Journal of Shahid Sadoughi University of Medical Sciences
Year:2008 | Volume:15 | Issue:4|Papers Count:19

Introduction: Hyperbilirubinemia is a common benign problem in neonates. Nonetheless, if untreated, severe hyperbilirubinemia is potentially neurotoxic. The standard method for diagnosis of hyperbilirubinemia is determination of serum bilirubin levels in the laboratory that requires a blood sample which is both painful and stressful for neonates and entails cost and time.The objective of this study was to study the correlation between transcutaneous bilirubin levels (JH 20-1 bilirobinometer) and serum bilirubin levels.Method: This prospective study was done on 100jaundiced newborn term infants from March to October, 2006. Initial clinical assessment of jaundice was carried out by a physician (researcher) and simultaneously, blood sample was collected and a JH20-1 bilirubinometer was applied at two sites; forehead and sternum.Results: The study group consisted of 57 boys and 43 girls diagnosed as jaundiced neonates. The mean serum bilirubin and mean transcutaneous bilirubin levels at forehead and sternum were 13.35, 12.95 and 12.46 mg/dl, respectively.The correlation coefficient of bilirubin levels estimated by the bi]irubinometer at the forehead and sternum and serum levels were 0.773 and 0.731, respectively. At bilirubin levels higher than 12 mg/dl (cut off point), the bilirubinometer had a decreased sensitivity, but an increased specificity.Conclusion: Transcutaneous bilirubin measurements using JH20-1 bilirubinimeter correlate well with total serum bilirubin levels, but when bilirubin levels are higher than 12mg/dl, sensitivity of the device is reduced and therefore not reliable.

Introduction: Most hospitals routinely examine microscopically all tonsillar and adenoid specimens from healthy pediatric patients complaining of recurrent infections or obstructive sleep apnea. Concern over missing the rare, unsuspected and significant diagnosis propagates this practice. Clinical examination for asymmetry could obviate the need for routine microscopic examination of tonsil and adenoid specimens in patients aged 16 years old and younger.Methods: A prospective controlled trial was carried out in one institution using database of 305 patients aged 16 years or younger who underwent tonsillectomy and/or adenoidectomy between 2003 and 2007 at the Shaheed Sadoughi Hospital .Patients with unilateral tonsillar enlargement were entered in this study. Patients who had risk factors for malignancy were excluded. After excision, two tonsil specimens were measured before sending for histological examination. Matched controls with symmetric tonsils underwent the same procedures. Preoperative diagnosis of tonsil asymmetry with the postoperative histological diagnosis was evaluated.Results: Of the 305 patients undergoing tonsillectomy, 106 patients (34.75%) had asymmetric tonsils. In the control group 102 patients had symmetric tonsils. The analysis showed statistically no significant difference in the age, sex, indication of surgery and type of surgery between the two groups. Most of the specimens had reactive lymphoid hyperplasia in both the groups (58.49% and 54.9%, respectively). Histological examination showed no malignancies or unusual pathological findings in both the groups. Discussion: Tonsil asymmetry may be apparent in patients with normal physical examination, secondary to benign hyperplasia or anatomical factors. Therefore the presence of tonsil asymmetry without risk factors like progressive enlargement of the tonsil, concomitant neck adenopathies, history of malignancy or immunocompromise may not indicate malignancy. Microscopic examination of all routine tonsils and adenoids for individuals aged 16 years or less is not indicated, but careful gross examination is still recommended.

Introduction: Refractory status epilepticus is a life-threatening disease in children wherein seizure movements don't response to first line anti convulsion drugs. This study reviewed risk factors, management and early outcome of children with refractory status epilepticus.methods: Patients with refractory status epilepticus admitted in Tabriz children's hospital between 2003 and 2006 were reviewed prospectively for risk factors, management and outcome at time of discharge from hospital.Results: Of the total of 121 patients with status epilepticus, 47 patients (38.8%) were afflicted with refractory status epilepticus. The most common form of refractory status epilepticus was acute symptomatic (38.3%).Seizure caused by acute symptomatic [RR= 2.36, (CI 95%=1.25 - 4.44), P=0.006] was a risk factor for refractory status epilepticus development. 87.2% of patients with refractory status epilepticus were treated by midazolam infusion. There was no significant relation between non-response to midazolam, etiology (P=0.798) and type of seizure (P=0.273). Early outcome of children with refractory status epilepticus was significantly worse than those with status epilepticus (P=0.0001).Conclusion: About 38% of patients with status epilepticus develop refractory status epilepticus with an increased mortality and morbidity. Seizure caused by acute symptomatic is an important risk factor for developing refractory status epilepticus. In most cases, midazolam infusion rhesus in end of seizure.

Introduction: Conductive hearing loss due to chronic otitis media (COM) can be treated by surgery. COM, however, may be associated with functional damage to the inner ear. Sensor neural hearing loss (SNHL) due to COM has been found to be significant by some authors, whereas it has been considered negligible by others. The present study aimed to answer the question; does COM cause SNHL?Methods: 120 patients with unilateral COM admitted for tympano-mastoidectomy were selected for this observational case-control study. Air conduction threshold (ACT) and bone conduction threshold (BCT) averages were calculated at the speech frequencies (500, 1000, 2000Hz) and 4 KHz, in affected (case ear) and non affected (control ear) and then entered in the questionnaire along with intraoperative findings.Multiple statistical tests were used to clarify the relationships between SNHL and COM.Results: COM was seen to be associated with SNHL. The Threshold shift was more accentuated at 4 KHz in older patients. SNHL at 4 KHz seemed to be higher than that at the speech frequencies. There was a significant positive relationship between the elevated BCT and duration of COM. The relationship between elevated BCT and cholesteatoma was also significant.Conclusion: The inner ear is vulnerable to COM. The proximity of the sensory cells to the potential source of harm (inflamed middle ear) may mean higher exposure, as reflected by the fact that sensory cells processing high frequencies are more seriously damaged. SNHL in affected ear is strongly dependant on duration of disease.

Introduction: Attention Deficit hyperactivity Disorder (ADHD) is the most common psychiatric disorder in school age children and has a negative effect on the individual's general functions. The purpose of this study was to estimate the prevalence of ADHD in preschool 6 year old children in Yazd in 2005 and the int1uence of gender, birth weight, birth order and parental education on ADHD.Methods: 400 preschool children including 200 boys and 200 girls were selected randomly through sampling method and the data of the cross sectional research was collected via compiled questionnaires based on the DSM-IV criteria and interview of parents. Data of this investigation was analyzed and evaluated using SPSS: 11.5 software.Results: The results showed that general prevalence of ADHD was 16/3% and more in boys (19/5%) than girls (13%). Most of the parents of the affected children were i1Iiterateor uneducated. There was no statistically significant relationship between gender, birth weight, order and ADHD frequency.Conclusion: In view of the high prevalence of ADHD among children in Yazd and its undesirable outcome, it is recommended to have a preventive mental health program for screening and treatment.

Introduction: Narcotic drug abuse and illicit use of drugs is a major, complicated multifactorial phenomenon affecting most of the societies today. Incidence of drug abuse among adolescents is very high. Adolescents become addicted to substances more quickly than adults. The aim of this study was to assess the pattern of drug abuse among male adolescents in Hamadan.Methods: This study was a descriptive study and samples (n=400) were collected on the basis of snowball sampling method. Information was collected individually through completion of a researcher-designed questionnaire including demographic and epidemiological indices, perceived familial support, religiosity, and locus of control.Results: The results showed that smoking (93%), alcohol (92.5%), marijuana (64.3%), and opium (57.8%) use were very high, while LSD (4.8%) and Cocaine(2.3%) use was rare. 77.8 % of adolescents began drug abuse between 12 and 18 years of age. Moreover, sensation seeking (26.5%), individual interest (24.8%), and peer pressure (22%), were the main reasons for drug abuse.Conclusion: As initial smoking, alcohol and marijuana use play an important role in determining the future addiction of adolescents to narcotics, yearly surveillance programs in the country and evaluation of etiological factors of narcotic addiction need to be studied carefully. All of the preventive and school programs designed for the young should take into account environmental, demographic and policy factors in addition to personal factors so that the programs have a maximum effect.

Introduction: Glaucoma is one of the leading causes of blindness throughout the world. Some studies have suggested a relationship between glaucoma and sensorineural hearing loss, while others have found no evidence of an association. We performed a study to determine whether there is a significant difference in hearing of patients with glaucoma and a match control population.Methods: In this cross-sectional study, horn February, 2005 till April, 2006, 44 patients with glaucoma were studied. The age range was between 15 to 60 years. After taking a complete medical history, those suffering from presbycusis, history of exposure to ototoxic drugs and substances and history of ear surgery were excluded from the study. All of the patients were cases of open-angle glaucoma, and were surveyed separately for normal-pressure glaucoma. Then complete audiometric tests (PTA, SOS, SRT, and Impedance) were conducted for all of them, and the results compared with a control group.Results: There was no statistically significant difference between the case group and control group in PTA, SOS, and SRT, except for Normal Tension Glaucoma (NTG). There wasn't any statistically significant difference between two groups with respect to age, gender, and history of diseases. In the NTG group, significant difference was seen only in high frequencies.Conclusion: As mentioned, there was a statistically significant difference between NTG group and control group. It is therefore recommended to conduct complete audiometric tests and histopathologic examinations in this group for early detection of hearing loss and application of rehabilitative measures.

Introduction: Zoonotic Cutaneous leishmaniasis (ZCL) is one of the most important parasitic diseases in Iran and common in rural districts of half of the 30 provinces of the country. In recent years, ZCL has become a serious and increasing public health problem in Yazd province. Following the epidemic of CL in Khatam county of Yazd province, this study was carried out to determine the animal reservoir hosts and human infection in 2005-2006.Methods: 300 households were examined in February 2006 and corresponding forms were completed for each household during a house-to-house visit. Rodents were caught by 20 live traps, biweekly from late August to late November 2006.The rodents were identified morphologically and 4 impression smears were prepared from the edge of their ear lobes. The causative agent of the disease was isolated from humans and rodents characterized by RAPD-PCR method.Results: The rate of ulcers and scars of ZCL among the inhabitant’s was 4.8% and 9.8%, respectively. Leishmania major was also isolated from human indigenous cases in Khatam County. In the study, Meriones libycus, Tatera indica and Rhombomys opimus were recorded and all of them were infected with leishmaniasis. Leishmania major was isolated and identified from R.opimus, too.Conclusion: Regarding the results of the present study, ZCL is prevalent in Khatam. It seems that .opimus is the main reservoir host of the disease and M.libycus and T.indica also maintain this ZCL focus.

Introduction: Intestinal parasites have worldwide prevalence and are considered to be as one of the leading hygienic and economic problems in the world. It can be said that there is nowhere in the world without parasitic infestations. The present study was conducted to determine the prevalence of intestinal parasites in patients referring to Yazd Central Laboratory in 2000-2002.Methods: The present study was a cross-sectional, analytic and descriptive study including 13388 stool specimens examined by two methods; Formalin-Ethyl Acetate and direct Method for intestinal parasites and Scotch tape method for Enterobius vermicularis.Results: 13388 samples examined included 6913 women and 6475 men. Parasites were observed in 1151 cases (8.6%) including 618 (53.7%) men and 533 (46.3%) women, respectively. Of these, 98.6% were infected with protozoa and 1.4% with helminths. Giardia lambdia (41.05%), E.coli (27.45%) and Blastocystis hominis (15.51%) were the most common infecting organisms. Helminth infections were few, but the highest frequency was related to Hymenolepis nana and Enterobious vermicularis. Maximum frequency was reported in summer. There was a significant association between stool consistency and infestation by intestinal parasites (P=0.002). There was a significant relationship with sex, too (P=0.001).Conclusion: In the present study, the most common parasites were Giardia, E.coli and Blastocystis hominis (higher than five), but the prevalence was less as compared to previous similar studies in other regions, which could be because of the hot and dry weather, better personal hygiene and improved sewage system of Yazd.

Introduction: Leishmanioses are important parasitic diseases presenting in three clinical fonns; visceral, cutaneous and muco-cutaneous. Some rodents are the reservoir hosts of zoonotic cutaneous leishmaniasis.The disease prevails in many rural areas of Yazd Province. This was the first comprehensive study on the fauna of rodents in Yazd and was conducted to determine the fauna, distribution and abundance of rodents during 2004-2005.Methods: The Rodents were collected by 30 Sherman live traps weekly from different parts of Yazd Province. The rodents were identified morphologically in the laboratory. To determine the Leishmanial infection of rodents, two smears of each ear lobe were prepared, fixed and stained by Geimsa and observed under light microscope.Results: A total of 106 rodents were collected and subsequently 6 species were identified as follows: Meriones libycus (52.8%), Rhombomys opimus (20.8%), Mus musculus (12.3%), Tatera indica(7.5%), Nesokia indica (5.7%) and Rattus rattus(0.9%). Of these 6 species, 8.1% of Meriones libycus and 5.9% of Rhombomys opimus were infected with Leishmaniaparasites.Conclusion: In the present study, leishmanial infection of Rhombomys opimus and Meriones libycus was determined. These species are the main reservoir hosts of zoonotic cutaneous leishmaniasis in Iran. Control operations are recommended in the hypoendemic and mesoendemic foci of the disease.

Introduction: Since discovery of high frequency waves, their biological effects have been in great attention. Increased male fertility problems proposed their possible relation to use of microwaves. Testes are of very active body tissues, which can be affected by these waves. Age of exposure may also be an important factor. Methods: This study was carried out to evaluated testosterone level in rats exposed to microwave radiation at pre and post puberty. For this study 18 adult (2 month old) and 18 immature (1 month old) male rats were selected and each group divided in two groups, control and test group. Test groups were exposed to 2450 MHZ microwaves produced by microwave oven (LG Brant), three times a day, 30 minute each time. Control groups were kept in laboratory at same temperature and light condition. After 60 days blood was collected by heart puncture and testosterone was measured in serum by RIA method. Mean testosterone levels were compared by T-test.Result: The results showed that in immature group testosterone has not changed significantly compare to control group; however in adult group this value was significantly decreased in test group in comparison with control (P<0.005).Conclusion: exposure to microwaves leakage of microwave oven decreased testosterone in adult male rats, which may be due to its direct effect on Leydig cells or indirectly through its effect on pituitary and hypothalamus.

Introduction: One the most anxious moments for mothers and families is labor pain and various methods for its relief have an effect on labor management, patient satisfaction and labor outcome. Both pharmacological and non-pharmacological methods are used to relieve labor pain, but in recently years, researchers have focused their attention to non-pharmacological methods for reduction of labor pain. Acupressure is one of the pain relieving methods that can be used for labor pain, but there have been few studies to date. The purpose of this research was to determine the effect of Hoku point ice massage on labor pain.Methods: Participants of this clinical trial study were 60 pregnant women having the inclusive criteria. Participams were randomly divided to two groups of thirty, each. (Control Group=only touch of Hoku point, Case group= ice massage of Huko point). This procedure was done for thirty minutes. Labor pain of subjects was measured by visual analog scale before and after the procedure.Results: There was no statistical difference between the gestational age, parity and age of the two groups. Results showed that reduction of labor pain by ice massage of Huko point was statistically significant (P<0.001). Conclusion: Acupressure is a noninvasive, simple and cheap method of relieving pain and our study confirms its effect on reduction of labor pain. This method is therefore applicable in delivery rooms.

Introduction: Construction phase in industries is a dynamic process that is naturally and intrinsically dangerous and as it becomes more complicated, the accidents rate also increases. One should note that without considering a model, one could not obtain useful and reliable information and method to prevent accidents. Therefore, to achieve useful methods for preventing accidents, it is desirable to consider a model the general goal of this study was presentation of a model. A model is the reflection of a fact. In other words, it should be said that the model represents a system or process whose behavior can be predicted. Models are therefore used for understanding the behavior of actual terminals and show a theory in the way that covers important variables for describing phenomena and instead, ignore factors of low importance in the expression of those phenomena.Methods: This study was a research article conducted in 2004-2005 in the Assaluyeh region. Data was gathered from accident reports present in security and health records of the projects and also statistics present at the treatment centers. In this study, an analytical model (multi-regression) was presented to describe the impact of effective and deep factors on the possibility of an increase in accidents leading to death, through measurement of the effects of independent variables on the dependent variables. For this purpose. The structure of 50 accidents that led to death were studied along with another 2700 accidents, and after studying the accident reports and related documents, observing operations and equipment, counseling with accident observers and an expert team of managers, supervisors and engineers, and simulation of some accidents, unsafe conditions and functions, mismanagement and use of worn out and defective tools, equipment, devices and machinery were considered as the four independent variables and the job accidents leading to death were considered as dependent variables. The relationship between independent and dependent variables, evaluation of regression coefficients and the test of different models were based on multi-regression analytical model and analyzed using Eviews software program.Results: The final findings of this study, while specifying the possibility of occurrence of accidents leading to death with the existence of any of the independent variables showed that among the independent variables, unsafe conditions and mismanagement have relatively more important roles to play in the occurrence of accidents leading to death such that in conclusion, these factors have been defined as root causes in the model.Conclusion: Since the adjusted coefficient determined for the model in this research was 0.99; that is, the specified model could describe 99 percent of changes related to the number of job accidents leading to death and it is only for one percent of other accidents that there was no justified answer. In another words, those causes were not seen in the model. Therefore, it could be concluded that this research as compared to similar researches gained more useful results. Thus, by omitting or lowering unsafe conditions and mismanagement factors, accidents resulting in deaths can be reduced.

Percutaneous vertebroplasty is a promising therapeutic technique for pain control in patients with pathologic fractures of vertebral bodies. Percutaneous vertebroplasty is an appropriate treatment for vertebral pathologic fractures, which is resistant to other usual treatment. It is a useful and only choice in special cases, because of less tissue damage and there is no risk of open surgery and patient's embolization is rapid. Herein we described the first case of percutaneous vertebroplasty in Yazd shahid sadoughi teaching hospital, which was done in ordybehesht 1386 in a 72 years old male with pathologic fracture of 2 lumbar vertebrae. He was suffered from pain and disability and open surgery was not appropriate treatment for him.