Iranian Red Crescent Medical Journal
Year:2008 | Volume:10 | Issue:3|Papers Count:18

Background: Clinical presentation, diagnosis and treatment, and outcome of pulmonary Fungus ball have been known to depend on the underlying lung disease. We described clinical findings, diagnosis and results of surgical treatment of Fungus ball.Methods: From 1992 to 2005, we operated 31 patients with aspergilloma. Among them, 18 were male with a median age of 52 (30 to 70 years). 11 were afflicted with simple aspergiolloma and the rest with complex aspergiolloma.Results: Hemoptysis and cough were the most complaints. Diagnostic tools were CXR and CT scan. Tuberculosis and Bronchectasis were the most common underlying lung diseases. 39 procedures were performed in the patients. The most common surgical procedures were Lobectomy, wedgresection and closed tube cavernostomy with amphotericin installation in the cavity. The most common postoperative complications in the complex type were bronchopleural fistula, empyema and persistent space. Intraoperative mortality occurred in two cases because of bleeding during one to four year follow-up. Eight patients died because of sepsis and respiratory failure.Conclusions: Because of the underlying lung disease, postoperative complications and mortality rate were high especially in complex aspergiolloma. However, surgery is the approach of choice in these patients. In high-risk patients, tube cavernostomy could be helpful.

Stress urinary incontinence (SUl) is the most common form of urinary incontinence in women and is associated with high financial, social, and emotional costs. The history and physical examination can identify most patients with a significant stress incontinence component without the need for urodynamic testing. A variety of pharmacologic agents have been used off-label, but an evidence-based pharmacologic treatment has not been readily available. The development of a selective serotonin and norepinephrine reuptake inhibitor will add a potentially useful drug to the primary care physician's practice for treating female patients with SUI. In August 2004, a selective serotonin and norepinephrine reuptake inhibitor, duloxetine, became the first medication approved for the treatment of women with moderate to severe SUI throughout the European Union. As of November 2005, however, duloxetine has not been approved for the treatment of SUI in the United States.

National Cancer Registry of the Slovak Republic, National Health Information Centre, would like to respond to many requests for easy and comprehensible access to the national and international data on cancer epidemiology. The working group created a new analytic web-page called "National portal on cancer epidemiology". All the data are valid, adapted for publications and quotation and the access to the web-page www.nor-sk.org is free for the wide professional public.

Background: Surveillance after orchiectomy alone has become popular for the management of clinical stage I nonseminomatous germ cell tumors of the testis (CS I NSGCTT). Efforts to identify patients at high risk of relapse have led to a search for prognostic factors of CS I NSGCTT. The aim of this study was to analyse long-term experiences with different therapeutic approaches in CS I NSGCTT patients according to relapse risk factors.Methods: From 2/1992 to 5/2008, a total of 352 CS I NSGCTT patients were included in the study and stratified into different risk-adapted therapeutic approaches (groups 1-3). 114 patients (group 1) with vascular invasion and majority of embryonal carcinoma component in the primary tumor were treated with 2 cycles of BEP chemotherapy.Results: Relapse was experienced in 2 patients (1.75 %). Among 12 patients (group 2) with vascular invasion and majority of teratomatous elements in the primary tumor undergoing primary retroperitoneal lymph node dissection (RPLND), 10 were found to be in pathological stage I. Relapse was observed in two patients (16.7 %), one of whom died 29 months following orchiectomy. Two patients (18.2 %) with pathological stage II received adjuvant chemotherapy and finally died. 226 patients (group 3) without vascular invasion were followed after orchiectomy. Relapse was observed in 41 patients (18.1 %). They were treated with BEP chemotherapy, of who three died. The overall survival rate of all the patients in group B1-3 was 98.3 %.Conclusions: Surveillance procedure is recommend only in patients without vascular invasion in the primary tumor.

Background: The fact that the adaptive capacities of medical students are decreased by psychiatric symptoms, especially depression, is well documented in the literature. Persistent dysphoric mood has also been associated with medical school dropout. This study was carried out to assess depression scores of medical students at Dubai Medical College using on Beck Depression Inventory.Methods: 103 medical students were selected randomly and evaluated by Beck Depression Inventory (BDI). A confidential questionnaire (BDI) was distributed, completed by the students and collected in the same sessions in 2007.Results: The mean age for the students was 18.85 years (Minimum: 17, Maximum: 22), and 90.3% were between 18 and 20. The mean depression score of the students was 14.88. Of the participants, 64.07% reported that they were particularly hopeful about the future and 73.78% indicated that they had no self-harming thoughts. Among them, 27.18% were in the normal depression range (0-9), 45.63% in the marginal depression range (10-19) and 23.30 in the moderate depression range (20-29). Only 3.88% were found to be in the moderate to severe depression range (30-39). None of the students had severe depression (BDI score > 40). The majority of the participants were particularly optimistic about the future. Most of the participants were in the normal or just marginal depression range and none of them had severe depression.Conclusions: Our results indicated that although a low percentage of Dubai Medical College students were found to have a significant level of depression, this should not be underestimated, and actions should be taken to encourage Dubai Medical College students to seek help for psychiatric problems especially depression. The risk factors as well as protective ones must be identified nation-wide to promote the mental health of the medical students.

Background: The notorious complications of measles and the contribution of maternal rubella to congenital malformation of the fetus (congenital rubella syndrome) resulted in inclusion of vaccination against measles and rubella in national preventive programs. The aim of the present study is to evaluate the coverage of mass vaccination of Measles and Rubella (MR) and to determine the prevalence of complications of these vaccines in the target population of Guilan Province, Iran.Methods: This is a population based epidemiologic cross-sectional study. After completion of a nationwide mass vaccination of MR for the age group of 5-25 years in 2003, in private and governmental medical and health centers of Guilan Province, demographic and epidemiologic information about the vaccination coverage and complications were extracted from the data banks. Statistical analysis was performed using software EPI 2002. P value< 0.05 was considered significant.Results: The target population considered for MR mass vaccination was estimated approximately 1,034,975 persons. 99.04% (1024998) of them were vaccinated from Dec. 2003 to Jan. 2004. Complications appeared in 765 cases (7 per 10000). 96% of the complications were of common types such as fever and headache, requiring no treatment. Gender difference in MR vaccine complications was significant as 5.6 per 10000 in males in comparison to 9.26 per 10000 in females. Similarly, the prevalence of complications was highest in the age group 10 to 14 years and least in the age group 20 to 25 years.Conclusion: Mass vaccination for Measles and Rubella, aiming at eradicating these diseases, was highly successful in terms of wide coverage, positive feedback from the public and low complication rate in this region.

Background: Post-transplant diabetes mellitus (PTDM) contributes to the risk for cardiovascular diseases and infection, reducing graft and patient survival. This study was conducted to identify the incidence and risk factors for development of PTDM.Methods: We studied 50 non-diabetic adult dialyzed patients awaiting renal transplantation prospectively. Oral glucose tolerance test (oGTT) was performed pre- and post-transplantation. The relationship between age, weight (BMI), dialysis modality, family history of diabetes, and duration of dialysis and PTDM was assessed.Results: Based on oGTT1, 13 patients had unknown diabetes mellitus; however, after transplantation only 9 had similar results. Based on oGTT2, 6 (16.22%) patients had actually PTDM. The age of patients with PTDM was significantly higher than that of those with normal test (43±17 vs 31±11 years old). There was a significant relationship between duration of dialysis with PTDM, as normal oGTT was seen in 85.2% of patient's dialyzed for less than 1 year. There was no significant relationship among dialysis modality and family history of diabetes and BMI with PTDM.Conclusion: Risk factors for diabetes in our study were age and duration of dialysis before transplantation. Therefore, identifying them might allow modification of post- transplant immunosuppressant with non-dibetogenic agents in high risk patients.

Background: Dispatching field hospitals meeting the needs of the sufferers is the ideal response to disasters such as earthquakes. The aim of this study is determining the settings of such a field hospital.Methods: A twelve-member expert panel selected used the RAND Appropriateness Methodology to rate scenarios derived from best current evidence, and additional comments resulted from Nominal Group and Modified- Delphi Techniques. A 9-point rating scale was used that permits the categorization of the items as appropriate, uncertain, or inappropriate. A descriptive analysis was undertaken of the final results of the panel meeting.Results: Of extracted evidence categorised as items in six chapters, 72.90% was considered appropriate, 15.89% uncertain and 11.21% inappropriate. In the first round, agreement was found for 87.06% of the 85 items. Following discussion on divergent ratings, much higher agreement was achieved, reaching 93.46% of the 107 final items.Conclusion: Using RAND/UCLA Appropriateness Method, on the basis of the best current evidence, an expert panel assessed the items of Principal Tasks of Field Hospital, Staffing pattern and equipment as sufficient and appropriate in a multidisciplinary field hospital, developing updated and clear recommendations for rapid access to the setting of the field hospital in earthquakes.

Background: Osteoporosis a serious and debilitating disease resulting in an increased risk of fracture, causing significant morbidity and mortality. This study was performed to determine the risk of osteoporosis in postmenopausal women in Shiraz, southern Iran.Methods: This is a descriptive cross-sectional study of 405 menopausal women over 55 who referred to health centers from June to October, 2005. The health centers had been chosen by random cluster sampling from different geographic areas of Shiraz. For gathering data, a modified questionnaire, based on postmenopausal osteoporosis evaluation form of NAMS (North American Menopausal Society) as well as an interview and examination were used.Results: The mean age of menopause was 49 years. Disease and medication intake which are considered as osteoporosis risk factors existed in 12.6% of the subjects. 8.4% of the subjects had positive family history, and lifestyle accounted for 78% of the high risk. The minimum and maximum lifestyle risk factors were inactivity and lack of exercise (33.3%) and no exposure to sunlight (5.9%), respectively. 15.3% of the subjects were smokers. From 75 individuals who had done BMD test, 58 had osteoporosis and 17 had no evidence of osteoporosis. Regarding risk factors, there was no significant difference between osteoporosis and nonosteoporotic individuals.Conclusion: In general, lifestyle is the most common risk factor in our sample. Lack of physical activity and smoking as life style risk factors are the most common causes of osteoporosis in menopausal women.

Background: Although the use of general anesthesia has been declining in obstetric patients, it may still be required in selected cases. Maintenance of the airway during obstetric anesthesia is difficult to achieve, and still remains the single most important cause of anesthetic related maternal morbidity and mortality. The purpose of this study was to determine the capability of the following preoperative airway predictive tests, in isolation and combination, to predict difficult visualization of larynx (DVL) in obstetric patients: upper lip bite test (ULBT), modified Mallampati test (MMT), sterno-mental distance (SMD), thyro-mental distance (TMD), horizontal length of the mandible (HLM), and inter incisor gap (IIG).Methods: 203 consecutive obstetric patients with ASA grade 1 and 2 undergoing general anesthesia for cesarean delivery were evaluated preoperatively using the ULBT, MMT, SMD, TMD, HLM, and IIG tests. The cut-off points for the airway predictors were ULBT III, Mallampati III and IV,  £ 13.5 cm, £ 6.5 cm, £ 9 cm and £ 4cm, respectively. During direct laryngoscopy by a blinded expert anesthesiologist, the laryngeal view was graded, using the Cormack and Lehane classification. Laryngoscopic grades III and IV were considered difficult laryngoscopy. The sensitivity, specificity and positive predictive value for each test in isolation and in combination were determined.Results: The difficulty to visualize the larynx was found in 37 (18.2%) parturients. The sensitivity, specify and positive predictive value for these tests were: ULBT (94.6%, 97.6%, 89.7%), MMT (29.7%, 74.7%, 20.8%), SMD (13.5%, 86.7%, 18.5%), TMD (10%, 99.4%, 10%), HLM (62.2%, 43.4%, 19.7%), and IIG (0%, 98.8%, 0%).Conclusion: The best single predictor was ULBT and the best combination of the tests was ULBT and MMT. Data analysis showed that demographic data, MMT and IIG were independent predictors of DVL. Thus, the ULBT is a useful predictor of difficult intubation in obstetric patients and also the combination of ULBT and MMT is a valuable airway predictor in parturients.

Background: Over 50% of patients with AML still relapse after autologous stem cell transplantation. We investigated the efficacy and feasibility of a new conditioning regimen consisting of a moderate dose of Idarubicine plus conventional dose of oral Busulfan in patients undergoing autologous transplantation without favorable cytogenetic state and high dose therapy with Cytarabine or other drugs.Methods: Ten Patients were given three days of bolus infusion of IDA followed by four days of oral Busulfan as conditioning regimen. Unpurged peripheral blood stem cells were used in all cases. All the cases were in first complete remission (CR1). The reasons for the selection of these patients in the first remission were that they had not received high dose chemotherapy or did not have available cytogenitic state.Results: The transplant related mortality occurred in one case (refactory thrombocytopenia, leading to CNS hemorrhage). The median CD34+ cell infused was 8 x 106/kg. The median days to neutrophil recovery > (0.5 x 109) and platelet recovery > (20x109 /kg) were +9 days (4-12 days); +16 (2-30 days) respectively. The patients needed transfusion of a median of 15 platelet units and 7 blood units, respectively. Six out of 10 patients (60%) had variable grades of mucositis (three cases had grade III, two grade II and one case grade I). After a median follow up of 48 months from ASCT, 8 patients out of 10 (80%) were alive in continuous complete remission. One case had relapse after 6 months of transplantation.Conclusion: The findings of the study demonstrated the efficacy and feasibility of a conditioning regimen based on a moderate dose of IDA plus Busulphan in AML. The results concerning anti-leukemic efficacy are promising but need to be confirmed on larger series.

Background: A remarkable increase has been observed in hospital expenditure in many countries during recent years, drawing especial attention to the problem. This study was conducted to present one of the operational research techniques pattern in evaluation of the hospital efficiency.Methods: The ratio analysis method was used to evaluate the hospital efficiency. This method is not effective in cases in which the relationship between an input and several outputs or several inputs and several outputs are involved. Data Envelopment Analysis Pattern (DEA) is one of the operational research techniques, lacking the problems of ratio method while efficiency evaluation can determine the critical parts of hospital, reducing the efficiency of the whole hospital and meanwhile compensating the deficiency in a particular measurement. In order to introduce this method in hospital efficacy evaluation, 18 general hospitals affiliated to Iran Social Security Organization were included.Results: This study revealed that Data Envelopment Analysis Pattern had more capacity than previous methods in relation to evaluation of the complicated organizations like hospitals.Conclusion: Operational research techniques in efficiency evaluation would provide the possibility to compare different efficiencies among various hospitals and present the necessary solutions to compensate the insufficiency and to correct them for the managers. This technique was used for the first time in this study to measure hospital efficiency in Iran.

Background: Shoulder pain is a common complication of hemiplegia, and many risk factors may predispose a stroke patient to shoulder pain. The aim of this study was to find out the factors that can predict the hemiplegic shoulder pain (HSP) after stroke. We used explorative design methods based on Logistic Regression.Methods: The sample of this study consisted of 152 patients (77 female and 75 male) with diagnosis of acute cerebrovascular accident (CVA) referred to the Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences during a period of 3 years. Several variables were considered through patients’ personal medical history, physical examination, laboratory data, questionnaire, psychological tests and interview.Results: 32% of the patients had an experience of HSP after stroke. The critical time for the occurrence of HSP was between 2 and 6 months after the onset of CVA. Logistic Regression showed that the best predictors for HSP were “Activity of daily living ability”, “Increased light touch threshold” and “Increasedvibration threshold”.Conclusion: Patients with serious sensory and motor disability have more chance for HSP symptoms after stroke, so each stroke treatment method should include a plan for prevention of HSP.

Background: Improper inflation of endotracheal tube cuff is associated with various complications. Recently, there has been high referral of patients with post-intubation complications to the clinics affiliated to Shiraz University of Medical Sciences. Herein, we examined the practice of cuff pressure monitoring at 9 adult intensive care units in 3 university-affiliated hospitals.Methods: The present study was performed on 57 tracheally intubated patients, whose cuff pressures were measured using either a cuff pressure gauge on 12 patients (Group 1) or manual palpation of the pilot balloon on 45 cases (Group 2) during summer 2004. The intracuff pressure (P1), intracuff volume (V1), and pressure exerted by the cuff against the tracheal mucosa (DP) were determined, analyzed and compared with the recommended values.Results: The P1 in Group 1 was 35.3±32.8 SD cm H2O, with 33.3% of the patients having values below 20 cm H2O. In group two, P1 was 88.8±27.1 cm H2O, all of which being above 40 cm H2O. The DP for the Groups 1 and 2 were 16.3±11.1SD cm H2O and 35.5±15.6 cm H2O, respectively.Conclusion: Our findings indicated that manual palpation of balloon cuff to monitor cuff pressure was not an accurate procedure. They also suggested that measures to increase the knowledge and skills of ICU staff and posting of cuff pressure monitoring protocols might help improve the practice.

Background: Subarachnoid hemorrhage (SAH) due to cerebral vessels aneurysm is a fatal disease with high mortality. Regarding the high mortality of the disease, this study was performed to evaluate the etiology, epidemiology, clinical manifestation, aneurysm and the diagnosis of the disease.Methods: 132 patients with SAH who were admitted in Neurosurgery Department of Nemazee and Beheshti hospitals affiliated to Shiraz University of Medical Sciences in Shiraz during September 2002 to March 2006 were evaluated for the mentioned factors.Results: Sixty-eight patients (51%) suffered from cerebral aneurysm among whom anterior common artery (33.8%) and middle common artery (23.5%) were more involved with aneurysm. Finally, 58.3% of the patients were completely treated, 19.6% were discharged with complications in spite of various treatment efforts and 21.9% expired.Conclusion: Regarding the high mortality of SAH due to aneurysm of cerebral vessels and considering various treatments measures, one third of patients still would experience the hemorrhage again. Therefore, attention to early diagnosis of the disease seems necessary.

Hand surgery is a distinguished sub-specialty of trauma and orthopedic management. Sprains and dislocations of the interphalangeal joint of the finger are relatively rare due to the protected position of this joint in the hand. However, unusual cases of a simultaneous Proximal and Distal Interphalangeal Joint Dislocation have been reported. We report this rare case of simultaneous dislocation of both interphalangeal joints of the little finger from Northern Iran. We observed that the mechanism, diagnosis and treatment of our case were similar to the published reports of the world literature. The patient had closed reduction of distal interphalangeal joint with excellent postoperative recovery. The importance of careful assessment of hand injuries with stress test of the joints under local anesthesia is reiterated. In conclusion, we recommend that this injury of rare occurrence be treated conservatively by manipulation, and if a good functional result is desired, adequate physiotherapy treatment is also required.

Hydatid disease is the most common helminthic disease in human beings; however, spinal hydatid cyst accounts for 1% of all cases. We report a case of spinal hydatid disease that relapsed after surgery in a patient treated with albendazol for 6 months, and also a combination therapy with albendazole and praziquantel without further surgical intervention.

Stillbirth rate still continues to be high in the world. Some studies have reported stillbirth rate to be between 10.4 and 46.4 per 1000 birth. The aim of this case control study was to investigate the incidence of stillbirth and the risk factors at Babol hospitals, Northern Iran.