Tehran University Medical Journal
Year:2006 | Volume:64 | Issue:1|Papers Count:18

Background and Aim: This study was conducted to evaluate the safety and efficacy of Tension-free Tape for the surgical treatment of female stress urinary incontinence.Materials and Methods: In a prospective open study for pre and post operative, we followed 36 patients at least 1.5 years after surgery (18-28 months); all patients underwent the operation under local anesthesia, allowing the surgeon to check intra-operatively that continence has been obtained.Results: Mean operation time was 36 minutes (range 20-45 minutes). 32(89%) of the patients was cured according to the protocol, another 3(8.3%) were significantly improved and there was 1 (2.7%) failure. Mast of patients (about 91%) were operated on a one day-care basis, which implies that they were released from the hospital the day after the procedure, and no post operative catheterization, defect healing and tape rejection occurred. Pain free recovery time without any analgesic was another benefit.Five patients needed an indwelling catheter for 3 days and two uncomplicated hematoma occurred.Conclusion: Based on the results, we conclude that Tension-free Vaginal Tape is a safe and effective ambulatory procedure for surgical treatment of genuine stress urinary incontinence, which allows the majority of the women to be discharged from the clinic the day after the procedure and start their works in the second week.

Background and Aim: What constitutes adequate dialysis has been debated in the nephrology literature over the past years. We believed that short and infrequent dialysis session contributed to poor outcome. This result provides additional evidence that (KT/V) in a flawed concept upon which to based the dose dialysis in general. Base on published evidence from many source we proposed a new index of adequacy of hemodialysis to be called hemodialysis product (HDP).Materials and Methods: The prospective study was performed on 100 dialysis patient in the Imam hospital dialysis ward in Tehran during 2002. delivered (KT/V) and (HDP) achieved for any patient separated.Results: 100 patients including 44 female and 56 male were studied. Result has shown (KT/V) d≥l in 43% and (KT/V) d<1 in 57%. HDP in patient with (KT/V) d> 1 were ≥36. HDP in patient with (KT/V) d < 1 were < 36. Correlation between (KT/V) d and albumin was significant (p< 0.03, Albumin ≥4mg/dl). Correlation between (KT/V) d and cholesterol, hemoglobin, creatinine were not significant. Correlation between (KT/V) d and HDP was significant (p< 0.001).Conclusion: Finding above has shown that higher weekly delivered (KTN) correlate with dialysis result increase hemodialysis product (HDP). More frequent and session dialysis results increase in HDP, provide better weekly (KT/V) d with normal albumin (show good caloric and protein intake).

Background and Aim: In epileptic patients, behavioral disorders are the most important deficits; therefore evaluation of deficits by animal model should be essential.The role of Zinc in behavioral disorder and its relation with hippocampus or serum zincmay help explain why some brain region is commonly facilitated while other did not harm. The main purpose of this study was to evaluate Zinc itself effect on changing behavioral disorder and control of brain seizure.Materials and Methods: Type of this study is prospective, empirical and blind. The population was adult male Sprauge-Dawley rats and randomly assigned in six groups (n=8). Each group was treated two months before of inducing animal model of seizure by Zinc (248 mg/lit) or tap water and also in group 1 and 4 saline, group 2 and 5 bicuculine (1 mg/kg) and group 3 and 6 pentobarbital (10mg/kg) epileptic model was induced by injection of Lithium chloride (127mg/kg) and 24 hr later, pilocarpin (50 mg/kg) in to peritoneum. During this study, neurological deficits (behavior) were I recorded at 1, and 2 hrs after sizuring.Results: The results showed that Zn had a minus feature on neurological deficits. GABA A antagonists had the same effect as Zn on neurological deficits but GABA A , agonists ameliorate it significantly. Serum zinc level didn't change significantly among the animals but hippocampus zinc was altered significantly in Zn treated animals compared with the controls.Conclusion: This study shows that Zn deleterious effects on neurological deficits were carried out via GABAergic system.

Background and Aim: Today, work related stress has become a common and costly problem in work places that most of studies in the last 30 decades have engaged in this problem. Several reports indicate that the occupations such as nursing which have high physiological job demands and low decision latitude are very stressful. This stress can cause harmful physical and psychological effects on nurses' health. On the other hand, job stress may result in high rates of injury, tardiness and absenteeism at work place and reduced productivity and organizational commitment leading to low quality of nursing care.Numerous studies suggested that learning new activities and skills such as communication skills is one of the best strategies against job stress. The purpose of this study was to test the effectiveness of communication Skills training in reducing work stress level among nursing personnel in rehabilitation centers.Materials and Methods: The quasi- experimental design was conducted. A sample of 48 nursing personnel participated in the study. Subjects were randomly assigned to one of two experimental or control groups. Subjects in experimental group participated in a 7- hour's workshop, all subjects were pre and post tested (one month later) for job stress and communication skills with the Karasek's Job Content Questionnaire (JCQ) and communication skills test.Results: Results revealed the following: (1) subjects in both groups after pretest were the middle level of stress and communication skills. (2) After training the experimental group scored higher on the rating of communication skills than control group and had successfully maintained their improvements for 4 weeks. (3) After training the experimental group showed lower level of stress than control group and had successfully maintained their improvements for 4 weeks.Conclusion: As a result of this research communication skills training could reduce level of stress among nursing personnel, thus. It is recommended to apply communication skills training programs for nursing personnel working at rehabilitation centers in order to assist them to coping with their job stress and improve the quality of nursing care.

Background and Aim: Total laryngectomy following laryngeal cancer has many sequelae, that loss of voice is the most important of them. Tracheoesophageal puncture (TEP) and prosthesis insertion has evolved into the most widely used and accepted technique for vocal rehabilitation.Materials and Methods: 10 patients that underwent TEP in Amir Alam and Imam Khomeini hospitals from Feb. 2002 through Nov. 2003; were included in this study.Prosthesis insertion in 4 patients is primary and in 6 patients is secondary; and all patients are men.Results: The age of patients was between 50 to 70. 90% of patients had history of cigarette smoking and 10% of them had history of drinking alcohol. Salivary leakage was seen in 30% of patients that was improved with conservative management. Fluency of speech in 30% of patients and intelligibility of speech & voice quality in 40% of patients is good.Conclusion: We could conclude that TEP has less complication & better speech results of other vocal rehabilitation methods. Carefully selection of patients & size of prosthesis has important role in results of TEP.

Background and Aim: Tuberculosis is one the major health care problems in developing countries. Miliary tuberculosis is induced by blood dissemination of multiple tubercle bacilli, the paramount importance of accurate diagnosis of military tuberculosis is because of its dismal outcome if untreated and the chance of cure if diagnosis happens early in the course of the disorder. In this study we describe the demographic and risk factors related to military tuberculosis, which enables us to control and reduce the incidence of military tuberculosis. This ultimately reduces the mortality and morbidity consistent with this disorder. Materials and Methods: we conducted a retrospective case control study, which compares 28 patients with military tuberculosis and 56 patients with pulmonary tuberculosis as control. We reviewed all the patients documents registered between years 1994-2004, after extracting raw data we analyzed them with chi-square and Fisher exact tests.Results and Conclusion: We found that HIV (P< 0.05) infection and lack of BCG vaccination (P< 0.05) increases the number of military tuberculosis among our patients.In addition we did not find any other significant risk factor.

Background and Aim: Sudden Sensorineural Hearing Loss (SSNHL) is an emergency situation, and is one of the most controversial subjects in domain of otolaryngology. In this article, we have analyzed some Epidemiologic Characteristics, clinical features, audiological Characteristics, and other findings in routine serological tests and MRI of 48 cases with SSNHL, who came or were referred to us in the past 2 years. Study design: Cross sectional.Materials and Methods: In 48 patients with chief complaint of SSNHL, from June 2003 to Feb. 2005, who were admitted in clinic of otolaryngology- in Kashani Hospital -Isfahan- Iran, physical examination and history taking, audiological evaluation, MRI, and serological tests were performed in a similar way, and data were analyzed by SPSS software.Results: From 48 cases (M:28, F:20) with mean age of 40.9 (+/-15.9) years, left ear was involved in 26 cases (54.1%) ,and right ear in 19 cases (39.5%) ,and in 3 cases (6.3%), both sides were involved. The severity of hearing loss was "subjectively" HIGH in 78% of patients, and the mean threshold of hearing had been calculated as 69 dB. The most common pattern in pure tone audiometry curves, was flat pattern (75%), and then down sloping pattern (16%).The most adjunctive chemical symptom was "tinnitus"(in 78.7%), and 40% of patients had "true vertigo". 44.4% of our patients had some evidences of upper respiratory tract infections (URIs) during recent 2 weeks. Positive family history, smoking, alcohol intake, oral contraceptive and ototoxic drugs consumption were uncommon. 24% of cases (11 of 39) had increased ESR, and 100% of 39 patients had negative VDRL. Diabetes mellitus was the most common underlying disease (in 6 cases). From 20 patients, who were succeeded to perform brain and ear MRI, 2 cases had tumor in internal auditory canal and cerebellopontine angle.Conclusion: SSNHL has some limitations in being studied histopathologically or in the form of clinical trials, and in nearly all of its aspects there are some mysteries to be cleared. Our 'Iranian' patients demonstrated some special characteristics.

Background and Aim: Cardiovascular disease is one of the main causes of mortality and morbidity around the world and because of insidious and chronic progression of arterioscleroses and coronary artery disease (CAD) and also correlation between peripheral arterial disease and CAD we evaluated ankle brachial index (ABI) as a predictive factor for early diagnosis of CAD.Materials and Methods: Evaluation of ABI performed in patients who referred to cardiology department of Imam Khomeini Hospital for coronary angiography from April 2003 to May 2004. 100 patients selected for the study, 50 patients with CAD (at least one vessel significantly involved) and 50 patients with normal coronary arteries as control cases. Relation between ABI and CAD studied in the patients, also other variables such as age, sex, family history of CAD, diabetes mellitus, hypertension, hyperlipidemia, cigarette smoking and claudication were evaluated.Results: The mean age in patients with coronary artery disease was 56±16 years old (66% male, 34% female) and in normal coronary patients was 52+15 years old (48% male, 52% female). The mean ABI in patients with abnormal coronary arteries was 1.07±0.028 and in cases with normal coronary arteries was 1.12±0.016 that was not significant (P= 0.128). In addition there was no significant value between ABI and other variables mentioned above. All patients with ABI≤0.9 (14% of patients) had CAD. Conclusion: This study revealed that although an ABI≤0.9 has a high predictive value for CAD, the ABI itself can not be a sensitive predictor of CAD diagnosis because a large numbers of CAD patients had ABI more than 0.9. Hence this level of ABI can not rule out the presence of CAD in many patients.

Background and Aim: Auditory and visual stimuli are the most important factors in communication. It seems during the brain maturation, decrease of visual inputs causes enhancement of somatosensory and auditory cortical responses. In this research latency and amplitude of auditory middle latency responses (AMLR) are studied in blinds and normally sighted subjects.Materials and Methods: This descriptive-analytical study was performed on 40 congenitally blinds and 40 normally sighted subjects in the range of 14-20 years. All of cases had normal hearing sensitivity and acoustic reflexes without any middle ear disorders. The reason of this age range is the maturation of auditory middle latency responses. Sampling was randomized.Results: There was significant difference between amplitude of Na, Pa & Nb waves and latency of Na while no significant difference between latency of Pa & Nb in blinds and normally sighted subjects.Conclusion: Increase of amplitude decrease of latency of AMLR in blind subjects was due to sensory compensation phenomenon, probably. It seems rate of processing and auditory perception in blinds is better than normally sighted subjects.

Background and Aim: Adenoids and tonsils are active lymphoid organs and playing an important role against invading antigens of upper aero digestive tract in children. The purpose of this study is observing the changes in cellular and humoral immunity of children six months after adenotonsillectomy.Materials and Methods: The study population consisted of 30 children (aged 4-10 years) with chronic adenotonsillar hypertrophy and 30 ages- matched healthy children. In all children serum level of IgM and IgG, percentage of T lymphocytes (CD3), T helper (CD4), T (CDS) and B lymphocytes (CD20) were measured. These parameters were remeasured in patients 6 months after adenotonsillectomy.Results: Before the operation, a reduction in percentage of T lymphocytes (CD3), TCD4, TCDS and B CD20 was seen compared with control group. This reduction was only significant in T Iymphocytes (CD3) (P.Value=0.03). The serum IgM level was not different in two groups and IgG level was elevated in two groups but not significantly different. Six months after operation the percentage of lymphocytes T CD3+, TCDS+, TCD4+ and BCD20+ was increased and reached the control group. The IgG level was also significantly decreased in patients after operation (P.Value=0.00).Conclusion: Our results indicate that cellular and humoral immunity decreases in children with chronic adenotonsillar hypertrophy preoperatively and increases to healthy children level, six months postoperatively. It means that chronic adenotosillar hypertrophy affects some parameters of cellular and humoral immunity and adenotonsillectomy by removing chronic stimulations reverses these changes without any negative effect on immune function of patients.

Background and Aim: Measuring the outcome of chronic diseases such as multiple sclerosis is an important factor in assessment of disease impact on different dimensions of quality of life and in evaluation of therapeutic interventions. The aim of this study was to perform the cross-cultural adaptation of the MSIS-29 which is a MS-specific outcome measure for Iranian patients.Materials and Methods: The Iranian adaptation process of the MSIS-29 included 5 steps. To evaluate psychometric properties of the translated version, the questionnaire was administered to a consecutive sample of 96 patients with clinically definite MS referred to our out-patient clinic. Test-retest reliability was assessed in a sub-sample consisted of 30 patients. These patients completed the questionnaire on two occasions separated by a 7-day interval. The Iranian version of the SF-36 was also administered to this sub-sample in order to evaluate the validity of translated MSIS-29.Results: Statistical analysis indicated that the Persian version of the MSIS-29 had high internal consistency (cronbach's alpha coefficients> 0.70) and test-retest reliability (intra-class correlation coefficients >0.70) and a good validity.Conclusion: The Persian version of the MSIS-29 is a reliable and valid instrument for measuring MS outcome in Iranian patients. It can be used in clinical trials and cross-sectional studies.

Background and Aim: Prevalence of malnutrition is high in under-5 years old children and mother's nutritional knowledge, attitude, practice (KAP) is associated to nutritional status of children and lack of nutritional knowledge and their poor practices can be considered of prominent causes of children malnutrition. This study carried out to assess the nutritional knowledge, attitude and practice of mothers.Materials and Methods: In this study a group of 632 mothers who had at least one child aged 6-36 month old referred to Kerman health centers were selected to evaluate their nutritional KAP. The data were collected using questionnaires and face-to-face interviews with the mothers and from children health care records. The KAP questionnaires were completed and scores were rated as: optimum, relatively optimum and poor for subjects that achieved 80% -- 100%, 60% - 80% and < 60% of high scores respectively.Results: The findings of this study indicated that 40/2%, 73/6% and 26/9% of mothers had respectively optimum knowledge, attitude and practice. A statistically significant association was found between mother education and maternal nutritional knowledge, attitude and practice. And family income had a statistically significant association with knowledge and not with practice and attitude. There was no association between mother age and knowledge, attitude, practice. And was found a significant positive association between knowledge, attitude, practice.Conclusion: Education of mothers concerning nutritional requirements of children makes them possible to benefit a proper nutritional program.

Background and Aim: In obstetrics, calcium antagonists, in particular nifedipine, have become increasingly popular for the management of preterm labor and are more effective tocolytic agents than beta 2-sympathomimetics. Our aim was to evaluate the effects of oral nifedipine therapy on ultrasonographic cord blood flow parameters in pregnant women with short cervical length.Materials and Methods: In a case-series study, 20 patients at risk of preterm labor with shortening cervix in serial examinations were included. Patients received oral nifedipine administered 40 mg per day until 37 w of gestational age (GA). Umbilical artery Doppler parameters including systolic/diastolic ratio (SD) and pulsatility index (PI) were recorded before and biweekly after nifedipine prescription.Results: The mean of age was 25.55±4.58 years. The mean cervical length was 19.68±6.32 nifedipine consumption was initiated at the 26.4±4.12 wand was terminated at 36.10±2.65 w. The side effects of nifedipine were occurred in 2 patients (10%). In no patient no SD and PI measure get out of normal values. In contrast to PI, after nifedipine consumption SD was significantly higher than before (2.28±0.45 vs. 2.65±0.21).Two neonates (10%) were delivered before 37w and less than 2500gr. Just one neonate needed NICU stay.Conclusion: Oral nifedipine can be used as a safe and effective tocolytic treatment in patients at risk of preterm labor with shortened cervical length.

Background and Aim: Due to the increased usage of carbamazepine, phenytoin and Sodium Valproate, a higher number of intoxication is to be expected. The aim of this Study is demographic evaluation of this agent.Materials and Methods: In this cross-sectional survey we studied 93 patients who were poisoned with these drugs from July 2003 until July 2004, in Loghman Hakeem hospital, Tehran, Iran.Results: In this study we found these results: 36.6 % were male and 63.4 % of, patients were female; mean age of patients were about 24.5 y. twenty nine present (29) % were routinely on these drugs. Mean time between consumption and admission was 6 hours and 56% of them had decreased level of consciousness and 90% had high serum level of drugs. 80% of them showed complications such as respiratory distress, Urinary tract infection and etc and 4.5% of patients admitted in ICU and mortality rate were 2%.Conclusion: Results of this study are compatible with other studies and according to high prevalence of overdose with these drugs we must focus on prevention factors like education for suitable management, good care, psychiatric consult and proper Treatment.