Medical Journal of The Islamic Republic of Iran
Year:2011 | Volume:24 | Issue:4|Papers Count:10

Governmental universities of medical sciences (and health services) in Iran, beyond teaching and research duties, are responsible for providing health services to residents of specified geographical areas.Parts of the health services are provided directly through medical university staffs and students; the university has also oversight on health services of non-governmental public and private sectors.

Background: To produce a reliable probe suitable for aneuploidy detection of chromosome 13 on uncultured lymphocytes and amniocytes by fluorescence in situ hybridization (FISH), we used a contig of three overlapping cosmids mapped to 13q12.3.Methods: The cosmid DNA carrying the expected sequences of human chromosome 13 was isolated from host cells and labelled with biotin-11-dUTP. The hybridization and detection conditions with FITC-Avidin were optimised using a series of cultured and uncultured lymphocytes and amniocytes.Results: Intensive signals were detected when a combination of three overlapping cosmids was used to enumerate the chromosome 13 on interphase nuclei. An average of 87 and 85.5 percent of interphase cells prepared from lymphocytes and amniocytes showed accurate number of specific signals for chromosome 13.Conclusion: The results obtained in present study indicate that the probe was capable of detecting the copy number of chromosome 13 on interphase cells prepared from peripheral blood or amniotic fluid cells providing that the uncultured amniotic fluid cells are free of cytoplasmic residues, RNA and protein debris.

Background: Clinical Risk Index of Babies (CRIB), Score for Neonatal Acute Physiology (SNAP), an update of the Clinical Risk Index for Babies score (CRIB II) and Score for Neonatal Acute Physiology - Perinatal Extension (SNAP-PE) are scoring devices developed in neonatal intensive care units. This study reviewed these scoring systems in critically ill neonates to determine how well they could predict mortality.Methods: This prospective cohort study was conducted at the neonatal intensive care units of Mofid and Mahdieh hospitals between March 2006 and May 2009. We evaluated CRIB, CRIB II, SNAP, SNAPII and SNAP-PE score for each neonate and the final scores were then obtained. The predictive accuracy of these parameters were expressed as area under the receiver operative characteristic curve, sensitivity, specificity, positive predictive value and negative predictive value.Results: Of 404 neonate evaluated 53% were male. Primary diagnoses were respiratory distress syndrome, gastrointestinal obstruction, sepsis, prematurity, and neuromuscular diseases. The authors detected mortality in 20.5% and found a significant difference in scoring systems between survived and death groups. The mean CRIB score in survived neonates was 2.57±3.66 and in death neonates 8.43±4.66 (p value<0.001). We also found that the SNAP score had the highest area under the curve and the highest sensitivity, specificity, positive predictive value, negative predictive value and we had the lowest score for CRIB II.Conclusion: We concluded that the neonatal scoring systems could be a useful tool for prediction of mortality in NICUs and SNAP can predict the mortality better than the others.

Background: Misdiagnosis of the acute appendicitis may increase the rate of negative appendectomies, which involve a huge waste of resources and are sometimes associated with severe complications. Furthermore, false negative result of ultrasonography (US) could lead to perforation of appendix. Since ultrasonography is still the most common imaging technique used in Iranian appendicitis patients, the study focused on evaluate the accuracy of ultrasonograghy in an educational hospital in Iran.Methods: We retrospectively reviewed the results of ultrasonograghy in 270 patients who referred to Rasoul-e-Akram hospital in Tehran, Iran, between April 2002 and October 2004 with acute abdominal symptoms suggestive of appendicitis. The results of ultrasonography were compared with the histopathologic reports of biopsies as a gold standard. In data analysis Chi-square, independent t-test and Mann-Whitney U-test were performed.Results: The accuracy of ultrasonograghy in acute appendicitis was 60.4% and the rate of negative appendectomy was 17.4%. Diagnostic values of US were calculated as the sensitivity of 55.4% [95% confidence interval (CI)=48.6-62], specificity of 72.3% (95%CI=57.1-83.9), positive predictable value (PPV) of 90.4% (95%CI= 83.9-94.6) and negative predictable value (NPV) 25.6% (95%CI=18.6-34).Conclusion: Although the results of our study implied that the diagnostic values of ultrasonography were not considerable, but it is still the only imaging techniques available for patients in Iran. In reference to the low NPV, using an alternative technique such as abdominal CT scan is recommended. More attention must be paid on the signs and symptoms related to acute appendicitis in such patients especially in teaching hospitals.

Background: The varieties of treatment methods for the scaphoid nonunion have always been a discussable issue for orthopaedic surgeons. The current study, considered to be review for treatment results of the patients who sustained the scaphoid nonunion with or without avascular necrosis and compared these two groups clinically and radiologically.Methods: The clinical and radiologic files of the patients who sustained the scaphoid nonunion and underwent surgical treatment between 2004 and 2009 in our hospital, were collected and in the final follow-up, 37 patients and 38 nonunions underwent physical exam, grip power test, DASH questionnaire and radiography.Results: Avascular necrosis was detected in 22 cases and 16 cases had no avascular necrosis changes. Following open reduction and bone grafing, union was seen in 36 cases, and nonunion in 2 cases which one was in the avascular necrosis group and another in without avascular necrosis group. The comparison of the residual pain, range of motion, DASH score and grip power in two groups, did not show a meaningful difference (p>0.05).Conclusion: Although multiple studies indicated that in the presence of the avascular necrosis in the proximal fragment of the scaphiod, possibility of union in the conventional graft methods was lower than vascular pedicle grafts, but this study demonstrated that the conventional treatment method yet was associated with a considerable successs and a reliable treatment method.

Background: Effective patient–professional communication can be of crucial importance to long-term psycho-social outcomes in patients with cancer. A cross sectional study was conducted to examine cancer patients' satisfaction with regard to various aspects of communication and information given by nurses.Methods: A proportional stratified sampling method was done and data collected via face-to-face interview based on a validated Patient Satisfaction Questionnaire (PSQ) during a 3 month period. A total of 384 patients aged 14 years old and above were selected.Results: The majority of respondents were males (52.3%) and married (66.4%), working (52.6%) and age group 45-54 year (26.6%) with secondary education level (44.8%), and 53.1% of them admitted at teaching hospitals of government A University of Medical Science. The findings revealed that a vast majority of respondents (81.5%) were satisfied with communication and information given by nurses, while the others (18.5%) not. There was significant relationship between patients’ satisfaction and age group (p£0.05). Also, the age groups of 15-44 years old and married patients were the best predictors for level of cancer patients’ satisfaction with communication, and information given by nurses.Conclusion: Key findings are a number of issues with regard to information and communication which can be clearly improved within teaching hospitals of in Tehran city. The study concluded that patient-professional communication should be tailored to meet individual need.

Bckground: Patients with obstructive sleep apnea (OSA) are at risk of developing the fatty liver as a result of being overweight. Several studies suggest that OSA per se could be a risk factor for liver injury; and ischemic hepatitis with OSA. The OSA is an independent risk factor for Insulin resistance. Therefore, we investigated liver enzymes and insulin resistance in patients with OSA, and compared with controls.Methods: Eighty-one consecutive patients with clinical suspicion of OSA were referred to the Sleep Unit of Masih Daneshvary hospital. On the basis of Polysomnography results patients were divided into two groups: The OSA and non-OSA cases, and also patients without OSA were used as internal controls. The Serum levels of liver enzymes were measured in all patients and abdominal ultrasound examination performed for screening the fatty liver and its grading. Insulin resistance was calculated via homeostasis model assessment (HOMA).Results: The OSA was present in 41 and absent in 40 patients. Age, sex and body mass indices were not significantly different in two groups. The mean of alanine aminotransferase (ALT) was 31.24±14.05 IU/L in OSA and 29.97±8.9 IU/L in non-OSA (p=0.349) and aspartate aminotransferase (AST) was 29.07±9.6 IU/L in OSA and 26.85±6.7 IU/L in non-OSA (p=0.389). The mean of HOMA was 2.05±18.2 in OSA and 1.5±0.54 in non-OSA (p<0.001).Conclusion: This study shows that OSA, independent of overweight conditions, is not a risk factor for abnormal liver enzymes. However, the OSA per se seems to be associated with increase in insulin resistance and severity of fatty liver.

A rare variant of ansa cervicalis was discovered during dissection of the neck in a male cadaver. The superior root of the Ansa cervicalis was formed by the C1 ventral ramus. It accompanied with the vagus nerve in place of the hypoglossal nerve and descended into the carotid sheath with it. Moreover the C1 ventral ramus formed from the sheath and joined the inferior root from C2 and C3 ventral rami.

All perilunate fracture-dislocations combine bone avulsions, ligament disruption and fractures in different forms. The most frequent pattern is the dorsal transscaphoid perilunate fracture-dislocation. The reported risk of missed initial diagnosis in perilunate dislocations is as high as 20%. Concerning pathomechanics of the perilunate fracture-dislocation, it should be noted that most dorsal injuries usually result from a fall on the outstretched hand or motor vehicle accidents although other mechanisms are also mentioned. We describe here a case of dorsal trans-scaphoid trans-capitate perilunate fracture-dislocation together with posterior olecranon fracture-dislocation of the left upper extremity. To the best of the authors' knowledge, such a case with this concomitant elbow fracture-dislocation has not been previously reported in the literature.

A case of 69- year-old woman with large pelvic mass and ascites is reported in this paper. With the exception of mild pelvic pain and a Pelvic mass in pelvic, she had no symptom or sign. All routine and hormonal Lab tests and tumor marker's were normal. The MRI revealed a large mass in anterosuperior of uterus, and left ovary was situated in neighborhood of pelvic mass. Her Uterus normal, with a small cyst in the right ovary. The total abdominal hysterectomy and bilateral salpingo- oophorectomy revealed a large cream solid mass (16x8x8 Cm, 1260 gr) in the left ovary .Nonetheless the right ovary had normal appearance with a cyst (3x2.5Cm). There was some free fluid in the pelvic cavity. The ovarian mass was identified as fibrothecoma, the right ovarian cyst as serous cystadenoma, but no malignant cells found in free fluid. This case had interesting features, because first clinical features suggested a bilateral malignancy in pelvic, but she had two different tumors which were benign.Also, the occurrence of bilateral fibrothecoma and serous cyst adenoma were rare. Furthermore, we did find no similar case in the literature.