Iranian Red Crescent Medical Journal
Year:2013 | Volume:15 | Issue:11|Papers Count:19

Background: Pilonidal is a painful disease which occurs mainly in the sacrococcygeal area. In 1833 Herbert Mayo first reported a case of a young woman with a hair-containing sinus in the sacrococcygeal area. In 1880, Hodge suggested the term “pilonidal” from the Latin “pilus” for hair and “nidus” meaning nest.Objectives: Effect of using autologous platelet-rich plasma (PRP) on pain reduction in patients with pilonidal abscess, subjected to extensive surgical removal tissue, was investigated through a clinical trial.Patients and Methods: The trial was conducted on two groups from the Center for Surgical Research at Mashhad University of Medical Sciences located at Ghaem hospital in Mashhad city in 2011. Purposive sampling was conducted and the samples were randomly assigned to two groups including test and control. All of the patients referred to the surgical unit of Imam-Reza hospital with acute pilonidal abscess (sacrococcygeal abscess) were considered and randomly assigned to two groups. Patients’ dressing was not removed for two days. To avoid systematic errors (Bias), the resident who checked the wound for the first time was completely unaware of the patient’s treatment plan. Recovery process and wound healing were monitored for the two groups and compared with each other (every other day for 10 days, and then once a week until complete healing). Data analysis was performed using SPSS19 software with Chi-square, independent t, and Mann-Whitney tests.Results: Based on the obtained results it was found that the pain in the test group was significantly reduced in the first and fourth weeks (P < 0.05), compared to the control group.Conclusions: Therefore, it has been demonstrated that using PRP can significantly reduce pain in patients subjected to surgical treatment for their pilonidal abscess.

A hiccup is the result of an involuntary, intermittent spasmodic contraction of the diaphragm and the inspiratory intercostal muscles. Based on Iranian Traditional Medicine, hiccups are stomach diseases and movements in the stomach with the combination of spasmodic contraction followed by a stretching distention (1). Although hiccups may be a temporary action which need no treatment, sometimes a refractory hiccup would be disturbing to a normal life. According to Avicenna, a hiccup may occur due to different causes, one of which occurs because of liver obstruction. We experienced the successful use of Chicory to cure two cases of hiccups caused by liver obstruction and inflammation in digestion Clinic of Shahid Beheshti Medical Faculty. The first case was a 78 year old male with two years of refractory and chronic hiccup, who was under a common drug treatment. Due to his refusal in using the drugs because of their side effects, his hiccups were continuous and loud enough to disturb his sleep, eating routines. It also was so severe that made him depressed.

Background: It was shown that plants derived agents are being used for treatment of cancer. In this study, crude ethanolic extract of Consolida orientalis L., Ferula assa-foetida L., Coronilla varia L., Orobanche orientalis G. Beck were screened in vitro for cytotoxic activity on Hela (Human cervical carcinoma) cell line.Objectives: We performed the present study to evaluate the in vitro cytotoxic activity of four plant extracts that we gathered from north of Iran, Mazandaran.Materials and Methods: Hela cells were treated with various concentrations of individual samples (0.0312, 0.0625, 0.125, 0.25, 0.5, 1, 2.5, 5, 7.5 and 10 mg/ml) for 72 hours. Cell proliferation measured by MTT assay.Results: Result from the performed assay showed that ethanolic extract of Consolida orientalis L., Ferula assa-foetida L., Coronilla varia L. has more significant cytotoxicity effect on Hela cell line than Orobanche orientalis G. Beck.Conclusions: Extracts of the Consolida orientalis L., Ferula assa-foetida L., Coronilla varia L. could be considered as potential sources of anticancer compounds but further studies are necessary for isolation and identification of biologically active substances.

Background: Leptospirosis is a worldwide zoonosis caused by pathogenic Leptospira species. A major challenge of this disease is the application of basic research to improve diagnostic methods and related vaccine development. Outer membrane proteins of Leptospira are potential candidates that may be useful as diagnostic or immunogenic factors in treatment and analysis of the disease.Objectives: To develop an effective subunit vaccine against prevalent pathogenic Leptospira species, we sequenced and analyzed the LipL 32 gene from three different Leptospira interrogans (L.interrogans) vaccinal serovars in Iran.Materials and Methods: Following DNA extraction from these three serovars, the related LipL32 genes were amplified and cloned in the pTZ57R/T vector. Recombinant clones were confirmed by colony- PCR and DNA sequencing. The related sequences were subjected to homology analysis by comparing them to sequences in the Genbank database.Results: The LipL32 sequences were>94% homologous among the vaccinal and other pathogenic Leptospira serovars in GenBank. This result indicates the conservation of this gene within the pathogenic Leptospires.Conclusions: The cloned gene in this study may provide a potentially suitable platform for development of a variety of applications such as serological diagnostic tests or recombinant vaccines against leptospirosis.

Background: To assess maternal confidence in her ability to cope with labor, a measure of childbirth self-efficacy is necessary.Objectives: This paper aims to assess the cultural adaptation and psychometric testing of the short form of childbirth self-efficacy Inventory among Iranian pregnant women.Patients and Methods: In this descriptive-methodological study, we investigated 383 Iranian pregnant women in the third trimester. They were recruited from the outpatient prenatal care clinic of Taleghani Hospital and an urban health center from August to November 2011. Content validity was evaluated by a panel of specialists after adding two religious items. The women completed the inventory and the demographic characteristics questionnaire in an interview room. The internal consistency and construct validity were assessed by Cronbach’s alpha and by exploratory and confirmatory factor analyses, respectively. Known group analysis on gravity assessed the discriminant validity of the measure.Results: Content validity of the short form of the Iranian childbirth self-efficacy Inventory was confirmed. Factor analyses supported the conceptual two-factor structure of measure and hence supported its construct validity. The internal consistency was approved for the total scale and both subscales. The instrument differentiated prim gravid from multigravida women in the total scale and the efficacy expectancy subscale.Conclusions: Validity and reliability of the measure supports the use of the short form of the instrument as a clinical and research instrument in measuring childbirth self-efficacy among Iranian pregnant women.

Background: Osteoid osteomas account for approximately 2-3% of all primary bone neoplasm's sampled for biopsy. 50% of all of them occur in the long bones of the lower extremities, but osteoid osteoma of the coracoid process is rare. We have found only nine previously reported cases of coracoid osteoid osteoma in the international literature. We report a child with coracoid base osteoid osteoma.Case presentation: A twelve-years-old boy with a persistent pain at the right shoulder since 9 months ago, were evaluated. His pain relatively responds to non-steroidal anti-inflammatory drugs (NSAIDs). Imaging studies showed foci of sclerosis at right coracoid base with increased uptake on the Technetium-99m study. Because proximity to the neurovascular bundle we couldn’t use radiofrequency ablation technique, so the patient underwent open surgery with a mini- deltopectoral approach and two level osteotomies ; one proximal to coracoid tip and the other at the base of coracoid just distal to subcoracoidphyseal line. Then a segment of coracoid resected. Tip of coracoid securely reattached with a screw.Conclusions: To our knowledge in the literature up to now there are only nine reports of coracoid osteoid osteoma. These cases were treated with different approaches and different techniques. We used en-bloc resection via mini-anterior approach. Our patient 30 months after surgery (October 2012) have full range of motion and became pain free since wound healing with normal control imaging.Definite diagnosis of osteoid osteoma in the uncommon sites may be delayed. En bloc resection of tumor with two osteotomies by an anterior approach has been limited soft tissue injury and is a reliable method of treatment.

Background: Alpha-1 antitrypsin deficiency is a genetic disease which affects both lung and liver. This disease is a recognized factor for chronic obstructive pulmonary disease (COPD). However its importance as the cause of COPD in a country such as Iran is unclear.Objectives: This study was conducted to find out the role of α-1 antitrypsin deficiency as a cause of COPD in Iranian patients.Materials and Methods: The serum concentration of α-1 antitrypsin was determined and the genotype of a-1 antitrypsin was also evaluated by PCR-RFLP in 130 patients with COPD and 50 normal healthy blood donors.Results: No α-1 antitrypsin deficient case was found in normal healthy people and COPD patients.Conclusions: Our results clarify that deficiency of α-antitrypsin is not a major cause of COPD in Iranian patients.

Background: A few studies are available actually comparing the clinical efficacy of intravenous acetaminophen with other medications such as dexamethasone to inhibit postoperative adverse events in children.Objectives: This randomized blinded controlled trial was designed to compare controlling status of postoperative events in children after tonsillectomy randomized to receive either intravenous acetaminophen or dexamethasone.Patients and Methods: Eighty four children aged between 4 to 13 undergoing tonsillectomy were randomized using a computer-generated schedule to double-blind treatment with intravenous acetaminophen (15 mg/kg) or intravenous dexamethasone (0.1 mg/kg). Children were post-operatively assessed for swallowing pain, pain while opening mouth, ear pain, and postoperative sore throat in recovery room (within one hour after surgery), at the time of admission to the ward, as well as at 12 and 24 hours after surgery, assessed by the objective pain scoring system (OPS; minimum score: 0 = no pain, maximum score: 10 = extreme pain).Results: There were no significant differences between the two groups with regard to the severity of postoperative pain due to swallowing or opening mouth measured at the different study time points from postoperative recovery to 24 hours after the surgery. There was no difference in ear pain severity at the time of postoperative recovery, at the admission time to ward and also at 12 hours after surgery; however mean score of ear pain severity was significantly higher in those who administered acetaminophen 24 hours after operation. Also, the mean score severity of sore throat was significantly higher in the acetaminophen compared with the dexamethasone group within 12 hours of surgery. Postoperative vomiting and bleeding were similarly observed between the two study groups. The severity of swallowing pain, pain while opening mouth, ear pain, as well as postoperative sore throat as gradually assuaged within 24 hours of tonsillectomy in both groups, however no between-group differences were observed in the trend of the severity of these events.Conclusions: The dexamethasone-based regimen may have more advantage over the intravenous acetaminophen regimen for inhibiting pain and PONV following tonsillectomy in children.

Background: Evidence-based medicine would come to the result by evidence-based implementation. Clinical Practice Guidelines (CPG) as one of the evidence-based knowledge products requires appropriate interventions after being produced to be applied.Objectives: The aim of this qualitative study was to identify the strategies for application of CPGs produced in Iran.Materials and Methods: The purposive snowball sampling was performed and it continued until reaching the theoretical saturation. In-depth semistructured individual interviews and Focus Group Discussion (FGD) were performed aiming at triangulation. The thematic framework approach was used for the analysis.Results: Twelve interviews were conducted with three health system policy makers and decision makers, four experienced in the production or adaptation of clinical practices, and five experts in evidence-based medicine development and education. In addition, 11 policy makers, managers, and decision makers of the health system took part in FGD. The proposed interventions were classified in the following themes: Health professionals-oriented, Financial, Organizational, Regulatory, and Multifaceted interventions.Conclusions: Along with adaptation and development process of CPGs, their utilization should also be planned; otherwise spent time and money would be in vain. Certainly, imposing above-mentioned interventions with the ultimate goal of sustainable behavior change in health system service providers is beyond the capacity of specific groups or few academic centers. It requires the participation of all practitioners under the monitoring and support of the Ministry of Health and Medical Education. Deployment of the family physician plan and referral system is an opportunity which must be considered a trophy.

Background: The nocturnal enuresis is one of the most common complaints of childhood. Upper airway obstruction and nocturnal snoring affect the nocturnal enuresis in children.Objectives: The aim of this study was to investigate the effects of breathing exercises on the nocturnal enuresis in the children with the sleep-disordered breathing.Patients and Methods: This study was conducted in year of 2011 by a semi-experimental design with the control group among 40 children, aged 6-12 years, who had the nocturnal enuresis. Participants were examined based on the criteria of nocturnal enuresis, oral breathing, and nocturnal snoring. Subsequently, they were randomly assigned to the case and control groups. In the case group, the breathing exercises were performed for 45 minutes, and were pursued for four weeks in the morning following and prior to sleeping, and subsequently the arterial blood gases were measured and the frequency of enuresis and the respiratory rates (RR) were recorded.Results: After intervention the means of PaCO2 and RR in the control group were significantly higher than the case group (P<0.0001). Likewise, O2sat, PaO2 in the case group were higher than the control group (P<0.0001). The nocturnal enuresis decreased significantly in the case group, compared to the control group (P<0.0001).Conclusions: This study suggests that the breathing exercises may reduce the frequency of nocturnal enuresis in the patients with the oral breathing and nocturnal snore. The clinical implications of these findings should be verified in the future longitudinal studies.

Background: About 46 million induced abortions occur in the world annually. The studies have reported 80000 cases of induced abortions in Iran annually.Objectives: This qualitative study was conducted to identify the causes of unsafe abortion in Iran from the standpoint of three groups of experts, women with a history of abortion or unwanted pregnancy and service providers.Patients and Methods: A total of 72 in-depth semi structured interviews were conducted in 2012 in Tehran and Shahroud. After coordination with 8 experts, sampling from them was done using the Snowballing method in their offices. Sampling from 28 married and 10 engaged women with a history of unwanted pregnancy or unsafe abortion and 12 providers was done in health care centers and a in number of gynecologists’ and midwives’ offices. Sampling from women with a history of unwanted pregnancy or unsafe abortion such as single women, HIV positive women and drug users, and women who had sexual intercourse for money was started by referring to the social rehabilitation center for women and continued using the snowballing method due to difficulties in accessing them. Participants were from different ethnic groups including Fars, Gilaki, Mazandarani, Arab, Azerbaijani, and Lor. Content analysis was performed on collected data.Results: Based on the results of the interviews, participants have abortion for following reasons: 1. Wanted pregnancy (sub categories: fetal abnormalities, Concern about fetal health and lack of trust to prenatal diagnostic methods, Fetal sex, Lack of independent and free decision making regarding pregnancy in women, 2. Unwanted pregnancy (sub-categories: Socio-economic factors, Beliefs and feelings, Lack of information about family planning) 3. Predisposing factors (sub-categories: Lack of information on religious aspects of abortion, Easy access to easy abortion methods). Some people, despite having unwanted pregnancy due to social, economic, cultural and family grounds, continued their pregnancy and did not have an abortion for the following reasons: Religious beliefs, Beliefs (fear of punishment in the afterlife and believing in fate) , Attachment to the unborn baby, Influence of the other people’s opinions (physician, mother or spouse) Late diagnosis of pregnancy, Unsuccessful abortion attempts (Self-treatment, Unsuccessful medical abortion), Economic weakness and arbitrary treatment.Conclusions: In the present study, women who continued their pregnancy despite being unwanted were also interviewed. Although they had the same social, economic, cultural, and family problems as women with a history of unsafe abortion and had easy access to abortion, analysis showed that the difference in religious beliefs between the two groups was the most important factor that led women to choose two different approaches. The authors believe that in-depth analysis of people’s beliefs and opinions in this regard and correction of false beliefs plays a crucial role in decreasing the rate of unsafe abortion.

Background: Research suggests that fixation disparity data are extremely useful in the assessment of the binocular and accommodative systems.Objectives: The purpose of this study was to evaluate fixation disparity curve (FDC) parameters with a modified near Mallett unit in symptomatic and asymptomatic students of Paramedical Sciences School of Mashhad University of Medical Sciences in 2007.Patients and Methods: In this analytical-descriptive study, 100 students were selected randomly and divided into symptomatic and asymptomatic groups. Fixation disparity curve parameters were determined for each subject and compared in symptomatic and asymptomatic groups.Results: There were more subjects with exo fixation disparity than eso fixation disparity in the study sample. The means for fixation disparity, fixation disparity curve x-intercept, and slope with the modified Mallett unit were each significantly different by Mann-Whitney U test in the symptomatic and asymptomatic groups. Also there was a significant difference in the distributions of fixation disparity curve types in the two symptom groups by Chi-square test.Conclusions: The X-intercepts (point at which the FDC crosses the X-axis) were on average more in the base-in direction, Y-intercepts (point at which the FDC crosses the Y-axis) were shifted in the exo direction, and slopes were steeper in the symptomatic group.

Background: Salmonella typhi, Bacillus anthracis, and Yersinia pestis are some serious human pathogens, which their early diagnosis is of great importance. Salmonella typhi, Bacillus anthracis, and Yersinia pestis cause typhoid fever, anthrax, and plague respectively. These bacteria can be used to make biologic weapons.Objectives: In this study, we designed a new and rapid diagnostic method based on Uniplex and Multiplex PCR method.Materials and Methods: Uniplex and multiplex Polymerase Chain Reaction (PCR) were conducted on virulent genes of hp and invA of Salmonella typhimurium, Pa and chr of Bacillus anthracis, and pla of Yersinia pestis. A genome from other bacteria was used to study the specificity of the primer and the PCR test.Results: Standard strains used in this study showed that primers were specific. As for sensitivity, it was shown that this method can diagnose 1-10 copies of the genome, or 1-10 Colony Forming Units (CFU) for each of the bacteria. All pieces except anthrax were sequenced in PCR to validate the product. DNA fragment resulted from Bacillus anthracis was confirmed by restriction enzyme digestions.Conclusion: The designed methods are accurate, rapid, and inexpensive to find and differentiate these bacteria from similar bacteria. They can be applied for rapid diagnosis of these agents in different specimens, and bioterrorism cases.

Background: Hearing capability plays a principal role on human's communication. Noise-induced hearing loss (NIHL) caused by exposure to high noise levels is a serious socio-economic problem in modern societies. NIHL can either be reversible, resulting in a temporary threshold shifts (TTS) or irreversible, resulting in a permanent threshold shifts (PTS). PTS is often confirmed in the time span of between 2 - 6 weeks. NIHL may be prevented by avoidance of excessive amounts of noise or reducing the sound energy entering the inner ear using hearing protective devices. However, there are some conditions that such prevention is not possible such as noise exceeding the protective capabilities of the hearing protection device, working in military or the person does not tolerate the protection device. Thus the protective agent for preventing NIHL would be useful.Objective: Free radical molecules and consequence oxidative stress have been shown to play a significant role in noise-induced hearing loss. Silymarin is an antioxidant flavonoid complex derived from the herb milk thistle has ability to mitigating the oxidative stress, scavenge free radicals. In the current study, we aimed to evaluate the protective effect of silymarin on noise induced hearing loss in guinea pig by auditory brain stem response.Materials and Methods: Twenty guinea pigs randomly divided into 2 groups. The animals in the experimental group were intraperitoneally injected with 100 mg/kg/day silymarin dissolved in propylene glycol for 6 consecutive days. The control subjects were intraperitoneally injected with propylene glycol for 6 consecutive days. All animals were exposed to 4 kHz octave band noise at 120 dB SPL for 6 hours. Auditory brainstem responses (ABRs) at frequencies of 2, 4, 6, 8, 12, 16 and 20 kHz were precisely recorded before intervention and then on intervals of 0, 3, 10 and 15 days after noise exposure. Data were analyzed using repeated measures ANOVA.Results: Threshold shifts for the experimental group at all frequencies immediately, 3, 10 and 15 days after noise exposure were significantly reduced compared to the control group (P<0.01).Conclusions: The findings indicate a protective effect of silymarin on temporary and permanent noise-induced hearing loss.

Background: Adolescence is the period of stress and strain. Researchers have shown that adolescents without strong social supports would have tendency towards smoking and drug abuse.Objectives: This study aimed to evaluate the relationship between low self-esteem and illegal drug abuse.Materials and Methods: Participants were 943 grades nine to 12 high school students, from Sarakhs during 2010-2011. Adolescents participated in the study, completed two self-report questionnaires. The first questionnaire included questions about individual and family information, smoking and illegal drug abuse history, and the second was the Rosenberg's self-esteem scale.Results: 53.8% of participants were male (507 individuals). The mean Rosenberg self-esteem score was 19.8+5.2, and the most frequent obtained scores were from 22 to 30. The difference of Rosenberg self-esteem score test between students who did not use any substance and those who had a history of smoking or drug abuse like heroin, pills, alcohols, betel nut (Nas) and other drugs (such as Pan and Hookah) was significant (P<0.001). But this difference was not significant for marijuana (hashish) and opium. The difference of mean self-esteem scores between adolescents who lived with both or one of the parents, and those who did not live with any of parents, was significant (P=0.04). There was also a significant association between the number of children in the family and self-esteem score.Conclusions: The current study showed significant association between the Rosenberg self-esteem test results and smoking, and illegal drug abuse like heroin, pills, alcohol, Nas, and other substances. Therefore, increasing self-esteem is essential for preventing the adolescents’ emotional and behavioral disorders. This fact could guide us to the new approaches for smoking and drug-abuse prevention in adolescents.

Background: The main sources of radiation exposure of all living organisms including humans are natural. In fact, radon and its decay products are the cause of 50% of the total dose that is derived from natural sources. Because of the significant health hazards of radon gas, its levels are widely monitored throughout the world. Accordingly, considerable researches have also been carried out in Iran.Objectives: The aim of this research is a systematic review of the most recent studies associated with evaluation of radon gas levels in Iran. The main emphasis of this study was on public exposure to radon gas.Materials and Methods: The most important route of exposure to such radiation is indoor places. In this investigation measurement of radon in water resources, tap water, indoor places and exhalation of radon from building material, the major sources of indoor radon gas emission, were considered.Results: Significantly high levels of radon gas were found mostly in water and residential buildings.Conclusions: It conclusion with regard to the study of building materials, granite stone and adobe coverings cannot be recommended for construction purposes.

Simultaneous dislocation of both interphalangeal (IP) joints of same finger is a highly uncommon finding. And dislocation of metacarpophalangeal (MCP) joint along with interphalangeal joints of thumb are reported in literatures if, scarcely. Here we are reporting the three cases, comprising of double dislocation of IP joints in little finger in two patients and simultaneous MCP and IP joint dislocation in thumb in another third patients as a perusal of rare entity from the northern India.

Background: Auditory scene analysis (ASA) is the process by which the auditory system separates individual sounds in natural-world situations. ASA is a key function of auditory system, and contributes to speech discrimination in noisy backgrounds. It is known that sensorineural hearing loss (SNHL) detrimentally affects auditory function in complex environments, but relatively few studies have focused on the influence of SNHL on higher level processes which are likely involved in auditory perception in different situations.Objectives: The purpose of the current study was to compare the auditory system ability of normally hearing and SNHL subjects using the ASA examination.Materials and Methods: A total of 40 right-handed adults (age range: 18-45 years) participated in this study. The listeners were divided equally into control and mild to moderate SNHL groups. ASA ability was measured using an ABA-ABA sequence. The frequency of the "A" was kept constant at 500, 1000, 2000 or 4000 Hz, while the frequency of the "B" was set at 3 to 80 percent above the" A" tone. For ASA threshold detection, the frequency of the B stimulus was decreased until listeners reported that they could no longer hear two separate sounds.Results: The ASA performance was significantly better for controls than the SNHL group; these differences were more obvious at higher frequencies. We found no significant differences between ASA ability as a function of tone durations in both groups.Conclusions: The present study indicated that SNHL may cause a reduction in perceptual separation of the incoming acoustic information to form accurate representations of our acoustic world.

Background: In recent decades, health care systems has greatly influenced by the technology development. The technology is helpful to enhance quality of care, reduce costs and improve patient care if appropriate training be applied for technology users. Technology user’s training has been studied in some quantitative studies; however, a few investigators have studied the challenges which nurses’ experienced in this regard.Objectives: This qualitative study conducted to explain how nurses explain and perceive challenges in technology user’s training.Materials and Methods: This qualitative study was conducted in 2012 by using the content analysis technique in which data were collected through interview. Twenty-four nurses who were occupied in hospitals affiliated to Isfahan University of Medical Sciences were selected by using purposive sampling and in-deep semi-structured interviews (focus-groups and individual interviews) were done. The content of data was analyzed by the Zhang and Wildmouth’s method.Results: Initial concepts evolved after content analyzing and five main categories were emerged. Theses categories were “Everything and everyone teach” technology users but there are “No effective training”, “Uninformed resources”, and managers always “Rely on trial and error” and there are some “Learning Barriers”.Conclusions: The result of this study outlined important concerns of nurses regarding biomedical technology user training, and determined the need for further education to modernized healthcare system for promoting and expanding patient care.