Journal of Shahid Sadoughi University of Medical Sciences
Year:2004 | Volume:12 | Issue:1|Papers Count:13

Introduction: Almost every one in four women experiences an incomplete abortion in her life. During the twentieth century, uterine contents were evacuated using either forceps or curettage. Re-evaluation of this treatment seems logical. This study was designed to evaluate the results of medical treatment of first trimester incomplete abortion with methyl ergonovine maleate. Methods and Materials: An observational, descriptive-analytical and cross-sectional study was designed to assess the effectiveness of a maximum of four doses of 0.2mg methyl ergonovine maleate in the treatment of first trimester miscarriage. Patients received serum oxytocin concurrently. A total of 100 women were selected using convenience, consecutive sampling method. If after 24h, the interface line was seen completely and there was no bleeding, patients were discharged without medications. If not, they received oral methergine for 6days, qid.Results were analyzed by SPSS 11.5 software, chi-square and T-tests. Results: A total of 100 women aged between 14 and 45 years were selected. On the whole, methergine was successful in 97% of patients (injection or orally). Only 13% of the patients had mild side effects. Conclusion: Methergine is an effective and safe drug for the management of first trimester miscarriage.

A case of iris metastasis secondary to prostate cancer is reported and the clinical features of the patient are described. A 75 years old man referred with a right iris tumor , secondary glaucoma and severe anterior uveitis. He had history of multiple bone metastases due to prostate cancer. The iris tumor was diagnosed as prostate cancer metastasis and the literature was searched using medline data base.Clinical findings were as follows: Gray white fleshy tumor was seen spread in iris of right eye. Iridocycliits and secondary glucoma were present. After external beam radiotherapy, the iris tumor regressed. Conclusions: Iris metastasis have typical clinical features that should suggest the diagnosis. Breast and lung cancers represent more than two thirds of the primary sites of these metastases.

Introduction :Acute myocardial infarction (AMI) is the most common cause of death in many countries, and also one of the common causes of death in Iran. As the death rate due to AMI is not clear and the survival rate of these patients had not yet been studied in the city of Yazd, this study was undertaken. Methods and materials : This was a survival study performed in Yazd between the years 2000 and 2002. 210 patients with definite AMI (according to clinical findings, ECG and enzyme criteria) were enrolled in this study (case series). They were admitted to Shahid Rahnemoon Hospital of Yazd (A general hospital). Results : The population under study included 161 males with mean age of 59± 14 years and 59 females with mean age of 66± 10 years. Frequency of hypertension, diabetes mellitus, hypercholestrolemia, hypertriglyceridemia and smoking was 27%, 22%, 20%, 22% and 32%, respectively. All risk factors except smoking were more common in females than men. 83.3% of infarctions were Q-wave infarctions, 16.7% non- Q-wave infarctions. 53% inferior wall and 40% were anterior wall infarctions. Infusion of streptokinase was done for 62% of patients. Mean ejection fraction of left vantricle was 48% in males and 45% in females. In-hospital mortality rate was 12.4% and higher in patients older than 70 years, diabetics, and anterior wall infarction patients. It had no correlation with sex. Surprisingly, smoking was accompanied with a very low in-hospital mortality rate. Conclution : One - year mortality rate of the patients in this study was 16.7% . It was higher in females, diabetics, anterior wall infarction patients and those with an ejection fraction less than 45%. The one year mortality rate in smokers was comparitively lower than non smokers in this study.

Introduction : In order to evaluate the role of thyroid autoimmunity in patients with goiter, this study was done 10 years after implementation of iodine supplementation program ( iodised salt). The serum levels of thyroid peroxidase antibodies (Anti TPO) and thyroglobulin antibodies (anti TG) were studied in a group of patients with simple goiter and compared with normal controls. Materials and methods: We performed this study at the endocrine clinic of Noor Hospital in Isfahan University using simple sampling method in those patients that had normal thyroid function tests: The patients with simple goiter were enrolled in case group (N =105) and those without goiter in control group (N=85). Results: 34.3% (n=36) in case group and 19.1% (n=17) in control group had elevated Anti TPO titer (p value=0.018). 42.9% (n=45) in case group and 23.6% (n=21) in control group had elevated Anti TG titer (p value=0.005). Discussion : Considering the higher percentage of elevated levels of anti thyroid antibodies in the case group,we conclude that thyroid autoimmunity has an important role in goiter prevalence and increased iodine intake may play a role in thyroid autoimmunity.

Introduction : Pilonidal cysts occur predominantly in males. The lesion usually manifests itself clinically near the end of the second decade of life. The patients are often hirsute and frequently unaware of the presence of the sinus.Clinically, the lesion is asymptomatic until it becomes infected. The diagnosis is made on the basis of one or more small openings in the midline over the sacrococcygeal region approximately 3.5 to 5 cm posterior to the anal orifice. Infection may occur because of its proximity to the anal region. The symptoms of an abscess are classic. Trauma preceding the onset of symptoms has been reported. As this disease is seen in the young and active population and has a high prevalence, need for a surgical operation with decreased complications& duration of admission leading to faster return of the patient to daily life activities is felt. Methods& materials :In this sinple blind randomized clinical trial study, 60 young patients ( mean age of 21.9+/-3.09 years) who refered to the surgical clinics of Baqiyatallah hospital and diagnosed as having pilonidal cysts requiring treatment were divided into two groups of 30 cases each, wherein Group One patients were operated upon using this new semi-closure technique and Group Two patients were operated upon using the classic open method. The patients were followed up till complete treatment and results were compared. Results :The effectiveness and advantages of semi closed method over the open method (p< 0.05) was observed.( post operative pain & bleeding , wound healing , change of dressing,time period of return to work and complete treatment). Conclusion : It is concluded that the semi closure excision method is better than the open method in all aspects for the treatment of pilonidal sinus.

Introduction: Prevalence of abdominal trauma is increasing during recent years. Abdomen is the third most affected part of body by trauma. Early diagnosis can help us select better methods for managing abdominal trauma. Even though newer imaging techniques such as CT scan are available, abdominal trauma is still a complex matter, which every doctor in the emergency department has to deal with. Physical examination for the evaluation of intra abdominal organ damage though impotant, is not enough. Material and Methods: This observational (cross-sectional) study was done over a period of 24 months (1999-2001). 135 patients (99male and 36 female) with abdominal trauma and no urgent laparotomy indication were included in this study. We calculated the sensitivity, specificity, positive&negative predictive values of DPL test in our cases using SPSS software. Results: Mean age of patients was 28.6 years. All of the patients were evaluated with peritoneal lavage which resulted in 70 positive and 65 negative cases. All of the 70 cases with positive results were further evaluated with laparotomy of which 63 cases have intra peritoneal injuries that needed surgical treatment, while 7 cases didnt have any intra peritoneal injuries (False positive results). All cases with negative results of peritoneal lavage test were treated conservatively for 3-5 days and during this period of time, 3 cases needed laparotomy and surgical treatment (False negative results). Conclusion : According to the results of this study, sensitivity of peritoneal lavage test in diagnosis of abdominal trauma was 95.5% and specificity was 90%. Negative predictive value of this test was 95.4% and positive predictive value of this test was 90%. Thus, peritoneal lavage test in abdominal trauma is sensitive, specific and has high specificity. It is therefore advisable that after initial evaluation of all penetrating and blunt abdominal traumas, peritoneal lavage test should be performed.

Interoduction: Gasteroenteritis is one of the problems worth consideration all over the world. It is one of the important causes of mortality, especially in children < 5 years of age, in developing countries including Iran. The aim of this descriptive study was to determine the demographic conditions influencing the presence of causative bacteria and protozoa, followed by antibiograms of isolated bacteria from stool samples of patients with gasteroenteritis referring to Nikoopour Clinic in the city of Yazd, Iran from 1998 - 2001. Materials and method: A total of 470 samples were microbiologically examined by direct method, culture and then antibiogramed. In order to isolate the possible bacteria, differential and selected media were used. Also, wet - mount technique was applied for detection of protozoa. Results: Results revealed that 272 samples (57.9%) were infected by pathogenic bacteria or protozoa. 138 (50.8%) pathogenic specimens were from male patients and the remaining 134(49.3%) were from female patients. Isolated species were: Enteropathogenic E.coli 117(43%), Shigella 51(18.8%), Salmonella.interetidis 25(9.2%), C.jejuni 16(5.9%), Giardia lambdia 51(18.8%) and Amoebae spp 12(4.4%). The most commonly detected shigella species was dysenteriae, (74.5%) while boydii with 2% was the least common type observed in the specimens. Except shigella, all the other bacteria were more common in males than female, but insignificant statistically. In order to determine the sensitivity and/or resistance of pathogenic bacteria, antibiogram test was performed using selected antibiotic disks such as Ampicillin, Nalidixic Acid, Ciprofloxacin, Gentamycin and Sulfamethaxazole. Conclusion: Results revealed that some patients were probably infected by pathogenic factors other than bacteria or protozoa. Since all viruses and parasites are almost resistant to antibiotics and on the other hand, administration of antibiotics may lead to resistance of bacterial agents, it seems necessary that the stool samples should be cultured and antibiogramed before treatment with antibiotics. The most common bacterial agent isolated in this study was E coli enteropathogens and the most effective antibiotic against it was Nalidixic acid.

Introduction: Many evidences have suggested that the Basolateral Amygdala (BLA) are probably involved in emotional learning and modulation of spatial memory processes. The aim of this present study was assessment of the effect of reversible abolition of BLA on spatial memory processes in a place avoidance learning model in a stable environment. Methods and Materials: Long-Evans strain rats (280-320 gr.) were selected and cannulae aimed at the BLA were surgically implanted bilaterally. The mice were trained to avoid a 60° segment of the arena by punishing with a mild foot shock upon entering the area. The punished sector was defined by room cues during the place avoidance training, which occurred in a single 30-min session and the avoidance memory was assessed during a 30-min extinction trial after 24 hours. The time of the first entry and the number of entrances into the punished sector during extinction were used to measure the place avoidance memory. Bilateral injections of Tetrodotoxin (5ng/0.6ml per side) were used to inactivate the BLA 60 min before acquisition, immediately, 60 and 120 min after training, or 60 min before the retrieval test. Control mice were injected saline at the same time. Results : The results indicated that acquisition, consolidation (immediately, 60 min after training) and retrieval of spatial memory in stable arena were impaired (p<0.01). Injection of TTX 120 min after training had no significant effect. (p value>0.05). Conclusion: We conclude that the Basolateral Amygdala (BLA) modulate spatial memory processes in place avoidance learning model in stable arena and this effect in regard to consolidation is time dependent.

Introduction: It is a fact that iron deficiency anemia in infants leads to unpleasant effects on Growth , Cognition and Psyche for life . During the late seventies,relation of iron deficiency anaemia(I.D.A) and permanent complications was suggested , and later on, several studies proved that handicaps occur when iron deficiency (I.D) is severe enough to develope I.D.A Method & Materials : In our study, we evaluated the prevalence of I.D.A and I.D in children aged between 6&60 months in Yazd . In this cross - sectional study, 449 cases were selected by clustering 239 boys and 210 girls. Hemoglobin( Hb) and ferritin was measured .5 cases were omitted from the study. Data was analyzed using SPSS computer software program. Results : In our study, prevalence of Iron deficiency anemia was 3.8% and that of Iron deficiency was 8.6%. Prevalence of other anemias in the population under study was 8.4% . 79.2% of children in this group were not anemic and considered as normal . Iron deficiency was twice that of Iron deficiency anemia. (p value< 0.05 ). Conclusion : The total prevalance of anemia in this study was 20.8% with Iron deficency anemia 3-4% and Iron deficiency 8.6% . The prevalence of iron deficiency and other forms of anemia in this study was less than many other parts of the world, except USA . Anemia in children aged 6-17 months was more than other age groups. Also, anemia in girls was more prevalent than boys .

Introduction : Patients with major thalassemia need recurrent transfusions and if not treated are at risk of heart dysfunction. Heart tissue could be abnormal in patients who use desferral continously due to iron deposits , fibrosis , hypertrophy and side effects of chronic anemia. Cardiac involvement is the main cause of morbidity and mortality in major thalassemics, so we decided to improve early diagnosis of cardiac involvement by measuring myocardial performance index( MPI ). Method & Materials : This case-control study was performed from April 2003 to December 2003 at the Ali-Asghar pediatrics hospital, Zahedan, Iran. MPI of both ventricles was measured by Doppler echocardiography in 48 patients with major thalassemia aged between 10-18 years and compared with 48 age , sex-matched controls. Patients had no abnormality in physical examination , chest x-ray and ECG and echocardiography did not show heart failure. Hemoglobin and serum ferritin levels was measured in all patients before echocardiography. Results: Mean age of patients was 12.3±2.4 years and that in the control group was 12.7±2years . Right ventricle isovolumetric relaxation time (RVIRT) (107 ± 14 vs 94 ±14 , p<0.001) and right ventricle isovolumetric contraction time (RVICT) (44 ± 20 vs 31 ± 23 , p<0.005) were prolonged in major thalassemia patients as compared to that in the control group, but ejection time was not significantly different in the patients and control group (260 ±29 vs 270 ± 23 , p>0.05). LVIRT (96 ±15 vs 89 ±16 , p>0.05) and LVICT (31 ± 13 vs 21 ± 15 , p<0.05) were prolonged in major thalassemia patients, but ejection time was not significantly different (263 ± 29 vs 270 ± 22 , p>0.05) in the two groups. Finally, RVMPI (0.59 ± 0.12 Vs 0.46 ± 0.12 , p<0.001) was increased in 87% of patients and LVMPI (0.49 ± 0.12 Vs 0.41± 0.09 , p<0.001) was increased in 73% of patients. There was a significant correlation between serum ferritin , RVMPI and LVMPI (r= 0.346 , p=0.016). How ever , there was no correlation between MPI and patients age (p>0.05). Conclusion: This study showed that RVMPI and LVMPI increase in major thalassemia patients that indicates systolic and diastolic dysfunction and RVMPI increases more than LVMPI. On the other hand, MPI has a direct correlation with serum ferritin . On the basis of this study ,we suggest MPI measurement in serial echocardiography in asymptomatic major thalassemia patients.

Introduction: Streptococcus pneumoniae is one of the most important causes of pneumonia, meningitis and septicemia. Decades after successful treatment of this infection with penicillin, frequency of penicillin resistance is reportedly on the rise throughout the world. This cross sectional study was designed in Yazd to determine the prevalence of pneumococcal pharyngeal carriers and its succeptibility pattern in children of day care centers. Method & materials : Two hundred children were selected randomly from 10 day care centers and pharyngeal swabs were collected and cultured in February, 2002. Results :51% of our study sample were boys and 49% were girls. Their age range was between 7 and 65 months. Prevalence of pharyngeal carriers was 37.5%. The rate of resistance detected was as follows: 50% to penicillin, 62.5% to erythromycin and TMP,SMX, 30.6% to tetracycline, 15.3 % to cephalothin, 5.6% to ceftizoxime and 4.2% to ciprofloxacin. Conclusion: We conclude that penicillin is not the drug of choice in invasive pneumococcal infections in Yazd and a third gereration cephalosporin should be used instead as the first line of treatment while awaiting the culture and sensitivity results.

Cardiac transplantation is life saving in patients suffering from end stage cardiac diseases. In recent years , advancement in cardiac surgery has contributed to increasing number of patients who require cardiac transplantation. This report is the first case of heart transplantation in Yazd. Recipient was a 53 years old man with dilated cardiomyopathy and candidate for cardiac transplant. The donor was a 35 years old man with documented brain death due to a car accident. Patient was discharged from hospital 7 days after the operation with no complications and on follow up 1 year after operation , patient is in good condition and under specific care.