Iranian Red Crescent Medical Journal
Year:2000 | Volume:3 | Issue:1|Papers Count:16

The incidence of perinatal morbidity is directly related to fetal macrosomia (birth weight ³4000g), but this morbidity is more common in macrosomic infants born diabetic mothers. Aim: To measure the antropometric parameters in two groups of full term macrosomic infants who were born from diabetic and non-diabetic pregnancies and to compare their morbidities. Method: Gestational assessment and antropometric measurements were done on 133 consecutive macrosomic infants, out of which 72 were born to non-diabetic mothers and 61 to diabetic mothers. The morbidity of the two groups were recorded and compared. Results: Although the macrosomic neonates born to diabetic pregnancies had the same lengths and head circumference when compared to fetal macrosomia of non-diabetic mothers, the formet group was significantly heavier with larger mid-shoulder and chest circumferences and greater shoulder to head and chest to head disproportion. Among macrosomic infants of diabetic pregnancies, Erb’s palsy occurred in 3, shoulder dystocia in 2 and one had fracture of clavicle, whereas only one Erb’s palsy was found among macrosomic babies of non-diabetic pregnancies.Conclusion: Although our data revealed higher morbidity in macrosomic infants of diabetic compared to non-diabetic pregnancies the number of patients in study groups were too few to draw any conclusions. This study suggests that if fetal macrosomia is suspected, suggests in a diabetic pregnancy, ultrasonic measurement of anthropometric parameters could be of value to select the route of delivery and to minimize birth trauma.

Eighty hirsute women (Ferry man and Gallwey score³8) who referred to the endocrinology clinics of Shiraz University and ten control normal nonhirsute women were assessed in this study. Baseline 17-hydroxyorogesterone (17 OH PG), cortisol, stimulated 17-hydroxyprogesterone and corti801 after 30 minutes of cosyntropin (short acting ACTH) injection were measured for screening of late-onset congenital adrenal hyperplasis (LOCAH) during follicular phase. Baseline testosterone, Luteinizing hormone (LH), follicular stimulating hormone (FSH), thyroid stimulating hormone (TSH) prolactin (PRI), and dihydroepian drosterone sulfate (DHEA-So4) were also measured. The ovaries were visualized in 42 patients by sonography, of the 80 hirsute women, 3 had late-onset CAH due to 21-Hydroxylase (21 OH) deficiency (3.8%), 43 women diagnosed as having Polycystic ovary syndrome (53.7%) and 34 women diagnosed as having idiopathic hirsutism (42.5%).

This is a prospective study on 100 knee joints in 98 patients of the knee, treated by modified valgus dome shaped osteotomy of the proximal tibia. The distal part of the osteotomy pushed anteroproximal to decompress the patellofemoral joint . Age of the patients was between 55 to 70 years. The amount of involvement of the knee compartments were assessed preoperatively by anteroposterior (AP), lateral, tunnel and merchant view. Arthroscopy was necessary for loose body removal in 3 patients. No permanent device for fixation was used, so it was possible to change the angle of osteotomy by weding the cast postoperatively for adjusting the alignment. A simple rod was used, to align the anterior superior iliac spine (ASIS) and center of patella with the medial aspect of the first metatarse. After osteotomy the patients were allowed to have a full weight bearing (WB) with a well molded long leg cast as early as convenient. There was one non-union of the tibia which followed impending compartment syndrome. After this treatment %63 of the patients can do more daily activities and their range of motion (ROM) improved, %17 gained improvement in their ROM and relieve of pain in their daily activities, %15 feel some improvement in their pain but they need to use medications and in 5% no improvement was gained.

Background/purpose: Proliferative diabetic retinopathy (PDR) is the serious sequel in diabetic patients. Retinal ablation by laser photocoagulation is accepted as the treatment of choice in PDR. Retinal ablation by croyopexy should also be effective in treatment of PDR. The aim was to evaluate cryotherapy in PDR and compare it with the results of photocoagulation.Patients/methods: 60 eyes with PDR and significant ocular media opacity were treated by crotherapy. At each quadrant of the retina, 8 to 10 spots of the cryopexy, between 7 to 15 mm of the limbus were applied. This was controlled by indirect ophthalmoscopy and was continued up to point of freezing and whitening of the retina. The patients were followed at one week, one month and every three months for at least one year.Results: 24 eyes (40%) had improved vision, 30 eyes (50%) had no change in the visual acuity and 6 eyes (10%) had decreased visual acuity.This result compares favorable with panretinal laser photocoagulation. 21 (36.6%) eyes gained more than 5 meter counting finger (CF) vision and 3 eyes less than 5 meter CF. there is significant difference (P<0.001).Conclusion: It seems that retinal cryoablation has a place in the treatment of PDR and in selected cases may be the method of choice.

Hematuria indicates the presence of an abnormal amount of red blood cells (RBCs) in the urine. The causes of hematuria are multiple and its investigation is crucial. One of the methods for differentiating between nephronal and non-nephronal hematuria is estimation of the percentage of dysmorphic RBCs in the urine. In this cross-sectional prospective study, the data showed that the presence of 25%dyrmorphic RBCs in the urine were diagnostic with a sensitivity of 92.5% and a specificity of 83.3%. Furthermore, the utility of diagnostic values of dysmorphic RBCs under light microscopy were compared with those under standard phase contrast microscopy. Results showed that there was no significant difference in the diagnostic accuracy between these two methods. In conclusion, a single, clinically relevant threshold percentage (25%) is now defined with acceptable sensitivity and specificity. Morcover, the results showed no significant difference in the diagnostic efficacy of light microscopy versus phase contrast in the diagnosis of dysmorphic hematuria.

Cardiovascular diseases remain the chief cause of death in the world and atherosclerosis is the principal cause of myocardial and cerebral infarction and accounts for the majority of these deathes. Atherosclerosis of the coronary artery is a major cause of sudden and unexpected death but the incidence of this disease would be different according to geographic area. Our main goal in this study was to evaluate coronary artery disease especially atherosclerosis in the region and compare the results with those of the literature.We examined the hearts of 100 consecutive forensic pathology cases which were referred from medicolegal center to the pathology department Shiraz University of Medical Sciences. Age of the patients was between 12 to 79 years, and most of them were in the young and middle age groups (75%).In young, middle and old age groups the incidence of normal coronary artery was 52.5%, 18and 4.8% respectively. Incidence of more than 75% narrowing of coronary arteries in young, middle and old age groups was 0.25% and 43% respectively and it shows that the incidence of coronary disease is increased with age.Frequency of atheromatous lesion and critical narrowing (more than 75%) according to vessel was as the following:Artery                                    Atheromatous lesion                                         Critical narrowing Left anterior descending                      56%                                                                35%Right-coronary                                      51%                                                                27.5%Left circumflex                                       49%                                                                25% According to the above-mentioned findings frequency and severity of atheromatous lesions were most commonly present in the left anterior descending, right coronary and left circumflex arteries in descending order. Calcification with atherosclerotic lesion was not present with narrowing of less than 25%, but if the narrowing was more than 75% its frequency was between 66 to 100%.The most interesting finding was absence of myocardial infarction with more than 75% narrowing and single, double and triple vessel involvement.

One of the main problems facing pulmonologists and internists is differentiating tuberculous effusions from malignant effusions. To help in this decision making we prospectively evaluated the pleural (P) cholesterol and its serum (S) ratio in 39.63 patients suspected either of malignancy or tuberculosis.Method: In 39 patients whose clinical presentation suggested either malignant or tuberculous effusion chest X-ray was taken to determine the size and the site of the effusion. In a fasting state, fluid was drawn for cytology, A.F.B. smear and culture, LDH, protein, glucose, cholesterol, and triglyceride. Simultaneously blood was sent for evaluation of the same biochemistry parameters. In all cases the definitive diagnosis was made by pleural biopsy.Results: Of 39 patients 21 had tuberculosis and 18 had malignancy. Using SPSS-Pc+program it chose pleural to serum cholesterol ratio as a variable with significant difference. The mean ratio for tuberculous patients was 0.52 and the patients with malignancy had ratio of 0.44 with P<0.01. Plugging P/S cholesterol ratio into two formulas (1) T.B=P.S cholesterol×60.38-16.45: (2) malignancy=P/S cholesterol × 50.64-11.91. Our diagnosis is most likely the one with higher value (P<0.007).Conclusion: In difficult cases where diagnosis of either a malignant pleural effusion or tuberculosis is either a malignant pleural effusion or tuberculosis is difficult use of cholesterol level or its ratio can play a pivoting role.

Seventy three cases (47 male and 26 female) of Kala azar were diagnosed within 8 years (1983-1990). 70 patients were under the age of 10 years (95.9%) and 3 were above 10 (4.1%). The youngest patient was at the age of 5 months and the oldest was 40 years. Diagnosis was based on observation of Leishman bodies in Giemsa stained smears prepared from bone marrow aspiration specimen. All of the patients had hepatosplenomegaly. In 71 patients (95.8%), the bemoglobin level was under 10 mg/100 ml. the bacmatocrit under 30% was present in 79.4% (58 patients). 66 (90.4%) patients were leukopenic and 79% showed lymphocytosis. The patients were living in different cities or villages of Khoozestan Province, predominantly from Izeh and Masjedsoleiman cities.

We evaluated 205 patients with diagnosis of migraine headache based on the criteria developed by the international headache society (HIS). 14 patients (6.8%) developed epileptic seizures (ES). In this group, sex ratio, type of migraine headache and epileptic seizures, electroencephalograms, and temporal relation between seizures and migraine episodes were investigated. Male to female ratio was higher inpatients with seizures than those with migraine headaches alone. Migraine with typical aura was observed in 85.7% of the 14 patients with migraine and seizures. In this sub-group of the migraine and seizures. In this sub-group of the patients. 78.5% suffered generalized tonic clonic convulsions and 21.5% had partial seizures. Of the 14 patients, in 21.4%patients’ seizures and migraine episodes occurred simultaneously.

Objective: to demonstrate the distribution of fungal agents responsible for onychomycosis either directly or indirectly in Khoozestan province, southwest of Iran.Methods: A retrospective study was performed on the basis of the mycology laboratory records of the basis of the mycology and Parasitology Center of Khoozestan province, Iran, during a period of 11 years (1987-1997). Nail samples were collected by clipping and scraping. Direct examinations were performed on all specimens. Sabouraud dextrose agar, Sabouraud with cycloheximide and chloramphenicol were used for culture.Results: A total of 2525 persons examined for nail mycotic infection. Women were effected more than men (%72.9) and 27.1% respectively, P<0.01). Of a total of 1085 positive nail cultures, 866 (79.8%) demonstrated Candida albicans, 84 (7.7%) Candida species, 22 (2.02%) dermatophytes, and 113 (10.4%) moulds. Of the species causing nail dermatophytosis, Trichophyton mentagrophytes was the most common (40.9%) whereas of the species causing mould infections. Aspergillus fumigatus was the commonest (38%).Conclusion: This study showed that Candida albicans might be the most common cause of onychpmycosis in Khoozestan, south-west of Iran. A similar situation is observed in neighboring countries.

Background: The role of Helicobacter pylori (H.pylori) in upper GI disease has been studied and its treatement in special groups of patients is necessary. Clarithromycin has been recognized as a major ingredient of the standard short term therapy for H.pylori. To compare the effect of azithromycin which is a new macrolide with clarithromycin, a prospective open study was conducted to evaluate the therapeutic effect of azithromycin against clarithromycin in the triple therapy.Method: Patients attending at GI clinic of our hospital with the complain of epigastric pain were included in this study and after endoscopy and confirmation of H.pylori by rapid urease test irrespective to the presence or absence of duodenal ulcer (DU), they were included in a single center open study. Patients were divided into two groups of LAC (lansoprazole 30mg b.i.d, amoxicillin 1000mg b.i.d. and clarithromycin 500mg b.i.d) and LAA (lansoprazole 30mg b.i.d, amoxicillin 1000mg b.i.d, and azithromycin 250mg b.i.d) who were both treated for one week. The efficacy is determined at least after four weeks of completing the anlibiotics by C13-urea breath test (C13UBT).Results: A total of 110 patients were included in both of LAC and LAA groups, LAC group consisted of 64 patients of whom 20 patients had DU and 44 cases had normal endoscopic finding, while in the group of LAA there were a total of 46 patients of whom 14 had DU and 44 had normal endoscopic finding.After the completion of treatment, to patients suffering from DU ranitidine 100mg B.i.d was given for another 3 weeks. Out of 64 patients from the group of LAC 59 patients (92%) cleared the organism (95% CI=8-92) while out of 46 patients from group LAA 26 patients (56.5%) cleared the organism (95% CI=41-71) and using the chi-squared method there was a significant difference in the level of its efficacy in the treatment regimen against H-pylori (P<0.00001). besides in the comparison of subgroups of those with DU, out of 20 patients of group LAC, 19 patients (95%) had cleared (95% CI=75-99) which means that in this two subgroups there was also a significant difference (P<0.003). Side effects of medicines used in the group of LAA were lesser than that of LAC.Conclusion: Although in some studies substitution of azithromycin for clarithromycin is recommended, but our study shows that in a low dose of 250mg b.i.d, azithromycin has not had a considerable effect on the H.pylori and further studies are recommended.

The coexistence of achondroplasia and Klinefelter’s syndrome is extremely rare. It would be of interest to note the effects of the two disorders and their recognition when occurring together.

Hemoperitoneum is a rare complication of acute cholecystitis. Early recognition and prompt intervention are the most crucial steps in the management of gall stone-induced complication. Presented here is a rare case report of a patient who developed a life-treatening hemoperitoneum due to erosion of the cystic artery by cholelithiasis and cholecystitis. Up to the knowledge of authors 45 similar cases have been reported between 1858 and 2000.

Zellweger syndrome, an autosomal recessive disorder, is generally considered as the prototype of the group of the rare peroxisomal disorders. Infants with Zellweger syndrome have a striking constellation of clinical features, which usually suggests the diagnosis. The condition has been reported in all races and from all parts of the world. Considerable progress has been made recently in the biochemical and molecular aspects of the disease as well as identifying the genetic defects involved. Here we present a case of Zellweger syndrome and discuss the pathophysiology of the disease. To our knowledge, this is the first case of Zellweger syndrome reported from United Arab Emirates.

The number of cases of non-A, non-B post transfusion hepatitis was significantly reduced after the discovery of hepatitis C virus (HCV) and subsequent introduction of routine screening of blood donors for IICV antibody. The recently discovered hepatitis G virus/GB virus C[HGV/GBV-C] was initially implicated an etiologic agent for the small number of residual cases of post-transfusion hepatitis. It is possible that cases of non A. non-B, non-C post transfusion hepatitis are caused by yet undiscovered infectious agents.By means of representational difference analysis, a viral clone (N22) of 500 nucleotides was isolated from serum of a patient (TT) with post-transfusion hepatitis of unknown etiology. The N22 clone showed a poor homology to any reported sequences. Oligonucleotide primers were deduced from the N22 sequence in serum banded at a sucrose of 1.26g/cm3, indicating its association with a viral particle which was designated TT virus (TTV). Since nucleic acid of TTV was sensitive to DNAase 1, it would be a DNA virus, TTV DNA was detected in sera from three of the five patients with post-transfusion non-A to G hepatitis, including the index case (TT). TTV DNA titers closely correlated with aminotransferase levels in the three patients. These results indicate that TTV would be a novel DNA virus with a possible capacity to induce post-transfusion non-A to G hepatitis. This was the first report of TTV infection in 1997….

The first day of Shahrivar (August 22) is the birth-day of Ibn-Sina. It is called as the ‘Physician’s Day’ in Iran. So, a brief biography of Ibn-Sina is presented here. ...