Journal of Shahid Sadoughi University of Medical Sciences
Year:2000 | Volume:8 | Issue:2|Papers Count:24

This study was undertaken to determine the prevalence and characteristics of diabetic retinopathy (DR), as well as their relation to various other risk factors. An eighteen months hospital based study was conducted of 282 patients who were presented with diabetes at the Afshar Diabetic Center in Yazd. 37.2% of the patients were males and the rest (62.8%) were females. The incidence of DR and its relation with the duration of diabetes, age, sex, FBS, blood pressure and lipids was evaluated. 14% of the cases had IDDM type, while 86% of the cases were shown with NIDDM. In addition, 38% of the individuals were presented with DR. the duration of diabetes, hypertension, and age were significantly correlated with the prevalence of DR. however, sex, smoking, blood lipids and sugar, were not significantly related of DR. in addition to the patient age, the duration, type of diabetes and hypertension were risk factors for retinopathy. Examination of the retina in diabetic patients with full mydriasis in the first admission is recommended in order to prevent the loss of vision.      

Autoimmune hepatitis is a self- perpetuating hepatocelluar inflammation of unknown cause. It is characterized by the presence of perportal hepatitis on histological examination. The clinical characteristics and the response to the treatment for 49 patients with autoimmune hepatitis diagnosed in Taleghani hospital: of Tehran were evaluated. Type I autoimmune hepatitis was observed in 59.3% of the cases that were ANA Positive, while in others was undetermined because of unavailability of anti LKM1 test. Immunosuppressive drug with Prednislon and Azathioprin treatment were effective in 56.3% of patients. However, 6.3% of patients showed no response to the treatment. Relapse was seen in 9.4% of the patients during reduction of dose of immunsuppresion. The follow-up evaluations for 28% of tlie cases were incomplete. Also, two of the 'patients died during the follow-up study.    

Appendicitis is the most common cause of surgical acute abdomen. However, but in spite of its high incidence, in some cases diagnosis may be difficult and perforation and gangren complications may be fatal. Diagnosis is based on clinical findings and observation, CBC count and recently sonography. Abdominal sonography was done for 100 hospitalized patients at the surgical ward of Rahnamoon Hospital. These patients had suspicious clinical findings of acute appendicitis. Sonography was done by livear 7/5 MH2 probe. In the questionnaire sheet the clinical and then the sonographic, operative and pathologic findings were written. In the next step, correlation of the collected data was analyzed. In the correlation of sonography with pathology, sonography had 86% sensitivity, 69% specificity, with 89% positive predictive value and 64% negative predictive value. In the correlation of operative and pathologic findings, surgical data had 100% sensitivity, 77% specificity, 93% positive predictive value with 100% negative predictive value. Therefore, sonography is a reliable modality in the diagnosis of acute appendicitis, especially in the doubtful cases.      

Low density lipoprotein (LDL) is known as a risk factor for atherosclerosis. Cholesterol metabolism related enzymes are under effects of thyroid hormones, and obvious changes are observed in hypothyroid patients. This study aimed to find out the probable physiologic relation between lipid levels and these hormones. A total of 666 (589 women and 77 men) healthy adults with no clinical evidence of thyroid disease were enrolled in this study. Blood samples were taken for measurement of T3, T4, TSH, cholesterol and triglycerides. Mean of age and weight was 40±12.9 years and 59±12 kilograms, respectively. The mean of cholesterol level and triglycerides was 189±61 mg/dl and 145±88 mg/dl, respectively. A significant (P<0.05) correlation was observed between cholesterol with T3 (r=-0.29), T4 (r=-0.37) and TSH (r=0.33). A similar correlation between triglycerides and T3 (r=-0.21), T4 (r=-0.26) and TSH (r=0.24) was noticed. It seems that even in healthy individuals without thyroid disease, the level of serum lipids and thyroid hormones are related inversely, ie with an increase in thyroid hormones, lipid level decline.    

Finding a simple easy and inexpressive treatment for common infections like urinary tract infection is ideal; As application of different types of antibiotics causes more bacterial resistance in germs causing UTI. Gentamicin is prescribed more for above reason. The goal of this experimental study was to evaluate the clinical efficacy and nephrotoxicity associated with one daily does of Gentamicin for the treatment of febrile urinary tract infection as compared to the divided dose model. A total of 83 cases of children over one year of age with febrile UTI were divided randomly in two groups: 52 patients received a dose once daily and 30 patients received a divided dose of Gentamicin for at least 7 days (3mg/kg). 4 cases in the divided dose and 11 cases in the once daily group had reflus of ureters. Satisfactory clinical responses occurred in all cases and with urine cultures becoming negative after 48 hours. Mean time of fever disappearance in the once daily and divided daily group were 1.2 and 1.4 days, respectively which did not have a statistical difference (P<0.05). We did not see any laboratory evidence of nephrotoxicity or clinical signs of ototoxicity in the two groups. Meanwhile, there was not a difference in the rate of relapse or recurrence of infection in the first three months of our observation. Although, we could not show a difference in the rate of scar formation with this moed of treatment, its simplicity and cost effectivness might serve as good reasons to encourage its use.

Due to a high prevalence of cataract surgery with intraocular lens implantation and as the lens power is the main object of postoperative outcome, a study of the comparison of I.O.L power determination based upon ocular finding (K-reading & Biometry) and refractive status was carried out. All the patients were examined carefully and exact data was recorded in a questionnaire Mean calculated I.O.L power by biometry was 21D ± 1.95 and by primary refraction method was 19.9D ±1.75 (P=0.0001). The mean postoperative refractive error upon spherical equivalent was l.2D±0.9 based upon biometry and 1.7D± 1.2 for refraction (P=0.0001). As a result, the I.O.L power calculation by biometry is the procedure of choice, although the refraction method is acceptable according to our findings.    

Circumcision is one of the most common' surgical operations which is done according to religious advice. Like in other surgical operations, it may have some complications which are evaluated in this prospective study. A total of 1500 children who were circumcised before the age of two were followed with median duration of twelve months and complications along with method of circumcision were studied. The most common complication after circumcision was bleeding (8.2%), while the least was urethrocutanous fistula (0.1%). Most of the children were between 0-3 months old when circumcised (80.3%) became. The complications were generally noticed when circumcision was done during the first 3 months of infancy (25%). Circumcision was done by surgical method in 71.2% of the patients and by Cup in 28.8%. Complications of operation were more prevalent in surgical group. In most cases, the circumcision was done by a general surgeon (43.3%), but complications were mainly observed in patients who were circumcised by Technicians. Due to the prevalence of this operation in our country and the above complications, it is strongly recommended that a surgeon be in charge of operation. In addition, circumcision may show less complication when it is done in children beyond age of 3 months.      

Diabetes is one of the metabolic diseases whose prevalence is very high. In Iran more than two million people suffer from diabetes. This research was carried out to evaluate the effect of experimental intervention on blood glucose and HbA1c control in diabetic patients in Yazd. 120 Diabetic patients participated in this study. They were divided into 2 groups of case (60 patients) and control (60 patients). A comprehensive experimental intervention was performed for the case group. The patients knowledge, attitude and practice about diabetes and glycated hemoglobin (G.HB) were measured in both groups. Glycated Hemoglobin was checked after five months. In addition, the knowledge, attitude and practice of both groups were measured and compared. Colorimetric technique was employed to measure glycated hemoglobin. Data analysis showed that the patients knowledge about diabetes increased. As a result, the practice of patients in control of their disease increased. The increased of practice was measured by the rate of glycated hemoglobin decrease. The long-term diabetic control was evaluated by measurement of glycated hemoglobin. In case group, the glycated hemoglobin in the pretest phase was 9.84±1.14%. It decreased in the post-test phase after 5 month to 7.28±1.65 (p<0.000). In the control group, the glycated hemoglobin in the pre-test phase was 9.35±1.24%. It decreased in the post- test phase after 5 months to 8.58±0.92.The blood glucose of the case and control groups were 189.3±54.5 and 180.5±6, respectively. It is recommended that experimental intervention can be used as a essential approach to control and prevent chronic diseases such as Diabetes.  

Valsalva maneuver (VM) is associated with rapid, intense changes is systolic blood pressure (SBP) and heart rate (HR). It is considered to cause lethal arrhythmia and sudden cardiac death in patients with cardiovascular disorders, especially those with coronary artery disease. Intensity of cardiovascular responses to the VM probably could depend on cardiac preload and venous return which is varied in different body positions. This research was under taken to determine the degree of changes of SBP and HR during the VM in three, positions (flat, 70 elevated and sitting leaning forward) . The method of sequential and convenience sampling has been used for the selection of units under study: Based on study criteria, 42 individuals (21 males, 21 females) were selected. Cardiac monitoring was used to measure HR. Subjects produced a VM of 40 mmHg for 10 seconds in each of three positions. The cardiac monitor recorded the HR continuously and SBP was obtained before, during and after the VM. The results showed that the body position may affect the intensity of SBP and HR changes during the VM. This was verified by friedman analysis of variance (P=0.0000) and repeated measurements of the analysis of variance (P=0.000).The widest range in SBP took place in the 70 elevated positions. The narrowest range of changes in SBP and HR occurred in the flat position. It was concluded that the intensity of SBP and HR changes in sitting and leaning forward position significantly differed from 70 elevated position (P= 0.000). Also, no significant difference from flat position (SBP changes, P= 0.07 and HR changes, P=0.12) was observed. In addition, the sitting and leaning forward position would appear to be superior to other postures during unavoidable VM, especially in patients with coronary artery disease.    

In this prospective, placebo -controlled study, the effect of oral Midazolam premedication on conscious sedation in children undergoing ambulatory surgery was examined. Two oral preanesthetic medication regimens according to a randomized protocol were studied in 60 healthy children ages 2-6 years old. Group A (Placebo) received 5 ml of fruit juice, and group B received Midazolam 0.5 mg/ml with fruit juice to a total volume of 5 ml, 1 hr before induction of anesthesia. 73.3% of the children who were separated from their parents within 60 min after administration of oral Midazolam had satisfactory separation scores (vs 13.3% of non - Midazolam treated children, P=0.00002). Midazolam -treated patients were more cooperative compared with non – Midazolam treated children (79% vs 17%). The time to early recovery from anesthesia was somewhat longer in children premedicated with Midazolam cooperative with controls (17% vs 13%). In conclusion, Midazolam (0.5 mg/kg) given orally 1hr before induction of anesthesia is safe and effective without any major side effects after ambulatory surgery.        

Since difficult vaginal delivery is more frequent with macrosomic fetuses, routine cesarean section is recommended for the delivery of fetuses. The purpose of this study was to evaluate the maternal and neonatal complications according to the method of delivery. This retrospective case control study was conducted comparing 232 macrosomic neonates weighing over 4kg. to a control group of 476 neonates, with mean birth weight of 2500 to 3999g. The macrosomia occurred in 4.3% of deliveries in 1997 at Imam Khomaini hospital, Tehran. Cesarean section was carried out in 22.5% of macrosomic babies as compared to 15.7% of the controls. The most frequent indication for cesarean section was failure to progress and fetal distress. Post -partum hemorrhage and use of oxytocin to accelerate the labor was occurred significantly more in the study group. Shoulder dystocia and meconium in liquid occurred significantly more in the macrosomic group as neonatal complications. In comparison between the fetal & maternal outcomes for the macrosomic group delivered vaginally versus C/S showed that more injuries of genital canal took place in vaginal delivery. This type of delivery is a reasonable alternative to elective cesarean section for infants with birth weights of less than 5000g. And a trial of labour can be offered. Furthermore, the occurrence of P.P.H shoulder dystocia and meconium in liquid is more frequent in macrosomic group. So, it may be of value to consider more diligence in identifying the macrosomic fetus prior to delivery in order to an appropriate approach in these cases.    

The processing of bone repair is complex- and different in the bone of denervated limbs. Therefore, the main objective of this study was to evaluate the effect of sciatic denervation on the healing of bone defects in the tibia of Wistar albino rats. Histological studies on healing of bony defects with and without sciatic denervation were carried out in 49 adult rats. All the animals had a right sciatic denervation in the level of hip joint. The bone defects were created in the shaft of both tibiae after 30 days of denervation by a round burr. The animals were killed at different time intervals of 1, 3,4,7,9,12,16,17 and 28 days after operation. The specimens were then sectioned and prepared for histological staining with Hematoxylin -Eosin, masson's trichrome and toluidine blue. The rate of callus and bone formation, also remodeling process in the denervated tibia was greater than that of normal side. The results also showed that initiation of edema and termination of inflammation took place earlier in denervated than normal tibia. These results confirm the clinical observation on enhanced healing of fractures in the extremities of neurologically injured patients.        

It has been suggested that disorders of lipid metabolism has an important role in pathogenesis of NIDDM. The high level of free fatty acid in NIDDM can prevent glucose uptake by peripheral tissues and may cause insulin resistance. Fibric acids, including clofibrate has been shown to decrease the level of free fatty acid, thus it may decrease insulin resistance. The goal of this study was to investigate whether treatment of hypotriglyceridemia with clofibrate improves glucose control in NIDDM or not. 30 NIDDM patients with triglyceride level above 250 mg/dl were enrolled in this study. The characteristics of patients were as follow: mean age: 52.5 ±7.8 yrs, mean BMI: 27/6 ±3.3 kg/m2, mean FBS: 217.5±49.3 mg/dl, and mean 2hpp: 295.9±71.9 mg/dl, mean Hb A1C: 105±1.2%, mean TG: 466.5±155 mg/dl and mean cholesterol: 252.0±38.1 mg/dl. The patients were given clofibrate 1500 mg/day for 10 weeks and the above parameters were measured again. The oral hypoglycemic agent dosage and diet were not changed during study. The level of all the above parameters were decreased with administration of clofibrate as follow (P<0.0001): FBS: 178.9±54, 21 PP: 233.5±56, TG: 227.4±54, Chol: 226.9±27, HbA1C: 9.0±1.2%. It was concluded that clofibrate treatment of hypertriglyceridemia in NIDDM patients can improve glucose control.      

In vivo proton Magnetic Resonance Spectroscopy (H-MRS) is one of the noninvasive techniques for measuring important brain metabolites. In many cases, MRS may lead to a specific diagnosis when CT and MRI imaging findings are not specific. Furthermore, MRS can detect abnormalities in metabolism even when structures appear normal on CT and MRI. The concentration of important human brain metabolites in the white and gray matter of different human cerebral lobes in a group of normal volunteers, including 165 individuals were measured using in vivo H-MRS. At the third stage, the 165 normal volunteers underwent routine MRI study and after inspecting the images, 12 predefined areas of white (8 area) and gray matter (4 area) using the H-MRS technique. Thereafter, the spectrum was obtained and related peak areas were measured using spectral processing software. At this phase, the area data from each metabolite were put into corresponding mathematical equations obtained from the study of the calibration solutions, and the exact concentration of each metabolite (NA, Cr, Cho, Lactate) of each brain area was measured. In this way, the pattern of metabolite distribution in the white and gray matters of different human cerebral lobes was obtained. Statistical tests show that NA concentration (Which is an important neuron marker) in the white matter is significantly higher than in gray matter (P=0.05), and a gradual increase in NA concentration is seen from the frontal to occipital lobes. Creatine has been distributed uniformly in the different cerebral lobes and there was no significant difference seen in its concentration in the white matter of the cerebral lobes (P=0.05). There was also no significant difference in choline concentrations in human brain lobes. Na is significantly lower in gray matter than in white matter (P=0.05), Creatine concentration in gray matter is significantly higher than white matter (P=0.05) but choline concentration in this lobe is significantly lower than white matter (P=0.05). Understanding the concentrations of important brain metabolites and their pattern of distribution in different human cerebral lobes may be useful as an index for primary differential noninvasive diagnosis of human brain diseases.      

Lipoprotein (a) [Lp (a)], a cholesterol -rich plasma lipoprotein which is structurally similar to low density lipoprotein (LDL), is an independent risk factor for coronary artery disease. In addition to genetic background, some other factors such as hyperlipidaemia may influence plasma Lp (a) levels. In the present study, the Lp (a) levels in various hyperlipidaemic patients are evaluated in full. Study populations (110 females, 170 males) were selected from subjects referred to clinical laboratory for lipid analysis. Lipids and lipoproteins were measured by routine methods and Lp (a) assay was done by electroimmunodifusion. Lp (a) levels in hypercholesterolemic (Mean = 41 mg / dl ) and mixed hyperlipidaemia ( Mean =43 mg /dl ) groups were significantly higher than control group ( 23 mg / dl ). No differences were found between hypertriglyceridaemic patients ( Mean =24 mg /dl ) and controls. Furthermore, a positive correlation was found between Lp (a) and cholesterol (r = 0.25, P < 0.001) in hyperlipidaemic patients, but no correlation was observed with triglyceride. In conclusion, plasma Lp (a) concentrations are elevated in hyperlipidaemia if the patients have high cholesterol levels. However, it is normal or even low in hypertriglyceridaemic cases.        

Chondrosarcoma of paranasal sinus is an extremely rare disease especially in children. In Dahlis study of 635 patients with chondrosarcoma only four patients had mid - facial chondro surcoma. An extremely rare case of primary chondrosarcoma of paranasal sinuses in a 4 year –old buy is presented. A massive tumor involving the nose, paranasal sinuses and orbit was reserted. The pathology report indicated low grate chondrosarcoma. The post surgical sign and symptoms was carefully evaluated. There was no evidence of the disease even two years after the operation. The patient is in good condition.        

Diverticulosis of jejuneum and ileum has been reported in the literature but diverticulosis of jejuneum, ileum and ascending colon together is rare and mostly reported in young women. A 34 years old woman with complaint of abdominal pain and vomiting was admitted to the emergency room of Afshar hospital. Intestinal transit revealed plenty of divesticulosis of jejuneum and ileum causing subocclusion of small intestine. The patient was taken for laparatomy. There were several diverticulosis along the midgut, one of which was inclamed causing subocclusion. Following resection of this portion, end to end anastomosis was carried out. After a week, the patient was discharged from hospital in a good condition. Diverticulosis of small intestine is a rare disease which is diagnosed by one of its complications such as hemorrhage, perforation and obstruction. If it involves the whole length of intestine, then the portion causing the complication should be resected.