Journal of Shahid Sadoughi University of Medical Sciences
Year:2002 | Volume:1 | Issue:2|Papers Count:16

Newborn infants as a group get sick much faster and in more alarming ways than any other pediatric group. Prematurity [Low Birth Weight (LBW)] is the leading cause of neonatal morbidity and death worldwide and accounts for 60-80% of the total deaths in infants during the first 4 weeks of life. As LBW infants are more likely to have brain damage and more prone to respiratory & liver diseases, LBW is considered as  a biological risk index. The objective of this study was to determine the incidence of LBW in Yazd province. In this cross-sectional study where in 5000 liveborn infants were studied, data obtained through a questionnaire was analyzed by means of analytical tests (X2& analysis of variance).Results showed that the total incidence of LBW infants in yazd is 7.97% which includes moderately LBW - 7.14%, very LBW-0.59% & extremely LBW 0.24%.

Spirometry is a valuable tool in pulmonary practice. As early as the first time since this kind of studywas introduced for clinical settings, determining the normal values for various parameters had been subject of major concern. Since the body builds of different human races are greatly variable, and the lung volumes are greatly affected by these racial differences, development of standard prediction equations for each race or even ethnic group is a research priority. We measured the lung function of 423 Healthy Non-moker children and adolescents, 3-20 years of age who were reported to have no respiratory symptoms, and had no cardiac or pulmonary abnormal finding on physical examination. These measurements were analyzed to develop simple equations for calculation of prediction values for each of the measured parameters in the series. Demography of the subjects, anthropo metric findings and analysis of the spirometric findings in relation to the calculated prediction equations are presented in this study. The lung volumes of children in Isfahan are slightly less than that of European and American children.

Unstable angina is common in our city (YAZD-IRAN), but as the patients characteristics and long term outcome are not clear, this study was performed. 100 patients with unstable angina were selected from Rahnemoon & Afshar hospitals (in Yazd) and the patients characteristics, their risk factors, in hospital course were recorded. After discharge, these patients were visited several times and any new events were recorded for one year. The mean age of the patients (47% female, 53% male) was 62.84±11.85. The frequency of hypertension, diabetes mellitus, smoking, hyperlipidemia and positive family history, was 48%, 29%, 18٪, 41% and 40% respectively. The ECG changes were ST depression >1 mm in 48%, ST elevation >1 mm in 17%, negative T wave in 25% and normal ECG in 10% of patients. Acute myocardial infarction occurred in 6% of patients, especially in the first week of unstable angina. Total death rate after one year was 13% and most of them were sudden deaths. Death was more common, in old age (more than 70ys), male patients (9% VS 4%) and in patients with ST depresstion >1mm. Recurrent unstable angina occurred in 20% of patients. Coronary artery bypass was done in 19% of patients. During a 1 year follow up of unstable angina patients in Yazd, new myocardial infarctions were seen in 6% of the patients and the mortality rate was 13%.

Digoxin is one of the main stay of treatment in congestive heart failure and supraventricular arrhythmia that has a narrow therapeutic window. This study was conducted to find whether factors like renal function, creatinine clearance, age, and drug interactions are considered during the prescription of digoxin. This prospective study was conducted in 1379 in Yazd. Demographic characteristics, disease(s), blood pressure, clinical and para-clinical signs and symptoms, arrhythmias, EKG results, dose and duration of digoxin use, and concurrent medications of 152 patients were recorded in the questionnaires. Patients were divided into five groups based on their digoxin dose: one tablet/day (A), half a tablet/day (B), one tablet, six days per week (C), one tablet five days per week (D), and half a tablet five days per week (E). Besides, serum digoxin concentrations (SDC), electrolyte, urea and creatinine levels were measured. Then digoxin dose was then evaluated based on the aforementioned factors. The average digoxin dose was 202.56±62.36 mcg/day and SDC was 0.95± 0.47 ng/ml. Creatinine clearance was on average 55.35± 23.17ml/min/1.73 m2. Mean SDC for groups A, B, C, D, and E were 1.05±0.40, 0.87±0.41, 0.95±0.37, 0.91±0.51, and 0.94±0.16, respectively. There was no significant difference in the creatinine clearance of these five groups. Even though digoxin interactions with quinidine and amiodarone were taken into account, its interactions with triamteren, spironolactone, and verapamil were not. Age and electrolyte disturbances were considered for determining digoxin dose. Overall, 26.32% of patient's had SDC's below 0.5 mg/ml, where as 14.47% had concentrations above 1.5 mg/ml. Hospitalization due to digoxin toxicity was 1.97%. Digoxin dosing was usually based on clinical evaluation and age of the patient without considering renal function and drug interactions. This led to over or under therapeutic levels in some patients.

Stroke is one of the common neurological disorders which results in both high mortality and morbidity and various complications. One of the important complications is brain edema for which various drugs are used and dexamethasone is one of the drugs used for treating brain edema. In recent years there have been conflicting reports on the usage of dexamethasone. We therefore decided to evaluate the effect of this drug on patients who had suffered from a stroke for the first time in their lives. 210 patients who had suffered form cerebral infarction for the first time were included in this prospective double blind clinical trial study. The patients were randomly divided into two equal groups. The patients in one group were treated with dexamethasone while the other group with placebo. Otherwise, all patients in both groups were treated with the same drugs, including the other drugs used for reduction of brain edema. The rate of mortality and morbidity, duration of hospitalization level of consciousness and disorders of motor and sensory function were compared in both the groups. No statistically significant difference was observed between the two groups except that only the disorders of motor function were more in the group receiving dexamethasone and this was also statistically significant. Taking into consideration the result of this study and other associated complications of dexamethasone itself, it is advisable not to use dexamethasone in patients suffering from stroke and it is better to use other drugs for reducing the brain edema.

Between 1997 and 2000, 12 Patients with choanal atresia underwent endoscopic surgery through transnasal approach. Mean age was 6.6 years with a range of one month to 14 Years. 17% of patients had bilateral atresia and the remaining 83% had single sided atresia. Of those with single sided atresia, 70% were on the right side and 30% on the left side. 41% had membranous atresia and 59% were bony atresias. All were treated by endoscopic surgery. In bony atresias it was opened by microdrilling and in membranous ones, it was opened bycurette and circular punch. Stent tube was placed for all of them. Mean follow up time was 28.4 months. 9 patients had complete success with both choanae open. In the other 3 Patients nasal obstruction recurred, of which one of them under went revision. The other 2 patients refused revision surgery. No complications occurred in surgeries. Considering these results, in seems that endoscopic surgery of choanal atresia through transnasal approach is the best method, which due to excellent visualisation of the field, yields better results compared to classic surgical methods.

Poisoning in one of the most common causes of emergency visits for all ages. This cross-sectional study was designed to find the local pattern of acute poisoning in children of Shiraz. All poisoned children who were referred to Nemazee Hospital Emergency Room, the largest Shiraz University Hospital, enrolled in this study during 1997-1998. Among 690 poisoned children, the male to female ratio was 1.5. The most common age group was the 1-5 year age group (P =0.009), and the most common age group of admission was the 11-15 year age group (P =0.003). Accidental ingestion of drugs was the main cause of poisoning (%90). The remaining toxic exposures were intentional, including 28 cases of suicidal attempts, all of which occurred in preadolescents. Drugs, chemicals and narcotics were responsible for most of the cases. Poisoning was more common in summer. 164 patients were admitted in wards and 6 patients (0.8%) died. Taking into consideration these findings, poison prevention education and child resistant packaging of drugs and chemicals are suggested, to decrease the cases of poisoning in the pediatric age group.

The cytological smear and biopsy of cervix are screening and diagnostic tools detection of cervical intraepithelial neoplasia (CIN) and invasive carcinoma. Any discrepancy between cervical cytological and histological diagnosis may cause under or over treatment or even a missed diagnosis. To investigate the causes of discrepancies between cervical cytological and histological diagnosis in our center. Slides of 54 cervical punch biopsies and related cervical smears were collected and reviewed during two years. From a total of 54 cases, 44(81.5%) showed correlation between histologic and cytologic diagnosis before review. Ten cases which had discrepancy between those diagnoses decreased to five after review. The leading cause of discrepancy was interpretative error which were six in histology and four in cytological interpretation. 17 cases which were diagnosed as CIN and invasive carcinoma decreased to 12 cases after review. The second cause of discrepancy was inadequacy of specimens 13 biopsy specimens and 6 pap smear specimens were considered in adequate for proper diagnosis. Careful screening of the papsmears and biopsies, especially those suspected to be CIN and consultation of difficult cases with other pathologists can decrease interpretation errors & improve diagnostic accuracy.

Streptococcus ß hemolyticus group A is the leading cause of pharyngitis and responsible for 15% of sorethroats  in the pediatric age group proper diagnosis requires proper clinical examination and laboratory tests which include Rapid Antigen tests and throat culture. Rapid Antigen tests are not available in our country and throat cultures are time consuming and unfortunately not performed correctly in our country. This study therefore suggess a clinical scoring system to aid clinicians exposed to this problem 'give a shot or not' for sore throat. This cross sectional study have performed on 250 children with sore throat attendeing in out patient clinic. First all symptoms and signs of patients recorded and then a throat culture were taken. Each sign or symptom recieved score one if exite included fever, lymphadenopathy, location of sore throat absent of sneezing, cough and rhinorrhea , abdominal pain and headache; mean score according to this system for streptococcal culture positive was 7.9 and 4.3 for negative ones. 85% of patient with score 8 or above had positive calture and less than 20% of patient with score 5 or lower were positive, rate of culture positive for score 6 and 7 was 50-55 percent. High sensivity among above items belong to fever and lymphadenopathy and high specifity belong to exudae and abdominal pain table (1) showed these scoring and rate of positivity.

The main purpose of deliberate hypotension is to decrease the need for blood transfusion in major surgical procedures or to improve the operating condition and field in microscopic surgeries. Mean artuial pressure of 50-55 mm.Hg is considered a safe range for deliberate hypotension. Different techniques and drugs are used for inducing hypotension. For this purpose in halational anesthetics, vasodilators, ß - blockers and many other drugs are used. Clonidine is a selective Alfa 2 -adrenoreceptor agonist that not only decreases sympathetic function centrally, but also lowers norepinephrine release peripherally in presynaptic Alfa 2 - receptors. We used clonidine to decrease the blood pressure in ENT surgical patients. The principal goal of this study was to determine the appropriate dose of oral clonidine as a premedication for intraoperative induced hypotension. This clinical trial study was a prospective one and a total of 106 healthy patients (15-50 years old) were studied. They received clonidine in three different doses and were compared with a control group ( no hypotensive drug preoperatively ). Blood pressure was maintained in the minimal range ( MAP ~ 55 mm.Hg ) intraoperatively in all groups by increasing halothane, opiod doses and finally using TNG infusion, if necessary. The results showed that 4 - 5 mcg/kg clonidine can decrease blood pressure significantly without any important side effects.

The gut is the source of many hormones and the gastrointestinal mucosa can be considered to be the largest endocrine organ. One of the three main groups of gastrointestinal hormones is cholecystokinin (CCK). The main effects of gastrointestinal hormones are related to digestion, absorption and movement of food in the gastrointestinal tract. The effects of cholecystokinin peptides on intestinal glucose transport were investigated by using in vitro techniques. The effects of CCK8 (the C, terminal octapeptide of (CCK33), sulfated and non-sulfated on the absorption of glucose from the guinea pig small intestine were studied using mini and large transport chambers. In small transport chambers, the paired sheets with CCK8 were studied as the experimental group while the paired sheets without CCK8 were used as control. In the large transport chambers, each sheet was used as a control. CCK8, both sulfated and non-sulfated inhibited glucose absorption by enterocytes up to 45% though the concentration of non sulfated CCK8 required for inhibition was more than the concentration of 1µg of sulfated CCK8 required for inhibition. The inhibitory effects of CCK8 on glucose absorption depended upon the cholecystokinin receptors (A & B). CCK8 (sulfated) had more affinity towards receptors as compared to CCK8 (non-sulfated) and therefore lesser concentrations were required to inhibit glucose absorption.

Zinc deficiency is a health problem in many communities, especially among adolescents because of pubertal growth sprout. This investigation was carried out to determine the epidemiology of zinc deficiency in junior high school students in Tehran city in 1997. This cross - sectional study was performed on 881 students (452 males and 429 females) with the mean age of 13.2±1.0 yr, who were selected by multistage random sampling method. Plasma, erythrocyte, and hair zinc levels were assayed by flame atomic absorption spectrophotometry. Anthropometric and demographic characteristics were measured and recorded on a questionnaire. Dietary intakes were evaluated by a 24-h recall method. Zinc deficiency was defines as having at least two indices from indices of erythrocyte, plasma, and hair zinc below 10 µg/ml,100  µg/dl,and 125  µg/g of hair, respectively. The results showed that zinc deficiency prevalence was 31.1% (confidence interval: 28-34.4%). Zinc deficiency was 65%, 49%, and 1.3% based on plasma, erythrocyte, and hair zinc levels, respectively. The mean ± SD for plasma, erythrocyte, and hair zinc concentration, height = for -age, as well as weight - for - age Z scores were 95.2±17.7µg/dl,10.3±2.3µg/ml,239.4±54.4µg/g.0.40±0.92. and 0.12±0.91,respectively. As for dietary intake compared with the RDA, 50% ofthe subjects consumed less than 50% oftheir requirement for zinc RDA based on a 24-h dietary recall. Zinc intake in subjects was 7.5±3.7µg,that in boys was higher than in girls. Correlation coefficients between zinc status indices were very weak. There was neither a linear nor nonlinear relationship between biochemical parameters and nutritional zinc intake. It is concluded that almost one - third to one - half of the subjects could be considered zinc deficient.

Lead is one of the heavy metals that have an adverse effect on renal function. Its effects can involve both renal tubules as well as glomeruli. Many studies based on observation and qualitative report have been performed and some of them report changes in volume and number of glomeruli. The present study using new and unbiased stereological techniques investigated changes in glomeruli after chronic lead acetate intoxication. This study was performed at the medical school of Ahwaz medical sciences university during Autumn and Winter of 2000 and 2001. Male Wistar rats were randomly divided to four groups (n=9). During a period of 12 weeks, the treatment groups were given 0.5% and 1% lead acetate in drinking water and the control and sham control were given distilled water and 0.4% acetic acid solution respectively. Stereo logical analysis based on Cavalierie's principle was performed to determine the reference volume (VRefrenceth),e fraction volume of glomeruli (VVGloma)and total glomerular volume (VTGlom), Furthermore, for estimating the numerical density (NVGlom)and total number of glomeruli (NTGlom),the physical dissector was utilized. Results showed that the number of glomeruli in treatment groups had decreased .significantly (P< 0.001), while for compensating this effect, the total volume of glomeruli had significant increased (P <0.001). This experiment using unbiased stereological methods confirms previous qualitative reports.

A 34 year old female (G3, P3, Ab0) presented with abdominal pain since 3 days. She had a history of vaginal bloody discharge for 30 days and her LMP was about 70 days ago. In physical examination, PR= 110/min, BP =  95/60 mmHg, T=37.9 and her abdomen was tender. In Gynecological examination there was a tender mass in her right adenex. We could obtain 10 ml uncIotted blood in coldusynthesis, Laboratory tests revealed positive BetaHCG and USG reported a heterogenous solid mass near the right ovary. The patient was admitted for emergency surgery with the diagnosis of ruptured ectopic pregnancy. We found 2 lit blood and clot in the abdomen. There was a ruptured ectopic pregnancy in the right ovary with active bleeding. After right salpinxectomy, we found another ectopic pregnancy in the contralateral tube without bleeding. So the left tube with the consumption of ectopic pregnancy was removed. Pathological examination confirmed the diagnosis of ectopic pregnancy in both the tubes.

Morgagni hernia is a rare diaphragmatic anomaly of congenital origin. It is usually asymptomatic and should be treated operatively whenever diagnosed. Morgagni hernia with congenital heart anomalies is a rare condition and one case associated with Secundum Atrial Septal Defect(ASD) has been reported. In this report, two cases with Morgagni hernias and secundum atrial septal defects are presented. Both patients had heart murmur, occasional respiratory tract infection and were accidentally diagnosed on chest X-ray. They were treated surgically and were discharged in good condition without any unwanted problems.