IRANIAN JOURNAL OF MEDICAL SCIENCES (IJMS)
Year:2008 | Volume:33 | Issue:1|Papers Count:14

Background: Alexithymia as a cluster of cognitive and affective deficits has been studied for its ability to predict a variety of psychological disorders. Given its clinical importance, various self report questionnaires have been developed to measure alexithymia. The aim of this study was to determine the psychometric characteristics of Persian version of the Toronto Alexithymia Scale-20 (FTAS-20) using confirmatory factor analysis. Methods: 175 patients (102 women, 73 men) who met the DSM-IV -TR criteria for depressive, anxiety or obsessive compulsive disorders, and 173 normal adults (99 women, 74 men) completed the FTAS-20.Results: Findings supported the three-factor structure, internal consistency, test-retest reliability, and predictive validity of FTAS-20 in both clinical and non-clinical samples. Conclusion: The three FTAS-20 subscales are useful to explore the distinct facets of the alexithymia construct.

Background: The treatment of open tibial fractures is still an orthopaedic challenge and full of complications. In many cases the use of external fixator that has been known as a nonunion machine is obligatory with a high incidence of pin track infection and other complications. The aim of this study was to compare the use of external fixation as a definite method for treatment of open tibial fractures with its subsequent conversion to internal fixation or casting. Methods: Sixty-seven young patients with type III open tibial fractures (Gustilo-Anderson classification) were treated with half pin external fixation. Twenty of them were converted into internal fixation after a period of 6-8 weeks. For another twenty-five, external fixator was removed and treatment continued with casting for a period lasting from 16 to 20 weeks. And for twenty two patients the fixator continued until complete union. The patients followed up for 10-16 months and were evaluated in terms of union time, union rate, infection, range of motion, malunion, non-union, nerve injury, and reduction. Results: There was a meaningful difference only in the union time and superficial infection between the first group and the other two groups. Conclusion: The conversion of external to internal fixation can be considered as a safe, effective, less complicated, and more acceptable method for the treatment of open tibial fractures.

Background: Primary nocturnal enuresis is a common disorder that often leads to considerable distress in affected children and their family. In many countries pharmacologic therapy is preferred to non-pharmacologic behavioral and conditional alarm therapy. Imipramine, oxybutynin, and desmopressin have been used for enuresis with various efficacies. The aim of the present study was to compare the efficacy of imipramine, oxybutynin, and combined imipramine and oxybutynin in enuretic children aged 6-14 years old. Methods: In a randomized controlled study 89 primary enuretic children who were otherwise normal were allocated to three groups: group A (imipramine users, n=29), group B (oxybutynin users, n=26), and group C (combined imipramine and oxybutynin users, n=34). The number of wet nights per week during control period (2 weeks prior treatment), and treatment period (I month) were compared in each group and inter groups. Also the cure rate in the treatment period and the relapse rate in the follow up period (I month) were compared between the three groups.Results: The mean ages in groups A, B, and C were 7.9±1.1.1years, 8.2±1.6 years, and 8.2±1.4 years respectively. There was no significant difference in the mean ages in the three groups (P=0.53). In each group the mean number of wet nights per week decreased during treatment period compared with pretreatment period. This reduction was statistically significant (P<0.001) in each group). Efficacy of treatment between the three groups was compared. There was significant difference between them (P<0.001), but there was no significant difference between group A, and group B (P=0.56). The cure rate during treatment period was 13.7%, 23%, and 41% in groups A, B, and C respectively. This difference was statistically significant (P=0.04). The relapse rate during follow up period in groups A, B, and C was 58.6%, 42.3% and 20.5% respectively, revealing statistical significance (P=0.008) No significant adverse effects for the medications were observed.Conclusion: Our findings suggest that combined imipramine and oxybuty.nin for primary enuresis is more effective than either drug used alone. The combined therapy is recommended in enuretic children who are non-responsive to imipramine or oxybutynin' alone.

Background: Neonatal jaundice is clinically presented in 60% of full-term newborns. About 8% of newborns with jaundice have urinary tract infection (UTI) without any other clinical signs in favor of UTI. In present study we evaluated clinical and paraclinical data that help to rapid and early diagnosis of UTI in apparently healthy newborns with jaundice. Methods: From February to August 2006, 51 apparently healthy full-term newborns with jaundice and UTI who had been admitted for management of jaundice in Motahary hospital, Jahrom (south of Iran), were studied and compared with 56 neonates with jaundice but without UTI. All the neonates had not any other symptoms such as fever or lethargy. At the time of admission, total and direct bilirubin, Coombs' test, mother and neonate blood group, urinalysis and urine culture were requested. Results: There was no significant difference of gestational age, birth weight, age of admission, age at the time of starting jaundice, and total serum bilirubin between the two groups.There was significant difference of direct bilirubin level, mean of decrease serum bilirubin after 24 hours, gender, and blood groups. Male gender with mean decrease of bilirubin less than 2.2 mg/dl after 24 hours phototherapy and direct bilirubin more than 1.6 mg/dl, during the first two weeks of neonatal period has about 7 times more risk for UTI. The presence of those three above mentioned factors had only 30% sensitivity and more than 94% specificity for suspicious of UTI in asymptomatic neonates with jaundice.Conclusion: Jaundice may be the only presenting sign of UTI in newborns, so according to high specificity for the presence of three below factors simultaneously, it seems better to evaluate newborns for UTI if they have high level of direct bilirubin (more than 1.6 mg/dl), slow decrease in serum bilirubin level with phototherapy (less than 2.2 mg/dl/day) especially in male newborn with blood group B.

Background: Methanol poisoning may result to death and permanent complications, sporadic cases of methanol poisoning are fairly rare and the largest experience are generally gained from managing methanol intoxication epidemics. The main metabolite of methanol is acid formic that is the prime metabolite responsible for toxic effects of methanol and since folate dependent systems are responsible for the oxidation of formic acid to CO2 and water. It is believed that administration of folic acid enhances the metabolism of formate. Though therapeutic effects of folic or folinic acid has never been fully tested in clinical trails in human. Our objective was to evaluate therapeutic effect of folinic acid in methanol poisoned persons. Methods: In recent methanol poisoning epidemic due to "bootleg" Liquor consumption in Shiraz at 2004, Sixty-two patients have hospitalized. Folinic acid was administered to 19 patients and therapeutic effect of folinic acid was studied.Results: There was no significant difference between two groups of patients and number of decreased visual acuity, renal function, hospital stays and needs to bicarbonate therapy and hemodialysis. The only effect was decreasing acidosis in folate treated patients.Conclusion: Regardless of prior animal studies and case reports, with attention to our study limitation we didn't found significant protective effect of folinic acid infusion among methanol poisoning patients. The only effect was decreasing acidosis in folate received patients. Further studies in optimal situation are needed for definite judgment.

Background: Oral squamous cell carcinoma is the sixth most common malignancy in the world today. ING 1b/p33 is a newly-discovered tumor suppressor which enhances p53 activity. Transfer of p33 protein from nucleus to cytoplasmic compartment has been previously reported in leukemias. The objective of this study was to determine the correlation between p33ingl b cytoplasmic transfer and lymph node metastasis in oral squamous cell carcinoma. Methods: Fifty seven patients treated with surgery alone or surgery and adjuvant radiotherapy for primary oral squamous cell carcinoma were enrolled into this study. Immunohisto chemical expression of all of the above-mentioned markers was studied.Results: Analysis of the sections demonstrated that p53 and MDM2 were expressed in 45.6% and 68.4% of patients, respectively. p33INGlb nuclear expression was completely absent while cytoplasmic translocation was noted in 78.9% of cases. Positive cytoplasmic expression of p33ING1b correlated with increased risk of lymphatic metastasis (p=0.04). No further correlation with overall disease recurrence or survival was noted.Conclusion: Apparently, p33ING1b cytoplasmic transfer correlates with lymph node metastasis in oral squamous cell carcinoma.

Background: Indirect genetic diagnosis using polymorphic DNA markers can detect carriers of hemophilia A. This technique is preferable in developing countries because of its simplicity and cost effectiveness compared to direct mutation analysis. In the present study, we examined usefulness of intragenic marker Bell restriction fragment length polymorphism (RFLP) at intron 18, for carrier detection. How this marker is informative was tested in 102 members of 16 hemophiliac families from Sistan and Baluchestan province, Southeast of Iran. Methods: Blood samples were obtained from 29 hemophilia A patients and 73 of their relatives, after taking informed consents. DNA was extracted using proteinase K digestion followed by DNA precipitation. Factor VIII gene polymorphism was identified by the polymerase chain reaction/RFLP which is both sensitive and economical. Results: Our results showed that almost 69.8% of X-chromosomes had restriction site for Bell enzyme. The heterozygosity rate for Bell polymorphism in tested women was 61.4%, signifying the usefulness of this marker in carrier detection. The informative rate respecting this polymorphism was 43.7% meaning that a remarkable percent of families from the target population could be diagnosed using this marker alone.Conclusion: In Sistan and Baluchestan province where there is limited access to sophisticated facilities of molecular diagnosis, use of PCR-based analysis of DNA polymorphism in the Bell locus can be used to identify a remarkable percentage of the carriers and even for prenatal diagnosis. Meanwhile, it is necessary to evaluate the effectiveness of other polymorphic DNA markers to enhance the informative rate.

Background: Effect of different doses of cysteamine on rate of in vitro maturation (IVM), in vitro fertilization (IVF) and glutathione (GSH) level was studied. Metaphase II (MII) spindle area was analyzed for quantification of shape and size of oocytes. Methods: Female mice were primed with 5 IU of pregnant mare's stimulating gonadotrophin. Germinal vesicle (GV) oocytes were retrieved 48 hrs later. IVM medium was supplemented with 0, 50, 100, 200 and 500 mM of cysteamine. For IVM and IVF assessment in each group, 150 GV oocytes were used. Experiments also included a group of ovulated oocytes (matured in vivo) after priming with pregnant mare's stimulating gonadotrophin and human chorionic gonadotropin. GSH level was measured by 5,5-Dithio-bis (2nitrobenzoic acid) DTNB-GR recycling protocol in GV and MU oocytes. For IVF, MII oocytes were inseminated with mature mouse sperm and rate of two-cell embryo was measured. For immunocytochemistry of microtubule and chromosomes, MII oocytes were fixed by methanol and immunostained with a- and b-microtubule antibody and Hoechst. The spindle area was then analyzed. Results: A dose-dependent improvement was observed in IVM and IVF rate. MU development and two-cell embryo formation were increased significantly in group which received 200 mm cysteamine compare to the control group.GSH level was increased in presence of cysteamine in group which received 200 mm cysteamine. Spindle area was increased in all groups in vitro except for the group which received 500 mm cysteamine. The difference between spindle area in 200 mm cysteamine and in vivo group was not significant (P>0.05).Conclusion: Administration of cysteamine improves IVM and IVF rate in a dose-dependant manner. Also cysteamine induces glutathione synthesis in MU oocyte and improves microtubule when administered at a dose of 200 mm. Therefore, addition of cysteamine as an antioxidant can improve IVM and IVF rate by increasing of oocytes quality.

Pressure ulcers result from immobility and continuous pressure on an area of body. Besides imposing further restriction of movements and thus creating a vicious circle in the healing process, these ulcers are of significant importance in decreasing the life quality and increasing the costs of treatment in these patients. In this study we compared the outcome of treatment of pressure ulcers with GA-AL-AS (Gallium- Aluminium -Arsenide) & Gal-AL-In-Ph (Gallium- Aluminium Indium - Phosphate) - diode lasers, on contact, continuous emission mode at an every other day dose of 4-6 J/cm2 for 3 weeks plus conventional treatments of pressure ulcers, with that of conventional treatment alone in two groups of veterans with spinal cord paralysis who reside in Tehran. The study was a triple blind clinical trial conducted among 16 veterans who were randomly divided into case and control groups.The diameter of the ulcers was measured and staged by one person who was unaware of the subjects' allocation. Digital photographs of the ulcers were initially taken and a combination of conventional treatment (wet dressing, irrigation) with Low Level Laser and conventional treatment alone was performed for the case and control groups respectively. After 3 weeks the subjects were evaluated again and photographed with the same method. The results demonstrated a statistically significant enhancement of the healing process by combination of Low Level Laser with conventional treatments of pressure ulcers.

A new method recently used for measuring the temperature is using tympanic thermometer. The aim of this study was to compare the accuracy of this method with rectal and axillary measurement in children less than 6 years old. A total of 220 pair ears, axillaries, and rectal sites were used to determine the body temperature in patients aged between 3 months to 6 years who referred to Emergency Department of Fateme Zahra Hospital affiliated to Bushehr University of Medical Sciences. Rectal temperature (RT) was considered as gold standard. Fever was defined as RT³38oC, axillary temperature (AT)³37.2oC and tympanic temperature (TT)³38oC. Correlation between rectal and tympanic temperature was statistically significant.The mean difference between RT and TT was 0.3oC and between RT and AT was 0.1oC. When cutoff point was considered 38oC for TT, the sensitivity was 46%, specificity was 97% and positive predictive value (PPV) and negative predictive value (NPV) were 92% and 72% respectively. ROC curve showed the best cutoff point for TT as 37oC, which increased the sensitivity to 92% and PPV to 0.98 but decreased the specificity to 90% and NPV to 0.57. Kappa test showed a good agreement rate between RT and TT. Age had significant effects on the TTIRT relationship. If the cut off point for TT is set at 38°Cthe sensitivity and NPV will be unacceptably low and a number of children with fever may be missed by screening with a tympanic thermometer. If the cutoff point is 37oC, the sensitivity and NPV will improve and TT can be used as a safe, easy, rapid, and accurate method in pediatrics.

Sydenham's chorea is a delayed complication of group Ab haemolytic streptococcal infections and forms one of the major criteria of acute rheumatic fever. It is characterized by chorea, muscular weakness, and a number of neuropsychiatric symptoms. It is considered to be an autoantibody mediated disorder with the evidence suggesting that patients with Sydenham's chorea produce antibodies that cross react with streptococcal, caudate, and subthalamic nuclei. However, documented evidence of previous streptococcal infection is found in only 20%-30% of cases. It has a good prognosis for full recovery so treatment is not warranted in most cases. Following case is a high school student presented with progressive changes in his handwriting during two months before. Chief complaint of this 15-year-old boy was difficulty in writing at classroom. His physics notebook has been shown as interesting figures.

Brucellosis is an endemic zoonotic infectious disease in Middle East countries including Iran. This infection may involve central nervous system. Psychosis has been reported in rare cases with chronic brucellosis. A 26-year-old male shepherd patient who developed neurobrucellosis and psychosis is presented. He had hallucinations (visual and auditory) and delusions. He was also impulsive and had serious difficulty in speech.In patients with atypical psychosis in endemic areas, physicians should consider the portability of chronic brucellosis.

Postoperative respiratory distress and pulmonary edema can be seen after a wide variety of serious clinical situations, or rare diseases such as familial Mediterranean fever (FM F). FMF is a multisystemic disorder characterized by recurrent bouts of fever and pain due to inflammation of the peritoneum, synovia, or pleura. We report a case with history of FMF who developed postoperative respiratory distress after repairing the abdominal incisional hernia. Ten hours after administration of colchicine, the patient's symptoms were reduced. This rare disease should be included as a differential diagnosis for acute-onset respiratory distress in postoperative period.

Congenital cystic lesions of the pancreas are rare findings. Furthermore, dermoid cyst of the pancreas is exceptionally uncommon. A review of the world literature showed that only 18 documented cases of dermoid cyst of the pancreas were reported so far. The pre-operative evaluation of this lesion is rather questionable, with definitive diagnosis taking place intraoperatively.Herein, we presented a 4-year-old female with a symptomatic 6-cm cystic mass in the head of her pancreas.