Iranian Red Crescent Medical Journal
Year:2009 | Volume:11 | Issue:1|Papers Count:23

This paper sets off with an argument that as an outcome of modernism, medical sciences excluded human soul and spirit and followed a more, if not mere, mechanico-chemical approach in treating patients. It then discusses alternative approaches to medicine and that models of medicine and health care are looking into not only the fundamental spiritual dimension of care, but also the significance of spiritual development of the individual towards healing. The paper presents Avicenna as a forerunner in medical sciences with a (w) holistic view while his contribution to cure and healing will be highlighted. The paper will end with some concluding remarks.

Nutrition is a subject of interest in many fields of medicine. So ophthalmologists have also attempted to find possible ways to preserve vision through diet and supplements. Ocular disorders such as cataracts, age-related macular degeneration and glaucoma are the leading causes of visual impairment and blindness in the world, so most of the studies have focused on these major disorders and nutritions containing antioxidant such as vitamin C and E. Zexanthin/luteins and omega 3 have been the main substances studied in this relation. Although benefits of the regimens with high amounts of antioxidants were observed in reducing progression of cataract, agerelated macular degeneration and so on, as many of these studies have been observational, the cause and effect relationship cannot be definitely concluded and multiple cohort prospective studies will be desired to evaluate the exact role of nutrition. Somehow, a healthy diet which means the diet which increases our health can be achieved in regimens with low saturated fatty acids and rich in fresh fruits, vegetables and fish. On the whole, even though they may not affect disease progression, they are generally good for overall health.

Background: Sophora moorcroftiana (Wallich) is an endemic shrub species in Tibet, China, and is a plant with a great value in folk medicine. The previous studies had shown that the ethanolic (95%) extracts were much more effective than other extracts from Sophora moorcroftiana seeds on antiproliferative effects, inducing apoptosis in the human stomach cancer SGC-7901 cell line in vitro.Methods: To investigate the antitumor activity of the ethanolic extracts from Sophora moorcroftiana seeds, various doses of ethanolic extracts (200 mg/kg/d, 400 mg/kg/d, 800 mg/Kg/d) were administered via gavage to tumorbearing mice with S180 sarcoma cell for ten days. The weights of tumor tissue stripped from the left flank, TNF-a and IL-2 in blood-serum were tested and analyzed for photochemical composition, using standard procedures. Results: The weight of tumor tissue was significantly decreased upon the treatment with ethanol extracts, but the decrease was more prominent in the group receiving ethanol extracts treatment at 800 mg/kg/d (1.35±0.21mg) and the inhibition rate on the growth of tumor tissue was higher (28.1%). The structural changes of post-treatment in the tumor tissue by the ethanolic extracts at a dose of 800 mg/kg/d showed larger areas of necrosis and more significantly invaded lymphocytes. IL-2 and TNF-a in serum from the treated mice significantly increased in ethanolic extract-treated groups, compared with the untreated control animals.Conclusion: This suggested that the ethanolic extracts from Sophora moorcroftiana seeds had a weak antitumor role and in high concentration to tumor-bearing mice in vivo, the 95% ethanolic extracts was rather effective.

Background: Acne vulgaris is a very common disorder affecting virtually every adolescent at some point in time. Topical treatment of acne involves the use of retinoids and antimicrobials. Antimicrobials reduce P. acne population and are effective for treatment of inflammatory lesions. We evaluated the efficacy and safety of topical ciprofloxacin solution and compared it with topical erythromycin solution.Methods: The study was a prospective single-blind clinical trial. One hundred patients with mild to moderate acne were enrolled. The patients were randomly treated with topical application of 0.3% ciprofloxacin or 4% erythromycin solutions. For a six week period, they were visited every two weeks. Acne severity index (ASI) was calculated in each visit and recorded.Results: Ninety-three patients completed the study, 50 patients in the ciprofloxacin and 43 in the erythromycin groups. Irritation was generally mild for both treatments and no discontinuation was reported because of adverse effects. There was no statistically significant difference between the two treatment groups in reduction of comedons or papules but reduction of pustules was greater in ciprofloxacin treatment group after 4 weeks. ASI was reduced in the two groups but in ciprofloxacin treated patients, this reduction was more significant at all follow up visits.Conclusion: The results of this study indicate that topical solutions of erythromycin and ciprofloxacin were effective in treating mild to moderate acne vulgaris and both were well-tolerated by the patients. Ciprofloxacin solution produced greater reduction in pustule counts and ASI, during the six week period of twice-daily application. This novel modality may have an important potential role in rotational topical therapy of inflammatory acne lesions.

Background: In patients undergoing surgery, acid-base imbalance during general anesthesia causes disruption in the function of cardiovascular, respiratory, musculoskeletal and the central nervous system. Since the potential complications of acid-base disturbances are serious, we decided to explore these changes and related causes so that prevention and compensation would be feasible.Methods: In this study, acid-base disruption and its causes during general anesthesia were studied in 60 patients. The patients were divided into three groups based on the location of surgery: abdominal (I), extremities (II), and head and neck (III). Body central temperature, type, and volume of injected fluids and bicarbonate (as needed) were recorded. In the second, third, and fourth hours of surgery, arterial blood gases and pH were measured.Results: The incidence and degree of metabolic acidosis in all patients were significantly related to the duration of the surgery. The number of patients with acidosis and the number of patients requiring treatment were also greater in groups I and II than in group III. Although all patients became hypothermic during the surgery, there was no significant relationship with development of acidosis. No relationship was found between the type and volume of the solution administered and development of acidosis.Conclusion: In our opinion, monitoring of acid-base status in prolonged surgeries especially in abdominal and extremity operations seems necessary.

Background: Traumas take a heavy toll throughout the world and Iran is increasingly involved in this problem. So, education and training of medical staff for successful handling of traumatic patients seem necessary. In this study, we tried to develop and evaluate a national training program on trauma management to use animal models through a trauma management workshop.Methods: After primary survey and designing an advanced trauma management workshop, 144 practitioners of one armed force were randomly selected to be trained. Participants could experience some practical and new aspects. For example, they handled high velocity traumas and were involved throughout the different phases of trauma management under the supervision of experienced leaders. To assess the program, participants completed open-ended (essay), multiple-choice question (MCQ), and skill exams before and after the workshop.Results: A trauma training program was developed and evaluated. In essay exam, scores significantly increased from 26 to 58, MCQ scores significantly rose from 49 to 65, and the participant’s practical competency significantly improved from 46 to 75.Conclusion: Immense attention is required to optimize doctors’ training in trauma care to avoid fossilization of cognitive knowledge and skills.

Background: Postoperative pain is a major poorly managed problem in millions of operations performed all over the world each year. Since infiltration of the operative field with lidocain as a local anesthetic is very cheap, it is easily available, and there are few side effects, this study aimed to evaluate its efficacy on post-op-pain of patients undergoing open intervertebral disc surgery.Methods: In this double blind clinical trial on 188 patients undergoing elective open intervertebral disc operation, the surgical incision site was infiltrated with 2 ml of 1/500,000 epinephrine for each centimeter in the control group and the same solution with 20 mg lidocain for each centimeter of the incision in the case group. Post-oppain was measured with visual analog scale (VAS) in the 6th, 12th, 24th, and 48th hours.Results: The mean age was 41.8±12.4 for the study group, and 43.5±15.6 for the control one. Statistical analysis revealed no significant difference in pain severity in females, but for males it was significant at the 6th and 24th hours. Interestingly, it was more severe in those receiving lidocain. The amount of narcotics used postoperatively revealed no significant difference in the groups.Conclusion: Lidocain used locally before skin incision has no effect on reducing post-op-pain, post-op-narcotics demand, and duration of hospital stay.

Background: Evaluating the radiological and functional results of surgical treatment of unstable pelvic injuries by spinopelvic fixation. The purpose of this study was to find out whether the surgical technique can reduce fractures of the sacrum and dislocations of the sacroiliac joint and provide pelvis with stable fixation.Methods: Ten vertical shearing pelvic fractures were treated by pedicular screw placement in L5 vertebra and in the wing of the ilium. According to Tile’s classification system, there were 10 type C fractures (8 type C1, one type C2 and one type C3). The patients were evaluated by plain radiographs at a mean follow-up period of 2 years (range 1-3 years) after surgery.Results: The patients had a mean age of 37.3 years at the time of surgery. The fracture was reduced by skeletal traction under general anesthesia and in prone position. A pedicular screw was placed in L5 vertebra on the same side of the fracture. Another screw was placed into the pelvic wing from PSIS (posterior superior iliac spine) toward AIIS (anterior inferior iliac spine). A molded titanium rod connected these two pedicular screws.Conclusion: This study supports the use of screw and rod system for posterior fixation of the VS injuries of the pelvis.

Background: Human cytomegalovirus (HCMV) has been an enormous threat for bone marrow transplant (BMT) recipients. For active and/or latent HCMV infection, diagnosis of the risk factors which increase the risk of posttransplant morbidity and mortality seems necessary. In this research, some of the HCMV risk factors were monitored and compared with HCMV molecular diagnostic methods for better detection of HCMV infection in BMT patients Methods: HCMV risk factors including clinical, biological, biochemical, haematological indexes, and also anti-HCMV and transplant prophylactic and therapeutic conditioning regimens were monitored from March 2002 to March 2006, in 104 BMT patients referred to BMT Unit of Nemazee Hospital in Shiraz University of Medical Sciences and was compared with HCMV molecular methods for BMT donors and recipients' pre- and posttransplantation.Results: Anti-HCMV-lgM was detected in 9.6% and 6.7% of BMT recipients and donors, respectively. Anti-HCMV-lgG was also detected in 8.7% and 9.1% of recipients and donors, pre-transplant, respectively. HCMVPCR results were positive in 20% of recipients and 33.3% of donors. Significant correlations were observed between HCMV positive results and the use of a therapeutic dose, but not the prophylactic dose of glucocorticoids and cyclosporine, pre and post-transplantation. Fasting blood sugar, creatinine, globulin, and liver enzymes levels such as alkaline phosphates and asparagine transpherase significantly correlated with detection of HCMVDNA in transplant patients. Also, negative results of HCMV-PCR significantly correlated with the use of prophylactic dose of acyclovir in BMT patients.Conclusion: Significant correlations of positive and negative HCMV-PCR results with HCMV disease risk factors suggest the possible role of these factors on prognosis and monitoring of HCMV disease in BMT recipients preand post-transplantation.

Background: It is well accepted that intraocular pressure should be controlled during general anesthesia (G/A) for intraocular procedures. This study was performed to compare the effects of the laryngeal and tracheal tubes on intraocular pressure (IOP), mean arterial pressure (MAP) and heart rate (HR) during the course of G/A.Methods: Eighty adult patients were randomly allocated to two groups for cataract surgery. Group A (n=40) underwent laryngeal tube (LT) placement and group B (n=40) had tracheal tube (TT) insertion. Anesthesia was induced by midazolam, fentanyl, propofol and atracurium and was maintained by propofol and 50% nitrous oxide in oxygen. IOP, MAP and HR were measured before and 3 minutes after induction of G/A, 1 and 5 minutes after tube placement, at the end of the operation, and 1 minute after extubation.Results: The IOP at 1 minute after removal of the tubes was significantly higher in the TT group than the LT group. The MAP at 1 minute and heart rate at 1 and 5 minutes after placement of the tubes were significantly higher in TT group than the LT group.Conclusion: In the course of G/A, using the same anesthetic agents such as propofol, and atracurium, LT had better control than TT on IOP, MAP and HR.

Background: Most women who report increased levels of physical activity are not at an increased risk of preterm delivery or reduced intrauterine growth. This study was conducted to look into the safety and effects of regularly timed aerobic exercises during pregnancy on both the mother and the neonate.Methods: A prospective, case-control study was done on 120 healthy pregnant women in their first trimester. The data were collected in the prenatal outpatient care, labor and delivery rooms of a university-based Obstetrics Department. After completing basic information forms, the pregnant women were educated on the specific exercises in 8 stages throughout the pregnancy. Sixty-three patients presenting for delivery without any history of physical exercise were selected as the control group.Results: There was no significant difference between the two groups regarding their occupation. The exercising group experienced significantly decreased durations of labor. There was no significant difference in neonatal birth weight or apgar scores. There were a significant decreased number of assisted deliveries in the exercising group.Conclusion: Exercise during pregnancy shortens the duration of the second stage of labor and reduces the risk of assisted delivery while is safe for the neonate too.

Background: BioGlue is a newly introduced sealant applied by several cardiovascular surgeons to seal graft anastomoses. This study was carried out to determine the effect of a synthetic BioGlue on the repair of meninges in comparison with contemporary bioadhesives.Methods: A synthetic BioGlue was provided by combining 45% human serum albumin and 10% glutaraldehyde. Forty Wistar female rats were randomly divided into 4 equal groups (Two case and two control groups). After craniotomy, dural incision was performed and the motor cortex was exposed. In the case group, the motor cortex was exposed to BioGlue and in the control group, the incision was closed without application of BioGlue. The rats were studied histpathologically after 5 and 14 days postcraniotomy.Results: Synthetic BioGlue caused an acute inflammatory response that resulted in a delayed gliosis in the superficial cerebral cortex, but the deep layers and adjacent areas of cortex were spared. Inflammatory changes and gliosis did not cause cell apoptosis or necrosis. Histopathological changes did not have any clinical significance as they were not accompanied by any neurological deficit or motor weaknesses and exposure to synthetic BioGlue could not cause any clinically significant neurological deficit either.Conclusion: The simplicity of producing this new synthetic BioGlue and its relative low cost, compared to other similar glues, opens a new horizon to the use of this synthetic BioGlueÒ in the neurosurgical field.

Background: Different natural and synthetic materials were used for temporary burn wound coverage; however, they are associated with disadvantages including high price which prohibit their widespread use, especially in developing countries. Among all, human amniotic membrane is the only easily available and cost free coverage. Its effects on burn wounds have been studied in this survey.Methods: One-hundred and twenty four patients with 20-50% second and third degree burns and without any other disease were randomly assigned into two groups. The first 61 patients (control group) underwent traditional method of dressing with silver sulfadiazine and gauze which were changed twice a day. The remaining 63 patients underwent dressing with human amniotic membrane (amnion group), being changed every 3-4 days.Results: Patients in the control group had significantly lower albumin and needed more albumin infusion (231.80±234 gr. versus 111.51±143.82 gr.), received more blood transfusion (1.75± 2.52 bags versus 0.65± 1.18 bags), had significantly more intense pain and so received more narcotics than amnion group (7.97±12.85doses versus 3.84±7.56). Wound infection was higher in the control group (65.66% versus 46.91%) and so was the incidence of sepsis (24.62% versus 6.10%). There was 8.53% mortality in the control group versus 0% in the amnion group. All of the above-mentioned differences were statistically significant.Conclusions: Amniotic membrane dressing in deep and more extensive burns leads to better homeostatic, immunologic and local results and because of its low price, its use is strongly recommended.

Background: Tuberculosis is one of the most common diseases among HIV-infected patients. A person with a positive tuberculin skin test (TST) acquiring HIV infection has a 3-13% annual risk of developing active tuberculosis. The diagnosis of TB in HIV infected patients may be difficult. QuantiFERON-TB Gold (QFT-G) test is a novel method as an aid for diagnosis of Mycobacterium tuberculosis infection. We evaluated the association between TST and QFT-G test in latent TB infection (LTBI) and TB in HIV-infected patients.Methods: One hundred and seventy six HIV-infected subjects from Shiraz Consultation and Behavioral Modification Center (SCBMC) entered our study. The individuals were screened for TST, using 5TU purified protein derivative (PPD). Also, blood sample was provided for QFT, measuring INF-g response to M. tuberculosis antigen.Results: Of 176 participants, 98.3% returned for evaluation of TST results. Among them, 63% and 37% were negative and positive for TST, respectively. All the participants returned for QFT-G sampling. Of them, 64.8% and 27.8% were respectively negative and positive for the test and 7.4% showed undetermined results. The agreement between PPD and QFT-G in their negative results was 39.9% and 8.1% in their positive results and the overall agreement was 50%. Disagreement of TST-/QFT+ was noticed in 19.7% of the subjects and TST+/QFT- disagreement in 24.9%. CD4+ count <100 mm3 was seen in 5.9%, ³100 and < 200 mm3 in 17.1% and CD4+ T cell count³200 mm3 in 76.9% of subjects.Conclusion: As the agreement rate between QFT-G and TST in HIV-infected patients was fair, a strategy of simultaneous TST and QFT-G testing would maximize the potential for LTBI diagnosis in HIV-infected subjects.

Background: There have been many studies in the literature on the advantages and disadvantages of bilateral versus staged or unilateral knee arthroplasty. In this study, the results of bilateral and unilateral total knee arthroplasty cases during the past 3 years were compared.Methods: The records of all cases undergoing total knee arthroplasty between March 2005 and February 2008 were studied retrospectively. There have been 62 patients (105 knees) operated, from seven different countries. Among these cases, 43 cases had bilateral TKA, from which 36 patients underwent simultaneous intervention, four patients had staged TKA with one-week gap and three cases were staged with one-year gap between interventions.Results: Except for two cases of postoperative delirium (probably due to transient fat emboli) and three cases of transient renal impairment, there had been no complications in the simultaneous bilateral cases. The need of blood transfusion was significantly higher in simultaneous cases (1.7 unit/patient) compared to unilateral cases (0.6 unit/patient).Conclusion: There were no major problems with the simultaneous bilateral total knee arthroplasty. In the case of bilateral varus deformity, the postoperative rehabilitation was easier and the patients were more satisfied. Moreover, considering the fact that most of our patients came from various countries, simultaneous total knee replacement effectively reduced the hospitalization costs and related expenses.

Background: Road traffic accidents (RTA) is recognized internationally as the major threat to human health and, motorcycle collision victims form a high proportion of those killed or injured in RTA.This study was performed to evaluate the patterns of motorcyclist’s mortalities.Methods: All motorcyclists’ corpses that were presented to the legal medicine center of Mazandaran Province during January 2002 to January 2004 were enrolled and the patterns of motorcyclist’s mortalities were determined.Results: Of the 89 bodies, 93.3% were male and 84.2% were riders. About 60% sustained injuries from collision with a car. Two third of the deaths occurred in the first half of the year. Three fourth of the death occurred in heavy traffic volume time of a day (7 am to 10 pm) peaking at 9 pm (21%). Fifty seven percent died on the rural roads collisions and 47% on the urban road collisions. Head injury was the main cause of death (50.6%).Conclusion: Motorcyclist’s mortalities were prevalent in young motorcycle riders (males), collision with a car, first half of the year, heavy traffic volume time, riding on rural roads, and head injury was the main cause of death.

Background: Burn injuries are in many respects the most of all tragedies an individual can experience. So there was an attempt to quantify the frequency of burn injuries, identify the risk and predisposing factors, determine the health outcomes at Imam Khomeini Hospital in Urmia, westen Iran.Methods: From March 2005 to March 2006, all demographic and epidemiological information of 639 patients (48.36% female and 51.64% male) about the burns and the complications were provided from the records of patients at Imam Khomeini Hospital in Urmia, Western Azarbaijan Province, westen Iran.Results: The incidence rate of burn hospitalization was 21.6 per 100.000. Almost 31.8% of admissions were in the 16-25 years age group. Pediatric (<5 years) and geriatric (>65 Years) burns were (21.6%) and (3.2%), respectively. Burning with flame, the most common cause of burning, accounted for 36.4% of admissions in males and for 43.6% in females. The mortality rate was 25.9%. The percentage of patients who had more than 40% body surface area (BSA) burn was 30.9%. Patients with >40% BSA burn had a mortality of 76.7%. The mean BSA burn was 33.8% in males and 25.2% in females. Admissions from Urmia were the most among the cities of the province. The mean duration of hospitalization was 7.76 days. The most cases occurred from October 22 to November 22; 10.95%) and from Jun 21 to July 21; 9.54%).Conclusion: The results of this study help to guide health care efforts towards the prevention of burn injuries and provide a valuable baseline for assessing future efforts directed toward the prevention of burn injuries.

Background: The persistence of HBV-DNA in the serum of hepatitis B surface antigen negative individuals with or without the presence of HBV antibodies is termed occult HBV infection.Methods: From April 2005 to November 2006, we evaluated 110 patients who had only a positive test for anti-HBc.Results: Out of 110 anti-HBc positive samples, HBV-DNA was detected in three cases. Positive samples for HBV-DNA had a level normal of ALT.Conclusion: HBV-DNA can be detected among anti-HBc only positive samples. Therefore, further testing for detection of HBV-DNA is recommended on each anti-HBc only positive individual.

Background: Reports of renal scar formation in children even in the absence of vesicoureteral reflux necessitates studying other causes of this major complication. The present study mainly focuses on the role of recurrent urinary tract infections (UTI) in renal scar formation.Methods: The records of 53 patients with recurrent UTI and the data on their regular follow up visits were reviewed. Renal scar formation was confirmed by dimercapto-succinic acid (DMSA) scan.Results: DMSA scan, done at a mean age of 8.31 years, revealed renal scar formation in 12 cases (22.44%). Seventy-five percent of the patients with scar formation and 80.5% without scar were older than 3 years at the time of the first documented UTI. The etiologic organism was found to be Escherichia coli in 89.2% of the infections in the scar forming versus 78.8% in the non-scar forming group.Conclusion: In the presence of normal urinary tract anatomy, recurrent UTI can be a significant cause of renal scar formation in children.

Leiomyosarcoma of the inferior vena cava (IVC) is a rare sarcoma, but it is the most common primary malignancy of the IVC. It has an extremely gloomy prognosis. We describe a 40 year-old white female complaining of abdominal fullness for 7 weeks before she sought medical assistance. Initial work-up including sonography and computed tomography showed a huge tumoral mass in the abdominal cavity seemingly originating from the IVC with displacement of the right ureter and hydronephrosis. The patient underwent surgical resection of the tumor. Pathologic diagnosis was leiomyosarcoma. Postoperatively, she was placed on coumadin and adjuvant chemotherapy was started. Considering the aggressiveness of this tumor, early radical enblock resection with clear margins is still the only chance for long-term survival.

A 43-year-old woman presented with headache, nausea, severe visual impairment and galactorrhea and decreased visual acuity. A 4´3.5´3 cm mass completely filling the sphenoid sinus, elevating the pituitary gland and stalk was observed. The patient underwent transsphenoidal removal of the lesion to alleviate visual loss. The tumor cells showed strong positivity for thyroglobulin and TTF-1. This patient was followed up for 2 years after the operation; the laboratory study and computed tomography showed no lesions. In conclusion, this is a rare benign finding in which complete surgical resection achieves a cure.

We have described a benign osteoblastic lesion in the right temporal bone in a 26 year-old girl who presented with a swell mass on the right supra-auricular area and tinnitus of 17 years duration. She had been operated conservatively through middle cranial fossa approach 17 years ago. After that time the patient has had no problem. There was no other developed neurologic deficit or evidence of malignant change throughout the 17 years. When we compared serial CT scans (the old and new films), there was no important difference between them. During a 17-year follow up period, no progression of the tumor was detected. Conservative treatment for such cases is suggested.

In atherosclerosis, the distal abdominal aorta and the iliac arteries are the most common sites of involvement. Aortoiliac occlusive disease rarely occurs in a younger group of patients (aged in their mid-50s), as compared with patients suffering from femoropopliteal disease. It also differs from the disease of the femoral-popliteal-tibial segment since it is rarely limb threatening. Symptoms typically consist of bilateral thigh or buttock claudication and fatigue. Men report diminished penile tumescence, and later there may be complete failure of erectile function. These symptoms constitute Leriche's syndrome. Rest pain is unusual with isolated aortoiliac disease. Femoral pulses are usually diminished or absent. There are usually no stigmata of ischemia unless distal disease coexists. A small group of patients report a prolonged history of thigh and buttock claudication that has recently become more severe. It is likely that this group has underlying significant aortoiliac disease that has suddenly progressed to acute occlusion of the terminal aorta5 as in the patient discussed in this article.