JOURNAL OF RESEARCH IN MEDICAL SCIENCES (JRMS)
Year:2005 | Volume:10 | Issue:3|Papers Count:17

During recent decades, many changes are happening in health sector and countries are trying to respond to the increasing health demands of people. Although hospitals have important role in health delivery system of any country, numerous factors have to be taken into account before establishing a new hospital in certain area. During recent decades, in many developing countries, new hospitals are built and equipped with sophisticated plant, without any scientific investigation. This means wastage of scarce resources. This paper aims to introduce need assessment methodology to establish hospitals and discuss the criteria to be met prior to their construction in the process of health care development.              

Background: Methotrexate has been the most frequently used antirheumatic drug in rheumatoid arthritis. Nevertheless, the possibility of hepatotoxicity continues to represent a major problem in tolerance. This study evaluated beneficial effect of chloroquine on incidence of liver enzyme abnormalities in patients with Rheumatoid Arthritis (RA) treated with Methotrexate. Methods: Eighty patients with RA who had elapsed from onset of disease less than two years, randomly divided into two groups (MTX alone vs MTX with Chloroquine). Liver enzymes and some indicators of disease activity were evaluated in two months intervals and for maximum of 10 months follow-up. Results: Five patients (12.5%) in MTX group and four patients (10%) in combination regimen developed abnormal liver enzymes. Response rate was more in combination therapy (87.5% ) than MTX alone ( 80%) without significant difference. Conclusion: The incidence of liver enzyme abnormalities was not different in patients received MTX alone and MTX with Chloroquine.  

Background: Cerebrospinal fluid leakage is a major problem in neurosurgical operations. For preventing it, the dural closure should be augmented. Current glues which use for augmentation are prepared with mixing cryoprecipitate, bovine thrombin and calcium gluconate in suitable concentrations which are expensive and unavailable anywhere. A new formulation is introduced here. Methods: This is a prospective randomized clinical trial in patients who need dural patch graft by using Cryocalcium glue, mixing the cryoprecipitate, calcium gluconate and patient’s own blood as the origin of thrombin, in our operating room. Results: Comparing two groups of cases (1o6) and controls(100), we found overall C.S.F leak 3.8% and 15% respectively, with 3.6%, Zero%, Zero% and 16.7% in supratentorial, infratentorial, skull base and spinal cord operations in cases versus 12%, 20%, 33% and 28.6% in controls respectively. Conclusion: Using Cryocalcium glue for dural closure augmentation was with better results in comparison with control group. In addition in reviewing literature, comparing this new formulation and old fashion of fibrin glue, revealed that the new one, if not better, is similar to the old one in quality point of view.  

Background: The correct interpretation of bone mineral density (BMD) measurement by dual energy x ray absorptiometry ( DEXA) requires a population specific reference range. We collected data on age 20-35 years to obtain reference values of BMD for Isfahani women in order to make a population specific diagnosis of osteoporosis. Methods: In 660 healthy Isfahani women Volunteers (20-35 years) without illness, use of drugs or predisposing conditions to osteoporosis, the BMD (gr/cm²) of lumbar spine and non-dominant femur was measured by lunar DPX –IQ machine. Results: The mean BMD and its standard deviations at each site were calculated and compared with normative data from Caucasian US/North European women. No significant differences were detected between them. Conclusions: Bone mineral density measurements of these 660 healthy Isfahani women can serve as a reference guide for the diagnosis of osteoporosis in Isfahani women.          

Background: Hepatitis B is a major infectious risk factor for health-care workers (HCWs) and public- safety workers. Although seroconversion rate following hepatitis B vaccination is estimated to be more than 90%, serologic response to Heberbiovac HB vaccine currently given in our center in Kermanshah province has been varied in different experiences, So, this study was conducted to determine serologic response in HCWs. Methods: In a descriptive-cross sectional study, in 138 HbcAb from 10 health care centers, HbcAb negatives and vaccinated with Heberbiovac HB (Cuba made, available vaccine in Iran), HbsAb titer was assessed by ELISA. Serologic response as antibody titer equal or more than 10mIU/ml considered protective level (serologic responder). The data were analyzed by SPSS software, using X² and Fisher exact test. Results: Within 138 HCWs(60.1% female and 39.9% male), 69.6% had serologic response. The age had significant role in serologic response rate, but sex, weight, smoking and interval from the last time of vaccine reception were not effective factors. Conclusion: Serologic response rate to HBV vaccine in Kermanshah was much lower than other experiences. We need more information about the efficacy of Heberbiovac HB in high-risk groups and general population, the reasons of low efficacy and increasing serologic response.      

Background: We evaluated the effect of phosphoric acid etching on microleakage of two current self-etching adhesives on enamel margins in comparison to a conventional total- etch system. Methods: Sixty buccal class V cavities were made at the cemento-enamel junction with beveled enamel margins of extracted human premolar teeth and randomly divided into five groups (12 specimens in each group). Group 1 was applying with Clearfil SE bond, Group 2 with 35% phosphoric acid etching of enamel margins plus Clearfil SE bond, Group3 with I bond, Group 4 with 35% phosphoric acid etching of enamel margins plus I bond and Group5 with Scotchbond multi-purpose. All groups restored with a composite resins. After 24 hours storage with 100% humidity, the samples were thermocycled, immersed in a dye solution and sectioned buccoligually and enamel margins microleakage were evaluated on a scale of 0 to 2. Results: The differences between Groups 1 & 3 and Groups 3 & 4 were significant (P<0.05) but no significant differences between Groups1 & 2 or 1 & 5 were observed. Conclusion: The findings suggest that all-in-one adhesive systems need pre-etching enamel margins with phosphoric acid for effectively seal.  

Background: During recent years, cardiopulmonary resuscitation (CPR) in hospital has received much attention. However, the survival rate of CPR in Iran’s hospitals is unknown. This study was designed to evaluate outcome of in-hospital CPR in Kashan. Methods: A longitudinal case registry study was conducted on all cases of in-hospital CPR during 6 months at 2002. Necessary data including; age, sex, underlying disease, working shift, time from cardiac arrest until initiating of CPR and until defibrillation, duration and result of CPR, frequency of tracheal intubations and time served for it were collected in a checklist. Results: In six months study, 206 cases of cardiopulmonary resuscitation attempted. The survival rate was similar for both sexes. Short-term survival observed in19.9% of cases and only 5.3% survived to discharge. Conclusions: Duration of CPR, time of the first defibrillation, response time and the location of cardiac arrest are the key predictors of survival to hospital discharge and in-hospital CPR strategies require improvement. This study promotes a national study on post CPR survival for accurate data on our performance in attention to chain of survival.  

Background: MRI screening for idiopathic scoliosis is controversial. Considering our clinical experiences, the results of MRI in all patients with idiopathic scoliosis were evaluated. Methods: In a prospective clinical study, all neurologically normal patients with idiopathic scoliosis screened by posterior fossa and total spine MRI. Results: After excluding 9 patients for mild neurological findings, in other 177 patients (132 female, 45 male), the average age and curve angle was 15±2 years and 59±17º (30 to 135º), respectively. Convexity was to right in 146 and to left in 31 cases. MRI was positive in 12 cases (6.8%). In 5 cases (2.8%), neurosurgical intervention was necessary prior to scoliosis surgery. There was no relation between age, sex, presence of pain or curve angle and positive MRI findings (P>0.05). Left convexity was significantly related to positive MRI findings (P=0.013). In males with left convex curves, the probability of positive MRI findings was 8.8 folds other patients. Conclusion: Considering our results and other reported articles, it seems that routine MRI screening of all patients presenting as idiopathic scoliosis is necessary for detection of underlying pathologies.    

Background: The purpose of this study was microbiology of chronic resistant rhino sinusitis with or without nasal polyp in patients undergoing functional endoscopic sinus surgery and antimicrobial resistance testing. Patients and Methods: In a cross-sectional study during December 2000 to June 2002, 94 CRS patients with or without nasal polyp were sampled through FESS for microbiology culture and In-vivo antimicrobial resistance was tested in both groups. Results: In CRS group with polyps (42 patients), the most common isolated organisms were Staph. coagulase-negative (26.2%), Staph. areous (23.8%), E-Coli (16.7%), Klebsiella (14.3%) and Enterobacter (7.1%). In CRS group without polyps (52 patients), the most common isolated organisms were Staph. coagulase-negative (25%), Staph. areous (11.5%), Klebsiella (9.6%), E-Coli (7.7%) and Strep. Non-group A (7.7%). Normal flora grew in 5 cultures (9.6%). In only one culture of CRS group without polyp, Pseudomonas was isolated. No resistance was reported from gram-positive bacteria against vancomycin and gram-negative rods were sensitive to ciprofloxacin, ceftriaxon and ceftizoxim. Conclusion: Despite of some previous studies, the most common micro- organisms in the cultures of CRS cases, regardless of having nasal polyps or not, was Staph. Coagulase-negative, Staph. aureus and gram-negative rods, respectively. The incidence of GNRs in CRS group with nasal polyps is higher which may lead to special antibiotic therapy in them. Increasing In Vivo resistance of these bacteria to antibiotics is problematic and the routine old antimicrobial therapy may not be effective enough to control these pathogens and avoid surgical therapy. However, In Vivo evaluations are recommended to reveal a better interpretation.      

Introduction: Tuberculosis (TB) is a leading cause of death worldwide due to any single infectious agent. It seems that health care workers including nursing students can be affected easier than the other people, because of probable contacts in hospital. The risk of TB infection in nursing students has not estimated in Iran, so we conducted this study to compare the results of tuberculin test in the beginning and the end of educational course for nursing and human-sciences student. Methods: In a Cohort study, 320 students (160 nursing and 160 human-sciences) underwent PPD skin test (5 units RT 23) at the beginning and the end of educational course by expert technician. The data of remaining students (123 nursing and 111 human-sciences) were analyzed by SPSS software using Wilcoxson and Mann-Whitney tests. Results: The frequency distribution of skin reaction in nursing students was negative (0-4 mm: 93.7%), suspected (5-9 mm: 4.4%) and significant (≥15mm: 1.9%) at the beginning of study, while it was negative ( 75.5 %), suspected (9.8%), positive (10-14 mm 3.3%) and significant (11.4%) at the end of study. The frequency of skin reaction in human-sciences student was negative (93.7%), suspected (0.6%), positive (1.3%) and significant (4.4%) at the beginning of study, while it was negative (79.3%), significant (10.8%), suspected (8.1%) and positive (1.8%) at the end of study. The difference in that proportion of nursing students and control group with positive and significant PPD test at the end of study was statistically significant. The difference for the above proportions between two groups was not statistically significant. Conclusion: All subjects had no significant difference regarding to age, indigenous area and PPD test. Both groups have the same chance for exposure to M. Tuberculosis. The rate of new TB infection in Iranian community has diminished in comparison with the last few decades. Although risk of new infection may be a little bit more after age of 18, but it is still much lower than countries of high burden. The epidemiologic pattern of TB transmission has changed and it is going to become similar to that of developed countries.    

Vocal cord paralysis is an uncommon complication of endotracheal intubation after induction of general anesthesia. It may be due to the endotracheal tube cuff pressure on the recurrent nerves. Vocal cord edema occurring in the presence of a paralyzed cord may precipitate complete airway obstruction and can cause bilateral cord paralysis. Here, we describe post anesthetic bilateral vocal cord paralysis in an elderly female patient which diagnosed by direct larayngoscopy and successfully treated by tracheostomy in respiratory intensive care unit. The patient discharged after two weeks and achieved complete recovery one month later.    

Hereditary neuropathy with liability to pressure palsies is an autosomal dominant and demyelinative peripheral neuropathy which characterized by reversible episodes of sensorimotor deficits after neural compression injuries. Their clinical hallmarks are recurrent and painless focal neuropathies maintly preceded by minor trauma or compression at entrapment sites of peripheral nerves. We describe multiple compression mononeuropathies in an individual who presented with left sided ulnar palsy after drilling for a period of 8 hours and report neurophysiologic findings in two clinically asymptomatic family members. We believe that this entity may be clinically and neurophysiologically underdiagnosed by orthopaedic surgeons and electromyographers. Electrophysiological abnormalities can be detected even in asymptomatic patients and it should be considered in differential diagnosis of patients with atypical presentations of compression neuropathies.    

We would like to point out recognizing and addressing modifiable risk factors such as hypertension, hyperlipidemia, asymptomatic atheromatous carotid plaques and etc, can reduce the prevalence of stroke. In our experience, we compared the frequency of extra cranial internal carotid artery (ICA) stenosis in Iranian stroke patients with control group strokes which has an annual rate of 100-300 in 100000 people in the general population