Galen Medical Journal
Year:2013 | Volume:2 | Issue:4|Papers Count:11

Aspirin (acetylsalicylic acid; ASA) is one of the most commonly used drugs, Studies have showed that low dose ASA can reduce cardiovascular events by irreversibly binding to cyclooxygenase and inhibiting platelet aggregation. However, ASA has not prevented all patients from cardiovascular events [1]. Ackerman and Newman were the first to describe the phenomenon of Aspirin resistance (AR) in 1990, named "incomplete antiplatelet effect of aspirin". Afterwards, in the last two decades, several studies have demonstrated that some people do not respond to low dose aspirin as an anti-platelet [2].

Background: Deep vein thrombosis (DVT) can be an ethnicity related disease and an important health issue for health-care systems. Thus, domestic recognition of risk factors and disease characteristics seem to be inevitable. This study was designed to evaluate the epidemiology, basic characteristics, and risk factors in patients with DVT. Materials and Methods: In this descriptive cross-sectional study, all patients with primary or final diagnosis of DVT, confirmed by Doppler ultrasound in a 5-year period were included. Demographic data and prognosis were extracted from medical files. To evaluate the outcome of the patients after discharge, a phone-call follow-up was performed for all available patients.Results: Three-hundred seventy-one DVT patients were included with 232/139 male to female ratio. The mean age was 55.72±20.01 years with significant difference between genders (p=0.006). Mean weight was 88.97±10.2 kg with no significant difference between genders (p=0.74). The most common affected veins were common femoral vein (257 cases, 69.2%), followed by Popliteal, iliac, axillary, and subclavian veins. No season preference was seen in DVT occurrence. One-year survival of the patients after discharge was 92.6% and two-year survival was 87.7%.Conclusion: By knowing local information about this disease, health-care providers can give accurate warnings and suggestions to prevent the probable thrombosis chances. As Iran lacked information about DVT characteristics, this study can be an epidemiologic guide for health-care systems and an opening path for future studies.

Background: Abnormal uterine bleeding (AUB) is one of the most common complains in women of any age seeking gynecologic health care and needs early diagnosis and proper management due to its impacts on the quality of life. This study was conducted to investigate the cut-off value of endometrial thickness (ET) by trans-vaginal ultra-sonography (TVUS) and evaluate its accuracy in the diagnosis of the endometrial abnormalities in premenopausal women with AUB. Materials and Methods: In this descriptive study, 64 married women between 35-50 years old were evaluated due to AUB during 2011-2012; TVUS and fractional curettage were done. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of the ET were calculated in different cut-off values.Results: The pathological evaluations of the biopsies were normal in 37 (57.8%) patients and were abnormal in 27 (42.2%) patients, 19 endometrial polyps, 6 hyperplastic lesions and 2 endometrial cancers. ET=4 mm had 100% sensitivity, 100% NPV, 10% specificity and 28% PPV in the detection of endometrial abnormalities. ET<10 mm had a proper sensitivity (67%-100%) and NPV (78.6%-100%) but specificity was low (%10-%44). ET=10 mm with sensitivity=63%, specificity=60%, NPV=65.8% and PPV=48.2% was introduced as the cut-off point with the best area under curve (LR+=2.22 LR-=0.77).Conclusion: Although an ET<10 mm was less likely to be associated with an endometrial abnormality, the low PPV of ET and low area under ROC curve shows sonography has high false positivity in premenopausal women. ET≤4 mm was more reliable and could reduce unnecessary biopsies.

Background: The choice of an accurate microorganism isolation from chronic osteomyelitis has been a big conflict between clinicians during the time. The aim of this study is to compare specimens from sinus tract and bone, for an accurate treatment of trauma induced chronic osteomyelitis (CO). Materials and Methods: A total of 139 patients with trauma induced CO, were entered to the study. The specimens were taken from both sinus tract and bone. All specimens were cultured by Karby Bauer method. finally isolated microorganisms from sinus tract and bone specimens, were compared.Results: The overall concordance between sinus tract and bone cultures was 46%. There was 17% false negative results in sinus tract specimens, but only 5.6% of the bone specimens had false negative results. In all cases, which the microorganisms were found in the sinus tract, they were isolated from the bone also. Conclusion: This study suggests that bone specimens are more reliable in diagnosis of trauma induced CO. Culture result of sinus tract specimen is reliable, except for Staphylococcus epidermidis, Proteus, and Candida albicans; In other conditions antibiotic therapy can be started based on sinus tract culture, until the bone culture becomes ready.

Background: One-third of the world’s population is currently infected by tubercle bacillus. This study was performed to evaluate epidemiological and clinical aspects of confirmed cases of tuberculosis infections in a seven-year time period, between years of 2002 to 2008, in the city of Hamadan, west of Iran. Materials and Methods: In this descriptive retrospective study, medical records of 375 patients from the year of 2002 to 2008 were evaluated and analyzed. Required data were obtained from medical records of all the patients and inserted into a detailed checklist. Obtained data were analyzed by using SPSS statistical software (version 11.0).Results: The mean age of the patients was 53.69±20.37. Most patients were female (58.7%).78.1% of the cases were from urban areas.58.7% of the patients were diagnosed by pulmonary tuberculosis. The mean age of the patients with extra-pulmonary tuberculosis was significantly younger than patients suffering from pulmonary tuberculosis.29.1% of males and 47% of females had extra-pulmonary tuberculosis.72.2% of the patients with pulmonary tuberculosis had a positive-sputum smear. Most patients with positive-smear for pulmonary tuberculosis were diagnosed (53%). Sputum culture was the most frequent diagnostic technique used in patients with negative-sputum smear. In patients suffering from extra-pulmonary tuberculosis, lymph node involvement was the most frequent (34.2%).44 patients (11.7%) were expired.Conclusion: Due to the increasing number of tuberculosis infections from 2005 to 2008, it is important for the health care providers and department of public health to monitor and pursue screening and prevention guidelines closely.

Background: Due to the higher risk of pain in preterm infants, pain management is important for such infants. The present study aimed to determine the effectiveness of kangaroo care on the severity of pain and physiological parameters after heel-stick in preterm infants. Materials and Methods: This was a prospective and randomized controlled cross-over study. Twenty preterm infants allocated into an intervention (30 minutes of kangaroo care before and throughout heel-stick) and a control condition (standard incubator care during heel-stick). The severity of pain and the physiological parameters (heart rate and oxygen saturation) were collected after the heel-stick procedure.Results: The pain mean scores in the intervention and control conditions were respectively 4.9 (SD=2.91) and 11.00 (SD=4.21) and a significant difference was found between the two conditions regarding the pain score 30 seconds after the heel-stick [t=5.33, P<0.001]. Moreover, a significant difference between the two conditions concerning the infants’ heart rate (F=3.73, P<0.001) and oxygen saturation (F=1.84, P<0.001) was demonstrated during the three study periods.Conclusion: In order to relieve the preterm infants’ pain and prevent quick acceleration and deceleration of heart rate and oxygen saturation in the intervention condition, the intervention is recommended to be done in a nursery.

The Safavid era (1501–1736 A.D.) was the threshold of spreading security and welfare in the Iranian society. This era provided the chance for the talents to set steps for advancement. One of the characters in the history of Persian medicine who achieved successes in the shadow of the existing peace and security during the Safavid Empire was Hakim Imad al-Din Mahmud Shirazi. While he was ministered in the court of Shah Tahmasb Safavi (King Tahmasb), he enjoyed the patronage of Dar al-Shifa Razavi (Razavi health care service) in Mashhad. He managed to leave a legacy of valuable essay and complications resulting from the abundant experiences he gained through the journey to India. The present paper is a study about Hakim Imad al-Din’s life and his essays.

Background: There have been several studies conducted on the relationship between bipolar mood disorder and attention deficit hyperactivity disorder (ADHD) during the recent years, and in most of them the rate of this association had been estimated as 22-90% and had been reported as noticeable. The goal of this study is to determine the prevalence of ADHD in patients with Bipolar mood disorder type I (BID). Materials and Methods: In this Cross-sectional study, 152 patients with BID that were referred to psychiatric clinic of Tehran psychiatric Institute for a better observation and treatment were included. Two questionnaires, Wender's for childhood ADHD and Conner’s’ for adulthood ADHD were filled by the patients.Results: 102 patients (67%) were males and 50 were females. The average age of patients at the time of our study (with the minimum of 17 and maximum of 76) was 33.5±10.9. The prevalence of ADHD in our patients was 11.8%.46 people (30.9%) had a history of childhood ADHD.21 persons had adult ADHD from whom only 3 ones mentioned a history of childhood ADHD (which means 18 people of our adulthood ADHD had no history of childhood ADHD).Conclusion: Since some treatments lead to improvement of ADHD and worsening of BID, investigations on their correlations and their alternative treatments seemed to be necessary. This study showed a significant correlation between ADHD and BID, which was similar to the results of other studies in this field.

Background: Various studies are seeking to find new methods to improve techniques of laryngeal mask airway (LMA) insertion and reduce possible complications. In this study, we embarked on a clinical study to investigate the advantages of a new insertion method of laryngeal mask and to compare it with the classic method. Materials and Methods: Two hundred patients aged 20-60 years old were randomly divided into two groups allocated to receive either the new technique of insertion of LMA (two-person method) or the classic method (one-person method). In the two person method, jaw thrust and mouth opening is done by a technician and then anesthesiologist inserts the LMA. Oxygen saturation, time to insert laryngeal mask, end-tidal carbon dioxide pressure, and the ease of insertion in both groups were measured. The collected data were analyzed by using ANOVA test. P-value<0.05 was considered as statistically significant. Results: The measured end-tidal pressure of carbon dioxide (ETCO2) and saturation of O2 were 31.68 mmHg and 98.87 % in the classic method and 30.47 mmHg and 99.42 % in the two-person method, respectively. These differences were statistically significant for both values. However, the discrepancy of insertion time and ease of insertion between the two groups were not statistically considerable.Conclusion: The new technique introduced in this study is associated with higher rate of success, as evidenced by enhancement of saturation of O2 and reduction of ETCO2. Therefore, this method could be considered as a safe and effective method in order to establish a secure airway in anesthetized patients in future studies.

Background: Different interpositional materials have been used to prevent recurrence after gap arthroplasty in temporomandibular joint ankylosis. In this study, the temporalis superficial fascia flap was evaluated as an interpositional material after condylectomy. Materials and Methods: 9 Cases of unilateral or bilateral temporomandibular joint ankylosis were evaluated in this study with a follow-up of 12 months. The Al-khayat approach was used as the surgical technique with the inferiorly based temporalis superficial fascia flap.Results: 9 Patients (6 female and 3 male) had a preoperative maximal inter-incisal opening of 3 to 10 mm. During the last follow-up observation after surgery, patients had a maximum inter-incisal opening of 40 to 45 mm. Paresthesia or anesthesia of the temporal branch of facial nerve was absent in all cases. There were no signs of re-ankylosing in any of the patients.Conclusion: The findings of this study showed that the temporalis superficial fascia flap is a good alternative as an interpositional material in treatment of temporomandibular joint ankylosis.

Dear Editor: Multiple sclerosis (MS) is the most common inflammatory demyelinating disease of the central nervous system. MS is characterized by dissemination in time and place. Dissemination can be clinically (clinically definite multiple sclerosis) or radiologically by magnetic resonance imaging (MRI). Correct diagnosis of MS needs dissemination both in time and in place and also exclusion of all other neurological diseases that can mimic MS. Clinically, dissemination in time is defined as two episodes of neurological symptoms occurrence, separated at least one month apart, and dissemination in place is characterized as the presence of symptoms or signs in at least two different parts of central nervous system (CNS) (e.g. visual, sensory, motor, etc.). Radiologically dissemination in space (DIS) was defined as the presence of clinically silent lesions in T2-weighted MRI in two of four locations including juxtacortical, preventricular, infratentorial, and spinal cord and dissemination in time (DIT) as the presence of simultaneous gadolinium enhancing and non enhancing lesions in MRI [1, 2].