may warn a risk to OR staffs but, it is not clear and requires further controlled studies.

Introduction. To find that is there any correlation between serum cholesterol, triglyceride, calcium, phosphorus and gallstone composition, this study was conducted.Methods. One hundred patients with gallstone admitted for elective cholecystectomy were studied. Serum lipid profile and calcium-phosphorous concentration were measured before operation and were correlated to their gallstone composition.Findings. Cholesterol and pigmented gallstones frequencies were 54 and 46 percent in our patients, respectively. There was not observed any significant correlation between serum triglyceride, cholesterol, calcium and phosphorous concentration and gallstones' composition.Conclusion. It seems that serum lipid profile & serum calcium phosphorous concentration are not a promoting factor to produce specific gallstone composition.

Introduction. The role of family as a preventive, promotive, and curative agent is well documented in mental health studies. However, few attempts have been made to engineer the positive family mechanisms in enhancing psychiatric patients' role performance.Methods. This study is an endeavor to demarcate the effect of family education on social functioning of 170 schizophrenics and 174 patients with mood disorders. Solomon's four group design allowed patients from each category to be assigned into four groups. Key family members from experimental groups participated in a one day monthly programmer over a period of six months. Attitude towards mental illness, family environment and skills in management of patient's verbal and non-verbal behaviors as well as patient's adjustment ability within the family, community and work place constituted the focus of this study. While applying batteries of test, data pertaining to the aforementioned characteristics were obtained from the subjects 6 and 18 months after intervention which were subsequently compared with the baseline data.Findings. Comparing the baseline data with the data pertaining to other phases of intervention, one could observe a regressively progressive change in the families' attitudinal, cognitive and behavioral aspects, allowed by the patients' desirable social adjustment.Conclusion. These observations are congruent with earlier findings in the west, reinforcing the promising role of education in bringing about desirable changes in the family dynamic which can ensure better outcome for the psychiatric patients' illness.

Introduction. Nonarteritic anterior ischemic optic neuropathy (NAION) is one of the causes of irreversible visual loss. As yet many treatment modalities are used for therapy, but non of them have had significant effect on recovery of visual acuity. To study levodopa plus carbidopa effect on NAION, this research was done.Methods. In this clinical trial double blind study, two groups (each contained 20 subjects) recieved randomly 100 mg levodopa + 10 mg carbidopa and placebo per day for 3 weeks. Subjects were followed up at 6, 12, 24 weeks after treatment for assess visual acuity.Findings. The mean differences of visual acuity between initial and 24 weeks later in interventional and control group were 4.6/100± 7.373/100 and 10.35/100± 17.572/100 respectively (P>0.05).Conclusion. There was not any effect of drug on recovery of visual acuity. Thus, due to their side effects, levodopa and carbidopa not recommended in NAION management.

Introduction. Vitreous loss (VL) is one of the most serious ocular complications during cataract surgery without correct management may causes other serious complications and sometimes visual loss. By selecting the correct method of anesthesia (general or local anesthesia) it is possible to reduce the incidence of this complication and consequent events. The aim of this research is to determine the incidence of VL in cataract surgery with local and general anesthesia and comparing them with each other.Methods. This survey was conducted in 210 patients over 40 years old who had been operated for cataract surgery. Subjects were randomized in two groups (general vs local anesthesia). There is no premeditations in anyone.Findings. The incidence of VL in general and local anesthesia was 3.6 and 9.1 percent, respectively (P<0.05). The groups were similar with respect to demographic data and potential confounding variables.Conclusion. The incidence of vitreous loss during cataract surgery under local anesthesia is more than general anesthesia. If general anesthesia is contraindicated, it is better to use sedative drugs during local anesthesia for cataract surgery to prevent vitreous loss.

Introduction. To improve testing sensitivity, most laboratories use two or more preparation methods but in our laboratories only one method is used which is "direct smear". In this study we tried to evaluate the diagnostic value of cell block as adjunct to direct smear in the cytologic investigation of serosal cavities fluids.Methods. In a clinical trial study 62 specimens of serosal cavity fluids were investigated in AL-Zahrapathology laboratory (Get. 1998 to Get. 1999). Cytologic slides from each specimens were prepared in two methods: direct smear and cell block (plasma- thrombin clot method). Smears and cell blocks were studied separately by the same cytopathologist. The diagnosis were categorized as positive, negative, suspicious or unsatisfactory. Also, the time required for studing of each slides were noted.Findings. The findings indicated that there are discrepancy between direct smear and cell block methods in the number of "suspicious" cases. Also there is significant difference between the mean time needed for studing of direct smear and cell block.Conclusion. It is recommended that the remainer of each specimen should be kept in refrigerator in order to prepare cell blocks in suspicious cases of direct smear. This method facilitates making a more definite diagnosis and reducing the number of suspicious cases.

Introduction. Appendicitis is the most common cause of acute surgical abdomen. However, many atypical manifestations of this disease make much difficulties in differential diagnosis. Diagnostic methods such as sonography or isotope scan are expensive or completely depend on sonographist's experience. So because there is no preoperative definite diagnostic test for appendicitis patients, it seems necessary to evaluate different variables to achieve this goal. Laboratory tests are inexpensive and available.Methods. A Series of 116 consecutive under 14 years old patients presenting with right lower quadrant pain were studied. All of the patients underwent operation and diagnosis was confirmed by histology. WBC count> 10000/mm3, neutr/Lymph>3/5 and positive CRP were indices of study.Findings. The sensitivity of WBC count above 10000/mm3, neutrophill to lymphocyte count ratio (>3/5) and positive CRP were 96, 76 and 70 percent, respectively. The specificity of them were 46, 65 and 68 percent. The sensitivity of combination of variables 53 percent and the specificity was 82 percent.Conclusion. These findings suggest that each of studied variable are usefull for diagnosis of acute appendicitis but the combination is usefull for rule- out the disease.

Introduction. In spite of high physiologic ability of lactation in mothers, most of them have not cooperation for breast feeding. Mothers' knowledge and attitude are important for lactation behavior. Although 99 percent of mothers are capable for breast feeding, but WHO's reports revealed that breast feeding is decreasing in low socioeconomic families. We decided to evaluate the knowledge of lactating mothers about the importance and necessity of breast feeding. Methods. Based on a descriptive, cross sectional study, 2799 mothers with infants younger than 15 months were selected by a cluster sampling. The study was performed in urban and rural health centers of Isfahan province.Findings. Nearly 80 percent of mothers did not know anything about the necessity of exclusive breast feeding during the first 4 months of life. Eighty five percent of mothers who worked out of home preferred formula feeding and 45 percent of mothers supposed that their milk has no good taste and is watery. More than half of mothers believed that antibiotic consumption, repregnancy and long time hospitalization are inhibitor factors for normal breast feeding. Almost 50 percent of mothers had no insight about the time of breast feeding after cesarean section delivery and the age of supplementary feeding. Knowledge about breast feeding was similar in urban and rural area. About 56 percent of mothers had not any training class and 32 percent had not been oriented in hospital about breast feeding.Conclusion. It seems that knowledge of mothers about importance of breast milk depended on their previous experience especially previous training and cultural believing and this training isn't suitable for maintenance of breast feeding. Therefore, it is necessary to promote the knowledge of mothers especially by radio and television according to their culture and educational levels.

Introduction. Giardiasis is one of the health problems in the world including Iran. To determine the biochemical and biological problems and also identification of various strains, it is essential to obtain pure culture and then mass production of Giardia lamblia. The goal of this study was to isolate this protozoa purely.Methods. Giardia lamblia cysts were isolated from 50 stool samples by use of floating of a four - layer of sucrose method. The cysts were transfered to an inducing solution. Subsequently, they were cultured in a modified culture medium (TYIS-33). Following excystation of trophozoite and its multiplication, the parasite was caltured and purified.Findings. Excitation of trophozoite was observed in 40 samples (80 percent) from which 22 samples (55 percent) yielded pure culture. The doubling time was approximately 13hr and the peak of parasite was observed between third and fourth days.Conclusion. The proliferation and growth rate of Giardia lamblia have enabled us to use this method widely. Cystein and ascorbic acid which are present in the induction solution, have a key role in excystation of trophozoite. Purification and passage of samples has facilitated the culture of this parasite in vitro. Therefore this method has yielded better results in comparison with other studies. This is probably due to a decrease in the amount of bovine bile or using different strains of Giardia lamblia in the present study.

Introduction. The laryngeal mask airway (LMA) was recently introduced in general anesthesia as an alternative to the face mask or tracheal intubation for airway maintenance.Methods. The effects of LMA insertion, face mask or tracheal intubation on homodynamic status were studied in 195 normotensive patients who underwent elective transurethral lithotripsy (TUL). The patients were monitored with blood pressure measurement and pulse oximetry. Anesthesia was induced with sodium thiopental, succynilcholine and fentanyl and maintained with halothane, nitrous oxide and oxygen.Findings. The heart rate (HR) and mean arterial pressure increased after LMA insertion. face mask or tracheal intubation, compared with baseline (P<0.05). The hemodynamic changes were significantly greater after tracheal intubation and face mask than after LMA insertion (P<0.05).Conclusion. We conclude that insertion of LMA is associated with less hemodynamic disturbances than face mask or tracheal intubation in normotensive patients undergoing elective operations.